THE

THE

OSCE
MEDICAL
M E D I C A L REFERENCE
REFERENCE
POCKET
P O C K E T GUIDE
GUIDE

2024
2 0 2 4 EDITION
EDITION

* TM

MEDSCHOOL BRO
EXAMINATION TABS
EXAMINATION TABS
History Taking....................................
Taking 1-2
1-2
Cardiology.
Cardiology........................................... 3-5
Respiratory........................................ 6-8
Respiratory...
Gastroenterology............................... 9-11
Gastroenterology. 9-11
Thyroid.............................................. 12-13
Thyroid....... .. . . . 12-13
Diabetic Foot......................................
Diabetic Foot. 14-15
14-15
MSK: Shoulder................................... 16-17
MSK: Shoulder 16-17
MSK:Spine..
MSK: Spine........................................ 18-19
18-19
MSK: Knee..
MSK: Knee......................................... 20-21
20-21
Neurology: Upper
Neurology: Upper Limb.......................
Limb........ • • 22-23
22-23
Neurology: Lower
Neurology: Lower Limb....................... 24-25
Limb... 24-25
Neurology: CranialNerves...
Neurology: Cranial Nerves.................. 26-2726-27
Mental State
State Exam
Exam (MSE)......
(MSE)..................... ...2828
Lymph Nodes
Lymph Nodes // Glascow Coma.............
Coma. 29
Snellen Chart......................................
Chart... .. 3030

INITIAL STEPS
INITIAL STEPS
MUST complete before
MUST complete before
commencing any
any exam
exam
1.1.HAND
HANDHYGIENE
HYGIENE

Ì 2.
2. INTRO
INTRO & INSTRUCTION

3.3.CONSENT
CONSENT

4.
4. GENERAL OBSERVATIONS
GENERAL OBSERVATIONS
• Respiratory status
Respiratory status
• Body
Body habitus
habitus
• Vital
Vital charts
charts
• Environmental
Environmental cues
cues
 Hx
11INTRODUCTION
INTRODUCTION
i) Introduce
Introduce yourself iii)Explain
yourself iii) Explain purpose
purpose
ii) Identify patient iv) Gain consent

22PRESENTING
PRESENTINGCOMPLAINT
COMPLAINT (PC)
(PC)
i) Identify main concern
Identify main concern (signs,
(signs, symptoms,
symptoms, etc.)

(3
3 HISTORY
HISTORYOF
OF PC 1.
Site
S ite - →
Where exactly
Where exactlyisisthe
thepain?
pain?
O nset What
Onset—→ What were
were theydoing
they doingwhen
whenthe
thepain
pain started?
started?
C haracter-
Character What
→ What does the pain
does the painfeel
feel like?
like?
R adiates
Radiates - →
Does the
Does pain
the go
pain go anywhere
anywhere else?
else?
A ssociations -
Associations → e.g.
e.g. nausea/vomiting
nausea/vomiting
T ime-
Time → How long have theyhad
How long have they hadthe
the pain?
pain?
E xacerbating
Exacerbating → Anything
Anything
makemake painbetter/worse?
pain better/worse?
S everity -
Severity → Obtain
Obtain an initial pain score
initial pain score

44PAST
PAST MEDICALHISTORY
MEDICAL HISTORY
i) Surgical History iii) Allergies
ii) Existing conditions iv)
iv) Medications (dosage + freq)
freq)
55FAMILY
FAMILY HISTORY
HISTORY
i) Known
Known genetic conditions
ii) Common conditions
conditions in
in the
the family
family (i.e. diabetes)
iii) Ask about health of
about health of parents,
parents, siblings,
siblings, etc.

66SOCIAL
SOCIALHISTORY
HISTORY
i) Smoking & Alcohol iv) School/work/hobbies
ii) Illicit drug
drug use
use v) Living arrangements
iii) Diet
Diet & & Activity
Activity vi) Ask about driving
driving

7 SYSTEMS
SYSTEMS REVIEW
REVIEW
i) Ask questions covering other
other systems
systems

88SUMMARY
SUMMARY
i) Summarize & & repeat
repeat complete
complete history
history
ii) Clarify
Clarity ifif you
you missed
missed any details
iii) Ask
iii) Ask patient
patient for forany
anyfinal
finalquestions
questions && thank
thank them
them
Hx MALE SEXUAL HISTORY
i)i) Testicular swelling/pain
swelling/pain iv)
iv)Urethral
Urethraldischarge
discharge
ii) Itching/sore
ii) Itching/sore genital
genital skin v) Dysuria
v)
iii) Skin lesions
ii) Skin lesions vi) Systemic symptoms
vi)

FEMALE SEXUAL HISTORY

FEMALE
i) Abdominal/pelvic pain v) Systemic symptoms
v)
ii) Vaginal bleeding/discharge
bleeding/discharge vi)
vi) Menstrual
Menstrual history
iii) Dyspareunia vii) OB history
vii) history
iv) Vulva
Vulva changes/itches viii) GYN
viii) GYN history
history

BOTH
Y BOTH
i)
i)Last
Lastsexual
sexual contact
contact iii)
ifi) Focused PMHx
ii) HIV risk
i) HIV risk assessment
assessment iv) Travel history

SYSTEM REVIEW QUESTIONS

• Chest
Chest pain • Syncope
Syncope
• SoB
SoB Leg
• Legpain
painor
orswelling
swelling
• Palpitations
Palpitations

• Cough
Cough (blood)
(blood)
Unusual
• Unusualphlegm
phlegmproduction
production
• Wheeze
Wheeze

Loss of
• Loss of consciousness
consciousness • Weakness/
Headaches
• Headaches numbness
Change
• Changeininvision
vision • Dizziness
Dizziness

Nausea/vomiting
• Nausea/vomiting • Heartburn
Heartburn
Difficulty swallowing
• Difficulty swallowing • Change
Change in
•Abdominal
Abdominal pain
pain bowel habits

Muscle/joint/bone
• Muscle/joint/bone
Pain/swelling/stiffness
• Pain/swelling/stiffness
Unusually
• Unusuallydry
dry mouth/eyes
mouth/ eyes

• Fever
Fever Skin
• Skinchanges
changes(rash)
(rash)
Excess sweating • Fatigue
sweating
• Excess Fatigue
• Weight
Weight loss/gain
loss/gain
I 1SPECIFIC
SPECIFICOBSERVATIONS
OBSERVATIONS
i)i) Cyanosis
Cyanosis iv) Shortness
Shortness of
of breath
breath
ii) Pallor Edema
v) Edema

CVS
iii) Malar
Malar flush vi) Specific
vi) Specific cues
cues (ECG, Meds, IV)
22HANDS
HANDS *IE Infective Endocarditis*
*IE = Infective Endocarditis*
i)i) Clubbing vi) Signs
vi) Signs of
of lE
IE
ii)
i1)Palmar
Palmar crease
creasepallor
pallor • Janeway
Janewaylesions
lesions
iii) Tar
Tar stains • Osler
Oslernodes ("O"uch)
nodes (“O”uch)
iv) Xanthomata Splinter
• Splinterhemorrhages
hemorrhages
Capillaryrefill
v) Capillary refilltime
time(<(<22secs)
secs)

(3
3 PULSE
PULSE& & BP
BP
i) Radial Pulse(rate,
i) Radial Pulse (rate,rhythm,
rhythm,strength)
strength) iii)
iii)Take
TakeBP
BP
ii) Radial-Radial delay & Radial-Femoral delay

