1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

Inspects for and comments on findings: scars, asymmetry, visible peristalsis etc.

Auscultates for bowel sounds and comments on their significance

Performs light palpation and comments on findings i.e. guarding, rigidity, etc.

6
7
8

Assess for rebound tenderness at McBurneys point, clearly informs patient of

procedure and comments on findings
Demonstrates Rovsings, Psoas and Obturator sign, listing each by name and explaining
procedure to patient. Comment on findings.
Knowledge question

OSCE Abdominal System

Examine for appendicitis
OSCE Abdominal System
Examine for ascites
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

Inspects and comments on findings: distended, full flanks, everted umbilicus, etc.

Percusses for dullness in flanks and comments on findings

Asses for shifting dullness and comments on findings

Checks for fluid wave and comments on findings

Knowledge questions

OSCE Abdominal system

Examine the patients kidneys
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

3
4

Perform a general inspection for systemic manifestation of kidney disease:

(periorbital edema, generalized edema, uremic fetor, pallor, etc.
Inspects the abdomen and comments on findings: masses, asymmetry, etc.

Auscultates for renal artery bruits. Comments on findings and significance

Bimanual palpation with ballottement & attempted entrapment of kidneys on deep

inspiration, comments on findings.

Palpate & percuss costovertebral angle for tenderness. Comments on findings.

Knowledge question

OSCE Abdominal System

Examine the Liver
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

3
4
5
6
7
8

Inspects for and comments on systemic manifestation of liver disease: jaundice,

palmer erythema, asterixis, ascites
Inspects the abdomen and comments on symmetry, visible peristalsis, striae, caput
medusa
Percusses lever and identifies upper and lower border. Gives liver span in cm.
Comments on findings
Palpates lower border starts in RIF, asks patient to inhale deeply, and describes
liver findings i.e. nodularity, tenderness, consistency
Checks for a Murphy sign and comment on findings. Describe the significance of a
positive sign
Knowledge question

OSCE Abdominal System

Examine the spleen
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

Inspects and comments on systemic manifestation of splenic disease: pallor,

conjunctival pallor, etc.

Inspects the abdomen and comments on symmetry,

Palpates lower border of spleen starts in RIF, asks pt to inhale deeply, bimanual,
roll patient to right

Demonstrates splenic percussion sign in Traubes space and comments on findings

List at least three ways to differentiate an enlarged spleen from an enlarged kidney

OSCE Vital signs

Obtain the patients blood pressure
1

Washes hands, appropriate dress and grooming. Introduces self and asks permission
Asks about comfort, coffee intake, cigarettes, etc.

Explains procedure to patient, positions and drapes. Locates brachial artery

Demonstrates selection of appropriate cuff size applies cuff properly. Describes

what error will occur if the cuff is too large or too small

Begins with palpation method for systolic pressure

Inflates cuff to appropriate level - > 30 degree of estimated systolic pressure by

palpation

Positions stethoscope and deflates appropriately (2mm/sec)

Reports patients blood pressure and interprets per the JNC 8 guidelines

Knowledge question

OSCE Peripheral Artery Circulation

Check the peripheral circulation on this patient

1
2
3
4
5
6
7

Washes hands, appropriate dress and grooming. Introduces self and asks permission
Inspects for evidence of arterial insufficiency on upper and lower limbs: cool skin,
dry thin skin, pallor, etc.
Palpates radial pulse and determines rate and rhythm
Palpates radial and brachial arteries bilaterally and comments on symmetry. Checks
capillary refill
Palpates the carotid artery bilaterally and comments on symmetry. Determines the
character and volume. Auscultates for carotid bruits bilaterally
Palpates the dorsalis pedis and anterior tibial artery bilaterally and comments on
symmetry
Checks capillary refill
Compare and contrast at least 3 different findings on physical exam between arterial
insufficiency and venous insufficiency, i.e. trophic changes, color, temp, edema etc.
Knowledge questions

OSCE General Survey

Perform a general survey on this patient
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

Inspects scalp for shape, hair, infection, bruise, hematoma, and comments on
findings

Inspects eyes for jaundice and pallor, and comments on findings

Inspects oral cavity examination for hygiene, cavities, caries etc., and comments on
findings

Inspects ear for wax, discharge, etc., and comments on findings

Inspects and palpates neck for lymph nodes and thyroid swelling

Inspects hand for pallor, clubbing, koilonychia, splinter hemorrhages, etc., and
comments on findings

Knowledge questions

OSCE CVS

Examination of JVP
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

Inspects neck, identifies external & internal jugular pulsation

Describe venous pulse: A & V waves, and lists at least 3 features which distinguish it
from the carotid

Measures vertical height with respect to sternal angle and reports in cm.

Calculates pressure in cm. from right atrium and comments on findings.

