Tuesday OSCE Flashcards
straw coloured urine indicates
normal
dark coloured urine indicates
dehydration
red urine indicates
macroscopic haematuria, rifampicin, beetroot or porphyria
brown urine indicated
bile, myoglobin, anti-malarial drugs
clear urine would indicate
normal
cloudy urine would indicate
UTI
frothy urine would indicate
nephrotic syndrome
offensive smelling urine would indicate
UTI
sweet smelling urine would indicate
glycosuria
specific gravity is a measure of
urine concentration
key renal questions
fever, dysuria, frequency, urgency, haematuria, nocturia, hesitancy, dribbling, poor stream, incontinence, N+V
inspecting the posterior aspect of the spine, what are you looking for?
posture of the head, neck + shoulders. check for thoracolumbar scoliosis
inspecting the spine from the side, what are you looking for?
cervical lordosis, thoracic kyphosis, lumbar lordosis
why do you ask the patient to shrug their shoulders during palpation?
to feel in the supraclavicular fossa for cervical ribs
what are you feeling for in the midline of the spine?
spinous processes
two things to check for in the iliac region?
iliac crest height, sacroiliac joints
why do you check for chest expansion in palpation of the spine?
reduced chest expansion can be a sign of AK
describe the movement of the cervical spine in the spine exam
flexion/extension, rotation and lateral flexion
describe the movement of the lumbar spine in the spinal exam
flexion (schobers test), extension and lateral flexion
what is schobers test?
mark the sacroiliac joints, measure 10cm above 5 cm below , ask patient to bend forward, should increase to 20cm
what are you inspecting the anterior aspect of shoulder for?
contour of shoulder, deltoid + trapezium muscle bulk, SC and ACJ joints, clavicle
what are you inspecting the lateral aspect of shoulder for?
scars and shoulder contour
what are you inspecting the posterior aspect of shoulder for?
SC ACJ joints, supraspinatus and infraspinatus fossa for wasting
what are you inspecting the axilla for during the shoulder exam?
scapula symmetry, swellings and scars
what do you palpate in the shoulder exam?
SC joints, clavicle, ACJ joint, acromion, long head of biceps, scapula; spine and body.
describe the movements tested in the shoulder exam
- external rotation
- forward flexion
- abduction
- internal rotation
what is the normal degree of external rotation in shoulder?
70o
what is the normal degree of forward flexion in the shoulder
150-170o
what is the normal degree of abduction in the shoulder
160-180o
what is the normal level of internal rotation in the shoulder
T5
what muscles are you testing during scapula winging?
serratus anterior, long thoracic nerve
what movement tests supraspinatus?
like movement like Jobes
what movement tests infraspinatus?
same movement as external rotation, ask patient to push against your hands
what movement tests subscapularis?
hand on bum, push off
special tests for impingement/rotator cuff pathology in shoulder exam?
painful arc, Hawkins-kennedy, Jobes, Scarf test
what special tests for instability of shoulder?
sulcus, A+P drawer tests, anterior apprehension and relocation, posterior apprehension
during the knee exam, patient standing what are you looking for?
limb alignment, muscle bulk, popliteal fossae
what do you look for during gait?
pace, symmetry, gross gait abnormality, walking aids
during the knee exam, patient lying on the couch, what are you looking for?
erythema, skin changes, bruising, scars, hair changes, swelling
during the knee exam, how many sides do you palpate?
one side only, affected
during the knee exam, straight leg raise is testing what?
extensor mechanism
what are the two effusion tests during the knee exam?
patellar tap and medial gutter sweep
what do you palpate for during the knee exam?
temperature, tibial tuberosity, effusion, patellar tendon, patellar instability, patellar grind test, medial and lateral joint line, collateral ligaments, cruciate ligaments
what test do you do if there is tenderness over the joint line in the knee?
Steinnmans, remember to twist the foot! not the leg
what stress do you apply to test the medial collateral ligament?
valgus stress
what movements do you test in the knee exam?
flexion, extension
what special test is at the end of the knee exam, if indicated?
heel height testing
three screening questions at the start of the GALS exam?
do you have any pain in the joints/muscles/back ATM?
can you dress yourself?
can you get up and down stairs ok?
GALS; patient standing in anatomical position what are you looking for?
muscle bulk of; shoulder, glutes, quads, calves.
limb alignment; spine, iliac crest height
spine; scoliosis, lordosis and kyphosis
popliteal swellings
foot abnormalities
GALS; first movement in the arm section?
hands behind head; testing shoulder abduction, external rotation, elbow flexion
GALS; describe the arms part of the exam?
hands behind head, hands held out
make a fist; assess power grip, hand + wrist function, range of finger movement, squeeze fingers
squeeze MCPs
GALS; describe the spine part of the exam?
cervical spine; lateral flexion
lumbar spine; lumbar flexion
GALS; describe the legs part of the exam?
knees; flexion, extension and crepitus hip; internal rotation patellar tap inspect feet; swelling deformity and callous squeeze across MTPs
SKIN; important HPC questions to ask?
duration site and appearance at onset details of evolution and spread symptoms; itch, pain, burning aggravating/relieving factors how does it affect you?
SKIN; systemic enquiry?
mouth/tongue involvement, eye involvement, hair +nail involvement, swellings + lumps anywhere.
SKIN; important PMH?
atopy, general health, mouth disease
SKIN; describe a flat lesion
macule 1cm
SKIN; describe some raised lesions
papule, nodule, plaque, wheal, fluid; vesicle/bulla, cyst, pustule
EAR; ototoxic drugs to ask for?
gentamicin, diuretics, cytotoxics
EAR; important points about occupation?
noise exposure
describe a normal Webers test
heard centrally
if webers is louder in the weaker ear, what is this interpreted as?
conductive HL
if Webers is louder in the better ear, what is this interpreted as?
sensorineural HL
Describe a positive Rinnes test
normal. air conduction is better than bone conduction
Describe a negative Rinnes test
abnormal, bone conduction is better than air conduction. conductive hearing loss
EAR; important PMH to ask
recent head surgery/injury , history of ear problems
THYROID; what do we need to check with the eyes?
exophthalmos
eye movement
lid lag
THYROID; what do you we need to check in the hands?
dry skin, sweat, tremor, pulse (rate+rhythm)
THYROID; what are you palpating for?
size, symmetry, consistency, masses, palpable thrill
THYROID; what is important in HPC?
recent viral illness
THYROID; iodine rich foods?
Sea stuff (fish, kelp etc), cereals and grains
SKIN; treatments for eczema
eczema; emollients, avoidance of stimulants, steroids, antihistamine
SKIN; treatments for psoriasis
Psoriasis; vitamin D, mild steroids, coal tar, phototherapy.
SKIN; treatments for acne
acne; face wash, benzoyl peroxide, retinoid cream, contraceptive pill, antibiotics, isotretinoin
SKIN; treatments for rosacea
avoid triggers, topical metronidazole, isotretinoin, tetracycline
SKIN; important to ask in suspected skin cancer
sun exposure, skin type, immunosuppression, family history
SKIN; systematic review of lesions
colour, size, flat/raised, border, surface features
