OSCE cards

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bbeckers88
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175333
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OSCE cards
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2012-10-03 17:39:16
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OSCE
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  1. red flags for disease of the spine
    • Hx of cancer
    • unexplained wt loss
    • fever/chills
    • malaise
    • loss of appetite
    • sharp/severe pain
    • unvarying sx
    • cape-like distrobution
    • horner's syndrome
  2. follow up tests for suspected disease
    • CBC
    • CRP or ESR
    • x-ray
  3. follow up tests for suspected cancer
    • Ca
    • ALP
    • protein
  4. follow up tests for suspected arthritis
    • RA
    • ANA
    • HLA B-27
  5. Facet syndrome s/sx
    • tenderness over facet
    • local spasm
    • joint restriction
    • extension causes pain
  6. trigger point s/sx
    • tender nodule
    • familiar pain
    • stretch causes pain
    • familiar pain referral
    • jump sign
    • twitch
    • muscle weakness
  7. muscle home treatment
    • AROM 3 cycles
    • moist heat
    • avoid strenuous exercise
    • gentle home stretching
  8. 5 high pay off areas of the lumbar spine
    • t/l junction
    • l/s junction
    • SI joints
    • pubic symphysis
    • hip
  9. signs of myelopathy
    • clumsy hands
    • clumsy gait
    • gait disturbances
    • paresthesia
    • proximal leg pain
    • proximal muscle weakness
    • bladder problems
  10. cauda equina sx
    • urinary retention
    • alterned saddle sensation/paresthesia
    • decreased sexual function
    • decreased sphincter tone
    • + SLR
  11. cauda equina causes
    • midline herniation
    • tumor
    • spinal stenosis
    • trauma
    • spinal manipulation
    • pneumococcal meningitis
    • paget's
    • A/S
  12. lumbar radiculopathy causes
    • disc herniation
    • stenosis
    • tumor 
    • instability
    • spondylolisthesis
    • NR adhesion
    • fx
    • infection
    • osteophytes
  13. pain aggravated by lumbar flexion suspect:
    • sprain
    • disc derangement
    • subluxation
  14. pain relieved by lumbar flexion suspect:
    • muscle spasm
    • facet syndrome
    • anterior disc derangement
  15. leg sx aggravated by lumbar flexion suspect:
    • disc derangement
    • disc herniation
  16. leg symptoms centralized by lumbar flexion suspect:
    • spinal canal stenosis
    • anterior disc derangement
  17. flexion sensitivity, pain with:
    • bending
    • lifting 
    • squating
    • sitting
  18. flexion sensitivity activity modification
    • avoid sustained flexion
    • shift posture often
    • microbreaks
    • hip hinge
    • proper lifting techniques
  19. pain aggravated by active lumbar extension suspect:
    extensor sprain
  20. pain aggravated by passive overpressure of lumbar extension suspect:
    • facet syndrome
    • disc derangement
    • subluxation
    • sprain
    • spondylolisthesis
  21. local pain with hypermobility into lumbar extension suspect:
    segmental instability
  22. leg sx aggraveted with lumbar extension and older than 55 suspect:
    stenosis
  23. leg sx centralized with repetitive lumbar extension suspect:
    disc derangement
  24. extension sensitivity, pain with:
    • walking
    • prolonged standing
    • working with arms above head
    • lift objects off a counter
  25. extension sensitivity activity modification
    • walk faster
    • stand with foot on a step
    • lean over the counter
    • posterior pelvic tilt
    • step stools/ladder for reaching
  26. positive orthopedic tests with L4 radiculopathy
    • femoral nerve stretch test
    • possible negative SLR
  27. Maigne's syndrome
    • TL restriction
    • crest pain
    • groin pain
    • hip pain
  28. recommended SI tests
    • ASLR
    • thigh thrust
    • Gaenslen's test
    • Fabere
    • SI compression
    • SI distraction
    • palpation of long dorsal lig
  29. lumbar instability palpation
    • tenderness
    • hypermobility
    • clunk
  30. stork stand for:
    • spondylosis
    • spondylolisthesis
  31. follow up test after positive stork stand
    • SPECT
    • MRI
    • CT
    • bone scan
  32. cervical radiculopathy causes
    • DJD
    • disc
    • trauma
    • tumor
    • NR adhesions
    • fx
    • infection
  33. tests for cervical radiculopathy
    • cervical compression
    • cervical distraction
    • ULTT
    • shoulder abduction
    • valsalva
    • door bell/tinels
  34. causes of visceral somatic pain
    • GI (esophagus, gallbladder, pancreas)
    • heart
    • lung
  35. T4 syndrome