44 NECK
NECK
i) Carotid
Carotid(palpate
(palpate&&auscultate)
auscultate) ONE
ONE ATAATIME
AT TIME
ii)JVP
ii) JVP (45%,
(45º, head
headleft,
left, sternal
sternal angle,
angle, < 4cm)
55FACE
FACE
i) Eyes
Eyes(conjunctival
(conjunctivalpallor,
pallor, xanthalasma)
xanthalasma)
ii) Mouth (central cyanosis,
cyanosis, high-arched
high-arched palate,
angular stomatitis,
angular stomatitis,dental/
dental/gum hygiene)
gum hygiene)
66CHEST
CHEST
i) Inspect (wall deformities,scars,
(wall deformities, scars,pulsations)
pulsations)
ii) Palpation (apex, heaves, thrills)
thrills)
iii) Auscultate (APTM
(APTM #2245)
#2245)
iv) Maneuvers + listen to
to M
M with
with bell
• Left
Left lateral
lateral decubitus - mitral regurgitation
decubitus
• Lean
Lean forward
forward++ breathe out
out w • triction
friction rubs
rubs
BACK
7 BACK
i) Inspect &
& Palpate
Palpate (sacral edema)
ii) Auscultate lung fields

88 LEGS
LEGS
i) Inspect
Inspect (trophic
(trophic changes, varicose
varicose veins,
veins, swelling)
swelling)
ii)
il) Palpate (pedal edema, temperature, pulses)
temperature, pulses)
 AUSCULTATION
A2
A2 =
= Aortic
Aortic 2nd
2nd ICS
ICS
APT. M # 2245 P2 = Pulmonic 2nd ICS
2nd ICS
CVS

T4 = Tricuspid 4th ICS

Tricuspid 4th ICS
CVS M5 = Mitral 5th ICS
Mitral 5th ICS
Pulmonic
Pulmonic
Aortic Pulmonic stenosis
Aortic stenosis
Aortic stenosis systolic ejection
→ crescendo-decrescendo
→ systolic
Tricuspid
Systolic
• Tricuspid
Tricuspid regurg.
Erb's Point
Erb’s Point VSD
VSD
Diastolic
Diastolic
Systolic
Systolic • Tricuspid
Tricuspidstenosis
stenosis
• HOCM
HOCM
Left ASD
ASD
Diastolic
Diastolic
sternal:
sternal Mitral
Mitral
• Aortic
Aorticregurg.
regurg. Systolic
→ decrescendo/blowing
decrescendo/blowing
border
border • Mitral
Mitralregurg•
regurg.
• Pulmonic regurg.
Pulmonic regurg. Right
Right Mid
Mid holosystolic
→ holosystolic
sternal
sternal clav. Diastolic
clavo Diastolic
border
border line
line Mitralstenosis
Mitral stenosis
opening snap
opening

RULES
RULES FOR
FOR MANEUVERS
MANEUVERS
Inspiration right-sided murmurs
nspiration rIght-sided Except
Except
HOCM &
HOCM &
Expiration lEft-sided murmurs
murmurs MVP
MVP

INC
INC Preload/Afterload
Preload/ Afterload ALL murmur
•ALL murmur intensity
intensity
Squatting Leg Raise Hand Grip Valsalva
Valsalva
INC Preload INC
INC Preload Preload INC
INC Preload INC Afterload
Afterload DEC
DEC Preload
Preload

Scan to
Scan to
Blood Pressure listen!
listen!
Urine Dipstick
Urine Dipstick
12-lead
12-lead ECG
ECG
Troponins (MI)
Troponins (MI)
 VENOUS PRESSURE
JUGULAR VENOUS PRESSURE (JVP)
i) Patient at
at 45º,
45°, turn head to left
ii) Look for JVP (between
for JVP (between medial
end of clavicle under
under the medial
<4cm sternoclemastoid)
iii)
iii) Measure vertical
vertical distance
Int. Jugular
Sternum between the sternal angle & top
pulsation point
45°
iv) Normal
Normal << 4cm

BLOOD PRESSURE
BLOOD PRESSURE
1 1 22 3

Twist air
air release
release Wrap cuff above elbow
Wrap elbow Place stethoscope
stethoscope
valve all the way
way to with
with arrows
arrows pointing head
head on brachial
right to close
right to close it
it off
off to
to brachial
brachial artery artery & find
artery & find pulse
pulse

4 5 6

160 ,8ó
200

0
Inflate
Inflatecuff
cuff to
to ~160°
~160
Slowly release the
Slowly release the 1st “thud” = Systolic P
(until
(until pulse no
pulse is no valve & listen
valve & listenclosely
closelySound
Sound absent
absent
1st "thud" =Distolic
Distolic
= =Systolic PFP
longer
longer present)
present)

SYMPTOMS POTENTIAL DX
Dx
Cold + white + painful limbs Acute limb ischemia
Cold + white + painful limbs Acute limb ischemia
C/P + neck, jaw or L-arm pain Acute coronary
syndrome
syndrome
C/P + neck, jaw or L-arm pain Acute cromery
Impending sense of
Impending sense of doom
doom Cerebral hypoxia
Cerebral hypoxia
Unilateral leg swelling DVT (risk of PE)
DVT (risk of PE)
Sudden onset
Sudden onsetthrobbing
throbbingC/P
C/P Thoracic
Thoracic AA
radiating
radiating totoscapula
scapula

Syncope/Presyncope on exertion Aortic

Syncope/Presyncope on exertion AorticStenosis
Stenosis
O1SPECIFIC
SPECIFICOBSERVATIONS
OBSERVATIONS
Cyanosis
i) Cyanosis iv) Shortness
iv) Shortness of
of breath
breath
ii) Pallor
ii) Pallor v) Cough,
Cough, wheeze,
wheeze, or
or stridor
stridor
iii) Edema
iii) Edema Surroundings (02,
vi) Surroundings (O2 , sputum,
sputum, cigs)
cigs)

22HANDS
HANDS
i) Clubbing (schamroth
(schamroth window
window test)
ii) Skin changes
changes (bruising, thinning, tar
(bruising, thinning, tarstains)
stains)
iii) Capillary
Capillary refill
refilltime
time(<
(<22secs)
secs)
iv) Tremor (fine
(fine && flapping/asterixis)
flapping/asterixis)
Holdfor
for at
PULSE
(33PULSE Hold
least
at
least 30s!
30s!

i) Radial Pulse
Pulse(rate,
(rate, rhythm,
rhythm, strength)
ii) Respiratory rate

44 NECK
NECK
i) JVP
JVP (45º,
(45%,head
headleft,
left,sternal
sternal angle,
angle, < 4cm)
ii) Trachea (position,
(position, cricosternal
cricosternaldistance)
distance)
Normal
Normal =
=
5 FACE
FACE 3-4
3-4 fingers
fingers

i) Eyes
Eyes(conjunctival
(conjunctivalpallor,
pallor, xanthalasma,
xanthalasma, Horner's)
ii) Mouth (central
(central cyanosis, oral
oral candidiasis)

