Osce 2
Osce 2
Retinal detachment
OSCE Page 1
Retinal detachment
CNV/CNVII
- Corneal Reflex Testing (EXPLAIN)
1. Use wisp of cotton, approach from side and touch cornea (this is the pain/noxious stimuli of CNV)
2. Observe facial blink muscles from CNVII
- Otoscopy (PERFORM)
1. Inspect around ears (lumps, lesions, deformities, burns)
2. Tug auricle up down and press tragus, ask patient to clench teeth (pain?) - otitis externa
3. Press firmly behind ear - otitis media
4. Place otoscope in correct position, use biggest cover
5. Insert and inspect for…
a. Discharge, foreign bodies, redness
b. Light reflex lower facial quadrant, color and contour of tympanic membrane
c. Malleus and perforations to membrane
CNVIII - Vestibulocochlear
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- OKN (Visual Pathway) (PERFORM)
- Using OKN tape, place 1.5 feet away from patient's face and ask to focus eyes straight on (black or white) stripes
- Observe for normal physiological nystagmus due to Optokinetic Reflex
- Once in motion, the fluid in your vestibular organ will reach the same velocity and the rotation, you will now use
the ocular-kinetic reflex to keep the physiological ipsilateral fast beating nystagmus
- Once you stop the chair, you will have a contralateral fast beating nystagmus because the fluid in the vestibular
organ will still be in motion but stimulating the opposing organ
- EXPLAIN
- You could also have them drink a cup of water and observe for any dysphagia
- You can also perform gag reflex testing (perform only if suspected dysarthria (hoarseness) or dysphagia (difficulty
swallowing)
- To perform, use tongue depressor to touch one side of pharynx, then test other
CNXII Hypoglossal
- PERFORM
- Ask patient to open mouth
- With pen light inspect tongue for atrophy, asymmetry, and/or fasciculations
- Ask patient to protrude tongue (look for any ipsilateral deviation)
SENSORY TESTING
should be performed for people with c/o of sensory issues
Test side to side, distal to proximal
Demonstrate testing on expected normal side first with eyes open
Ensure demonstration is clear and patient is understands
Nociception (PERFROM)
- Sharp and dull (pin prick/soft edge) explain that you want only those two options as responses
- Intersperse stimuli along different dermatomes (if doing C8 on left arm, then do C8 on right arm, then do another
dermatome)
- Alternate randomly from sharp and dull
Hot/cold (EXPLAIN)
- Fill test tubes with hot/cold water (explain what hot/cold feels like with eyes open)
- Place tube over skin and ask if it's hot or cold (eyes are closed)
OSCE Page 3
Hot/cold (EXPLAIN)
- Fill test tubes with hot/cold water (explain what hot/cold feels like with eyes open)
- Place tube over skin and ask if it's hot or cold (eyes are closed)
Proprioception (PERFORM)
- Stabilize the joint by placing hands on sides of the proximal bone of joint and hands on sides distal to joint
- Move the distal part up or down and ask patient where it is (use sides of fingers!)
- Do 5 tests, if not normal, move to the next joint (Can do fingers and/or toes)
- Test other limb
Vibration (PERFORM)
- Test with 128-256Hz fork demonstrate with ulnar palm what vibration feels like
- Close eyes, perform on distal phalanx of index finger or great toe
- Ask if its vibrating or not (test with vibrations or no vibrations)
MOTOR TESTING
Being with simple observation, posture, chorea, asymmetry, resting tremors, etc.
Test muscle groups proximal to distal
- PERFORM
- Observe Bulk and grasp for bulk
○ Look for any atrophy
○ You could measure with tape (not performed)
- Tone
○ Grab hand and elbow and test ROM for tone
○ Grab tight and foot and test ROM of knee for tone
○ Observe for hypotonia, hypertonia or rigidity
- Strength
○ Perform resistance testing on arms and legs (these were not detailed)
- C7/8 Triceps
○ Support arm with your arm and feel for triceps tendon, strike perpendicular
NOTES
- With tests that involved closing eyes, demonstrate on the persons sternum
- Do everything bilaterally!
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- Do everything bilaterally!
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