OSCEs 2 Flashcards
What BMI do women have to be for referral to Fertility Clinic?
<35
What should fetal heart be on ausculatation?
110-160bpm
Name the three types of lie on obstetric examination?
Oblique
Transverse
Longitudinal
Name the 5 types of engagement of head on obstetric examination?
5/5: Free Float
4/5 Fixing
3/5 Nearly Engaged
2/5 Engaged
1/5 Just palpable
0/5 deep enagaged (ready for birth)
When is there an absolute contraindication to vaginal speculum exam?
Antepartum Haemorrhage due to Placenta Praevia
Uterus is commonly in what position?
Anteverted Anteflexed
Stages of Obstetric Examination? (7)
Position
Inspection: Scars, Striae Graviarium, Linea Nigra
Palpation of Fetal Poles
Fundal Height (after 20 weeks)
Presenting part
Engagement (after 36 weeks)
Auscultation over anterior shoulder
Name the 5 moments of hand hygiene
Before patient contact
Before aseptic task
After body fluid exposure risk
After patient contact
After contact with patient surroundings
What model to use for Breaking Bad News? (6)
SPIKES
Setting and Listening
Patient Perception
Invitation
Knowledge
Explore Emotion and Empathise
Strategy and Summary
Diarrhoea may be associated with what two endocrine conditions?
Hyperthyrodism
Adrenal Insufficiency
Constipation may be associated with what two endocrine conditions?
Hypothyrodism or Hypercalcemia
Sweating is associated with what four endocrine conditions?
Hyperthyrodism
Phaeochromaocytoma
Hypoglycemia
Acromegaly
In a examination looking for Diabetes what to look for? (9)
Weight Loss
Peripheral Pulses
Blood Pressure
Peripheral Vascular Disease
Peripheral Neuropathy
Charcot Foot
Skin Infection
Cataracts and Glaucoma
Diabetic Eye Disease
In an examination looking for thyrotoxicosis what to look for? (10)
Weight Loss
FIne Tremor
Palmar Erythema
Tachycardia
Collapse Pulse
Atrial Fibrillation
Proximal Myopathy
Exopthalmus
Lid Retraction and Lag
Goitre
In an examination looking for Hypothyrodism what to look for? (7)
Sluggishness
Skin coarse,pale, dry
Bradycardia
Periorbital Oedema
Xanathalasma
Dry/Thin Scalp Hair
Slow Reflexes
What to look for in Cushings Syndrome? (9)
Moon Face
Central Obesity
Bruising
Excessive Pigmentation
Proximal Myopathy
Visual Field Defects
Optic Atrophy
Papilloedema
Hypertension
What to look for on Inspection in Diabetic Foot? (7)
Shoes
Plantar aspects of feet
Skin. colour and integrity
Pressure damage/ulcers
Signs of infection
Hair loss
Deformity eg bunion (hallux valgus), over riding of toes, charcot joint, joint subluxation, high or flat arches or exostosis
What is exostosis?
is a benign bony lump with a cartilage cap that arises usually at the end of the long bones.
What is charcot foot?
Progressive degeneration of weight bearing joint due to diminished proprioception, repeated sustained trauma in ankle and joint = destruction
Where are arterial ulcers found?
Below ankle
Where to assess vibration in diabetic foot exam? (4)
Lateral metatarsophalngeal joint of big toe
midfoot
medial and lateral malleoli
knee
Where to test monofilament in diabetic foot? (5)
Apex of 1st and 3rd Toes
1st, 3rd and 5th Metatarsal Heads
What is paroxysmal nocturnal dyspnoea?
a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position.
Blood Flow through the Heart?
Right Atrium > Tricuspid Valve > Right Ventricular > Pulmonary Valve > Pulmonary Artery > Pulmonary Vein > Left Atrium > Mitral Valve > Left Ventricle > Aorta
What does Systole (S1) represent?
Mitral and Tricuspid closure
What does Systole (S1) represent?
