Case 1: Chest Pain Cardiovascular system
1) Extra-Cardiac Examination of the Cardiovascular System.
1. Washes hands, appropriate dress and grooming. Introduces self and asks for consent.
2. Explains procedure to patient, positions and drapes
3. Inspects for malar flush, central cyanosis, respiratory distress, neck vein distension.
4. Examine the Hands for splinter hemorrhages, clubbing, peripheral cyanosis, pallor, capillary
refill. Examines the legs for pedal edema. Auscultate the chest for rales.
5. Inspects neck, identifies external & internal jugular venous pulsation. Describe A & V waves,
6. Measures vertical height with respect to sternal angle and reports in cm. Calculates pressure in
cm from right atrium and comments on findings.
7. Demonstrates hepato-jugular reflux and comments on findings. Describes what a positive
finding would be.
2) Cardiac Examination
1. Washes hands, appropriate dress and grooming. Introduces self and asks for consent.
2. Explains procedure to patient, positions and drapes
3. Inspects the chest looking for scars, pacemaker, chest deformity.
4. Palpate the 4 cardiac areas for pulsations and thrills. Describe locations. Describe location of
the apical impulse. Explain a thrill. (thrills suggest turbulent blood flow).
5. Palpates for a parasternal heave.
6. Auscultates for heart sounds and murmurs at the 4 areas and indicates which sound is heard
best in each area.
7. Identify where a split S2 is heard most loudly and describe the physiological split.
8. List which murmurs radiate to which areas, demonstrate positioning techniques to augment the
aortic and mitral valve murmurs and list the murmurs that are augmented by inspiration and
expiration
Case 2: Leg pain Peripheral Vascular System
OSCE Peripheral Artery Circulation
1. Washes hands, appropriate dress and grooming. Introduces self and asks permission
2. Explains procedure to patient, positions and drapes
3. Inspects arterial insufficiency in the upper and lower limbs: skin, looking for any dry skin,
pallor, ulcers, thickened nails, loss of hair, etc.
4. Palpates temperature, radial pulse and determines rate and rhythm. Palpates radial and brachial
arteries bilaterally and comments on symmetry. Checks capillary refill
5. Palpate the carotid arteries and comments on symmetry. Determines the character and volume.
Auscultates for carotid bruits bilaterally
6. Palpates the dorsalis pedis and posterior tibial artery bilaterally and comments on symmetry.
Checks capillary refill. Comment on other arteries that could be examined in the lower limb.
7. Demonstrates the Allen test and Buerger test and explain their significance.
OSCE Peripheral Venous System
1. Washes hands, appropriate dress and grooming. Introduces self and asks permission
2. Explains procedure to patient, positions and drapes.
3. Inspects for evidence of venous insufficiency in the lower limbs: warmer than normal skin,
skin pigmentation changes, prominent veins, ulcers, swelling, etc.
4. Palpates for temperature, pitting edema, venous tenderness or cords, calf tenderness.
5. Demonstrate the Trendelenburg test and explain its significance.
6. Compare and contrast at least 3 different findings on physical exam between arterial
insufficiency and venous insufficiency, i.e. trophic changes, color, temp, edema.
Case 3: Cough Respiratory System
OSCE Respiratory System: Inspection and Palpation of the Thorax
1. Washes hands, appropriate dress and grooming. Introduces self and asks permission
2. Explains procedure to patient, positions and drapes.
3. Inspects for systemic manifestations of lung disease, wasting, voice changes, central or
peripheral cyanosis, clubbing, asterixis, nicotine staining, use of accessory muscles, etc.
4. Inspects the neck for tracheal deviation. Describes what a tracheal deviation may indicate
5. Inspects the chest wall looking for deformities, scars, shape, intercostal retraction,
symmetrical movements, etc. Describes signs of respiratory distress
6. Palpates for chest wall tenderness, crepitus, chest expansion.
7. Checks the A/P diameter of the chest. Describes the significance of a positive finding
8. Checks tactile fremitus. Describes the findings in lobar pneumonia, pleural effusion,
pneumothorax, asthma and chronic obstructive pulmonary disease (COPD)
OSCE Respiratory System: Percussion and Auscultation of the Lungs
1. Washes hands, appropriate dress and grooming. Introduces self and asks permission
2. Explains procedure to patient, positions and drapes.
3. Percusses the anterior and posterior lung fields and comments on findings. Describes the
percussion notes found in lobar pneumonia, pleural effusion, pneumothorax, asthma and chronic
obstructive pulmonary disease (COPD)
4. Percuss the level of the diaphragm posteriorly.
5. Auscultates the anterior and posterior lungs fields and comments on findings. Describes
normal breath sounds and adventitious sounds.
6. Checks for transmitted voice sounds (vocal fremitus, bronchophony, egophony, and whispered
pectoriloquy) and comments on findings. Describes what one would find in lobar pneumonia,
pleural effusion, pneumothorax, asthma and COPD
Case 4: Dysuria Renal System
OSCE Rubrics Abdominal System (Integrated).
Examination for Extra abdominal signs.
1. Washes hands, appropriate dress and grooming. Introduces self and asks permission
2. Explains procedure to patient, positions and drapes.
3. Inspects for generalized swelling, inspects the hands for Clubbing, Palmar erythema, Flapping
tremor (asterixis), Dupuytren’s contracture. Inspects arms for Bruising, Scratch marks.
Comment on findings.
