OSCE systems: skin, cervical,spinal Flashcards
Cervical Spine: What is the Canadian C-Spine Rule?
This is a rule for determining if radiography should take place. It says if a patient is over 65, has been involved with a dangerous mechanism, or has paresthesia in the extremities then radiography is a must.
However, Range of Motion can be assessed for simple rear-end collisions, where they can sit at 45 degrees, or they are ambulatory, there is a delayed onset of neck pain or there is an absence of midline C Spine tenderness and active rotation of the neck is 45 degrees on both sides then radiography is not required
Cervical Spine: Describe the Distraction test
The practitioner stands to one side of the seated patient and places one hand under the patient’s chin (with the mouth and teeth closed) and one hand around the occiput.
2) The practitioner slowly lifts the hands to apply a distraction force through the neck by lifting the head.
3) The practitioner then slowly relieves the distracting force.
Cervical Spine: What is the purpose of the Distraction test?
The distraction test is used when the patient has complained of radicular symptoms and these symptoms are present during the consultation. The aim of this test is to alleviate the radicular symptoms by reducing mechanical pressure on the irritated structure.
Cervical Spine: What is a positive finding for the Distraction test?
The test is considered positive if the patient reports a relief or decrease in radicular symptoms when the head is lifted. A positive result may indicate pressure on cervical nerve root(s).
Cervical Spine: Describe the Sharp-Purser test
The practitioner stands beside the patient who is seated at the treatment table.
The practitioner places one hand on the patient’s forehead and the thumb of the other hand over the spinous process of C2.
2) The patient is asked to slowly flex the head. As this is occurring the practitioner presses posteriorly on the forehead.
Cervical Spine: What is the purpose of the Sharp-Purser test?
This test is used to determine if subluxation of the atlas on the axis is present and should therefore be used with caution.
If the transverse ligament of the atlas is torn C1 will be allowed to translate anteriorly on C2 when moving into flexion.
Cervical Spine: What is a positive finding of the Sharp-Purser test?
This test is considered positive if the practitioner feels the head translate posteriorly during the movement (this may be accompanied by an audible ‘clunk’). Translation of the atlas on the axis may indicate rupture or absence of the transverse ligament, resulting in upper cervical instability.
Cervical Spine: Describe the shoulder abduction test
The patient is sitting or lying on the treatment table.
2) The practitioner passively or the patient actively abducts the shoulder and places the hand or forearm on the head.
Cervical Spine: What is the purpose of the shoulder abduction test?
assess for radicular symptoms
Cervical Spine: What is a positive finding of the shoulder abduction test?
This test is considered positive if the patient reports relief or a decrease in symptoms. A positive test may indicate the presence of nerve root compression in the cervical spine (usually C4-C5 or C5-C6).
Cervical Spine: Describe the Spurling test
The patient is sitting on the treatment table.
2) The practitioner applies a downward force on the patient’s head (observe for symptoms).
3) The patient’s head is side-bent toward the non-symptomatic side first, followed by the symptomatic side (observe for symptoms).
4) The practitioner then carefully applies a downward pressure straight down through the head maintaining side-bending (observe for symptoms).
5) Finally, if symptoms have not already been reproduced the patient’s neck is taken into extension with rotation toward the same side as side-bending (observe for symptoms).
Cervical Spine: What is the purpose of the Spurling test?
This test is used to assess for radicular symptoms or radiculopathy. The symptoms may be present at the time of testing, or absent or diminished.
The test is designed to provoke symptoms.
Cervical Spine: What is a positive finding of the Spurling test?
This test is considered positive if the patient reports the production of radicular pain into the upper limb on the side of the neck side-bending and rotation.
This is believed to indicate radiculitis due to pressure on a cervical nerve root. This positioning of the neck reduces the intervertebral foramen.
Observe for a dermatomal pattern to the pain. Localized neck pain without upper limb referral is not a positive test.
Cervical Spine: Describe the First Upper Limb Neurodynamic test for the median nerve (ULNT1)
The patient is lying on the treatment table.
The practitioner stands at the side of the table beside the patient’s trunk facing the head of the table. The patient’s shoulder is abducted to allow the practitioner to stand inside the upper limb.
2) The practitioner depresses the patient’s shoulder girdle using the forearm.
3) The patient’s shoulder is passively abducted to approximately 110° while the elbow is maintained in a flexed position.
4) With the forearm supinated the wrist and fingers are taken into extension.
5) The patient’s elbow is then taken toward extension while the shoulder remains depressed, and the wrist and hand are maintained in extension.
6) Note the production or worsening of symptoms and the degree of elbow flexion they occur.
