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Physiology OSCE "Common"

By: Mamdouh Alotaibi

:‫ محطات‬٤ ‫ختبار رح يكون فيه‬4‫ في ا‬2‫ ان شاء ا‬،‫على حسب مافهمت‬

F‫حصلة درجت‬Y‫ اسئلة نظرية )بصورة أو بدون( ← درجة لكل محطة = ا‬٢-١ ‫ كل محطة فيها‬،Written F‫أثن‬
‫حصلة أربع درجات‬Y‫ لكل فحص = ا‬F‫ ← درجت‬F‫ يكون ببساطة تسوي فحص مع‬Practical F‫أثن‬

.‫هو الي ركزوا عليه الدكاترة هالسنة‬ ‫ ولكن الي عليه‬،‫كل ا`سئلة جايبها من اللوكر‬
Notability ‫ الصور ما تطلع على برنامج‬:‫م"حظة‬
(!‫سئلة )وليس مصدر أساسي‬4‫لف فقط للتدريب على طريقة ا‬Y‫ محتوى هذا ا‬:‫م"حظة أهم وأهم‬
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Examination of Sensory System
■ Written
What are the sensations transmitted by spinothalamic tract?
— Ventral spinothalamic → crude touch
— Lateral spinothalamic → pain & temperature
What are the sensations transmitted by dorsal column tract?
— Proprioception
— Vibration
— Fine touch
— Stereognosis

■ Practical
Vibration (Tuning fork test)
1. Introduce yourself
2. Explain what you will be doing
3. Ask the patient to close his eyes
4. Take the tunning fork
5. Strike the fork against your hand (or elbow)
6. Place the fork stem in the most distal joint of a finger (e.g., index)
7. Ask the patient if there is a sensation, what sensation, and when it stops
8. If it stops, put it in your finger to make sure that the fork is actually stopped tunning
9. Repeat on the other hand
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Tactile localization
1. Introduce yourself
2. Explain what you will be doing
3. Ask the patient to close his eyes
4. Take a pencil
5. Touch the skin of the finger
6. Let the patient localize the touch site
7. Repeat on the other hand

Tactile discrimination
1. Introduce yourself
2. Explain what you will be doing
3. Ask the patient to close his eyes
4. Take a Weber's compass (‫)فرجار‬
5. Put it gently on the skin of the hand
6. Ask the patient to localize the two points
7. Repeat on the other hand

Crude touch
1. Introduce yourself
2. Explain what you will be doing
3. Ask the patient to close his eyes
4. Take a cotton
5. Place it gently so that the patient will feel something but cannot localize
6. Repeat on the other hand

Pain = Pin prick test

1. Introduce yourself
2. Explain what you will be doing
3. Ask the patient to close his eyes
4. Take a safety pin
5. Start distally and while you apply the safety pin ask the patient (is it the the same?)
6. Repeat on the other hand
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1- What is the name of the test?

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2- What is the name of the tool?
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3- In which spinal tract does this sensation travel?
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4- What is the sensory receptor?
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_____________________________________________________________________
1- What is the name of the test?
..................................................................
2- What is the name of the tool?
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3- In which spinal tract does this sensation travel?
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4- What is the sensory receptor?
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Examination of Special Senses
■ Written
What is the meaning of 6/60 in visual acuity examination?
The patient sees at 6 meters the row seen by a normal subject at 60 meters.
What are the visual field defects seen in right optic nerve and right optic tract lesions?
— Right optic nerve lesion: complete loss of vision on the right eye
— Right optic tract lesion: left homonymous hemianopia
Name the tool that is used for visualizing the interior of retina? Ophthalmoscope
Name the tool that is used for testing visual aquity? Snellen's chart
Name three normal findings of ophthalmoscope?
1. Optic disk is pale and round with visible boundaries
2. Optic arteries are intact with no hemorrhage
3. Macula are darker spot around which no blood vessels are seen
Name the method used in visual field examination?
The visual field of the patient is compared to the visual field of the examiner's opposite
visual field, by sitting face to face and hanging fingers from the most peripheral field.
Compare between Rinne's test & Weber's test in patients with conductive deafness?
1. Rinne's test: Reduction in AC hearing with no affection on BC hearing
2. Weber's test: Sound is louder/better in the deaf ear
Compare between Rinne's test & Weber's test in sensorineuronal deafness?
1. Rinne's test: Reduction of both AC and BC hearing
2. Weber's test: Sound is louder/better in the healthy ear
■ Practical

ILight reflex
1. Introduce yourself
2. Explain what you will be doing
3. Take the torch light
4. Ask the patient to look for distant object
5. Shine the light on his right eye for 1 second
— While you shine with torch light → pupil will constrict in both sides
— After 1 second, cease the shining of light and wait till it dilates
6. Repeat on the left eye
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IVisual field test

1. Introduce yourself
2. Explain what you will be doing
3. Sit 50 cm from the patient face to face
4. To examine the right eye, ask the patient to cover his left eye
5. You similarly cover your right eye (so both of you have parallel visual field)
6. Move your hand from most peripheral part of temporal to nasal field
Notes:
1) Your hand must be midway between you and the examiner
2) Normally, patient and examiner see the same thing