Mitral and Tricuspid closure
Examination of Spine
What to do in Inspection? (6)
Observe whole spine and curvatures
Cervical and Lumbar - Lordosis
Thoracic - Kyphosis
Posture of Neck and Head
Scars or Sinuses
Scoliosis
Examination of Spine
What to do in feel? (4)
Feel down spine
Palpate midline spinous processes
Feel sacrolilac joints
Feel paraspinal muscle tenderness
Examination of spine
What to do in move (6)
Flexion
Extension
Lat Flexion
Rotation
Lumbar spine flexion and extension
Lumbar spine lateral flexion
Examination of Spine
what to do in neuro? (4)
Straight Leg Raise
Reflexes
Power/Sensation
Which dermatomes to test in spine examination? (13)
C5,C6,C7,C8,T1,T2,L1,L2,L3,L4,L5,S1,S2
C5 dermatome covers where?
Regimental badge area
C6 dermatome covers where
Thumb
C7 Dermatome where
Mid Finger
C8 Dermatome where
Little Finger
T1 dermatome where?
medial antecubital fossa
T2 dermatome where
Axilla
L1 dermatome where
Upper medial thigh
L2 dermatome where
Medial mid thigh
L3 dermatome where
medial side knee
L4 dermatome where
medial malleolus
L5 dermatome where
dorsal foot
S1 dermatome where
lateral heel
S2 dermatome where
Back of thigh
S3-5 dermatomes cover where?
Rectal tone and bum
Which muscle groups to test in spine power examination? (9)
Deltoid
Biceps
Triceps
Finger Flex
Finger Abduction
Hip Flex
Quadriceps
Great Toe Dorsiflexion
Foot Plantarflex
C5 dermatome where?
Deltoid
C6 dermatome where?
Biceps
C7 dermatome where?
Triceps
C8 dermatome where?
Finger Flexion
T1 dermatome where?
Finger abduction
L1/2 dermatome where?
Hip flexion
L3/4 dermatome where?
Quadriceps
L5 dermatome where?
Great toe dorsiflexion
S1/S2 dermatome where?
Foot Plantarflexion
Biceps reflex what dermatomes
C5/6
Triceps reflex what dermatomes
C7/8
Knee reflex what dermatomes
L3/4
Ankle jerk reflex what dermatomes
S1/2
The shoulder joint consists of what joints?
Glenohumeral and Acromioclavicular
Shoulder examination
What to look for on inspection? (7)
Loss of symmetery or deformity
Winging of scapula
Muscle wasting: deltoid/supraspinatus/infraspinatus
Scars, wounds, sinuses, discolouration
Shoulder examination
Where to feel? (10)
Temperature at joint and adjacent areas
Bony Landmarks
Acromion Process and along scapula
Spine of scapula
Greater tuberosity of humerus
Ant and Pos Joint Lines of Humerus
Supraspinatus
Infraspinatus
Deltoid
Axillary nerve sensation
Shoulder examination
What to check in move? (4)
Full Extension and Flexion
Full Abduction
External and Internal Rotation of Shoulder
Scapula movement
What is a painful arc?
Shoulder examination - pain between 10 and 120 degrees
Elbow examination
What to look at in look? (10)
Ant, Pos, Medial and Lateral Joints
Scars
Swelling
Wounds
Sinuses
Rashes
Rheumatoid Nodules
Evidence of Olecranon Bursitis
Deformity and Normal Carrying
Muscle Wasting
What is the normal carrying angle of elbow in males?
-10
What is the normal carrying angle of elbow in females?
-15
Where to palpate in elbow examination? (4)
Temp
Tenderness over medial (golfers elbow)
Tender over lateral epicondyle (tennis elbow)
Tender over olecranon process and radial head
What is phalen’s test?
The wrist is held in full flexion for 60 seconds (reverse prayer sign). The test is positive if patient’s symptoms are elicited by this manoeuvre. For carpal tunnel
What is Tinel’s Test?
Tinel’s test is performed by lightly tapping over the median nerve as it passes through the wrist. A positive response to the test is denoted by tingling in the thumb, index and middle fingers (distribution of median nerve). for carpal tunnel
Hand and Wrist Examination
What to look for on looking? (12)
Scars, Wounds or Thinning of Skin
Rash
Nails: Clubbing, Psoriatic Changes (Pitting Oncyholysis), Splinter Haemorrhages, Nail Fold Vasculitis
Posture of Hand
Finger Deformity
Muscle Wasting
Swellings eg Bouchard Nodes (PIP) and Heberden (DIP)
Fascial Thickening
What is pitting oncycholysis and where can it be found?