7) If symptoms are produced ask the patient to actively side-bend away from the side of symptoms (this may exaggerate the symptoms). Then have the patient side-bend the neck toward the side of symptoms (this may reduce symptoms). The ipsilateral neck side-bending is referred to as a ‘sensitizing’ movement
Cervical Spine: What is the purpose of the First Upper Limb Neurodynamic test for the median nerve (ULNT1)?
The upper limb neurodynamic tests are designed to place stress on the neurological structures in the upper limb by placing them under tension.
Cervical Spine: What is a positive finding of the First Upper Limb Neurodynamic test for the median nerve (ULNT1)?
This test is considered positive if the patient reports the reproduction of radicular symptoms in the upper limb.
It is important to note that the test can also cause aggravation of pain in inert and contractile tissues. The character and familiarity of the symptoms reproduced or aggravated should be noted.
Cervical Spine: Describe the Second Upper Limb Neurodynamic test for the radial nerve (ULNT2)
The patient is lying on the treatment table. The practitioner stands at the side of the table beside the patient’s head.
The practitioner then uses their hip/thigh to depress the patient’s shoulder on the affected side.
2) The patient’s hand and wrist are taken into full flexion, with the forearm in pronation.
3) The practitioner abducts the patient’s shoulder to approximately 40° and extends it to 25°.
4) While maintaining the shoulder in abduction and the wrist and hand in flexion the patient’s elbow is taken toward extension until symptoms are reproduced.
5) If symptoms are produced ask the patient to actively side-bend away from the side of symptoms (this may exaggerate the symptoms).
Then have the patient side-bend the neck toward the side of symptoms (this may reduce symptoms). The ipsilateral neck side-bending is referred to as a ‘sensitising’ movement.
Cervical spine: What is the purpose of the second Upper Limb Neurodynamic test for the radial nerve (ULNT2)?
The upper limb neurodynamic tests are designed to place stress on the neurological structures in the upper limb by placing them under tension
Cervical spine: What is a positive finding of the second Upper Limb Neurodynamic test for the radial nerve (ULNT2)?
This test is considered positive if the patient reports the reproduction of radicular symptoms in the upper limb.
Cervical Spine: Describe the Third Upper Limb Neurodynamic test for the ulna nerve (ULNT3)
1) The patient is lying on the treatment table. The practitioner stands at the side of the table beside the patient’s trunk facing the head of the table. The patient’s shoulder is abducted to allow the practitioner to stand inside the upper limb.
2) The patient’s shoulder girdle is depressed using the forearm or hand, and the shoulder is taken into 90° abduction.
3) The patient’s forearm is pronated and the wrist and fingers are extended.
4) The shoulder is then passively taken into further shoulder abduction and elbow flexion while maintaining the wrist and finger position. Stop when symptoms are reproduced or worsened.
5) If symptoms are produced ask the patient to actively side-bend away from the side of symptoms (this may exaggerate the symptoms). Then have the patient side-bend the neck toward the side of symptoms (this may reduce symptoms). The ipsilateral neck side-bending is referred to as a ‘sensitizing’ movement.
Cervical spine: What is the purpose of the third Upper Limb Neurodynamic test for the ulna nerve (ULNT3)?
The upper limb neurodynamic tests are designed to place stress on the neurological structures in the upper limb by placing them under tension
Cervical spine: What is a positive finding of the third Upper Limb Neurodynamic test for the ulna nerve (ULNT3)?
This test is considered positive if the patient reports the reproduction of radicular symptoms in the upper limb.
Thoracic Spine: Describe the Adson Manoeuver
1) The practitioner locates the radial pulse on the side to be tested.
2) The patient is asked to rotate the neck over the shoulder on the test side and move the neck into extension (chin up).
3) The practitioner extends the shoulder on the side to be tested and externally rotates the shoulder while continuing to palpate the radial pulse.
4) Finally, the patient is asked to take a deep breath and hold it (no time specified).
Thoracic Spine: What is the purpose of the Adson Manoeuver
This test is used to assess for potential thoracic outlet syndrome.
Thoracic Spine: What is a positive finding of the Adson Manoeuver?
The test is considered positive if the pulse disappears and/or symptoms are reproduced in the upper limb.
Thoracic Spine: Describe the Costoclavicular (Miltary Brace) Test
1) The practitioner locates the radial pulse on the side to be tested.
2) The practitioner then takes the patient’s upper limb into extension and depresses the shoulder girdle, while maintaining contact over the radial pulse for observation.
Thoracic Spine: What is the purpose of the Costoclavicular (Miltary Brace) Test?