Demonstrates hepato-jugular reflux and comments on findings. Describes what a

positive finding would be

Knowledge question

OSCE CVS
Heart Auscultation
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

3
4
5
6
7

Auscultate the 4 areas of the heart:

Describe location, time S1 with the carotid upstroke, comment on findings i.e. in the
aortic area, S1 is louder than S2 and there are no additional sounds or murmurs
Identify where a split S2 is heard most loudly and describe the hemodynamics of a
physiological split.
List which murmurs radiate and demonstrate how you would check for this
radiation.
Demonstrate positioning and techniques useful in identifying aortic and mitral
murmurs.
Knowledge question

OSCE CVS
Inspection and palpation for the cardiac system

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

Inspects for systematic findings relevant to the cardiac system, including malar
flush, cyanosis, respiratory distress, diaphoresis, neck vein distension etc. Comments
on findings
Examine the Hands and list signs related to cardiac including splinter hemorrhages,
clubbing, cyanosis, pallor, capillary refill etc. Comments on findings

Inspection the chest looking for scars, pacemaker, forceful PMI, chest deformity,
apical impulse etc. Comments on findings.

Palpate for the apical impulse and describe finding

Check for and discuss the significance of a parasternal heave

Palpate the 4 cardiac areas for thrills. Explain the significance of a thrill

Knowledge question

OSCE Neuro
Examine cranial nerves 1 -6 excluding 5
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

Inspect the nasal cavities looking for blockage, discharge, etc. Inspect the eyes
looking for aniscoria, narrow angle glaucoma, conjunctivitis, subconjuctival
hemorrhage, strabismus, etc.

Check for CN 1 and comment on findings

Check visual acuity on Snellen chart and comment on finding

Check visual fields by confrontation and comment on finding

Tests direct and consensual pupillary reflexes and comment on finding. Describe
findings in Horners syndrome and Argyll Robertson pupils

Check for accommodation and comment on findings

Examine CN 3,4 and 6 and comment on findings including diplopia, concordant

movement of eyes

Knowledge question

OSCE Neuro
Examine cranial nerves 5 and 7
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

Test light touch in the three branches of the trigeminal nerve and comments on
findings. Describe how to test for the corneal reflex

Test strength of the muscles of mastication and comment on findings

Test jaw jerk and comment on findings

6
7
8

Inspects the face for evidence of CN 7 paralysis and explains the different findings
for a central versus a peripheral lesion
Test strength of muscles innervated by the facial nerve including eye closure, cheek
puffing, smile, and wrinkling of forehead and comment on findings
Knowledge question

Neuro OSCE
Examine cranial nerves 8-12

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

2
3
4
5

Explains procedure to patient, positions and drapes

Inspects for: ear lesions or discharge, symmetrical soft palate, muscle asymmetry for
the trapezius and sternocleidomastoid
CN 8: perform Weber and Rinne test and report findings. Describe what the findings
of these tests would be for a conductive vs a sensory neural hearing loss
CN 9 and 10: Ask patient to say ahhhh and comment on finding. Describe how to
illicit a gag reflex and neural pathway for this

CN 11: Asses strength of SCM and trapezius and comment on findings

CN 12: Ask patient to protrude tongue and comment on findings. Describe findings
in central CN 12 lesion

Knowledge question

OSCE Neuro
Motor system lower limb
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent
Explains procedure to patient, positions and drapes

Explains procedure to patient, positions and drapes

3
4

Inspects the lower limbs commenting on deformities, length discrepancy, symmetry,

muscle wasting, fasciculation, etc.
Tests for muscle tone of both lower limbs and comments and findings. Describes
what one would expect to find in a central vs a peripheral nervous lesion
Tests for muscle power bilaterally and comments on findings:
Hip flexion and extension, hip abduction and adduction, knee flexion and extension,
and foot dorsiflexion/plantar flexion

Elicit reflexes bilaterally and comment on findings: patellar reflex, ankle reflex and
clonus bilaterally, demonstrates reinforcement techniques.
Check for a plantar response bilaterally and comment on findings. Describe a
positive response and its significance

Knowledge question

OSCE Neuro
Motor system upper limb

Washes hands, appropriate dress and grooming. Introduces self and asks for consent
Explains procedure to patient, positions and drapes

Explains procedure to patient, positions and drapes

Inspects the upper limbs commenting on deformities, length discrepancy, symmetry,

muscle wasting, fasciculation, etc.
Tests for muscle tone of both upper limbs and comments and findings. Describes
what one would expect to find in a central vs a peripheral nervous lesion
Tests for muscle power bilaterally and comments on findings:
Shoulder abduction and adduct6ion, elbow flexion and extension, wrist flexion and
extension, thumb opposition, finger grip strength, finger abduction and adduction
Elicit reflexes bilaterally and comment on findings: biceps, triceps, and
brachioradialis.
Check for a Hofmann response bilaterally and comment on findings. Describe a
positive response and its significance

