Clinical skills exams

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mewinstanley@googlemail.com
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84549
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Clinical skills exams
Updated:
2011-06-01 17:32:50
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OSCE skills year medicine
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All exams (1 per card)
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  1. Respiratory Exam
    • Introduction, Consent & Explain procedure
    • 1. Inspection
    • Note: Relaxed/distressed
    • Resp Rate: norm= 8-12/min
    • Hands: Peripheral Cyanosis
    • Clubbing
    • Palmar creases/Erythemma
    • Radial pulse
    • Flapping tremor (?)
    • Face: Central Cyanosis - lips & tongue
    • Pallor of conjunctiva (anaemia)
    • Chest: shape (kyphosis, scoliosis, barrel)
    • Symmetry
    • Scars´╗┐

    • 2. Palpation
    • Position of Trachea - Central
    • Apex beat - 5th intercost, mid clavicular
    • Chest Expansion (2 @ front, 3 @ back) Thumbs @ midline
    • Vocal Fremitus (111, diminished vibration on pathology)

    • 3. Percussion
    • Tap Clavicles intercostals & axillae
    • Dull over liver & heart

    • 4.Auscultation
    • Deap Breaths THRU THE MOUTH
    • Listen for crackles, wheeze, bronchial breathsnormal = vesicular
    • Vocal Resonance (111, louder on pathology)

    • Continue onto back and do same
    • Examine lymph nodes (cervical and supraclavicular)for malignancy
  2. Cardiovascular Exam
    • 1. Inspection
    • General: unwell/breathless/uncofortable
    • Hands: Tar stains
    • Cyanosis
    • Clubbing
    • Anaemia (pale creases)
    • Splinter Haemorrhages (Infect. Endocarditis)
    • Face: Mallor flush (red cheeks)
    • Conjuctiva - pale, anaemia
    • Eyelids - Xanthalasma (hyperlipidaemia)
    • Corneal Arcus
    • Tongue for Central Cyanosis
    • Pulse & B.P
    • JVP: Right internal jugular vein, indicates RH fail
    • estimate height from sternum
    • Antagonise w. hepatojugular reflux
    • Chest: Scars
    • Visible
    • Pulsations

    • 2. Palpation
    • Apex Beat - norm 5th midclavicular
    • RV Heave - @ L. sternal edge, during expiration
    • Thrills - Palpable murmur (aortic stenosis)

    • 3. Auscultation
    • Over 4 valve areas, use diaphragm then bell
    • Apex - Mitral Area
    • L. Lower Sternal edge - Tricuspid
    • 2nd Int on L. Side - Pulmonary
    • 2nd Int on R. Side - Aortic
    • S1 = Mitral & Tricuspid closing (APEX)
    • S2 = Aortic & Pulmonary closing (A & P)
    • Carotid (Bruits)
    • Amplify by turning patient on left side/leaning forward
  3. REMs Spinal Exam
    • Look
    • Normal shape, cervical lordosis, thoracic kyphosis, scoliosis

    • Feel
    • Spinal processes
    • sacroiliac joints
    • paraspinal muscles -> Spasm/Tenderness

    • 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
  4. REMs 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

    • 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

    • Function
    • Gait;
    • trendelenburg
    • Antalgic (Limping)
    • Short Limb

    • Additional Tests
    • Thomas' Test
    • Flex knee, w. hand under back @ Lumbar region
    • For fixed flexion deformity
    • Trendelenburg Sign
    • Lift leg, bum drop on opposite side
  5. REMs Knee Exam
    • Look
    • Assymetry
    • Errythema/rash
    • Scarring
    • Quad wasting
    • Deformity; Fix flex/valgus/varrus

    • 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
  6. REMs 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

    • Move
    • Dorsi & Plantar flex;
    • Hallux
    • Ankle Joint
    • Inversion/Eversion;
    • Subtalar J

    • Function
    • Gait
    • Weight bearing -> Alignement/Arches-Achilles Calcaneal Tendon Align of hindfoot (Varrus/Valgus)
  7. Neuro Exam Upper Limbs
    • Inspection
    • wasting
    • tremor
    • posture
    • fasciculation
    • Tone
    • Rotate & Ext. Wrist -> Cogwheeling
    • quick suppination; Spastic catch

    • Power
    • Shoulder;
    • Elbows out, push against (above & below)
    • ElbowBoxing gloves, pull = biceps, push = triceps
    • Wrist
    • Flex/Ext against resistance
    • Fingers
    • Grip 2 finger (C5&6)
    • Abduction w. resistance
    • Thumb Ab/ADduction
    • OK sign

    • Reflexes
    • biceps/triceps/suppinator jerk
    • Reinforce w. clenched teeth

    Sensation Not Req'd

    • Co-ordination
    • Finger -> Hand -> Nose
    • Hand Clapping; Dysdiodokinesis
  8. Neuro Exam Lower Limbs
    • Inspection
    • Wasting
    • Posture
    • Fasciculation

    • Tone
    • Hip & Knee
    • Log rolling, hand under & lift knee
    • (Inc tone, heel off)
    • Ankle
    • 90deg flex knee
    • Sharp move of ankle -> Clonus

    • 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
  9. GI EXAM
    Introduce self, explain, consent, wash hands

    • 1. Inspection
    • Stand @ foot of bed, central/lateral distension
    • Hands: spooning/white fleks on nails, palmar creases/erythema, dupytrons contracture (fibrosis of aponeurosis)
    • Face: look @ eyes, conjunctiva (anaemia) sclera (jaundice)
    • Mouth: hydrated, central cyanosis, sores (vit defficient)
    • Abdomen: Previous surgery, caput medusae/spider nevae
    • 2. Palpation
    • light palpation from left iliac fossa round to right. Tenderness/GuardingDeep palpation for for lumps/growths
    • Palpate for liver (breathe in, from RIF)
    • Palpate for spleen (Breathe in, RIF to LHpC)
    • Palpate for Kidneys (Hand on front & Back)

    • 3. Percussion
    • Percuss for liver & spleen
    • Percuss from midline to flanks, check for shifting dullness

    • 4. Auscultation
    • Listen to ileocaecal valve (RIF)

    • Thank patient, Wash hands
    • "I would finish me exam with an examination of the hernial orifices, a PR and a urine dipstick"

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