This test is used to assess for potential thoracic outlet syndrome
Thoracic Spine: What is a positive finding for the Costoclavicular (Miltary Brace) Test?
This test is considered positive if the pulse disappears and/or the patient reports a reproduction of the upper limb symptoms
Thoracic Spine: Describe the Wright Test
1) The practitioner locates the radial pulse on the side to be tested.
2) The practitioner then takes the patient’s upper limb into abduction to 90 degrees, horizontal extension/abduction, and flexion of the elbow to 90 degrees.
3) In some texts the patient is asked to rotate the neck to the contralateral side (observe for symptom reproduction and/or loss of pulse.
4) For the original Wright test the shoulder is taken into full elevation.
Thoracic Spine: What is the purpose of the Wright Test?
This test is used to assess for potential thoracic outlet syndrome
Thoracic Spine: What is a positive finding for the Wright Test?
This test is considered positive if the pulse disappears and/or the patient reports a reproduction of the upper limb symptoms.
Thoracic Spine: Describe the Roos (Aka: The elevated Arm Stress) Test
1) The patient stands and abducts the shoulders to 90 degrees, laterally rotates the shoulders and flexes the elbows to 90 degrees (surrender position)
2) The patient is asked to open and close the hands repetitively for up to 3 minutes or until symptoms are reproduced/exacerbated.
Thoracic Spine: What is the purpose of the Roos (Aka: The elevated Arm Stress) Test
This test is used to assess for potential thoracic outlet syndrome
Thoracic Spine: What is a positive finding of the Roos (Aka: The elevated Arm Stress) Test
This test is considered positive if the patient is unable to hold this position for 3 minutes, suffers ‘ischaemic’ pain, heaviness, or profound weakness of the arm, or numbness and tingling of the hand(s).
Thoracic Spine: Describe the Reflex Hammer Test
1) The patient is seated on the treatment table
2) The practitioner taps over the spinous process at the level of interest with the reflex hammer.
Thoracic Spine: What is the purpose of the Reflex Hammer Test
This test is used to assess for potential vertebral fracture
Thoracic Spine: What is a positive finding of the Reflex Hammer Test
Localized pain with the tapping of the vertebra may indicate a potential fracture of the vertebra. Further imaging may be advised to help rule out vertebral fractures.
Thoracic Spine: Describe the Rib Spring Test
1) The patient is lying prone on the treatment table
2) The practitioner places the extended thumb and adjacent finger along the angle/shaft of the rib to be tested and applies a posterior-anterior force through the rib.
3) The practitioner then places the ulnar surface of the other hand over the region of the transverse process on the other side of the spine to ‘prevent rotation’ of the vertebra, attempting to block rotation of the segment.
4) The springing motion is then repeated while this pressure is maintained on the other side of the spine.
Thoracic Spine: What is the purpose of the Rib Spring Test
This test is used to assess for a potential costotransverse or costovertebral contribution to the patient’s thoracic pain.
Thoracic Spine: What is a positive finding of the Rib Spring Test
If the second springing motion (providing blocking of movement) is painful but the first is not this may suggest a costotransverse or costovertebral source of pain
Skin: what are the six descriptors for describing a lesion
Number Colour Size Shape(&otherdescriptors) Arrangement Distribution
Skin: lesions; name Non-palpable lesions:
<1cm are macules >1m patch
Skin: lesions; name palpable elevated lesions:
Papule <1cm
Plaque >1cm
Nodule >1cm and has depth
Tumor solid mass>1cm
Wheal superficial localized oedema
Vesicle fluidfilled,<1cm
Bulla fluid filled, >1cm
Pustule pus filled
Skin: lesions; name depressed skin lesions
Erosion loss of superficial dermis
Excoriation erosion from scratch
Fissure linear crack
Ulcer deeper loss epidermis & dermis
Atrophy thinning, loss of bulk
Lumbar Spine: Describe the Slump test
The patient is seated on the treatment table with the hips in neutral and the legs hanging off the end of the bed (approximately 90 degrees knee flexion). The patient is asked to place the hands behind the lower back.
2) The patient is asked to ‘slump’ the torso into lumbar and thoracic flexion while maintaining a neutral head and neck position. Seek feedback on any symptoms.
3) The practitioner uses a forearm to apply overpressure across the shoulders to maintain thoracic and lumbar flexion. The patient is then asked to flex the cervical spine and head as far as possible. Seek feedback on any symptoms.
4) The practitioner then uses the same arm as before to apply overpressure to the patient’s flexed head, neck, and trunk to maintain this position.
