OSPE Flashcards by Megan Haine

Describe and demonstrate the surface marking and palpation of the trachea at the suprasternal notch

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Demonstrate how you would investigate symmetrical inflation of the lung and describe the anatomical basis

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Observe and describe the breathing pattern and the breathing rate

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Demonstrate percussion of upper/middle/lower lobes of right/left lungs

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Describe and demonstrate where you would auscultate upper/middle/lower lobes of right/left lungs using a stethoscope

Diaphragm of the stethoscope used to auscultate lobes whilst bell of the stethoscope is used to auscultate apex

ANTERIOR CHEST WALL (patient lies supine=lie on back, facing upwards)
-Apex: above middle third of clavicle
-Superior lobe: 3rd intercostal space in mid-clavicular line
-Middle lobe (in right lung only): 5th intercostal space in mid-clavicular line and below axilla in mid-axillary line
-Inferior lobe: 7th intercostal space in the mid-axillary line
POSTERIOR CHEST WALL (patient sits over the edge of the couch)
-Superior lobe:
-Inferior lobe:

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Describe and demonstrate the surface markings of upper, middle and lower lobes of right/left lungs

Right upper lobe:
Right middle lobe:
Right lower lobe:
Left upper lobe:
Left lower lobe:

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Describe and demonstrate the surface markings of the oblique and horizontal fissures of right/left lungs

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Describe and demonstrate the surface marking of the inferior margin of parietal pleura of right/left lungs

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Describe and demonstrate the surface marking of inferior margin of visceral pleura of right/left lungs

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Describe and demonstrate the triangle of safety for insertion of a chest drain

-The most common position for chest drain insertion is anterior to the mid-axillary line, avoiding the long thoracic nerve lying behind it

Anterior border: lateral border of the pectoralis major (anterior axillary fold)
Posterior border: anterior border of the latissimus dorsi (posterior axillary fold)
Inferior border: horizontal line at the 5th intercostal space at the mid-axillary line (superior to horizontal level of male nipple)
Superior border: apex below the axilla

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Describe and demonstrate the surface marking of mediastinal pleura of right and left lung on the anterior chest wall

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Demonstrate the surface marking of upper/right/inferior/left borders of the heart

Upper border-> sloping line from marking 2.5cm lateral of the left sternal border at the 2nd costal cartilage to a marking 1cm lateral of the right sternal border at the 3rd costal cartilage
Right border-> curved line to the right from marking 1cm lateral of the right sternal border at the 3rd costal cartilage to marking 1cm lateral of the right sternal border at the 6th costal cartilage
Inferior border-> line passing (diagonally) through xiphisternal joint from marking 1cm lateral of the right sternal border at the 6th costal cartilage to marking in the midclavicular line at the 5th intercostal space (apex beat position)
Left border-> curved line to the left from marking in the midclavicular line at the 5th intercostal space (apex beat position) to marking 2.5cm lateral of the left sternal border at the 2nd costal cartilage

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Demonstrate where you would auscultate for aortic/pulmonary/mitral/tricuspid valves using a stethoscope

Aortic valve-> right 2nd intercostal space near sternum
Pulmonary valve-> left 2nd/3rd intercostal space near sternum
Mitral valve-> left 5th intercostal space at midclavicular line (apex beat position)
Tricuspid valve-> left 5th intercostal space near sternum

Stethoscope placed downstream of the given valve (sound carried by bloodstream along direction of flow) to isolate the sound of the valve

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Examine the radial/ulnar/brachial (2 sites)/carotid pulse and describe then (rate and rhythm)

Radial->
Ulnar->
Brachial (mid arm)->
Brachial (cubital fossa)->
Carotid->

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Describe the surface marking of the apex beat of the heart and demonstrate palpation

Pulsation caused by apex of left ventricle (inferolateral part of left ventricle forcing against the anterior chest wall during contraction)

Location may vary from 4th intercostal space (in children) to 5th intercostal space (in adults) and is about 6-10cm from the midsternal line
Patient sits over edge of seat
Palpate with palm and middle 3 fingers of hand
Middle finger aligned in left 5th intercostal space with other two fingers in intercostal spaces above and below
Palpate from lateral side (MAL=mid-axillary line), moving anteriorly to the MCL (midclavicular line)
Jogging on the spot for one minute increases rate and strength of heartbeat if the apex beat is difficult to palpate
For palpating the apex beat in females, lay the hand underneath the breast along its lower border

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Demonstrate the sites of routine venepuncture (antebrachial vein in the cubital fossa)

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Describe and demonstrate the surface marking of the arch of the aorta

Within superior mediastinum behind manubrium with the 3 main branches (brachiocephalic trunk, left common carotid artery and left subclavian artery) arising within the superior mediastinum