6 ANTERIOR
ANTERIOR CHEST
CHEST
i) Inspect (wall deformities,scars,
(wall deformities, scars,pulsations)
pulsations)
ii) Palpation
Palpation (apex,
(apex,chest
chest expansion,
expansion, RVRV heave)
iii)
iii) Percuss (supra/infra clavicular, chest
Percuss (supra/infra chestwall,
wall, axilla)
axilla)
iv) Vocal Resonance (say "99")
Resonance (say "99")
v) Auscultate (deep breaths
breaths in ++ out
out through
through mouth)
• 7BACK
BACK *pt cross
*pt cross arms
arms ++ lean
leanforward*
forward*

i) Inspect (wall deformities,scars,

(wall deformities, scars,recessions)
recessions)
ii) Percuss
Percuss(anterior/middle/lower lobes)
(anterior/middle/lower lobes)
iii)
iii) Vocal
Vocal Resonance (say"99")
Resonance (say "99")
iv) Auscultate (deep
(deep breaths
breaths in
in &
& out
out through
through mouth)
(8 LEGS
8 LEGS
i) Inspect (signs
(signs of
of DVT,
DVT, erythema
erythema nodosum)
ii) Palpate (pedal edema, temperature, pulses)
temperature, pulses)
 ANT
ANT LUNG FIELDS 2 \ POST
POST
O- LUNG FIELDS) O

RES
Wheeze Stridor
"Whistle"
“Whistle” “Squeaky
"SqueakyDo(o)r”
Do(o)r"
High pitched
pitched “musical
"musical flute”
flute" High pitch
pitch inspiratory
inspiratory squeak
Asthma &
Asthma & COPD
COPD Upper airway
Upper airwayobstruct,
obstruct,
croup
croup

Crackles Rhonchi
Rhonchi
“Crackle-Pop”
"Crackle-Pop" "Rumble"
“Rumble”
Fluid
Fluid crackly/bubbly sound
crackly/bubbly sound Low
Low pitched rattle
rattle or rumble
Pulmonary edema,CHF
Pulmonary edema, CHF Bronchitis, COPD, Pneumonia
Bronchitis, COPD, Pneumonia

Friction
Friction Rub Scan to
to
listen
listen
“Cat Scratch"
"Cat Scratch”
High pitched scratchy sound
Pleurisy, pericarditis

CHEST
CHEST EXPANSION
EXPANSION

i) Position your
your hands beneath the nipples
ii) Wrap
Wrap fingers
fingers around
around the
the chest
chest &
& bring
bring thumbs together at midline
iii) During patient's
iii) patient's deep breath,
breath, observe:
→ symmetrical upward/outward movement
symmetrical upward/outward movement during inspiration
downward/inward
downward/inwardmovement
movement during
during expiration
 TRACHEAL PALPATION
TRACHEAL PALPATION
Cricosternal Distance
Cricosternal Distance Trachea Position
RES

RES
-B
RES → Normal
Normal = 3-4 fingers
i) Dip
Dip finger
finger into thorax beside trachea
thorax beside
A = cricoid cartilage
cartilage ii) Apply
Apply side pressure toto locate
locate border
border
B= suprasternal
suprasternal notch iii) Compare space
iii) Compare space on both
both sides
sides

Interpretation:
SCHAMROTH'S Midline = normal
Midline = normal position
position
Clubbing =
= NO
NOwindow
window tension pneumothorax,
pneumothorax,
Away =
Away = large
large pleural
pleural effusion
lobar collapse,
Towards = lobar collapse,
Towards pneumonectomy
pneumonectomy

PERCUSSION
PERCUSSION
keep middle finger
keep middle finger flat!
flat!

Resonant
Resonant == normal
normal tissue
tissue
fluid (i.e. pneumonia,
Chest X-Ray
X-Ray Dull = fluid
Dull =
atelctasis, edema)
ABG
• SputumSample
Sputum Sample Stony
Stony Dull pleural effusion
Dull == pleural effusion
• Spirometry
Spirometry
pneumothorax,
pneumothorax,
Hyperresonant =
Hyperresonant = COPD
COPD

SYMPTOMS POTENTIAL DX
Dx
Hemoptysis TB, Lung
TB, Lung cancer,
cancer, PE
PE

Weight loss
Weight loss Lung cancer, COPD (end stage),
Lung cancer
Corcoronald
Cor pulmonale stage),

Sudden onset C/P Spontaneous pneumothorax,

• Spontaneous pneumothorax, PE

Sudden onset dyspnea Spontaneous pneumothorax, PE

Spontaneous pneumothorax, PE
Sudden onset
onset stridor
stridor Anaphylaxis, foreign object,
Anaphylax acute epiglotitis
epiglotitis
spigloiti object,
 11SPECIFIC
SPECIFICOBSERVATIONS
OBSERVATIONS
Confusion
i) Confusion distention & ascites
iv) Abdominal distention
ii) Pallor
ii) Pallor v) Hyperpigmentation
iii)
iii) Jaundice vi) Specific cues
vi) cues (stoma
(stoma &
& drains)
drains)
22HANDS
HANDS
i)i) Clubbing
ii) Palms
Palms (pallor,
(pallor, erythema, Dupuytren's contracture)
iii) Nails (koilonychia, leukonychia)
Tremor (flapping
iv) Tremor (flapping tremor/asterixis)
tremor/asterixis)
3 PULSE
PULSE

GIT
i) Radial Pulse
Pulse(rate,
(rate, rhythm,
rhythm, strength)
ii) Respiratory
ii) Respiratory rate
rate
44 ARMS
ARMS & AXILLA
AXILLA
i) Bruising, spider nevi, stretch marks)
ii) Axilla
Axilla (acanthosis
(acanthosis nigricans, hair
hair loss)
loss)

5J FACE
FACE
i) Eyes
Eyes(conjunctival
(conjunctival pallor, jaundice, Kayser-Fleischer)
pallor, jaundice,
ii) Mouth (stomatitis,
(stomatitis, glossitis,
glossitis, candidiasis,
candidiasis, ulcers)
ulcers)

NECK &
6 NECK & CHEST
CHEST
i) Neck
Neck (lymphadenopathy
(lymphadenopathy & left supraclavicular
supraclavicular node)
ii) Chest
Chest (spider
(spider nevi,
nevi, gynecomastia, hair
hair loss)
loss)

O7ABDOMEN
ABDOMEN
i)i) Inspect (scars,
(scars, distention,
distention, striae,
striae, Cullen's/Grey Turn)
ii) Palpation
ii) Palpation (9
(9 quadrants:
quadrants: superficial → deep)
iii) Liver: Palpate
iii) Liver: Palpate &&Percuss (RIF → Rt.
Percuss (RIF Rt. costal
costal margin)
margin)
iv) Spleen: Palpate
Palpate && Percuss (RIF →Lft.
Percuss (RIF Lft. costal
costal margin)
margin)
v) Ballot kidneys (push
(push fingers
fingers together
together on breath
breath in)
vi) Palpate aorta (width<< 3cm)
aorta (width 3cm)
vii) Shifting
vii) Shifting dullness
dullness (percuss Umbilicus → Lft.
(percussUmbilicus Lft. flank)
flank)
viii) Auscultate
viii) Auscultate (bowel
(bowel sounds, aortic
aortic & renal
renal bruits)
8 LEGS
LEGS
i) Palpate (pitting
(pitting edema)
 99 QUADRANTS
QUADRANTS
Right Left
Left
Hypochondriac Epigastric Hypochondriac
Hepatitis
Hepatitis Gastritis
Gastritis Pancreatitis
Pancreatitis
Cholesystitis
Cholecystitis GERD
GERD
Splenis Infarct//
Splenic Infarct /
Cholengitis
Cholengitis Pancreatitis
Pancreatitis
Gallstones
Gallstones Peptic Ulcer
Peptic Uker Rupture
Rupture

