OSCE Medical Reference Pocket Guide 2024 PDF

THE OSCE MEDICAL REFERENCE POCKET GUIDE 2024 EDITION TM EXAMINATION TABS History Taking.................................... 1-2 Cardiology......................................... 3-5 Respiratory........................................ 6-8 Gastroenterology................................

THE OSCE MEDICAL REFERENCE POCKET GUIDE 2024 EDITION TM EXAMINATION TABS History Taking.................................... 1-2 Cardiology......................................... 3-5 Respiratory........................................ 6-8 Gastroenterology............................... 9-11 Thyroid.............................................. 12-13 Diabetic Foot...................................... 14-15 MSK: Shoulder................................... 16-17 MSK: Spine........................................ 18-19 MSK: Knee......................................... 20-21 Neurology: Upper Limb....................... 22-23 Neurology: Lower Limb....................... 24-25 Neurology: Cranial Nerves.................. 26-27 Mental State Exam (MSE)..................... 28 Lymph Nodes / Glascow Coma............. 29 Snellen Chart...................................... 30 INITIAL STEPS MUST complete before commencing any exam 1. HAND HYGIENE 2. INTRO & INSTRUCTION 3. CONSENT 4. GENERAL OBSERVATIONS Respiratory status Body habitus Vital charts Environmental cues 1 INTRODUCTION Hx i) Introduce yourself iii) Explain purpose ii) Identify patient iv) Gain consent 2 PRESENTING COMPLAINT (PC) i) Identify main concern (signs, symptoms, etc.) 3 HISTORY OF PC 1. S ite Where exactly is the pain? nset What were they doing when the pain started? haracter What does the pain feel like? adiates Does the pain go anywhere else? ssociations e.g. nausea/vomiting ime How long have they had the pain? xacerbating Anything make pain better/worse? S everity Obtain an initial pain score 4 PAST MEDICAL HISTORY i) Surgical History iii) Allergies ii) Existing conditions iv) Medications (dosage + freq) 5 FAMILY HISTORY i) Known genetic conditions ii) Common conditions in the family (i.e. diabetes) iii) Ask about health of parents, siblings, etc. 6 SOCIAL HISTORY i) Smoking & Alcohol iv) School/work/hobbies ii) Illicit drug use v) Living arrangements iii) Diet & Activity vi) Ask about driving 7 SYSTEMS REVIEW i) Ask questions covering other systems 8 SUMMARY i) Summarize & repeat complete history ii) Clarify if you missed any details iii) Ask patient for any final questions & thank them Hx MALE SE UAL HISTORY i) Testicular swelling/pain iv) Urethral discharge ii) Itching/sore genital skin v) Dysuria iii) Skin lesions vi) Systemic symptoms FEMALE SE UAL HISTORY i) Abdominal/pelvic pain v) Systemic symptoms ii) Vaginal bleeding/discharge vi) Menstrual history iii) Dyspareunia vii) O history iv) Vulva changes/itches viii) GYN history OTH i) Last sexual contact iii) Focused PMHx ii) HIV risk assessment iv) Travel history SYSTEM REVIEW UESTIONS Chest pain Syncope So Leg pain or swelling Palpitations Cough (blood) Unusual phlegm production Wheeze Loss of consciousness Weakness/ Headaches numbness Change in vision Dizziness Nausea/vomiting Heartburn Difficulty swallowing Change in Abdominal pain bowel habits Muscle/ oint/bone Pain/swelling/stiffness Unusually dry mouth/eyes Fever Skin changes (rash) Excess sweating Fatigue Weight loss/gain  1 SPECIFIC O SERVATIONS i) Cyanosis iv) Shortness of breath ii) Pallor v) Edema iii) Malar flush vi) Specific cues (ECG, Meds, IV) CVS 2 HANDS IE Infective Endocarditis i) Clubbing vi) Signs of IE ii) Palmar crease pallor aneway lesions iii) Tar stains Osler nodes ( O uch) iv) anthomata Splinter hemorrhages v) Capillary refill time ( 2 secs) 3 PULSE & P i) Radial Pulse (rate, rhythm, strength) iii) Take P ii) Radial Radial delay & Radial Femoral delay 4 NECK i) Carotid (palpate & auscultate) ONE AT A TIME ii) VP (45 , head left, sternal angle, 4cm) 5 FACE i) Eyes (con unctival pallor, xanthalasma) ii) Mouth (central cyanosis, high arched palate, angular stomatitis, dental/gum hygiene) 6 CHEST i) Inspect (wall deformities, scars, pulsations) ii) Palpation (apex, heaves, thrills) iii) Auscultate (APTM 2245) iv) Maneuvers + listen to M with bell Left lateral decubitus mitral regurgitation Lean forward + breathe out friction rubs 7 ACK i) Inspect & Palpate (sacral edema) ii) Auscultate lung fields 8 LEGS i) Inspect (trophic changes, varicose veins, swelling) ii) Palpate (pedal edema, temperature, pulses)  AUSCULTATION A2 Aortic 2nd ICS P2 Pulmonic 2nd ICS T4 Tricuspid 4th ICS CVS M5 Mitral 5th ICS Pulmonic Aortic Pulmonic stenosis Aortic stenosis systolic e ection crescendo decrescendo Tricuspid systolic Systolic Tricuspid regurg. Erb s Point VSD Diastolic Systolic Tricuspid stenosis HOCM ASD Left Diastolic Mitral sternal Systolic Aortic regurg. border Mitral regurg. decrescendo/blowing Pulmonic regurg. Right Mid holosystolic sternal clav. Diastolic border line Mitral stenosis opening snap RULES FOR MANEUVERS Inspiration rIght sided murmurs Except HOCM & Expiration lEft sided murmurs MVP INC Preload/Afterload ALL murmur intensity Squatting Leg Raise Hand Grip Valsalva INC Preload INC Preload INC Afterload DEC Preload Scan to lood Pressure listen Urine Dipstick 12 lead ECG Troponins (MI)  UGULAR VENOUS PRESSURE ( VP) i) Patient at 45 , turn head to left ii) Look for VP (between medial end of clavicle under the medial CVS sternoclemastoid) iii) Measure vertical distance between the sternal angle & top pulsation point iv) Normal 4cm LOOD PRESSURE 1 2 3 Twist air release Wrap cuff above elbow Place stethoscope valve all the way to with arrows pointing head on brachial right to close it off to brachial artery artery & find pulse 4 5 6 Inflate cuff to 16 Slowly release the 1st thud Systolic P (until pulse is no valve & listen closely Sound absent Distolic P longer present) SYMPTOMS POTENTIAL Dx Cold + white + painful limbs Acute limb ischemia C/P + neck, aw or L arm pain Acute coronary syndrome Impending sense of doom Cerebral hypoxia Unilateral leg swelling DVT (risk of PE) Sudden onset throbbing C/P Thoracic AA radiating to scapula Syncope/Presyncope on exertion Aortic Stenosis  1 SPECIFIC OBSERVATIONS i) Cyanosis iv) Shortness of breath ii) Pallor v) Cough, wheeze, or stridor iii) Edema vi) Surroundings (O2 , sputum, cigs) 2 HANDS i) Clubbing (schamroth window test) ii) Skin changes (bruising, thinning, tar stains) iii) Capillary refill time (< 2 secs) RES iv) Tremor (fine & flapping/asterixis) Hold for at 3 PULSE least 30s! i) Radial Pulse (rate, rhythm, strength) ii) Respiratory rate 4 NECK i) JVP (45º, head left, sternal angle, < 