Starts and ends at the level of the sternal angle
Beginning mark at the right 2nd costal cartilage, top of arch marked midway between jugular notch and sternal angle and ending mark at left 2nd costal cartilage

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Recognise radiographs, CT and MRI imaging of the thorax and describe the views obtained

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Identify major anatomical structures on radiographs, CT and MRI imaging

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Describe the position of the inguinal ligament and superficial and deep inguinal rings in bony models

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Sex male and female pelvic girdles using pelvic inlet and subpubic angle

Pelvic inlet:

Pelvic inlet in females is circular
Pelvic inlet in males is heart-shaped

Subpubic angle (angle formed by arms of pubic arch):

Females have a greater subpubic angle (80-85 degrees)
Males have a smaller subpubic angle (50-60 degrees)

Ischial spines:
-do not project as medially into the pelvic cavity in females as they do in males

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Surface mark and palpate: liver, gall bladder and spleen on the anterior abdominal wall

Liver:

Gall bladder:
-where the transpyloric plane meets the right mid-clavicular line (tip of the right 9th costal cartilage or where the lateral border of the rectus abdominis muscle crosses the costal margin)

Spleen:

lies along the left 9th, 10th and 11th ribs between the erector spinae muscles and the mid-axillary line
palpate 10th rib and surface mark (costal margin meets mid-axillary line at level of 10th rib so use this as a reference)
palpate 11th rib and surface mark (lies below 10th rib and floating end is easy to palpate)
palpate 9th rib and surface mark (lies above 10th rib)
surface mark lateral border of erector spinae muscles and the mid-axillary line

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Describe and demonstrate 9 regions of the abdomen

Divided by the midclavicular plane, the subcostal plane and the intertubercular plane

The nine abdominal regions:

Right hypochondriac region
Epigastric region
Left hypochondriac region
Right lumbar region
Umbilical region
Left lumbar region
Right inguinal region
Suprapubic region
Left inguinal region

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Describe and demonstrate position of subcostal plane, transpyloric plane, transtubercular plane and supracristal plane

Subcostal plane: horizontal plane passing across the right and left costal margins in the mid-axillary line and at the level of the body of the L2/L3 vertebrae
Transpyloric plane: horizontal plane through ends of right and left 9th costal cartilage and at level of the L1 vertebra, halfway between the jugular notch and pubic symphysis
Transtubercular plane: horizontal plane through right and left iliac tubercles, passing through the body of the L5 vertebra (L5 level)
Supracristal plane:

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Describe and demonstrate 4 quadrants of the abdomen

- Divided by the sagittal plane and the transumbilical plane - sagittal plane: vertical line through umbilicus from xiphisternum to pubic symphysis) - transumbilical plane: horizontal line through umbilicus The four abdominal quadrants: - right upper quadrant (RUQ) - left upper quadrant (LUQ) - right lower quadrant (RLQ) - left lower quadrant (LLQ)

Surface locate the position of the stomach, duodenum, appendix and caecum, ascending and descending colon and urinary bladder on the anterior abdominal wall

Surface mark the right and left kidneys and ureters on the posterior abdominal wall

Palpate the lower poles of kidneys through the anterior abdominal wall

Palpation of abdominal wall: superficial and deep palpation

Superficial palpation: light - using the fingertips - palm of hand moulds over the abdominal surface and fingers flex at metacarpo-phalangeal joints Deep palpation: deep - flat of hand over abdominal wall, applying firm steady pressure - may use both hands where the upper hand exerts pressure and lower hand feels the organ/mass

Percussion of underlying organs: liver

-Percussion from the midclavicular line to the costal margin (defines the upper and lower borders of the liver)

Auscultation of bowel sounds

Demonstrate palpation of arterial pulses: 1) abdominal aorta in the umbilical region 2) femoral artery

Map the dermatomes of the abdominal region (T8, T10 and T12)

Describe sites of referred pain from visceral organs

Recognise radiographs, CT and MRI imaging of the abdomen and pelvis and describe the views obtained

Identify major abdominal and pelvic anatomical structures on radiographs, CT and MRI imaging

Demonstrate the surface landmarks of C7, T3, T7, L2 and L4 vertebrae

Demonstrate the surface landmarks used for placement of epidural injections

Test the range of motion of the different regions of the vertebral column and describe the anatomical basis for your findings using osteological specimens

Locate the carotid pulse

Demonstrate the technique for palpation of the cervical lymph nodes

Locate the hyoid bone, thyroid and cricoid cartilages, lateral mass of the atlas and spinous process of C7

Demonstrate the boundaries of the anterior and posterior triangles of the neck and recall the contents of each