Lumbar
Right Lumbar Umbilical
Umbilical Left Lumbar
Left Lumbar

Kidney stones Apendicitis

Kidney stones (carly) Kidney
Apendicitis (early) stones
Kidney stones
GIT

Pyelonephritis
Pyelonephritis Gastroenteritis
Gastroenteritis Pyelonephritis
Pyelonephritis
Colitis
Colitis
Colitis Ruptured
RupturedAAAAAA Colitis

SBO
SBO

Right Iliac Hypogastric

Hypogastric Left Iliac
Left Iliac

Ovarian
Ovarian Torsion
Torsion Cystitis
Cystitis Ovarian Torsion
Ovarian Torsion
Crohn's Disease
Crohn’s Disease PID
PID Ulcerative Col.
Ulcerative Col
Ectopic Pregnancy
Ectopic Pregnansy
Apendicitis
Apendicitis Diverticulitis
Diverticulitis
Testicular Torsion
Testicular Torsion

McBurney’s
McBurney's 2/3s fromumbilicus
2/3s from umbilicusto
to right
right ASIS
ASIS
Point
Point 8

Rt
Rt Costal
Costal Margin, Mid-Clavicularline
Margin, Mid-Clavicular line
Murphy’s Sign
Murphy's Pain
• Painon
ondeep
deep breath in
breath in

Pain in right
Pain in right iliac
iliacregion
regionupon
upon
Rovsing’s Sign
Rovsing's Sign palpation ofleft
palpation of left side
side

Virchow's Node
Virchow's Node • Left
Leftsupraclavicular
supraclavicularnode
node (enlarged)
Associated with gastric cancer
with gastric

SPIDER NEVUS KAYSER-FLEISCHER

SPIDER KOILONYCHIA
KAYSER-FLEISCHER KOILONYCHIA

Estrogen Metabolites
Metabolites Copper Deposition IronDeficiency
Iron Deficiency
 INCISIONS/SCARS
INCISIONS/ SCARS PALPATION

Mercedes Benz LIVER

Kocher's
Kocher’s Upper
Upper Rt. 5-10th rib
5-10th rib
Midline
SPLEEN
SPLEEN
Right
Right
Lft.
Lft. 9-11th rib
9-11th rib
Paramedian
Lower
Lower
Midline
Midline

Appendicectomy
Appendicectomy • Left
Left Inguinal
Inguinal
KIDNEYS
KIDNEYS
Hernia exam
DRE
DRE
External
genetalia

SHIFTING DULLNESS

1. Percussumbilical
1. Percuss umbilical\ 2. Continuing percussing
percussing 3.3.Roll
Roll patient
patient to
to side,
side,
region region to right flank wait 30s
wait 30s & repeat

SYMPTOMS POTENTIAL DX
Dx
Shock,
Shock, guarding,
guarding, rebound
tenderess
tenderess Peritonitis
Peritonitis

Severe intermittement
Severe intermittement RUQ
RUO
pain (worsewith
pain (worse with fatty
fatty food)
food)
Biliary
BiliaryColic
Colic

Severe epigastric
epigastric pain
pain Pancreatits
Pancreatits
radiating to
radiating to back
Loin to
to groin
groin pain Renal
Renal colic
colic
(cannot lie still)
Distended
Distended tender
tender abdomen Bowel
Bowelobstruction
obstruction
(tinkling bowel sounds)
(tinkling bowel sounds)
Pain
Pain out
out of
of proprtion
proprtion to exam Acutemesenteric
Acute mesenteric
ischemia
ischemia
 1 SPECIFIC
SPECIFICOBSERVATIONS
OBSERVATIONS
i) Weight
Weight loss or
or gain iv) Hoarse voice
ii) Behavior Pretibial myxoedema
v) Pretibial
iii) Clothing

22 HANDS
HANDS
i) Thyroid acropachy (similar to clubbing)
ii) Onycholysis (nail
(nail bed detachment)
iii)
ili) Palmar erythema
iv) Radial pulse
pulse (rate,
(rate, rhythm,
rhythm, amplitude)
Access for
v) Access forperipheral
peripheral tremor
tremor
vi) Access
vi) Access for
for Pemberton’s
Pemberton's sign (arms
(arms above head)

3 FACE
3) FACE
i) Dry skin
skin (hypothyroidism)
(hypothyroidism)
ii) Excessive
Excessive sweating
sweating(hyperthyroidism)
(hyperthyroidism)
iii) Eyebrow
Eyebrow loss (outer ⅓ ==hypothyroidism)
(outer ⅓ hypothyroidism)
4 EYES
i) Lid
Lid retraction
retraction iii) Movement ("|")
Movement (“H”)
ii) Exophthalmos
Exophthalmos(bulging
(bulgingeyes) iv) Lid
eyes) iv) Lid lag

5 THYROID
i) General inspection
inspection (midline,
(midline,masses,
masses, scars)
ii) Swallow
Swallowassessment
assessment
iï) Tongue
iii) Tongue protrusion
iv) Palpation
Palpation(size,
(size, symmetry,
symmetry,consistency,
consistency,mass)
mass)
Auscultation (bell → bruit)
v) Auscultation bruit)
vi) Percuss
vi) Percuss sternum
sternum (retrosternal dullness)
(retrosternal dullness)

6 LYMPH NODE
NODES
i) Cervical
Cervical lymphadenopathy
lymphadenopathy
• Submental
Submental Superficial
• Superficial cervical
cervical
• Submandibular
Submandibular Deep
• Deepcervical
cervical
Pre-auricular
• Pre-auricular • Posterior
Posteriorcervical
cervical
Post-auricular
• Post-auricular • Supraclavicular
Supraclavicular

7 REFLEXES
REFLEXES&&MYOPATHY
MYOPATH
i) Biceps
Biceps &
& knee
knee jerk
jerk ii) Proximal myopathy
 HYPOTHYROID
HYPO•THYROID HYPERTHYROID
- T3
T3 &
& T4
T4 Dry Hair
Dry Hair Hair
Hair loss
loss T3 &
1 T3 & T4
TSH
A TSH TSH
g TSH
Bulging
Bulging eyes
Puffy face
(exopthalmos)
Goiter Goiter
Goite
Cold intolerance
intolerance Heat intolerance
intolerance

Slow heartbeat
Slow heartbeat Rapid
- Rapidheartbeat
heartbeat
(bradycardic) (tachycardic)
(tachycardic)

Weight gain
Weight gain Weight loss
Weight loss

Constipation Diarrhea
Diarrhea

THY
Thyroid
Dry skin acrophacy
Oncholysis
Palmar
Palmar
erythema

Stand
Stand behind
behind patient
patient PALPATION
11 with chin
(with chin tilted
tilted down)
down)

Place
Place 33 fingers
fingers of each
2
2 hand along midline
midline of
of neck
AA

3 Locate upper edge of thyroid

cart. dared
(Adam’sAppl
Apple: AA) CC
3 Locate thyroid
4 Move tingers down to react
4 Move fingers down to reach
cricoid
cricoid cartilage
cartilage (CC)
(CC)
Lobe
Lobe Lobe
Lobe

Palpate isthmus (midline)

Palpate is (midline) &
&
5 each lobe= (laterally)
each (laterally) Isthmus
Isthmus

Ask patient
patient to swallow,
swallow, then
6
6
to protrude
protrude their
their tongue