5) The practitioner passively holds the patient’s ankle (on the side being tested) and brings it into full dorsiflexion. The patient is asked to extend the knee on that side as far as possible while the practitioner maintains overpressure through the spine.
Lumbar Spine: Describe the Straight Leg test
1) The patient is lying supine on the table with the hip medially rotated and adducted to a neutral position and the knee fully extended.
2) The practitioner passively flexes the hip on the side to be tested until pain or tightness is reported in the back or lower limb.
3) If the patient reports pain the practitioner extends the hip to a degree that relieves symptoms and the patient is asked to flex the neck bringing the chin to the chest, the practitioner dorsiflexes the patient’s ankle, or both are performed together.
Lumbar Spine: Describe the Passive Lumbar Extension test
The patient is lying prone on the table with hips and knees in neutral. 2) The practitioner grasps the lower leg of both lower limbs and passively elevates the legs off the table (approximately 30cm) bringing the hips into extension.
Lumbar Spine: Describe the Kemp’s test
The patient standing in front of you facing away from you
2) Guide the patient into a combination extension followed by rotation and side-bending to the side of symptoms.
3) Overpressure is applied in an inferior direction to add additional stress on the structures involved
4) The movement is continued until the end range is achieved or pain is produced.
skin: what is this? what could it indicate?
Xanthelasma could be hyperlipidemia, diabetes, and/or thyroid dysfunctions
skin: what is this? what could it indicate?
Wheal … the release of histamine : could be an allergy.
skin: what is this? what could it indicate?
Vitiligo- could be
A disorder of the immune system (autoimmune condition)
Family history (heredity)
A trigger event, such as stress, severe sunburn or skin trauma, such as contact with a chemical
skin: what is this? what could it indicate?
Vitiligo of hands and face - could be
A disorder of the immune system (autoimmune condition)
Family history (heredity)
A trigger event, such as stress, severe sunburn or skin trauma, such as contact with a chemical
skin: what is this? what could it indicate?
Fluid-filled Vesicle if less than 1 cm, bulla if greater can be caused by infection or inflammation (nettles)
skin: what is this? what could it indicate?
Ulcer poor circulation and pressure
skin: what is this? what could it indicate?
Tinea versicolour. An overgrowth of a type of yeast (fungus) that’s naturally found on your skin. Hot weather, humidity, and sun exposure can make tinea versicolor worse.
skin: what is this? what could it indicate?
Telangiectasia (teh·lan·juh·ek·tay·zeeu): associated with
alcoholism: can affect the flow of blood in vessels and can cause liver disease
pregnancy: often applies large amounts of pressure on venules
aging: aging blood vessels can begin to weaken
rosacea: enlarges venules in the face, creating a flushed appearance in cheeks and nose
habitual corticosteroid use: thins and weakens the skin
scleroderma: hardens and contracts the skin
dermatomyositis: inflames skin and underlying muscle tissue
systemic lupus erythematosus: can increase skin sensitivity to sunlight and extreme temperatures
skin: what is this? what could it indicate?
spider angioma (nevus araneus) are asymptomatic benign lesions. When extensive, they may be associated with significant underlying internal pathology, such as liver disease.
skin: what is this? what could it indicate?
shingles A viral infection that causes a painful, blistering rash. It is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. You can only get shingles if you have had chickenpox in the past.
skin: what is this? what could it indicate?
Scleroderma results from an overproduction and accumulation of collagen in body tissues. Collagen is a fibrous type of protein that makes up your body’s connective tissues, including your skin. Doctors don’t know exactly what causes this process to begin, but the body’s immune system appears to play a role
skin: what is this? what could it indicate?
Pustules may be a sign of an infection. In some cases, they are non-infectious and associated with inflammation in the skin or taking certain medicines.
skin: what is this? what could it indicate?
Purpura: they happen when small blood vessels leak blood under your skin’s surface. Purpura isn’t a medical condition but a sign of another condition causing the bleeding. Purpura can also be caused by drug interactions, vitamin deficiencies or congenital disorders.
skin: what is this? what could it indicate?
Psoriasis: Severe psoriasis has been associated with nutritional deficiencies because of an accelerated loss of nutrients, in particular of vitamin D, from the hyperproliferation and desquamation of the epidermal layer of skin
skin: what is this? what could it indicate?
Plaque: Discoid eczema may cause round or oval plaques consisting of small raised spots and skin scaling.
skin: what is this? what could it indicate?
Petechiae: Petechial rashes result from areas of hemorrhage into the dermis. The primary pathophysiological causes of petechiae are thrombocytopenia, platelet dysfunction, disorders of coagulation, and loss of vascular integrity
skin: what is this? what could it indicate?