Demonstrate the surface landmarks for insertion of a central line into the internal jugular vein

Demonstrate the positions of the external and internal jugular veins and their surface landmarks

Test the functions of the accessory nerve by asking the subject to contract the sternocleidomastoid (look over the opposite shoulder) and upper fibres of trapezius (shrug the shoulders)

Test the general sensory function of the three divisions of the trigeminal nerve (ophthalmic, maxillary and mandibular) by stimulating the appropriate dermatomes with a pin

Test the motor function of the mandibular division of the trigeminal nerve by palpating masseter and temporalis muscles

Test the motor function of the facial nerve by asking the subject to adopt various facial expressions and looking for asymmetry

Recall the testing of the glossopharyngeal nerve using a tongue depressor on the back of the tongue to evoke a gag reflex

Test the motor function of the vagus nerve by asking the subject to open their mouth and say 'ahh' and observing the elevation of the uvula to see if there is any deviation from the midline (away from the lesioned side)

Test the motor function of the hypoglossal nerve by asking the subject to protract their tongue and observing any deviation from the midline (towards the lesioned side)

Examine the teeth in the subject's mouth using a penlight. Identify incisors, canines, premolars and molars, and record the number of each in each quadrant of the mouth

Locate the hyoid bone, the thyroid and cricoid cartilages, the cervical part of the trachea, and the thyroid isthmus

Demonstrate the positions of the paranasal sinuses and the mastoid air cells

Demonstrate the anatomical basis of tracheostomy and cricothyroidotomy

Identify the features of the external auditory meatus and eardrum that can be seen through an otoscope

Using visual pursuit of the finger, test the function of the extrinsic muscles of the eye

Using a penlight, test the ipsilateral and consensual pupillary light reflex

Recall the afferent and efferent arms of the accommodation reflex

Describe and demonstrate the surface markings of the internal jugular vein and common carotid artery

Left and right internal jugular veins-> -just lateral to the common carotid arteries to reach the sternoclavicular joints Left common carotid artery-> -patient turns head to right so left sternocleidomastoid muscle is prominent and visible -artery runs from aortic arch to the sternoclavicular joint, ascending into the neck, along the left side of the trachea, up along the anterior border of the left sternocleidomastoid muscle and to the lobe of the left ear Right common carotid artery-> -patient turns head to left so right sternocleidomastoid muscle is prominent and visible -artery runs from the right sternoclavicular joint to the lobe of the right ear -when above the upper border of the thyroid cartilage, the artery is the internal carotid artery

Recall the afferent and efferent arms of the corneal reflex

Recognise radiographs, CT and MRI imaging of the head, neck and spine and describe the views obtained

Identify major anatomical structures on radiographs, CT and MRI imaging

Testing joints and their movements

Testing muscle groups

Demonstrate palpation of arterial pulses in the upper limb and describe rate-subclavian, axillary, brachial in the arm, brachial in the cubital fossa, ulnar and radial at the wrist. The bones against which these pulse palpations occur should be recognised

Map the dermatomes of the upper limb C5-T1, T2

Test deep tendon reflexes-biceps (C5,C6) and triceps (C7,C8) using tendon hammers and recall nerve roots

Test motor and sensory components of axillary nerve

Test motor and sensory components of musculocutaneous nerve

Test motor and sensory components of radial nerve (arm and forearm)

Test motor and sensory components of ulnar nerve (forearm and hand=vulnerable to damage at elbow)

Test motor and sensory components of median nerve (forearm and hand=carpal tunnel syndrome)

Identify and demonstrate: the boundaries of the axilla and cubital fossa, the anatomical snuff-box for palpation of scaphoid, the position of the flexor retinaculum as the roof of the carpal tunnel

Demonstrate palpation of arterial pulses in the lower limb and describe rate-femoral, popliteal, dorsalis pedis and tibialis posterior pulse. The bones against which these pulse palpations occur should be recognised

Surface mark long saphenous vein and short saphenous vein, particularly their relationship to the malleoli

Map and test the dermatomes of the lower limb (L1-S2)

Test deep tendon reflexes-patellar tendon (L4) and ankle jerk (S1) using tendon hammers and recall nerve roots

Surface mark sciatic nerve

Test motor component of sciatic nerve

Test motor component of gluteal nerve

Test motor component of femoral nerve

Test motor component of obturator nerve

Test motor component of superficial nerve

Test motor component of deep peroneal nerve

Demonstrate how to define the gluteal 'safe area'

Outline the general anatomical relations of the femoral triangle and the popliteal fossa

Recognise radiographs, CT and MRI imaging of the limbs and describe the views obtained

Identify major anatomical structures on radiographs, CT and MRI imaging

OSPE Flashcards

(90 cards)