4cm) ii) Trachea (position, cricosternal distance) Normal = 5 FACE 3-4 fingers i) Eyes (conjunctival pallor, xanthalasma, Horner's) ii) Mouth (central cyanosis, oral candidiasis) 6 ANTERIOR CHEST i) Inspect (wall deformities, scars, pulsations) ii) Palpation (apex, chest expansion, RV heave) iii) Percuss (supra/infra clavicular, chest wall, axilla) iv) Vocal Resonance (say "99") v) Auscultate (deep breaths in + out through mouth) 7 BACK *pt cross arms + lean forward* i) Inspect (wall deformities, scars, recessions) ii) Percuss (anterior/middle/lower lobes) iii) Vocal Resonance (say "99") iv) Auscultate (deep breaths in & out through mouth) 8 LEGS i) Inspect (signs of DVT, erythema nodosum) ii) Palpate (pedal edema, temperature, pulses)  ANT LUNG FIELDS POST RES heeze Stridor histle S ueaky Do(o)r High pitched musical flute High pitch inspiratory s ueak Asthma & COPD Upper airway obstruct, croup Crackles Rhonchi Crackle-Pop Rumble Fluid crackly/bubbly sound Low pitched rattle or rumble Pulmonary edema, CHF Bronchitis, COPD, Pneumonia Friction Rub Scan to listen Cat Scratch High pitched scratchy sound Pleurisy, pericarditis CHEST E PANSION i) Position your hands beneath the nipples ii) rap fingers around the chest & bring thumbs together at midline iii) During patient's deep breath, observe symmetrical upward/outward movement during inspiration downward/inward movement during expiration  TRACHEAL PALPATION Cricosternal Distance Trachea Position RES Normal = 3-4 fingers i) Dip finger into thorax beside trachea A = cricoid cartilage ii) Apply side pressure to locate border B= suprasternal notch iii) Compare space on both sides Interpretation SCHAMROTH'S Midline = normal position Clubbing = NO window Away = tension pneumothorax, large pleural effusion Towards = lobar collapse, pneumonectomy PERCUSSION keep middle finger flat! Resonant = normal tissue Chest -Ray Dull = fluid (i e pneumonia, atelctasis, edema) ABG Sputum Sample Stony Dull = pleural effusion Spirometry Hyperresonant = pneumothorax, COPD S MPTOMS POTENTIAL Dx Hemoptysis TB, Lung cancer, PE eight loss Lung cancer, COPD (end stage), Cor pulmonale Sudden onset C/P Spontaneous pneumothorax, PE Sudden onset dyspnea Spontaneous pneumothorax, PE Sudden onset stridor Anaphylaxis, foreign object, acute epiglotitis  1 SPECIFIC OBSERVATIONS i) Confusion iv) Abdominal distention & ascites ii) Pallor v) Hyperpigmentation iii) Jaundice vi) Specific cues (stoma & drains) 2 HANDS i) Clubbing ii) Palms (pallor, erythema, Dupuytren's contracture) iii) Nails (koilonychia, leukonychia) iv) Tremor (flapping tremor/asterixis) 3 PULSE i) Radial Pulse (rate, rhythm, strength) GIT ii) Respiratory rate 4 ARMS & A ILLA i) Bruising, spider nevi, stretch marks) ii) Axilla (acanthosis nigricans, hair loss) 5 FACE i) Eyes (conjunctival pallor, jaundice, Kayser-Fleischer) ii) Mouth (stomatitis, glossitis, candidiasis, ulcers) 6 NECK & CHEST i) Neck (lymphadenopathy & left supraclavicular node) ii) Chest (spider nevi, gynecomastia, hair loss) 7 ABDOMEN i) Inspect (scars, distention, striae, Cullen's/Grey Turn) ii) Palpation (9 uadrants superficial deep) iii) Liver Palpate & Percuss (RIF Rt costal margin) iv) Spleen Palpate & Percuss (RIF Lft costal margin) v) Ballot kidneys (push fingers together on breath in) vi) Palpate aorta (width < 3cm) vii) Shifting