    • T4 joint dysfunction
    • glove paresthesia
    • HA on top of head
  36. high pay off locations of the thorax
    • vertebra/intrinsic muscles
    • ribs
    • paraspinal muscles
    • scapula/scapular muscles
  37. causes of chest pain
    GI>heart>chest wall
  38. heart referral
    • retrosternal/preordial
    • radiate ulnar aspect of left arm
    • jaw
    • interscapular
    • epigastric
  39. associated symptoms of a heart attack
    • dyspnea
    • diaphoresis
    • enausea
    • weak/fatigue
    • syncope
  40. predisposing factors for coronary syndrome
    • hypertension
    • smoking
    • diabetes
    • hyperlipidemia
  41. cardiac red flags
    • pain stops patient from activity
    • pain plus vomitting
    • pain in the right arm
  42. typical angina
    • substernal chest discomfort
    • provoked by exertion
    • relieved by rest and nitroglycerin
  43. atypical angina
    • two of the following
    • substernal chest discomfort
    • provoked by exertion
    • relieved by rest and nitroglycerin
  44. non-cardiac chest pain
    • one or none of the following
    • substernal chest discomfort
    • provoked by exertion
    • relieved by rest and nitroglycerin
  45. stable angina
    • occurs during activity
    • lasts 10-20 minutes
    • provoked by exertion, stress, cold
    • relieved by rest and nitroglycerin
  46. unstable angina/acute MI
    • no previous sx
    • sudden/rapid progression
    • have at rest and during exercise
    • niroglycerin relieves unstable angina but not MI
    • unstable angina lasts 30-40 minutes, MI lasts > 1 hr
  47. angina ancillary studies
    • 12 lead EKG
    • stress test
    • lipid and glucose pannel
    • chest radiograph
  48. MI ancillary studies
    • 12 lead EKG
    • cardiac enzymes
    • troponin, myoglobin, ESR
  49. mitral valve prolapse
    • mid systolic click/murmur
    • do echocardiogram
  50. pericarditis
    • non-pleuritic friction rub
    • forward bending aggravates
  51. pleuritis
    • pleuritic pain, respiration friction rub
    • fever/malaise
    • chest x-ray, CBC, chem, ESR
  52. pubic symphysis palpation
    • palpate rectus abdominus
    • tender bony palpation
    • compare height of ramus
    • motion palpation
  53. tests for a cervical disc herniation
    • cervical compression
    • cervical distraction
    • shoulder abduction
    • ULTT
    • valsalva
    • palpation
  54. specificity/sensitivity cervical compression
    90/50
  55. specificity/sensitivity  cervical distraction
    90/50
  56. specificity/sensitivity  shoulder abduction
    90/50
  57. specificity/sensitivity  ULTT
    22/97
  58. specificity/sensitivity valsalva
    94/22
  59. tests for lumbar disc herniation
    • anchilles reflex
    • L5 sensations
    • S1 sensations
    • S1 plantar flexors
    • L5 hallux extension
    • ankle dorsiflexion
    • calf wasting
    • SLR
    • XSLR
    • ankle reflex
  60. specificity/sensitivity achilles reflex
    89/45
  61. specificity/sensitivity L5 sensory
    95/25
  62. specificity/sensitivity S1 sensory
    90/45
  63. specificity/sensitivity S1 plantar flexors
    99/26
  64. specificity/sensitivity L5 hallux extension
    75/12-51
  65. specificity/sensitivity ankle dorsiflexion
    89/54
  66. specificity/sensitivity calf wasting
    94/29
  67. specificity/sensitivity SLR
    40/80
  68. specificity/sensitivity XSLR
    95/25
  69. specificity/sensitivity ankle reflex
    60/50
  70. red flags for cancer
    • age >50
    • hx of cancer
    • weight loss
    • no response for 1 month
    • no pain relief with bed rest
    • pain duration > 1 mo
  71. serious disease associated symptoms
    • fever/chills
    • malaise
    • loss of appetite/anorexia
    • significant fatigue
    • bilateral sciatica
    • sciatica with non-dermatomal symptoms
    • sciatica thats non-responsive
    • urinary changes
    • multiple joint involvement
    • sexual dysfunction
    • abnormal menstrual bleeding
    • GI/GU symptoms
  72. increased risk of serious disease
    • bacterial infections
    • increased susceptibility to infection
    • taking anti-coagulants
    • history of corticosteroids
    • history of diabetes
  73. timing of pain pattern for serious disease
    • spontaneous onset of LBP
    • progressive pain over wks/mo
  74. signs of serious disease from physical
    • neurological deficits in older patients
    • pt points to location of specific pain during SLR
    • pain with spinal percussion
    • hip pain with contracture
    • pronounced hip flexor loss
    • palpable mass
    • bony tenderness
    • vascular deficits
    • deformity
    • abdominal mass/bruit

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