The Peripheral Nervous System OSCE

Question 1

What sections can the Peripheral Nervous System Exam be divided into?

Answer 1

Set up,
Inspection
Assessment
Scope for further Examination

Question 2

List the steps involved in ‘set up’

Answer 2

Explanation of exam to patient

Positioning and Exposure

Question 3

List the steps involved in ‘Inspection’

Answer 3

Overall Inspection

Limb Inspection

Question 4

List the steps involved in ‘Assessment’

Answer 4

Tone assessment
Power assessment
Reflexes
(Plantar response)
Coordination
Function

Question 5

List the steps involved in ‘Scope for further examination’

Answer 5

sensory examination and cerebellar testing

Question 6

What is included in Positioning and Exposure?

Answer 6

May be conducted lying or sitting

Fully expose limbs including shoulders and upper thighs

Question 7

What is included in Overall Inspection?

Answer 7

Inspects patient overall for posture, signs of disability, deformity, and build

Question 8

What is included in Limb Inspection?

Answer 8

Inspect limbs for muscle wasting, fasciculation, resting position, symmetry, scars, skin lesions, abnormal movements
Test for pronator drift and postural tremor

Question 9

What is included in Limb Inspection?

Answer 9

Inspect limbs for muscle wasting, fasciculation, resting position, symmetry, scars, skin lesions, abnormal movements
Test for pronator drift and postural tremor

Question 10

What is included in Tone assessment?

Answer 10

Assess tone with the patient relaxed,
compare symmetry
and evaluate a range of limb movements at varying velocity include test for ankle clonus

Question 11

What is included in Power assessment?

Answer 11

Assess the maximum power and symmetry of all major limb movements
Evaluate any weakness against the MRC grading scale for power
If weakness is present, identify specific pattern such as pyramidal or proximal

Question 12

What is included in Reflex assessment?

Answer 12

Performs an assessment of deep tendon reflexes of a) biceps, triceps and supinator (in arms) and/or b) patellar and ankle reflex in lower limbs

Use an effective technique with patient relaxed
Compare symmetry
Employ reinforcement if needed

Question 13

What is included in Plantar Response assessment?

Answer 13

Use a blunt instrument to run up the lateral edge of the foot
Identify movement of big toe
Compare symmetry

Question 14

What is included in Coordination assessment?

Answer 14

Undertakes a test of overall function appropriate to the limbs being examined (finger-nose for arms, heel-shin for legs)

Question 15

What is included in Function assessment?

Answer 15

Undertake a test for overall function (bimanually manipulating an object with the hands, testing gait for legs)

Question 16

How would you perform a sensory examination (pin-prick)

Answer 16

1) The patient’s eyes should be closed
2) Touch the patient’s sternum with the end of a neuro-tip
3) Ask the patient to say “yes” when touched, and assess the dermatomes in the upper limbs
4) Compare left to right by asking the patient whether it feels the same on both sides

Question 17

How would you examine cerebellar function (Dysdiadochokinesia)

Answer 17

1) Demonstrate patting the palm of your hand with the back-palm of your other hand to the patient
2) Ask the patient to mimic this rapid alternating movement
3) Enourage them to do this alternating movement as fast as they are able to
4) Repeat test using the patient’s other hand