Nails it is psoriatic change
Where are Bouchard Nodes found?
PIP
Where a Hebden Nodes found?
DIP
Hand and Wrist examination
- What to check for in move? (3)
Straighten then make fist
Flex and Extend of MCPJ, PIPJ and DIPJ
Phalen/Tinel
Hand and wrist examination
what to check for in function?
Power Grip
Pincer Grip
Hand and wrist examination what to check in neuro exam?
Sensation and Power of Median, Ulnar and Radial Nerves
Hand wrist examination
How to assess radial nerve power?
Resisted finger extension
Hand and wrist examination
How to assess median nerve power?
Test abductor pollicis brevis. Place hand flat with palm to ceiling. Ask patient to point thumb to ceiling and hold it there whilst you try to push it down.
Hand and wrist examination
How to assess ulnar nerve power?
testing the interossei by asking patient to spread fingers wide and keep them there whilst you try to squeeze them together.
Hand and wrist examination
How to test sensation of median nerve?
touch volar tip of index finger and thenar eminence
Hand and wrist examination
How to test sensation of ulnar nerve?
touch volar tip of little finger and hypothenar eminence
Hand and wrist examination
How to test sensation of radial nerve
touch first web space on dorsum of hand between thumb and index finger
What is the Trendelnburg Test a sign of?
Weak/paralysed abductor muscles (gluteus minimus and gluteus medius of hip)
When is Trendelnberg test positive?
Pelvis dips on side of non weight bearing leg
What is Thomas test for?
Assessment of fixed flexion deformity of hip - increased lumbar lordosis
What to look for on hip examination? (5)
Deformity and Symmetery
Scars
Swelling
Muscle Wasting
Leg Length Discrepancy
What to feel for on hip examination? (3)
Tender over greater trochanter
Apparent leg length discrepancy
True length discrepancy
Where to measure apparent leg length discrepancy?
xiphisternum to medial malleolus
Where to measure true leg length discrepancy?
ASIS to medial malleolus
What to check on hip examination movement? (6)
Thomas Test
Flexion
Rotation
- Abduction
- Adduction
Trendelburg
What does a high stepping gait mean?
foot drop
What is a knee valgus deformity?
The distal part (tibia) is deviated laterally
or away from the midline. A bilateral valgus
deformity will give a knock-kneed
(Genu Valgum) appearance.
What is a knee varus deformity?
The distal part (tibia) is deviated medially
or towards the midline. If the deformity
is bilateral, it will give a bow legged
appearance.
What is a patellar tap used for?
Moderate to Large Effusion >50ml
What is a bulge tap used for?
Smaller fusions
What to check on knee examination inspection? (6)
Symmetry and Alignment
Varus or Valgus Deformity
Fixed Flexion of Knee
Rash
Wounds/Scars/Swelling
Waste of Quadriceps
What to check on knee examination palpation? (7)
Temp Difference
Tenderness over patella, extensor mechanism, medial and lateral joints
Behind knee for popliteal cysts
Effusion
What to check on knee examination movement? (5)
Flexion
Extension
Hyperextension
Medial and Lateral Collateral Ligaments
Cruciate Ligaments
A positive sag (draw) test means what?
Issue with cruciate ligaments in knee
Ankle and Foot Examination
What to look for? (11)
Nail Changes, Skin Rashes, Scars, Wounds and Calluses
Swelling and Muscle Wasting of Calf Muscles
Clawing or Hammer Toes
Joint Swelling or Hallux Valgus
Callus Formation
Ankle and Knee Examination
what to look for on standing? (4)
Toe alignment
Foot arch position
Alignment of Hind Foot eg Varus/Valgus
Achilles Tendon Swelling or Thickening
Ankle and Knee Examination
What to feel for? (7)
Temperature over forefoot, mid foot and ankle
Lateral and Medial malleolus
Fibula Head
Bones in Foot
Lateral Squeeze MTP Joints for Morton Neuroma
Subtalar, Midfoot, Tarsal and Ankle
Ankle and Knee Examination
What to look at on movement? (3)
Dorsiflexion and Plantarflexion at Ankle
Inversion and Eversion at Subtalar
Mid Tarsal and Subtalar movements
What is a boxers fracture?
Transverse fracture of 5th metacarpal neck