SYMPTOMS POTENTIAL DX
Dx
Soft
Soft &
& Diffusely
DiffuselyEnlarged
Enlarged Grave’s Disease
Grave's Disease

Firm,
Firm, diffusely
diffusely enlarged,
enlarged, Hashimoto's Thyroiditis
Hashimoto’s Thyroiditis
slighly tender
slighly tender

Firm,
Firm, singular
singular nodules
nodules Malignancy

Multinodular goitre Iodine

lodine Deficiency
 1 INSPECTION
i) Peripheral cyanosis
cyanosis & & pallor
pallor
ii) Ulcers
Ulcers (diabetic,
(diabetic, venous,
venous,arterial)
arterial)
iii) Gangrene, scars, hair
iii) Gangrene, loss
hair loss
iv) Foot deformities
deformities (i.e. Charcot)
Footwear (soles,
v) Footwear (soles, size,
size, materials)
materials)
22PALPATION
PALPATION
i) Temperature
ii) Pulses
Pulses (posterior
(posterior tibial dorsalis pedis)
tibial & dorsalis
33SENSATION
SENSATION
i) Monofilament (pressure points
Monofilament (pressure points -- see
see next page)
ii) Vibration (128Hz tuning
Vibration (128Hz tuning fork)
fork)
iii) Proprioception(access
(access joint
joint position)
position)
DIA

iii) Proprioception
DIA
4 GAIT
GAIT
i)i) Pattern
Pattern & abnormalities
ii) Speed, stance, Optic Disc
Optic Disc

steps,
steps, turning
turning Optic Cup
Optic Cup
Macula
Macula
REFLEXES
55REFLEXES
i) Ankle-jerk
Ankle-jerk(S1)
(S1)
Retinal
Retinal vein Fovea
Fovea

6 FURTHER TESTS - Retinal

Retinal art.
art.
i) Fundoscopy
ii) HbA1c/Glucose
i) HbA1c/Glucose
Fasting Plasma
Fasting Oral Glucose
Plasma1 Oral Glucose
HbA1c
(%)
Glucose
Glucose Tolerence Test
Tolerence Test
(%) (mg/dL)
(mg/dL) (mg/du)
(mg/dL)

Diabetes
Diabetes 265
≥ 6.5 2126
≥ 126 ≥≥ 200
200

Pre-
Pre-
Diabetes
Diabetes
5.7-- 6.4
57 6.4 100
100 -- 125
125 140
140 -- 199
199

Normal
Normal •57
~ 5.7 599
≤ 99 S139
≤ 139
 MONOFILAMENT TESTING
MONOFILAMENT TESTING
1) Provide
1) Provide sensation to
patient's
patient’s sternum
2) Ask patient toclose
patient to close eyes
3) Apply monofilament to
4) Press
Press aginst
aginst skin
skin until
until
monofilament bends slighly
monofilament
5) Ask
Ask paitent
paitent to
to report
report when
the monofilament
they feel the monofilament

PERIPHERAL PULSES
Extensor
hallucis longus
hallucis longus
Medial
Medial
malleolus
malleolus

Dorsalis
Dorsalis
pedis
pedis artery
artery
Posterior
Posterior
tibial
tibial artery
artery
DORSALIS PEDIS
DORSALIS POSTERIOR TIBIAL
Lateral
Lateral to
to extensor

DIA
Posterior to medial
hallucis longus
hallucis malleolus
malleolus
DIA

KNEE
KNEE (L3-4)
(L3-4) REFLEXES ANKLE (S1-2)
L3-4 =
"Kick
“Kick the
Door!
S1-2=
S1-2=
“Buckle my
"Buckle
Shoe!"
Shoe!”

FOOT ULCERS
DIABETIC ARTERIAL
ARTERIAL VENOUS
VENOUS

• Irregular,
Irregular,Red
Red • Irregular
Irregularpunched
punched • Thick
Thickcylinidrical,
cylinidrical,
Granulation
Granulation out
out &
& Cold Pink
Pink base & Warm
Warm
• Sensory
Sensory deficit Weakpulse
deficit • Weak pulse & pain
pain • Exudate
Exudate&&pain
pain
 1 SPECIFIC
SPECIFIC OBSERVATIONS
i) Scars
i) Scars iv) Swelling
ii)
iT)Muscle
Musclewasting
wasting v)
v) Symmetry
Symmetry of
of shoulder
shoulder girdle
girdle
iii) Bruising Abnormal bony
vi) Abnormal bony prominence
prominence
LOOK
22LOOK
i) Anterior
Anterior inspection (symmetry,
(symmetry, swelling, wasting)
ii) Lateral
Lateral inspection
inspection (deltoid
(deltoidwasting,
wasting,scars)
scars)
iii) Posterior inspection
iii) Posterior inspection(trapezius,
(trapezius,scapula,
scapula,scoliosis)
scoliosis)

3 FEEL
FEEL
i) Temperature
ii) Palpate
Swelling,
• Swelling,bony
bonyabnormalities,
abnormalities, tenderness
MOVE
44MOVE
i) Active movement
movement (patient
(patient performs independently)
• Shoulder
Shoulderflexion
flexion&&extension
extension
SHLD

• Shoulder
ShoulderABduction
ABduction & & ADduction
ADduction
• External
External && Internal rotation
• Scapular
Scapular movement
movement
ii) Passive
Passive movement
movement (controlled
(controlled by
by examiner)
examiner)
• Instruct
Instructsame
samemovements
movements as as above
Lookfor
• Look forrestricted
restrictedROM,
ROM, crepitus, pain

55 SPECIALTESTS
SPECIAL TESTS

Push-Off Wall
Wall Test
Test Winged Scapula
Winged

Empty Can Test Supraspinatus

Painful Arc Assessment

Painful Arc Assessment
Supraspinatus
Supraspinatus
Impingement
Infraspinatus & Teres
External RotationPower
External Rotation Power Minor
Infraspingtus & Teres
Internal
Internal Rotation
Rotation
Subscapularis
(Gerber’s
(Gerber's Lift-Off
Lift-Off Test)
Neer's
Neer’s Test & • Impingement
ImpingementSyndrome
Syndrome
Hawkins Kennedy Test

Speed’s Test
Speed's Biceps
BicepsTendonitis
Tendonitis
 2 5 3
PALPATION 4

1.
1.Sternoclavicular
Sternoclavicular joint
joint 7
2.
2. Clavicle 6
3. AC joint
joint Supraspinatus
Supraspinatus
4.
4. Acromion 8 Infraspinatus
/ Infraspinatus
5. Coracoid process (ant)
(ant) Teres minor
minor

6.
6. Head
Head of humerus
7. Greater tubercle
8. Spine of scapula
9. Inf. border scapula
border scapula
9

PASSIVE/ACTIVE
PASSIVE/ ACTIVE MOVEMENT
Internal
Internal
rotation
rotation

ABduction
ABduction

External
External
rotation
rotation
ADduction Extension V Flexion
ADduction Extension

PUSH-OFF NEER’S TEST

NEER'S GERBER’S
GERBER'S
SHLD
SHLD

EMPTY-CAN SPEED’S
SPEED'S PAINFUL ARC
Pa
in l
es
s
Painless

Painful
Painful
arc

s
es
nl
P ai
Painless
 O1SPECIFIC
SPECIFICOBSERVATIONS
OBSERVATIONS
i) Scars
i) Scars iv) Swelling
ii) Muscle
Muscle wasting
wasting v) Symmetry shoulders/hips/knees
shoulders/hips/knees
iii) Bruising Abnormal bony
vi) Abnormal bony prominence
prominence

