osce component physicals

7/26/2019 OSCE Component Physicals

1/13

1 Washes hands, appropriate dress and grooming. Introduces self and asks for consent

2 Explains procedure to patient, positions and drapes

3 Inspects for and comments on findings: scars, asymmetry, visile peristalsis etc.

! "uscultates for o#el sounds and comments on their significance

$ %erforms light palpation and comments on findings i.e. guarding, rigidity, etc.

&"ssess for reound tenderness at 'c(urney)s point, clearly informs patient of

procedure and comments on findings

*+emonstrates ovsing)s, %soas and -turator sign, listing each y name and explaining

procedure to patient. omment on findings.

/ 0no#ledge uestion

OSCE Abdominal System

Examine for appendicitis


Examine for ascites



3 Inspects and comments on findings: distended, full flanks, everted umilicus, etc.

! %ercusses for dullness in flanks and comments on findings

$ "sses for shifting dullness and comments on findings

& hecks for fluid #ave and comments on findings

* 0no#ledge uestions


2/13

OSCE Abdominal system

Examine the patients kidneys



3%erform a general inspection for systemic manifestation of kidney disease:

periorital edema, generalied edema, uremic fetor, pallor, etc.

!Inspects the adomen and comments on findings: masses, asymmetry, etc.

$ "uscultates for renal artery ruits. omments on findings and significance

&

(imanual palpation #ith allottement 4 attempted entrapment of kidneys on deep

inspiration, comments on findings.

* %alpate 4 percuss costoverteral angle for tenderness. omments on findings.

/ 0no#ledge uestion


Examine the Liver



3Inspects for and comments on systemic manifestation of liver disease: 5aundice,

palmer erythema, asterixis, ascites

!Inspects the adomen and comments on symmetry, visile peristalsis, striae, caput

medusa

$%ercusses lever and identifies upper and lo#er order. 6ives liver span in cm.

omments on findings

&%alpates lo#er order 7 starts in I8, asks patient to inhale deeply, and descries

liver findings i.e. nodularity, tenderness, consistency

*hecks for a 'urphy sign and comment on findings. +escrie the significance of apositive sign

/ 0no#ledge uestion


3/13


Examine the spleen



3Inspects and comments on systemic manifestation of splenic disease: pallor,

con5unctival pallor, etc.

! Inspects the adomen and comments on symmetry,

$%alpates lo#er order of spleen7 starts in I8, asks pt to inhale deeply, imanual,

roll patient to right

& +emonstrates splenic percussion sign in 9raue)s space and comments on findings

* ist at least three #ays to differentiate an enlarged spleen from an enlarged kidney

OSCE Vital signs

Obtain the patients blood pressure

1Washes hands, appropriate dress and grooming. Introduces self and asks permission

"sks aout comfort, coffee intake, cigarettes, etc.

2 Explains procedure to patient, positions and drapes. ocates rachial artery

3+emonstrates selection of appropriate cuff sie applies cuff properly. +escries

#hat error #ill occur if the cuff is too large or too small

! (egins #ith palpation method for systolic pressure

$Inflates cuff to appropriate level ; < 3= degree of estimated systolic pressure y

palpation

& %ositions stethoscope and deflates appropriately 2mm>sec?

* eports patient)s lood pressure and interprets per the @A / guidelines

/ 0no#ledge uestion

OSCE eripheral Artery Circulation


4/13

Check the peripheral circulation on this patient

1 Washes hands, appropriate dress and grooming. Introduces self and asks permission

2Inspects for evidence of arterial insufficiency on upper and lo#er lims: cool skin,

dry thin skin, pallor, etc.

3%alpates radial pulse and determines rate and rhythm%alpates radial and rachial arteries ilaterally and comments on symmetry. hecks

capillary refill

!%alpates the carotid artery ilaterally and comments on symmetry. +etermines the

character and volume. "uscultates for carotid ruits ilaterally

$

%alpates the dorsalis pedis and anterior tiial artery ilaterally and comments on

symmetry

hecks capillary refill

&ompare and contrast at least 3 different findings on physical exam et#een arterial

insufficiency and venous insufficiency, i.e. trophic changes, color, temp, edema etc.

* 0no#ledge uestions

OSCE !eneral Survey

erform a general survey on this patient



3Inspects scalp for shape, hair, infection, ruise, hematoma, and comments on

findings

! Inspects eyes for 5aundice and pallor, and comments on findings

$Inspects oral cavity examination for hygiene, cavities, caries etc., and comments on

findings

& Inspects ear for #ax, discharge, etc., and comments on findings

* Inspects and palpates neck for lymph nodes and thyroid s#elling

/Inspects hand for pallor, cluing, koilonychia, splinter hemorrhages, etc., and

comments on findings

B 0no#ledge uestions

OSCE CVS


5/13

Examination of "V



3 Inspects neck, identifies external 4 internal 5ugular pulsation

!+escrie venous pulse: " 4 C #aves, and lists at least 3 features #hich distinguish it

from the carotid

$ 'easures vertical height #ith respect to sternal angle and reports in cm.