dullness (percuss Umbilicus Lft flank) viii) Auscultate (bowel sounds, aortic & renal bruits) 8 LEGS i) Palpate (pitting edema)  9 QUADRANTS Right Left Hypochondriac Epigastric Hypochondriac Hepatitis Gastritis Pancreatitis Cholecystitis GERD Splenic Infarct / Cholengitis Pancreatitis Gallstones Peptic Ulcer Rupture Right Lumbar Umbilical Left Lumbar Kidney stones Apendicitis (early) Kidney stones Pyelonephritis Gastroenteritis Pyelonephritis GIT Colitis Ruptured AAA Colitis SBO Right Iliac Hypogastric Left Iliac Ovarian Torsion Cystitis Ovarian Torsion Crohn’s Disease PID Ulcerative Col. Apendicitis Ectopic Pregnancy Diverticulitis Testicular Torsion McBurney’s 2/3s from umbilicus to right ASIS Point 8 Rt Costal Margin, Mid-Clavicular line Murphy’s Sign Pain on deep breath in Pain in right iliac region upon Rovsing’s Sign palpation of left side Left supraclavicular node (enlarged) Virchow's Node Associated with gastric cancer SPIDER NEVUS KAYSER-FLEISCHER KOILONYCHIA Estrogen Metabolites Copper Deposition Iron Deficiency  INCISIONS/SCARS PALPATION Mercedes Benz LIVER Kocher’s Upper Rt. 5-10th rib Midline SPLEEN Right Lft. 9-11th rib Paramedian Lower Midline GIT Appendicectomy Left Inguinal KIDNEYS Hernia exam DRE External genetalia SHIFTING DULLNESS 1. Percuss umbilical 2. Continuing percussing 3. Roll patient to side, region to right flank wait 30s & repeat SYMPTOMS POTENTIAL Dx Shock, guarding, rebound Peritonitis tenderess Severe intermittement RUQ Biliary Colic pain (worse with fatty food) Severe epigastric pain Pancreatits radiating to back Loin to groin pain Renal colic (cannot lie still) Distended tender abdomen Bowel obstruction (tinkling bowel sounds) Pain out of proprtion to exam Acute mesenteric ischemia  1 SPECIFIC OBSERVATIONS i) eight loss or gain iv) Hoarse voice ii) Behavior v) Pretibial myxoedema iii) Clothing 2 HANDS i) Thyroid acropachy (similar to clubbing) ii) Onycholysis (nail bed detachment) iii) Palmar erythema iv) Radial pulse (rate, rhythm, amplitude) v) Access for peripheral tremor vi) Access for Pemberton’s sign (arms above head) 3 FACE i) Dry skin (hypothyroidism) ii) Excessive sweating (hyperthyroidism) iii) Eyebrow loss (outer ⅓ hypothyroidism) THY EYES i) Lid retraction iii) Movement ( H ) ii) Exophthalmos (bulging eyes) iv) Lid lag 5 THYROID i) General inspection (midline, masses, scars) ii) Swallow assessment iii) Tongue protrusion iv) Palpation (size, symmetry, consistency, mass) v) Auscultation (bell bruit) vi) Percuss sternum (retrosternal dullness) LYMPH NODES i) Cervical lymphadenopathy Submental Superficial cervical Submandibular Deep cervical Pre-auricular Posterior cervical Post-auricular Supraclavicular REFLE ES & MYOPATHY i) Biceps & knee erk ii) Proximal myopathy  HYPOTHYROID HYPERTHYROID T3 & T Dry Hair Hair loss T3 & T TSH TSH Bulging eyes Puffy face (exopthalmos) Goiter Goiter Cold intolerance Heat intolerance Slow heartbeat Rapid heartbeat (bradycardic) (tachycardic) eight gain eight loss Constipation Diarrhea Thyroid acrophacy Dry skin Oncholysis THY Palmar erythema 1 Stand behind patient PALPATION (with chin tilted down) Place 3 fingers of each 2 hand along midline of neck AA 3 Locate upper edge of thyroid cart. (Adam’s Apple AA) CC Move fingers down to reach cricoid cartilage (CC) Lobe Lobe Palpate isthmus (midline) & 5 Isthmus