Knowledge question

3
4
5
6

OSCE Neuro
Sensory system lower limb
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

4
5

6
7
8

Explains procedure to patient, positions and drapes

Test for light touch of the lower limb bilaterally. Demonstrate a knowledge of the
major dermatomes while performing task. Comments on findings and compares
distal with proximal results.
Test for pain bilaterally in the major dermatomes. Comment on findings.
Check for vibration sense in big toes bilaterally using a t128 Hz tuning fork at the
distal bony prominence of the big toe. Assesses for ability to tell when vibration
ceases. Comments on findings
Check for proprioception in the big toes bilaterally, holding the toe laterally at distal
phalange, and asking the patient to close eyes. Give preview of upward and down
ward movement before testing. Comments on findings
Check for a Romberg sign. Comment on findings and explain significance of a
positive Romberg sign.
Knowledge question

OSCE Neuro
Sensory system upper limb
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

4
5

6
7

Explains procedure to patient, positions and drapes

Test for light touch of the lower limb bilaterally. Demonstrate a knowledge of the
major dermatomes while performing task. Comment on findings and compares distal
with proximal results.
Test for pain bilaterally in the major dermatomes. Comment on findings.
Check for vibration sense in thumb bilaterally using a t128 Hz tuning fork at the
distal bony prominence of the thumb. Assesse for ability to tell when vibration
ceases. Comment on findings
Check for proprioception in the big toes bilaterally, holding the toe laterally at distal
phalange, and asking the patient to close eyes. Give preview of upward and down
ward movement before testing. Comments on findings
Knowledge question

OSCE Respiratory System

Inspection and palpation of the thorax
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

Inspect for systemic manifestations of lung disease, i.e. central or peripheral

cyanosis, clubbing, etc.

Inspect the trachea for deviation. Describe what a tracheal deviation may indicate
Inspect the chest wall looking for deformities, scars, etc. Describe signs for
respiratory distress

Palpate for chest wall tenderness. Describe the significance of a positive finding

Check the A/P diameter of the chest

Check chest expansion

Check tactile vocal fremitus and describe the findings lobar pneumonia, pleural
effusion, pneumothorax, asthma and COPD

OSCE Respiratory System

Percussion and auscultation of the lungs

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

3
4
5

Percusses the anterior and posterior lung fields and comment on your findings.
Describe the percussion notes found in lobar pneumonia, pleural effusion,
pneumothorax, asthma and COPD
Auscultate the anterior and posterior lungs fields and comment on your findings.
Describe normal breath sounds
Check for Transmitted Voice Sounds (bronchophony, egophony or whispered
pictoriliquy) and comment on your findings. Describe what you would find in lobar
pneumonia, pleural effusion, pneumothorax, asthma and COPD

OSCE Musculoskeletal System

Examine the knees
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

3
4

Inspects the knees for symmetry, swelling, scars, fasciculations etc. and comments
on findings
Palpates the knees for tenderness, swelling, warmth, crepitus, etc. and comments on
findings

Checks for range of motion of the knees bilaterally

Checks for joint effusion: bulge or balloon test, and patellar tap

7
8
9

Checks the stability of the anterior and posterior cruciate ligaments bilaterally via
the anterior and posterior drawer tests respectfully
Performs valgus and varus stress tests to evaluate the stability of the medial and
lateral collateral ligaments
Knowledge question

OSCE Musculoskeletal System

Examine the shoulders

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

3
4
5
6
7

Inspects the shoulders for deformity, swelling, scars, fasciculations, abnormal

positioning, etc. and comments on findings
Palpates the shoulders for tenderness beginning at the sternoclavicular joint, clavicle,
acromion, acromioclavicular joint, coracoid process and bicipital groove and tendon
Checks for range of motion of the shoulder bilaterally:
Flexion, extension, abduction, adduction, internal rotation, external rotation
Check the strength of the supraspinatus, subscapularis and infraspinatus muscles and
comment on your findings
Knowledge question

OSCE Musculoskeletal System

Examine the back
1

Washes hands, appropriate dress and grooming. Introduces self and asks for consent

Explains procedure to patient, positions and drapes

3
4
5
6
7
8

Inspects the back for symmetry, muscle atrophy or fasciculations, kyphosis,

scoliosis, posture, etc. and comment on your findings
Palpates for tenderness or step offs along the spinous processes. Palpates for
tenderness over the sacroiliac joint. Comments on findings
Checks for range of motion: flexion, extension, rotation and lateral bending.
Comments on findings
Checks for signs of meningitis: Brudzindkis sign and Kernigs sign. Describes the
significance of a positive sign
Checks for lumbosacral radiculopathy with a straight leg raise. Describes the
significance of a positive sign
Knowledge questions