& alculates pressure in cm. from right atrium and comments on findings.

*+emonstrates hepato;5ugular reflux and comments on findings. +escries #hat a

positive finding #ould e

/ 0no#ledge uestion

OSCE CVS

#eart Auscultation



3

"uscultate the ! areas of the heart:

+escrie location, time D1 #ith the carotid upstroke, comment on findings i.e. in the

aortic area, D1 is louder than D2 and there are no additional sounds or murmurs

!Identify #here a split D2 is heard most loudly and descrie the hemodynamics of a

physiological split.

$ist #hich murmurs radiate and demonstrate ho# you #ould check for this

radiation.

&+emonstrate positioning and techniues useful in identifying aortic and mitral

murmurs.* 0no#ledge uestion

OSCE CVS

$nspection and palpation for the cardiac system


6/13



3

Inspects for systematic findings relevant to the cardiac system, including malar

flush, cyanosis, respiratory distress, diaphoresis, neck vein distension etc. omments

on findings

!

Examine the ands and list signs related to cardiac including splinter hemorrhages,

cluing, cyanosis, pallor, capillary refill etc. omments on findings

$Inspection the chest looking for scars, pacemaker, forceful %'I, chest deformity,

apical impulse etc. omments on findings.

& %alpate for the apical impulse and descrie finding

* heck for and discuss the significance of a parasternal heave

/ %alpate the ! cardiac areas for thrills. Explain the significance of a thrill

B 0no#ledge uestion

OSCE %euro

Examine cranial nerves & '( excluding )




7/13

3

Inspect the nasal cavities looking for lockage, discharge, etc. Inspect the eyes

looking for aniscoria, narro# angle glaucoma, con5unctivitis, sucon5uctival

hemorrhage, straismus, etc.

3 heck for A 1 and comment on findings

! heck visual acuity on Dnellen chart and comment on finding

$ heck visual fields y confrontation and comment on finding

&9ests direct and consensual pupillary reflexes and comment on finding. +escrie

findings in orner)s syndrome and "rgyll oertson pupils

* heck for accommodation and comment on findings

*Examine A 3,! and & and comment on findings including diplopia, concordant

movement of eyes

/ 0no#ledge uestion

OSCE %euro

Examine cranial nerves ) and *



39est light touch in the three ranches of the trigeminal nerve and comments on

findings. +escrie ho# to test for the corneal reflex! 9est strength of the muscles of mastication and comment on findings

$ 9est 5a# 5erk and comment on findings

&Inspects the face for evidence of A * paralysis and explains the different findings

for a central versus a peripheral lesion

*9est strength of muscles innervated y the facial nerve including eye closure, cheek

puffing, smile, and #rinkling of forehead and comment on findings

/ 0no#ledge uestion

%euro OSCE

Examine cranial nerves +'&,



8/13


3Inspects for: ear lesions or discharge, symmetrical soft palate, muscle asymmetry for

the trapeius and sternocleidomastoid

!

A /: perform Weer and inne test and report findings. +escrie #hat the findings

of these tests #ould e for a conductive vs a sensory neural hearing loss

$A B and 1=: "sk patient to say Fahhhh) and comment on finding. +escrie ho# to

illicit a gag reflex and neural path#ay for this

& A 11: "sses strength of D' and trapeius and comment on findings

*A 12: "sk patient to protrude tongue and comment on findings. +escrie findings

in central A 12 lesion

/ 0no#ledge uestion

OSCE %euro

-otor system lo.er limb

1Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes


3Inspects the lo#er lims commenting on deformities, length discrepancy, symmetry,

muscle #asting, fasciculation, etc.

!9ests for muscle tone of oth lo#er lims and comments and findings. +escries

#hat one #ould expect to find in a central vs a peripheral nervous lesion

$

9ests for muscle po#er ilaterally and comments on findings:

ip flexion and extension, hip aduction and adduction, knee flexion and extension,

and foot dorsiflexion>plantar flexion

&Elicit reflexes ilaterally and comment on findings: patellar reflex, ankle reflex and

clonus ilaterally, demonstrates reinforcement techniues.

*

heck for a plantar response ilaterally and comment on findings. +escrie a

positive response and its significance

/ 0no#ledge uestionOSCE %euro

-otor system upper limb

1Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes


9/13


3Inspects the upper lims commenting on deformities, length discrepancy, symmetry,

muscle #asting, fasciculation, etc.

!

9ests for muscle tone of oth upper lims and comments and findings. +escries

#hat one #ould expect to find in a central vs a peripheral nervous lesion

$

9ests for muscle po#er ilaterally and comments on findings:

Dhoulder aduction and adduct&ion, elo# flexion and extension, #rist flexion and

extension, thum opposition, finger grip strength, finger aduction and adduction

&Elicit reflexes ilaterally and comment on findings: iceps, triceps, and

rachioradialis.