each lobe (laterally) Ask patient to swallow, then to protrude their tongue SYMPTOMS POTENTIAL Dx Soft & Diffusely Enlarged Grave’s Disease Firm, diffusely enlarged, Hashimoto’s Thyroiditis slighly tender Firm, singular nodules Malignancy Multinodular goitre Iodine Deficiency  1 INSPECTION i) Peripheral cyanosis & pallor ii) Ulcers (diabetic, venous, arterial) iii) Gangrene, scars, hair loss iv) Foot deformities (i.e. Charcot) v) Footwear (soles, size, materials) 2 PALPATION i) Temperature ii) Pulses (posterior tibial & dorsalis pedis) 3 SENSATION i) Monofilament (pressure points - see next page) ii) Vibration (12 Hz tuning fork) iii) Proprioception (access oint position) GAIT DIA i) Pattern & abnormalities ii) Speed, stance, Optic Disc steps, turning Optic Cup Fovea 5 REFLE ES i) Ankle- erk (S1) Macula Retinal vein FURTHER TESTS Retinal art. i) Fundoscopy ii) HbA1c/Glucose Fasting Plasma Oral Glucose HbA1c Glucose Tolerence Test ( ) (mg/dL) (mg/dL) Diabetes.5 12 200 Pre- 5. -. 100 - 125 1 0 - 199 Diabetes Normal 5. 99 139  MONOFILAMENT TESTING 1) Provide sensation to patient’s sternum 2) Ask patient to close eyes 3) Apply monofilament to ) Press aginst skin until monofilament bends slighly 5) Ask paitent to report when they feel the monofilament PERIPHERAL PULSES Extensor hallucis longus Medial malleolus Dorsalis pedis artery Posterior tibial artery DORSALIS PEDIS POSTERIOR TIBIAL Lateral to extensor Posterior to medial hallucis longus malleolus DIA KNEE (L3- ) REFLE ES ANKLE (S1-2) L3- Kick the Door S1-2 Buckle my Shoe FOOT ULCERS DIABETIC ARTERIAL VENOUS Irregular, Red Irregular punched Thick cylinidrical, Granulation out & Cold Pink base & arm Sensory deficit eak pulse & pain Exudate & pain  1 SPECIFIC OBSERVATIONS i) Scars iv) Swelling ii) Muscle wasting v) Symmetry of shoulder girdle iii) Bruising vi) Abnormal bony prominence 2 LOOK i) Anterior inspection (symmetry, swelling, wasting) ii) Lateral inspection (deltoid wasting, scars) iii) Posterior inspection (trapezius, scapula, scoliosis) 3 FEEL i) Temperature ii) Palpate Swelling, bony abnormalities, tenderness 4 MOVE i) Active movement (patient performs independently) Shoulder flexion & extension Shoulder ABduction & ADduction External & Internal rotation Scapular movement SHLD ii) Passive movement (controlled by examiner) Instruct same movements as above Look for restricted ROM, crepitus, pain 5 SPECIAL TESTS Push-Off Wall Test Winged Scapula Empty Can Test Supraspinatus Supraspinatus Painful Arc Assessment Impingement Infraspinatus & Teres External Rotation Power Minor Internal Rotation (Gerber’s Lift-Off Test) Subscapularis Neer’s Test & Impingement Syndrome Hawkins Kennedy Test Speed’s Test Biceps Tendonitis  2 5 3 PALPATION 4 1 Sternoclavicular oint 2 Clavicle 3 AC oint Supraspinatus 4 Acromion Infraspinatus Teres minor 5 Coracoid process (ant) Head of humerus Greater tubercle Spine of scapula Inf border scapula PASSIVE ACTIVE MOVEMENT Internal rotation ABduction External rotation ADduction Extension Flexion P SH-OFF NEER’S TEST GERBER’S SHLD EMPT -CAN SPEED’S PAINF L ARC Pa inl es s Painful arc s les in Pa  1 SPECIFIC OBSERVATIONS i) Scars iv) Swelling ii) Muscle wasting v) Symmetry shoulders hips knees iii) Bruising vi) Abnormal bony prominence 2 LOOK i) Anterior inspection (symmetry, posture, wasting) ii) Lateral