Rinne's test (testing of individual ear's AC & BC) ‫دكتورة الفيميل تقول مو مهم‬
1. Introduce yourself
1. Explain what you will be doing
2. Take the tuning fork
3. Strike it with your elbow, knee, or your hand
4. Place the stem of the fork on mastoid process (BC)
5. Ask the patient if he hears, and when it stops
6. When it stops, bring the arms of the fork perpendicular to his ear (AC)
7. Ask the patient if he hears
Normally: AC > BC (+ve Rinne's test)

Weber's test (testing of both ears) ‫دكتورة الفيميل تقول مو مهم‬

1. Introduce yourself
2. Explain what you will be doing
3. Take the tuning fork
4. Strike it with your elbow, knee, or hand
5. Put its base on the midline of the patient head or in his forehead
6. Ask him if he hears the sound equally in both ears
Normally: Bone conductions are heard equally on both sides
■ Lab 2 SS

1- What is the name of the test?

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2- What is the nerve being tested?
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*

1- What is the nerve being examined?

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1- What is the name of the test?

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2- What is the normal finding for this test?
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Examination of Motor System
■ Written
Name two deep reflexes in the upper limb with its centers?
1. Biceps jerk, C5,C6
2. triceps jerk, C6,C7
Name two deep reflexes in the lower limb with its centers?
1. Knee jerk L2,L3,L4
2. Ankle jerk S1,S2
What is the center and normal response of plantar reflex?
1. Center: S1
2. Normal response: Plantar flexion + drawing other toes together
Define muscle tone and defines what happens in acute & chronic UMNL?
1. Definition: maintained subtitanic contractions of all muscles at rest.
2. Acute UMNL: 1) Hypotonia 2) Areflexia 3) +ve Babinski's sign
3. Chronic UMNL: 1) Hypertonia 2) Hyperreflexia 4) +ve Babinski's sign
List two coordination tests for upper limb?
1. Finger to nose test
2. Finger to finger test
List two coordination tests for lower limb?
1. Heel to chin test
2. Gait

■ Practical
Biceps jerk
1. Introduce yourself
2. Explain what you will be doing
3. Position the patient (i.e., the elbow should be partially flexed)
4. Take the tendon hammer
5. Put your thumb in a reference point (i.e., tendon of biceps)
6. Strike your nail of the tumb & note contractions
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Knee jerk
1. Introduce yourself
2. Explain what you will be doing
3. Position the patient (i.e., sit down with knee flexion)
4. Take the tendon hammer
5. Find a reference point (i.e., patellar tendon)
6. Strike the patellar tendon and note contrations of quadriceps muscles

Coordination of upper limb

1. Introduce yourself
2. Explain what you will be doing
3. Position the patient (i.e., let him sit)
4. Ask the patient to place his tip of the finger on his nose or your tip of your finger

Muscle tone of the upper limb

1. Introduce yourself
2. Explain what you will be doing
3. Position the patient (i.e., let him sit)
4. Ask the patient to relax
5. You passively move joints (i.e., wrist and elbow) and note resistance
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Examination of Cranial Nerve
■ Written

■ Practical

X1.
Trigeminal sensations
Introduce yourself
2. Explain what you will be doing
3. Ask the patient to close his eyes
4. Take a cotton wisp
5. Gently moves the cotton wisp in the three regions of trigeminal
— Ophthalmic division (forehead)
— Maxillary division (cheeks)
— Mandibular division (jaws)
6. Make sure that you test right and left sides before moving from another region
7. While you test, ask the patient "Do you feel?" and "is it as same as the other side"

XTrigeminal motor function

1. Introduce yourself
2. Explain what you will be doing
3. Position the patient (i.e., sit down)
4. Inspect the temporal and masseter muscles & check if there is no wasting
5. Ask the patient to clinch his teeth (i.e., hold the teeth tightly)
6. Palpate the temporal and masseter while he is clinching
Extra for trigeminal motor examination: Test pterygoid muscle.
a) ask the patient to open his mouth
b) put your hand under his chin
c) Tell the patient "Don't let me close your jaw!)
Normally: You should not be able to close his jaw because of the pterygoid muscle.
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Motor function of facial nerve

1. Introduce yourself
2. Explain what you will be doing
3. Position that patient (i.e., let him sit down)
4. Let the patient do the following:
— Raises both eye brows
— Close his eye and tell him "don't let me open your eyes" and he should resist
— Smile
— Puff out cheeks (i.e., ‫)انفخ خدودك‬
— Whistle
■ Motor Lab
1- What is the name of the test?
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2- What is the normal response?
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3- What is the effect of the UMNL on this reflex?
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1- What is the name of the test?

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2- What CNS function does this test illustrate?
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(Lab 2)

1- What is the nerve affected?

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2- What is the reason for this lesion?
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1- What is the name of the reflex?

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2- This reflex is exaggerated in what condition?
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3- What is the center for this reflex?
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4- What type of reflex is that? (deep)
1- What is the CNS structure related to that test?
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2- What does this test clarify?
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1- What is the test?

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2- What is the tool?
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3- What is the center for this reflex?
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1- What is the test?

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2- What is the center?
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3- Condition that exaggerate the reflex?
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1- What is the name of the test?

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2- What function does this test assess?
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