Clinical Skills

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Author:
mewinstanley@googlemail.com
ID:
73537
Filename:
Clinical Skills
Updated:
2011-03-17 16:24:04
Tags:
Medicine 2nd year OSCE
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Description:
Clinical skills for YR2 OSCE
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  1. Spinal Exam
    • Look
    • Normal shape, no kyphosis/lordosis

    Feel


    • Spinal processes
    • sacroiliac joints
    • paraspinal muscles -> Spasm/Tenderness
  2. Spinal exam cont.
    Move

    • Flexion -tough toes
    • Extension
    • Fingers adjacent to spinal process to show movement
    • Lat. Flexion-> Hands down thighs
    • Rotation -> seated, arms @ sides

    • C-spine
    • -flex/ext/rotation/lat flex

    Temporo-mandibular joint

    Additional

    • Peripheral pulses
    • Reflexes
    • Straight leg raise
  3. Hip Exam
    • Look
    • -scars
    • -swelling
    • -deformity
    • -gluteal muscle wasting
    • -assymetry
    • -length discrepancy (True/Apparent)

    • Feel
    • G. Trochanter
    • -trochanteric bursa -> inflamm/heat

    Warmth @ Hip, Knee & Ankle
  4. Hip Exam cont.
    • Move (N.B. Active & Passive)
    • -Flexion; stabilise iliac crest, move @ knee
    • -Rotation; bend knee, int/ext rotation
    • -Abduction; stabilise opposite hip, leg away
    • -Adduction; Stablise same hip, leg move medial
    • -Extension; Assist hamstring curls
  5. Hip Exam cont
    • Function
    • Gait;
    • -trendelenburg
    • -Antalgic (Limping)
    • -Short Limb

    • Additional Tests
    • -Thomas' Test
    • Flex knee, w. hand under back @ Lumbar region
    • For fixed flexion deformity
    • -Trendelenburg Test
    • Lift leg, bum drop on opposite side
  6. Knee Exam
    • Look
    • -Assymetry
    • -Errythema/rash
    • -Scarring
    • -Quad wasting
    • -Deformity; Fix flex/valgus/varrus
  7. Knee Exam cont.
    • Feel
    • -Warmth (mid thigh to calf)
    • -Effusion; Patellar tap/bulge test
    • -Popliteal Swelling
    • -Pain; Patelar/Joint Line/Tibial Tuberosity

    Move

    • -Flex & Extend (0-140 degrees) Feel for crepitus
    • -Hyperetension -> Pull up @ ankles

    Additional:

    • Cruciates -> Ant. Drawer test (ACL)
    • Collaterals (Med/Lat bending of knee)
    • McMurrays(Menisci)
    • -Hold @ foot & Flex knee, outward = m, inward = l feel for clicks

    • Function
    • -Gait
  8. Feet & Ankles
    • Look
    • -symmetry
    • -joint swelling
    • -Clawed Toes
    • -Hallux Valgus
    • -Calluses
    • -Footwear -> insoles/abnormal wearing

    • Feel
    • -temperature
    • -Pulses -> Dorsalis Pedis &Post. Tibial
    • -Metatarsal Squeeze
    • -Tarsal J's
    • -Ankle Joint line
    • -Sub-talar joints
  9. Foot & Ankle cont.
    • Move
    • Dorsi & Plantar flex;
    • -Hallux
    • -Ankle Joint

    • Inversion/Eversion;
    • -Subtalar J

    • Function
    • -Gait
    • -Weight bearing -> Alignement/Arches
    • -Achilles T
    • -Align of hindfoot (Varrus/Valgus)
  10. Neuro I (Upper Limbs)
    • Inspection
    • -wasting
    • -tremor
    • -posture
    • -fasciculation

    • Tone
    • - Rotate & Ext. Wrist -> Cogwheeling
    • ->quick suppination; Spastic catch
  11. Neuro I cont.
    • Power
    • -Shoulder;
    • Elbows out, push against (above & below)

    • -Elbow
    • Boxing gloves, pull = biceps, push = triceps

    • -Wrist
    • Flex/Ext against resistance

    • -Fingers
    • Grip 2 finger (C5&6)
    • Abduction w. resistance
    • Thumb Ab/ADduction
    • OK sign
  12. Neuro I cont.
    • Reflexes
    • -biceps/triceps/suppinator jerk
    • Reinforce w. clenched teeth

    • Sensation
    • Not Req'd

    Co-ordination

    Finger -> Hand -> Nose

    Hand Clapping; Dysdiodokinesis
  13. Neuro II (Lower Limbs)
    • Inspection
    • -Wasting
    • -Posture
    • -Fasciculation

    • Tone
    • 1. Hip & Knee
    • -Log rolling, hand under & lift knee (Inc tone, heel off)

    • 2. Ankle
    • -90deg flex knee
    • Sharp move of ankle -> Clonus
  14. Neuro II cont.
    • Power
    • -straight leg lift w. resist
    • -Knee Ext w. resist
    • -Pull against flexed knee
    • -Foot Dorsi/Plantar Flex w. resist
    • -Inversion w. resist

    Reflex

    • -Knee/Ankle/Plantar Flex
    • Reinforce w. Hand Clasp

    Co-ordination

    • Rub shin w. heel
    • Heel to toe walking

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