22LOOK
LOOK
i) Anterior
Anterior inspection
inspection (symmetry, posture, wasting)
ii) Lateral
Lateral inspection (lordosis & kyphosis)
iii)
ili) Posterior inspection
inspection (alignment,
(alignment, wasting,
wasting, hair)
33GAIT
GAIT
i) Access
Access full
full gait
gait cycle
Symmetry
• Symmetry&&Turning
Turning
Signs
• Signsofofdiscomfort
discomfort
44FEEL
FEEL
i) Temperature
ii) Palpate
•Cervical
Cervicalspinal
spinal processes
•Thoracic/Lumbar
Thoracic/Lumbar spinal
spinal processes
Paraspinal
• Paraspinalmuscles
muscles(tenderness,
(tenderness, spasms)

55MOVE
SPNE

MOVE
i) Active movement
movement (patient
(patient performs independently)
Cervical
• CervicalSpine
Spine(flexion,
(flexion,extension,
extension,rotation)
rotation)
• Thoracic
Thoracic Spine (rotation)
Spine (rotation)
Lumbar
• LumbarSpine
Spine(flexion,
(flexion,extension,
extension,latlat flexion)
flexion)
ii) Passive
Passive movement
movement (controlled
(controlled by
by examiner)
examiner)
• Instruct
Instructsame
samemovements
movements as as above
Look
• Lookfor
forrestricted
restricted ROM,
ROM,crepitus,
crepitus, pain
pain
6 SPECIAL
SPECIALTESTS
TESTS

Schober's
Schober’s Test Restricted spinal flexion
Restricted spinal flexion
Straight Leg Raise
Straight Leg Raise Sciatic nerve irritation
Sciatic nerve irritation
Femoral Nerve Stretch Test Femoral nerve
Femoral nerveirritation
irritation
Femoral Nerve Stretch Test
Pelvic DistractionTest
Pelvic Distraction Test Sacroiliac joint irritation
Sacroiliac joint irritation
 STRAIGHT LEG
C2 90º 75°
90° 75º
C7 60°
60º
T1 45°
45º
T7 30°
30º

Inf.
Inf.
Scapula 15º
capula
0º

T12
T12 PELVIC DISTRACTION
PELVIC

4
L4

PSIS
•PSIS

Coccyx FABER'S
FABER’S

Neurovascular
exam
exam
Examine joints
Examine
above & below
Imaging
Imaging

SCHOBER'S
SCHOBER'S
FEMORAL
I,
SPNE

STRETCH
STRETCH
SPNE

SYMPTOMS
Age 20-50
20-50 Hx of osteoporosis
Hx of osteoporosis

Trauma significant Hx of
of malignancy
for age
for age
Night pain/
pain/constant
constant IV drug use
V drug use
pain (non-mechanical)
Chronic steroid use
use // Red+hot+swollen joint
Red+hottswollen joint
immunocompromised with limited
with limitedROM
ROM
 PALPATION
Apophysitis
Joint
Joint lines
lines
Patellar tendon

Peripatellar
Peripatellar pain
pain
Medial
Medialknee
knee
Lateral
Lateral knee
knee

Quadriceps tendon

Posterior knee

ANT.DRAWER
ANT. DRAWERTEST
TEST LACHMAN'S
LACHMAN’S

POST. DRAWER
POST. DRAWER SIGN POST. SAG
POST. SAG SIGN
KNEE

KNEE

MCMURRAYTEST
MCMURRAY TEST COLLATERAL TESTS
COLLATERAL TESTS

(INT +
+ EXT
EXTrotation)
rotation) Valgus
Valgus Varus
O1 SPECIFIC
SPECIFICOBSERVATIONS
OBSERVATIONS
Scars
i) Scars iv) Swelling
ii) Muscle
Musclewasting v) Symmetry
wasting v) Symmetry shoulders/hips/knees
iii) Bruising Abnormal bony
vi) Abnormal bony prominence
prominence

22LOOK
LOOK
i) Anterior
Anterior inspection
inspection (varus/valgus, patellarposition)
(varus/valgus, patellar position)
ii) Lateral inspection (extension/flexion abnormalities)
(extension/flexion abnormalities)
iii) Posterior inspection (popliteal
(popliteal swellings)

33CAIT
GAIT
i) Access
Access full
full gait
gait cycle
• Symmetry
Symmetry & & Turning
• Signs
Signs of
of discomfort

FEEL
4 FEEL
i) Temperature
ii) Palpate
Quadricpes
• Quadricpesbulk
bulk
Extended
• ExtendedKnee
Knee(patella,
(patella,medial/lateral jointlines)
medial/lateral joint lines)
FlexedKnee
• Flexed Knee (tibial
(tibial tub,
tub, head
head of fib,
fib, popliteal
popliteal fossa)
fossa)
iii) Joint effusion (patellar tap &
(patellar tap & sweep
sweep test)

5 MOVE
MOVE
i) Active movement
movement (patient
(patient performs independently)
• Knee
KneeFlexion
Flexion && Extension
Extension
ii) Passive
Passive movement
movement (controlled by examiner)
(controlled by examiner)
Instructsame
• Instruct samemovements
movements as as above
Lookfor
• Look forrestricted
restrictedROM,
ROM, crepitus, pain

6 SPECIAL
SPECIAL TESTS
TESTS

Posterior
Posterior Sag
Sag Sign
Sign PCL injury
PCL injury
KNEE

Anterior/Posterior
Anterior/Posterior ACL/PCLinjury
ACL/PCL injury
DrawTests
Draw Tests
KNEE
Lachman'stest
Lachman's test ACL injury
ACL injury

Medial && Lateral

Medial Lateral
Collateral Ligament
Collateral Tests
Ligament Tests
collateral ligaments
collateral ligaments

Medial &
Medial & Lateral
Lateral
McMurray's Test
McMurray's Test
meniscus
meniscus
 11SPECIFIC
SPECIFICOBSERVATIONS
OBSERVATIONS
Scars
i) Scars Fasciculations
iv) Fasciculations
iI) Musclewasting
ii) Muscle wasting v) Chorea
v) Chorea &
& Clonus
iii) Tremor vi) Pronator Drift

22TONE
TONE
i)i) Support
Support patient's
patient's limb
limb & ask them
them to
to relax
relax
ii) Move each
eachmuscle
musclegroup
groupwith
withvarying
varying velocity
iii) Access
Access for
forspasticity,
spasticity,rigidity,
rigidity, hypotonia
3 POWER
POWER
i) Shoulder ABduction (C5)
(C5) && ADduction
ADduction (C6/7)
(C6/7)
ii) Elbow
ii) Elbow Flexion
Flexion (C5/6)
(C5/6) && Extension
Extension (C7)
iii) Wrist Extension
iii) Wrist Extension (C6) & & Flexion
Flexion (C6/7)
(C6/7)
iv) Finger Extension
iv) Finger Extension (C7)
(C7) & & ABduction
ABduction(T1)
(T1)
Abduction(T1)
v) Thumb Abduction (T1)