4. Inspects CNS for orientation in time, place and person. Inspects the face and eyes for
periorbital edema, Jaundice, pallor, signs of dehydration, parotid enlargement (seen with
alcoholism), etc. Comment on findings.
5. Inspects mouth (tongue, lips, gums) for e.g. Fetor hepaticus, Uremic Fetor, Mucosal
discoloration, Ulcerations, etc. Inspects and palpates neck for Supraclavicular lymphadenopathy.
Comment on findings.
6. Inspects chest for Gynaecomastia, Spider naevi, Loss of hair, Reduced skin turgor. Inspects
Lower limbs for Peripheral edema. Comment on findings.
Examination of the abdomen proper 1: Inspection, Auscultation and
Palpation
1. Washes hands, appropriate dress and grooming. Introduces self and asks permission
2. Explains procedure to patient, positions and drapes.
3. Inspects the contour (size and shape), scars, asymmetry, visible peristalsis, striae, bruising,
engorged veins, distention, full flanks, everted umbilicus, ascites, caput medusa etc.
4. Asks patient to raise both head and shoulders off table to demonstrate any ventral hernia and
rule out any masses in the abdominal wall.
5. Auscultates for bowel sounds, Bruits, Friction rubs and comments on findings and their
significance.
6. All palpation should start from areas of least pain. Performs light palpation in all quadrants,
for tenderness, superficial masses, and comments on findings. Assess for Peritonitis by
performing the cough test, guarding, rigidity, rebound tenderness etc.
7. Performs deep palpation in all quadrants. Palpate for the liver border– starts in RIF, asks
patient to inhale deeply, and describes liver findings i.e. nodularity, tenderness, consistency.
Palpate the gall bladder, check for Murphy sign and comment on significance of findings.
8. Perform bimanual palpation of the kidneys with ballottement & attempted entrapment of
kidneys and comments on findings.
9. Palpates lower border of spleen– starts in RIF, asks patient to inhale deeply, roll patient to
right and comment on findings. List at least three ways to differentiate an enlarged spleen from
an enlarged kidney
10. Performs deep palpation for the aorta and abdominal masses if present e.g tumors,
distended bladder.
Examine for the abdomen proper 11-continuation of above: Percussion,
Ascites and Appendicitis.
1. Washes hands, appropriate dress and grooming. Introduces self and asks permission
2. Explains procedure to patient, positions and drapes.
3. Percusses lightly in all quadrants, Percuss upper and lower liver border. Gives liver span in
cm.
4. Percuss the costovertebral angle for tenderness. Comments on findings.
5. Demonstrates splenic percussion sign and Traube’s space resonance and comments on
findings.
6. Assess for Ascites by Percussing for dullness in flanks, assess for shifting dullness and
comments on findings.
7. Checks for fluid wave and comments on findings.
8. Assess for Appendicitis by testing for: rebound tenderness at McBurney’s point, clearly
informs patient of procedure and comments on findings. Describe the purpose of a rectal exam in
this case.
9. Demonstrates Rovsing, Psoas and Obturator sign, listing each by name and explaining
procedure to patient. Comment on findings.
Case 5: Fatigue Endocrine System
OSCE: Thyroid Examination: General
2. Explains procedure to patient, positions and drapes.
3. Observes for restlessness, anxiety, immobility, lack of interest, evaluate body habitus (weight
gain/loss).
4. Inspects the Hands for increase/decrease temperature, palmar erythema, increase sweating,
clubbing (thyroid acropachy), onycholysis (Plummer’s nails), fine tremors.
5. Inspects the Skin for vitiligo, warm/moist/smooth, pretibial myxedema (non-pitting edema),
coarse/dry, myxedematous changes, yellowish discoloration, pallor.
6. Inspects the Eyes for lid lag (on looking down the eyeball moves ahead of the eyelid (usually
move together), lid retraction (sclera visible above the iris), ophthalmoplegia of EOM, chemosis,
exophthalmos (whiteness of sclera visible below the iris), proptosis (eye protrusion beyond the
level of the supraorbital ridge), periorbital edema, loss of lateral 1/3 /thinning of eyebrows.
7. Inspects the Cardiovascular System for fast/slow pulse, systolic hypertension.
8. Inspects the Musculoskeletal/neuro for proximal muscle weakness, delayed relaxation phase
of deep tendon reflexes/hyperreflexia.
OSCE: Thyroid Examination: Thyroid Gland Proper
3. Inspects the neck by having the patient slightly extend the neck with good cross light falling
on the anterior neck, takes note of the landmarks (thyroid cartilage, the cricothyroid membrane
and the cricoid cartilage), looks for scars, fullness over the area of the thyroid, contour,
asymmetry of size and shape, abnormal pulsations, masses within or outside of the thyroid.
4. Observes the mobility (up and down) of the thyroid gland on swallowing. Asks patient to
protrude the tongue (thyroglossal cyst, moves up and down on tongue protrusion).
5. Stands behind the patient and instructs to swallow whilst palpating the landmarks (thyroid
cartilage, cricothyroid membrane and cricoid cartilage). Palpates isthmus of the thyroid gland.
Feels for the size, shape, symmetry, surface characteristics e.g. nodularity, consistency,
tenderness.
6. Palpates the lateral lobes as the patient swallows while still behind the patient.
Feels for the size, shape, symmetry, surface characteristics e.g. nodularity, consistency,
tenderness. Repeats the maneuver for the left lobe with the hands in the reverse corresponding
positions.
7. Auscultates for bruit (over lateral lobes using the bell of the stethoscope).