inspection (lordosis & kyphosis) iii) Posterior inspection (alignment, wasting, hair) 3 GAIT i) Access full gait cycle Symmetry & Turning Signs of discomfort 4 FEEL i) Temperature ii) Palpate Cervical spinal processes Thoracic Lumbar spinal processes Paraspinal muscles (tenderness, spasms) 5 MOVE i) Active movement (patient performs independently) SPNE Cervical Spine (flexion, extension, rotation) Thoracic Spine (rotation) Lumbar Spine (flexion, extension, lat flexion) ii) Passive movement (controlled by examiner) Instruct same movements as above Look for restricted ROM, crepitus, pain SPECIAL TESTS Schober’s Test Restricted spinal flexion Straight Leg Raise Sciatic nerve irritation Femoral Nerve Stretch Test Femoral nerve irritation Pelvic Distraction Test Sacroiliac oint irritation  STRAIGHT LEG C2 90º 75º C7 60º T1 45º T7 30º Inf. Scapula 15º 0º T12 PELVIC DISTRACTION L4 PSIS Coccyx FABER’S Neurovascular exam Examine joints above & below Imaging SCHOBER'S FEMORAL STRETCH SPNE SYMPTOMS Age 20-50 Hx of osteoporosis Trauma significant Hx of malignancy for age Night pain/constant IV drug use pain (non-mechanical) Chronic steroid use / Red+hot+swollen joint immunocompromised with limited ROM  PALPATION Apophysitis oint lines Patellar tendon Peripatellar pain Medial nee Lateral nee uadriceps tendon Posterior nee ANT. DRA ER TEST LACHMAN’S POST. DRA ER SIGN POST. SAG SIGN KNEE MCM RRAY TEST COLLATERAL TESTS (INT + E T rotation) Valgus Varus  1 SPECIFIC OBSERVATIONS i) Scars iv) Swelling ii) Muscle wasting v) Symmetry shoulders/hips/knees iii) Bruising vi) Abnormal bony prominence 2 LOOK i) Anterior inspection (varus/valgus, patellar position) ii) Lateral inspection (extension/flexion abnormalities) iii) Posterior inspection (popliteal swellings) 3 GAIT i) Access full gait cycle Symmetry & Turning Signs of discomfort 4 FEEL i) Temperature ii) Palpate Quadricpes bulk Extended Knee (patella, medial/lateral joint lines) Flexed Knee (tibial tub, head of fib, popliteal fossa) iii) Joint effusion (patellar tap & sweep test) 5 MOVE i) Active movement (patient performs independently) Knee Flexion & Extension ii) Passive movement (controlled by examiner) Instruct same movements as above Look for restricted ROM, crepitus, pain 6 SPECIAL TESTS Posterior Sag Sign PCL injury Anterior/Posterior KNEE ACL/PCL injury Draw Tests Lachman's test ACL injury Medial & Lateral Collateral Ligament Tests collateral ligaments Medial & Lateral McMurray's Test meniscus  1 SPECIFIC OBSERVATIONS i) Scars iv) Fasciculations ii) Muscle wasting v) Chorea & Clonus iii) Tremor vi) Pronator Drift 2 TONE i) Support patient's limb & ask them to relax ii) Move each muscle group with varying velocity iii) Access for spasticity, rigidity, hypotonia 3 PO ER i) Shoulder ABduction (C5) & ADduction (C6/ ) ii) Elbow Flexion (C5/6) & Extension (C ) iii) rist Extension (C6) & Flexion (C6/ ) iv) Finger Extension (C ) & ABduction (T1) v) Thumb Abduction (T1) 4 REFLE ES i) Test Reflexes Biceps (C5/6) Brachioradialis (C5/6) Triceps (C ) ii) See next page for grading chart 5 SENSATION i) Dermatomes (C3 T1) Light touch (dorsal columns & spinothalamic tract) Pin prick sensation (spinothalamic tract) ii) Vibration Patient eyes closed & ask if they feel tuning fork on fingers 12 iii) Proprioception NEUR old distal phalanx by its sides & move thumb upwards & downwards with eyes closed 6 COORDINATION i) Finger to Nose Test (dysmetria, intention tremor) ii) Dysdiadochokinesia (alternating movements)  ANT POST REFLE ES Biceps Triceps Brachioradialis PO ER GRADING REFLE GRADING No contraction Absent 1 Flicker of contraction 1 ypoactive 2 Active movement, no gravity 2 Normal Active movement against 3 gravity yperactive IT O T 3 clonus Active movement against 4 gravity and resistance NEUR 4 yperactive IT clonus 5 Normal power  1 SPECIFIC OBSERVATIONS i) Scars iv) Fasciculations ii) Muscle wasting v) Chorea & Clonus iii) Tremor vi) Access Gait Romberg's Test 2 TONE i) Support patient's limb & ask them to relax ii) Move each muscle group with varying velocity iii) Access for spasticity, rigidity, hypotonia iv) Ankle clonus (rapidly dorsiflex foot) 3 PO ER i) ip Flexion (L1/2) & Extension (L5/S1/S2) ii) Knee Flexion (S1) & Extension (L3/4) iii) Ankle Dorsiflexion (L4/5) & Plantarflexion (S1/2) iv) Big Toe Extension (L5) 4 REFLE ES i) Test Reflexes Knee (L3/4) Ankle (S1) Plantar/Babinski (L5/S1) ii) See grading on previous page 5 SENSATION i) Dermatomes (L1 S1) Light touch (dorsal columns & spinothalamic tract) Pin prick sensation (spinothalamic tract) ii) Vibration Patient eyes closed & ask if they feel tuning fork on toes 12 iii) Proprioception old distal phalanx by its sides & move big toe upwards & downwards with eyes closed 6 COORDINATION NEUR i) Toe to Finger Test (dysmetria, intention tremor) ii) eel to Shin Test (lower limb ataxia cerebellar)  BABINSKI Neg Pos ROMBERG S 1 Eyes closed 2 ANT POST Maintain erect posture 3 Assess for 6 s D SDIADOC OKINESIA Full Neuro Examination Neuroimaging (i e MRI spine or head) S MPTOMS POTENTIAL Dx Fever, neck stiffness, altered Meningitis mental status Morning headaches, fatigue, Brain tumor cognitive dysfunction, N&V nilateral pulsating pain, Migraine eadache photophobia, N&V Sudden onset worst Subarachnoid headache ever hemmorage Ascending paralysis Gullian Barre Syndrome Contralateral motor & sensory deficets Stroke ( MN lesion) NEUR Resting tremor, rigidity, Parkinson s Disease akinesia, shuffling gait  SPECIFIC OBSERVATIONS i) Speech abnormailites iii) Eyelid abnormalities ii) Facial symmetry iv) Pupillary abnormalities I. OLFACTORY i) Ask for recent changes in smell II. OPTIC i) Pupils (size, shape, symmetry) ii) Visual Acuity (Snellen chart on back of guide) iii) Pupillary reflex (direct & consensual, swinging light reflex, accommodation) iv) Visual fields (cover eye & swap hands) v) Fundoscopy (if warranted) III. OCULOMOTOR/IV. TROCHLEAR/VI. ABDUCENS i) Eyelids (i.e. ptosis) & palsies ii) Eye movements (make "H" with pin) iii) Strabismus (light reflex & cover test) V. TRIGEMINAL i) Facial Sensation (V1 forehead, V2 cheek, V3 jaw) ii) Muscles of mastication (V3) iii) Reflexes (jaw jerk & corneal) VII. FACIAL i) Ask if any changes in taste ii) Muscles of facial expression VIII. VESTIBULOCOCHLEAR i) Gross hearing (whisper a number) 512-Hz fork ii) Rinne's (mastoid process --- ext. acoustic meatus) iii) Weber's (midline forehead --- ask for lateralization) IX. GLOSSOPHARYNGEAL / X. VAGUS i) Soft Palate & Uvula (say "ahh") ii Ask patient to cough & perform swallow assessment XI. ACCESSORY i) Test trapezius (shrug) & sternoclemastoid (turn head) NEUR XII. HYPOGLOSSSAL