4 REFLEXES
REFLEXES
i) Test Reflexes
Biceps (C5/6)
• Biceps
Brachioradialis
• Brachioradialis(C5/6)
(C5/6)
Triceps (C7)
• Triceps
ii) See
ii) See next
next page
page for
for grading
grading chart
55SENSATION
SENSATION
i) Dermatomes
Dermatomes (C3 (C3 -Т1)
-T1)
Light
• Lighttouch
touch(dorsal
(dorsalcolumns
columns&&spinothalamic
spinothalamic tract)
tract)
Pin-prick
• Pin-pricksensation
sensation(spinothalamic
(spinothalamic tract)
tract)
ii) Vibration
Patient
• Patienteyes
eyesclosed
closed&&ask
askif ifthey
theyfeel
feeltuning
tuning fork
fork on
fingers 128-Hz
128-Hz
NEUR

iii) Proprioception
Hold
• Holddistal
distalphalanx
phalanx byby its
its sides
sides && move
move thumb
thumb
"upwards"
"upwards"& &"downwards"
"downwards"with witheyes
eyesclosed
closed

6 COORDINATION
COORDINATION
i) Finger-to-Nose
Finger-to-Nose Test
Test(dysmetria,
(dysmetria, intention
intention tremor)
tremor)
ii) Dysdiadochokinesia (alternating movements)
(alternating movements)
 ANT POST

L1 S2
C8 (S2 C8 S3 S4
L2 S3 S1
L3 C7 S2

REFLEXES

Biceps
Biceps Triceps Brachioradialis

POWER GRADING
POWER REFLEX GRADING
REFLEX GRADING
0 No contraction 0 Absent
1 Flicker of contraction
Flicker of contraction 1+
1+ Hypoactive
Active
Active movement, no
22 gravity
"Normal"
2+
2+ “Normal”
Active movement against
33 gravity
3+
3+ Hyperactive
HyperactiveWITHOUT
WITHOUT

4
4 Active movement against clonus
clonus
NEUR

gravity and
gravity resistance
and resistance

5 Normal
Normal power
power 4+
4+ Hyperactive
HyperactiveWITH
WITH clonus

NEUR
 I 1SPECIFIC
SPECIFICOBSERVATIONS
OBSERVATIONS
Scars
i) Scars Fasciculations
iv) Fasciculations
ii) Muscle
il) wasting v)
Muscle wasting v)Chorea
Chorea && Clonus
Clonus
iii) Tremor vi) Access
vi) Access Gait
Gait + Romberg's
Romberg's Test
22 TONE
TONE
i) Support patient's limb & ask them to to relax
relax
ii) Move each
eachmuscle
musclegroup
groupwith
with varying
varying velocity
iii) Access
Access for
forspasticity,
spasticity,rigidity,
rigidity, hypotonia
iv) Ankle clonus
clonus (rapidly
(rapidly dorsiflex foot)
3 POWER
POWER
i) Hip Flexion (L1/2)
(L1/2) & Extension
Extension (L5/S1/S2)
(L5/S1/S2)
ii) Knee Flexion (S1)
(S1) &
& Extension
Extension (L3/4)
(L3/4)
iii) Ankle Dorsiflexion (L4/5) & Plantarflexion
Plantarflexion (S1/2)
iv) Big Toe Extension (L5)

44 REFLEXES
REFLEXES
i) Test Reflexes
• Knee
Knee (L3/4)
Ankle(S1)
• Ankle (S1)
Plantar/Babinski
• Plantar/Babinski (L5/S1)
ii) See
See grading
grading on previous page
55SENSATION
SENSATION

i) Dermatomes
Dermatomes(L1 (L1 -S1)
-S1)
Light
• Lighttouch
touch(dorsal
(dorsalcolumns
columns&&spinothalamic
spinothalamic tract)
tract)
Pin-prick
• Pin-pricksensation
sensation(spinothalamic
(spinothalamic tract)
tract)
ii) Vibration
Patient
• Patienteyes
eyesclosed
closed&&ask
askififthey
theyfeel
feeltuning
tuning fork
fork
on toes 128-Hz
128-Hz
iii)
ili) Proprioception
Hold
• Holddistal
distalphalanx
phalanx by
by its
its sides
sides & & move
move big
big toe
"upwards" &
"upwards" & "downwards"
"downwards" with witheyes
eyesclosed
closed

66COORDINATION
COORDINATION
NEUR

i) Toe-to-Finger Test (dysmetria, intention

intention tremor)
tremor)
Heel-to-Shin Test
ii) Heel-to-Shin Test (lower
(lower limb
limb ataxia
ataxia = cerebellar)
NEUR
 L1 IL3 BABINSKI
LS1
S3L2, HS2
1H52 S4
1S5 Neg
Neg
(S3.

IS2-
L3 HL3
Pos
Pos

L5 ROMBERG’S
ROMBERG'S
1.
L4 Eyes
L5- closed
closed
2.
2.
ANT
ANT POST
POST Maintain
Maintain
erect
S1H posture
3.
3.
S1 Assess
Assess
HL5
H4 for
for 60s
60s

DYSDIADOCHOKINESIA
DYSDIADOCHOKINESIA
Full
Full Neuro
Neuro
Examination
Examination
• Neuroimaging
(i.e. MRI spine
i.e. MRI
or head)
or

SYMPTOMS POTENTIAL DX
Dx
Fever, neck stiffness,
stiffness, altered
altered Meningitis
mental status
Morning headaches, fatigue,
Morning fatigue, Brain
Brain tumor
tumor
cognitive dysfunction, N&V
Unilateral pulsating pain, Migraine Headache
photophobia,
photophobia, N&V Migraine Headache
Sudden onset "worst Subarachnoid
Subarachnoid
Sudded acheever"
headache "erorst hemmorage
hemmorage

Ascending paralysis
paralysis Gullian-Barre
Gullian-Barre
Syndrome
Contralateral
Contralateral motor
motor &
& sensory
sensory
deficets
deficets Stroke (UMN
Stroke (UMN lesion)

Resting
Restingtremor,
tremor,rigidity,
rigidity Parkinson's
Parkinson’sDisease
Disease
akinesia,
akinesia, shuffling
shuffling gait
gai
 SPECIFIC OBSERVATIONS
SPECIFIC OBSERVATIONS
i) Speech
i) Speech abnormailites
abnormailites iii) Eyelid
iii) Eyelidabnormalities
abnormalities
ii) Facial
ii) Facial symmetry
symmetry iv) Pupillary abnormalities

I.I.OLFACTORY
OLFACTORY i) Ask for recent changes
for recent changes in
in smell

II. OPTIC
II. OPTIC
i) Pupils (size,
(size, shape,
shape, symmetry)
symmetry)
ii) Visual Acuity
Acuity (Snellen chart on back of guide)
iii) Pupillaryreflex
i) Pupillary reflex(direct
(direct&&consensual,
consensual, swinging light
reflex,
reflex, accommodation)
iv) Visual fields (cover eye & swap hands)
Fundoscopy (if
v) Fundoscopy (ifwarranted)
warranted)
III.OCULOMOTOR/IV.
III. OCULOMOTOR/IV.TROCHLEAR/VI.
TROCHLEAR/VI. ABDUCENS
ABDUCENS
i) Eyelids (i.e.
(i.e. ptosis) & palsies
ii) Eye
Eye movements
movements(make (make"H""H" with
with pin)
iii) Strabismus (light reflex
reflex &
& cover test)

V.TRIGEMINAL
V. TRIGEMINAL
i) Facial Sensation
Sensation (V1
(V1forehead,
forehead, V2
V2 cheek,
cheek, V3
V3 jaw)
jaw)
ii) Muscles
Muscles of
of mastication
mastication (V3)
iii) Reflexes (jaw jerk
ii) Reflexes jerk &
& corneal)