Papule (raised on the surface under 1 cm) The primary causes of papules, and acne in general, include bacteria. excess oil production. excess activity of androgens (male sex hormones
skin: what is this? what could it indicate?
Nodule (greater than 0.5cm ) has depth: inflammatory skin nodules arise from inflamed blood vessels (vasculitis) or adipose tissue (panniculitis). Either can arise in response to underlying infection or antigen stimulation with the influx of inflammatory cells.
skin: what is this? what could it indicate?
Mole: It’s produced in cells called melanocytes. Moles are caused when cells in the skin called melanocytes grow in clusters. Melanocytes are generally distributed throughout the skin. They produce melanin, the natural pigment that gives skin its color.
skin: what is this? what could it indicate?
Macule (under 1 cm) or patch (over 1 cm): Macules can feature in any number of common and uncommon medical conditions, including: Vitiligo, the loss of skin color associated with autoimmune disorders. Tinea versicolor, dark or light patches of skin caused by a fungus. Cutaneous candidiasis, a red, itchy rash caused by the same fungus as oral thrush.
skin: what is this? what could it indicate?
erthema nodosum: indicative of IBD
skin: what is this? what could it indicate?
Fissure: skin fissures are splits in the skin, usually to the point of bleeding. They can occur interdigital, especially between the fourth and fifth toes, and are caused by hyperhydrosis or prolonged sweating in endurance events. Fissures are also seen with the reduced moisture content of the skin (anhydrosis) around the heels.
skin: what is this? what could it indicate?
Erythema: Erythema multiforme is a skin disorder that’s considered to be an allergic reaction to medicine or an infection. Symptoms are symmetrical, red, raised skin areas that can appear all over the body. They do seem to be more noticeable on the fingers and toes.
skin: what is this? what could it indicate?
Skin Erosion is a breakdown of the outer layers of the skin, usually because of a: Cut. Scrape. Inflammation.
skin: what is this? what could it indicate?
Ecchymosis can be caused by trauma, surgery, disordered cell function, or infection. Medical conditions, including cancer or blood clotting disorders, can cause ecchymosis. Vitamin deficiencies, in particular vitamin K and vitamin C, can increase the risk of ecchymosis.
skin: what is this? what could it indicate?
Dehydrated skin reveals itself through dry skin, itchy skin, and/or an uneven complexion. Dehydrated skin is caused by a lack of water
skin: what is this? what could it indicate?
Cyanosis refers to a bluish-purple hue to the skin. It is most easily seen where the skin is thin, such as the lips, mouth, earlobes and fingernails. Cyanosis indicates there may be decreased oxygen attached to red blood cells in the bloodstream. It may suggest a problem with the lungs or heart.
skin: what is this? what could it indicate?
Striae, or stretch marks, are indented streaks that often affect the abdomen, buttocks, thighs, back, breasts, axillae and groin. They are divided into striae atrophicans (thinned skin), striae gravidarum (following pregnancy), striae distensae (stretched skin), striae rubrae (red), striae albae (white), striae nigra (black), and striae caerulea (dark blue). They are also a symptom of Cushing’s Disease
skin: what is this? what could it indicate?
Cherry angioma They’re typically noncancerous (benign) and not a cause for concern unless they bleed or change appearance, which may be an early indicator of skin cancer. Cherry angiomas are made of small blood vessels, which gives them a reddish or purplish appearance
skin: what is this? what could it indicate?
Cafe au Lait : Café-au-lait spots are light to dark brown pigmented birthmarks that commonly appear on a newborn’s skin. Spots can change in size and number over time. More than six café-au-lait spots can be a sign of an underlying genetic condition like neurofibromatosis type 1 (NF1)
skin: what is this? what could it indicate?
General skin atrophy consists of a reduction in epidermal and dermal thickness, regression of the sebaceous glands, subcutaneous fat loss, and muscle-layer atrophy. These changes are typically observed following 2 to 3 weeks of moderate- to high-potency topical corticosteroid use.
skin: what is this? what could it indicate?
Angular cheilitis describes an inflammatory skin process of variable etiology occurring at the labial commissure, the angle of the mouth. It is usually a symptom of another condition and leads to saliva-induced maceration of the structurally susceptible epithelium at the labial commissures.
skin: what is this? what could it indicate?
Acanthosis Nigricans is most commonly associated with diabetes and insulin resistance, but rarely it can be a sign of internal malignancy. It can also occur with hormone disorders or with the use of certain medications like systemic glucocorticoids and oral contraceptives