*

heck for a ofmann response ilaterally and comment on findings. +escrie a

positive response and its significance

/ 0no#ledge uestion

OSCE %euro

Sensory system lo.er limb



10/13


3

9est for light touch of the lo#er lim ilaterally. +emonstrate a kno#ledge of the

ma5or dermatomes #hile performing task. omments on findings and compares

distal #ith proximal results.

! 9est for pain ilaterally in the ma5or dermatomes. omment on findings.

$

heck for viration sense in ig toes ilaterally using a t12/ tuning fork at the

distal ony prominence of the ig toe. "ssesses for aility to tell #hen viration

ceases. omments on findings

&

heck for proprioception in the ig toes ilaterally, holding the toe laterally at distal

phalange, and asking the patient to close eyes. 6ive previe# of up#ard and do#n

#ard movement efore testing. omments on findings

*heck for a omerg sign. omment on findings and explain significance of a

positive omerg sign./ 0no#ledge uestion

OSCE %euro

Sensory system upper limb



11/13


3

9est for light touch of the lo#er lim ilaterally. +emonstrate a kno#ledge of the

ma5or dermatomes #hile performing task. omment on findings and compares distal

#ith proximal results.

! 9est for pain ilaterally in the ma5or dermatomes. omment on findings.

$

heck for viration sense in thum ilaterally using a t12/ tuning fork at the

distal ony prominence of the thum. "ssesse for aility to tell #hen viration

ceases. omment on findings

&

heck for proprioception in the ig toes ilaterally, holding the toe laterally at distal

phalange, and asking the patient to close eyes. 6ive previe# of up#ard and do#n

#ard movement efore testing. omments on findings

* 0no#ledge uestion

OSCE /espiratory System

$nspection and palpation of the thorax



3Inspect for systemic manifestations of lung disease, i.e. central or peripheral

cyanosis, cluing, etc.

! Inspect the trachea for deviation. +escrie #hat a tracheal deviation may indicate

Inspect the chest #all looking for deformities, scars, etc. +escrie signs for

respiratory distress

$ %alpate for chest #all tenderness. +escrie the significance of a positive finding

& heck the ">% diameter of the chest

* heck chest expansion

/ heck tactile vocal fremitus and descrie the findings loar pneumonia, pleuraleffusion, pneumothorax, asthma and -%+

OSCE /espiratory System

ercussion and auscultation of the lungs


12/13



3

%ercusses the anterior and posterior lung fields and comment on your findings.

+escrie the percussion notes found in loar pneumonia, pleural effusion,pneumothorax, asthma and -%+

!"uscultate the anterior and posterior lungs fields and comment on your findings.

+escrie normal reath sounds

$

heck for 9ransmitted Coice Dounds ronchophony, egophony or#hispered

pictoriliuy? and comment on your findings. +escrie #hat you #ould find in loar

pneumonia, pleural effusion, pneumothorax, asthma and -%+

OSCE -usculoskeletal SystemExamine the knees



3Inspects the knees for symmetry, s#elling, scars, fasciculations etc. and comments

on findings

!%alpates the knees for tenderness, s#elling, #armth, crepitus, etc. and comments on

findings

$ hecks for range of motion of the knees ilaterally

& hecks for 5oint effusion: ulge or alloon test, and patellar tap

*hecks the staility of the anterior and posterior cruciate ligaments ilaterally via

the anterior and posterior dra#er tests respectfully

/%erforms valgus and varus stress tests to evaluate the staility of the medial and

lateral collateral ligaments

B 0no#ledge uestion

OSCE -usculoskeletal System

Examine the shoulders


13/13



3

Inspects the shoulders for deformity, s#elling, scars, fasciculations, anormal

positioning, etc. and comments on findings

!%alpates the shoulders for tenderness eginning at the sternoclavicular 5oint, clavicle,

acromion, acromioclavicular 5oint, coracoid process and icipital groove and tendon

$hecks for range of motion of the shoulder ilaterally:

8lexion, extension, aduction, adduction, internal rotation, external rotation

&heck the strength of the supraspinatus, suscapularis and infraspinatus muscles and

comment on your findings

* 0no#ledge uestion

OSCE -usculoskeletal System

Examine the back



3Inspects the ack for symmetry, muscle atrophy or fasciculations, kyphosis,

scoliosis, posture, etc. and comment on your findings

!%alpates for tenderness or step offs along the spinous processes. %alpates for

tenderness over the sacroiliac 5oint. omments on findings

$hecks for range of motion: flexion, extension, rotation and lateral ending.

omments on findings

&hecks for signs of meningitis: (rudindki)s sign and 0ernig)s sign. +escries the

significance of a positive sign

*hecks for lumosacral radiculopathy #ith a straight leg raise. +escries the

significance of a positive sign

/ 0no#ledge uestions

osce component physicals

Documents