VII.
VII. FACIAL
FACIAL
i) Ask if any
any changes in taste
ii) Muscles
Muscles of
of facial
facial expression
VIII.VESTIBULOCOCHLEAR
VIII. VESTIBULOCOCHLEAR
i)i) Gross
Gross hearing
hearing (whisper number) 512-Hz
(whisperaanumber) 512-Hz fork
fork
(mastoid process →
ii) Rinne's (mastoid ---ext.
ext.acoustic
acousticmeatus)
meatus)
Weber's(midline
iii) Weber's (midlineforehead
forehead---ask
askfor
forlateralization)
lateralization)

IX.
IX. GLOSSOPHARYNGEAL
GLOSSOPHARYNGEAL // X. VAGUS
i)i) Soft Palate &
Soft Palate Uvula (say
& Uvula (say "ahh")
"ahh")
ii Ask
ii Askpatient
patient to
to cough
cough & &perform
perform swallow
swallow assessment
assessment
XI.
XI. ACCESSORY
ACCESSORY
i) Test trapezius
trapezius (shrug) & sternoclemastoid (turn
(turn head)

XII. HYPOGLOSSSAL
XII. HYPOGLOSSSAL
i) Tongue (fasciculations, wasting, deviation)
wasting, deviation)
 DERMATOMES EYE PALSY
EYE PALSY
OCULOMOTOR (III)
Down & Out
V1
V1

C2
2
V2
TROCHLEAR (IV)
TROCHLEAR (IV)
V3 C3 Head
Head tilt
tilt to AWAY from
from lesion
lesion

WEBER’S TEST
WEBER'S TEST
Normal
Normal Midline
Midline

louder in
in
ABDUCENS (VI)
(VI)
Conductive
Conductive louder
affected ear
affected ear Cannot ABduct

Sensorineural
Sensorineural
louder
louder in
normal
normal ear

W
W

1.Mastoid
1. Mastoid
1. RINNE'S TEST
RINNE'S TEST
process
process Normal
Normal Air
Air >
> Bone
R
R
Conductive
Conductive Bone
Bone > Air

(2.Ext.
2.Ext.Acoustic
Acoustic Meatus
Meatus Sensorineural
Sensorineural Air >
Air > Bone
Bone

ARGYLL ROBERTSON
ARGYLL PUPIL
ROBERTSON PUPIL
(late-stage syphilis, diabetes,
(late-stage syphilis, diabetes, multiple
multiple sclerosis)
sclerosis)
NEUR

DO
DO constrict
constrict when
when focused
Do NOT
NOTconstrict
constrict to
to light
light on near object NEUR
 MENTAL STATE
STATE EXAMINATION
EXAMINATION
OPENING THE CONSULTATION
1 OPENING CONSULTATION
i) Wash
Wash your hands and
your hands iv)
iv)Explain
Explain that you'd
you’d like to
don PPEPPE ififappropriate
appropriate have a chat to see how
how
ii)
ii) Introduce with
Introduce yourself with they're
they’re feeling
name and role v) Gain
v) Gain consent to proceed
iii) Confirm the patient’s
patient's with
with aa mental
mental state
name and and date
date of
of birth
birth examination
APPEARANCE
22APPEARANCE i) Observe the
the patient’s
patient's appearance

33 BEHAVIOR
BEHAVIOR
i) Note how the patient
how the patientengages
engages andand ifif there
thereseems
seems to be
rapport
ii) Observe the patient’s level of
patient's level of eye contact
iii)
iii) Observe the patient’s facial expressions
patient's facial expressions
iv) Observe the
the patient’s
patient's body language
Identify any evidence
v) Identify evidence ofof abnormal
abnormal psychomotor
psychomotor activity
activity
vi) Note any abnormal
vi) abnormal movements
movements or or postures

SPEECH
4 SPEECH
i)
i)Note
Note the
the rate
rate and
and quantity of the
quantity of the patient’s
patient's speech
speech
ii)
ii)Note
Notethe
thetone
toneand
and volume of the
volume of the patient’s
patient's speech
speech
iii)
iii) Note
Notethe
thefluency
fluencyand
andrhythm of the
rhythm of the patient’s
patient's speech
speech

55 MOOD AND AFFECT

MOOD AND AFFECT
i) Explore
Explore the
the patient’s
patient's current
current mood
mood by
by asking
askingappropriate
appropriate
questions
ii) Observe the
the patients
patients affect

6 6 THOUGHT
THOUGHT
i) Note the
i) Note thespeed,
speed,flow,
flow,and
andcoherence
coherenceof ofthe
thepatient’s
patient's
thoughts
ii) Explore the
the content
content ofof the
the patient’s
patient's thoughts
thoughts for
for
abnormalities
Ask about thought
thought possession
possession to to screen
screenfor
for abnormalities
abnormalities
the patient’s
i) Explore the patient's current
current
PERCEPTION
O7PERCEPTION perception
MSE

i)
i)Formally
Formally assess the patient’s
MSE
8 COGNITION
COGNITION assess the
cognition(ex.
cognition (ex.AMTS,
patient's
AMTS,MMSE,
MMSE, ACE-III)
ACE-III)
 LYMPH NODES
LYMPH NODES OF HEAD
HEAD &
& NECK
NECK

Posterior Preauricular
auricular
Occipital
Occipital.
Parotid
Parotid

Superficial
cervical
cervical
Tonsillar
•Tonsillar
Deep
Deep
cervical
cervical

Posterior
cervical
cervical
Submental

Supraclavicular
Submandibular
Submandibular

GLASCOW COMA
GLASCOW COMA(/15)
(/15))
Behavior Response
Response
Eye
Eye Opening
Opening Response
4. Spontaneously
To speech
3. To speech
44 2. To pain
1.
1. No
No response
response

VerbalResponse
Verbal Response 5. Oriented to time, person,
and place
4. Confused
4. Confused
5 3. Inappropriate words
2. Incomprehensible sounds
2. Incomprehensible sounds
1. No
1. No response
response

MotorResponse
Motor Response 6. Obeys
6. Obeyscommand
command
5. Moves to to localized pain
pain
4. Flex
Flex to
to withdraw
withdraw from
from pain
6 3.
3. Abnormal
Abnormal flexion
2.
2. Abnormal
Abnormal extension
extension
1. No
1. No response
response
14

13
20/200
20/200

12

11

10 F P 20/100
20/100

FP Z 20/80
20/80

•PICFDS
00

20/50

ED FCZP 4 20/40

DEFPOTE 20/25
20/25

20/20
20/20

Hold
Hold chart
chart 6ft
6ftaway
away from
from
d
patient's direct line of sight

·
Published: January 2024
Published: January 2024
Printed
Printedin inthe
the USA
USA
Title:The
Title: The OSCE
OSCE Medical
Medical Reference
ReferencePocket
PocketGuide
Guide2024
2024 edition
edition
Author:Jacob
Author: Jacob Portnoff,
Portnoff,HBSc,
HBSc, MD MD Candidate
Candidate 2025 (@MedSchoolBro)
2025 (®MedSchoolBro)
- MedSchoolBro
MedSchoolBro assumes
assumesno noliability
Info: [email protected]
Contact Info:
liabilityor
or responsibility
responsibility for
for any errors
errors or
or omissions
omissions in the content
of this guide.This
guide. Thisguide
guideisisintended
intendedfor for educational
educational purposes
purposes only.
only. Not medical advice.

TM

MEDSCHOOLBRO®™