i) Tongue (fasciculations, wasting, deviation)  DERMATOMES EYE PALSY OCULOMOTOR (III) Down & Out V1 C2 V2 TROCHLEAR (IV) V3 C3 Head tilt to AWAY from lesion WEBER S TEST Normal Midline ABDUCENS (VI) Conductive louder in affected ear Cannot ABduct Sensorineural louder in normal ear W 11.. Mastoid RINNE'S TEST process Normal Air Bone R Conductive Bone Air 2.Ext. Acoustic Meatus Sensorineural Air Bone ARGYLL ROBERTSON PUPIL (late-stage syphilis, diabetes, multiple sclerosis) NEUR DO constrict when focused Do NOT constrict to light on near object  MENTAL STATE EXAMINATION 1 OPENING THE CONSULTATION i) Wash your hands and iv) Explain that you d like to don PPE if appropriate have a chat to see how ii) Introduce yourself with they re feeling name and role v) Gain consent to proceed iii) Confirm the patient s with a mental state name and date of birth examination 2 APPEARANCE i) Observe the patient s appearance 3 BEHAVIOR i) Note how the patient engages and if there seems to be rapport ii) Observe the patient s level of eye contact iii) Observe the patient s facial expressions iv) Observe the patient s body language v) Identify any evidence of abnormal psychomotor activity vi) Note any abnormal movements or postures SPEECH i) Note the rate and uantity of the patient s speech ii) Note the tone and volume of the patient s speech iii) Note the fluency and rhythm of the patient s speech 5 MOOD AND EFFECT i) Explore the patient s current mood by asking appropriate uestions ii) Observe the patients affect THOUGHT i) Note the speed, flow, and coherence of the patient s thoughts ii) Explore the content of the patient s thoughts for abnormalities Ask about thought possession to screen for abnormalities i) Explore the patient s current PERCEPTION perception MSE COGNITION i) Formally assess the patient s cognition (ex. AMTS, MMSE, ACE-III)  LYMPH NODES OF HEAD & NECK Posterior Preauricular auricular Occipital Parotid Superficial cervical Tonsillar Deep cervical Posterior Submental cervical Supraclavicular Submandibular GLASCOW COMA (/15) Behavior Response Eye Opening Response 4. Spontaneously 3. To speech 4 2. To pain 1. No response Verbal Response 5. Oriented to time, person, and place 4. Confused 5 3. Inappropriate words 2. Incomprehensible sounds 1. No response Motor Response 6. Obeys command 5. Moves to localized pain 4. Flex to withdraw from pain 6 3. Abnormal flexion 2. Abnormal extension 1. No response  20/200 20/100 20/80 20/50 20/40 20/25 20/20 Hold chart 6ft away from d patient's direct line of sight Published: January 2024 Printed in the USA Title: The OSCE Medical Reference Pocket Guide 2024 edition Author: Jacob Portnoff, HBSc, MD Candidate 2025 (@MedSchoolBro) Contact Info: [email protected] MedSchoolBro assumes no liability or responsibility for any errors or omissions in the content of this guide.This guide is intended for educational purposes only. Not medical advice. TM IMPORTANT INFORMATION AND DISCLAIMERS By downloading this material, you acknowledge and agree to the following terms and conditions: you recognize that the material and all other media produced by MedSchoolBro.com, owned by Portnoff Management Corp., are intended solely as guides and should not supersede your medical school course material and teacher instruction. 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