Semester 1 OSCE Physical Examination Rubrics
Order of Systems…………………………………………………page #
General Survey………………………………………………………………………….2
Vital Signs………………………………………………………………………………...2
Musculoskeletal System……………………………………………………………3
Cranial Nerves………………………………………………………………………....5
Sensory/Motor System…………………………………………………………….7
Abdomen…………………………………………………………………………………11
Page 1 of 15
OSCE General Survey: Perform a General Survey on this Patient
1
Washes hands & maintains sanitation and Explains procedure to patient
2
Positions appropriately and drapes (re-drapes as needed).
3
Assesses the Apparent State of Health of the patient, Level of Consciousness and Signs
of Distress.
4
Observes the Skin Color and Obvious Lesions.
5
Assesses the Dress, Grooming, and Personal Hygiene.
6
Assesses the Facial Expression and Odors of the Body and Breath.
7
Assesses the Posture, Gait, and Motor Activity.
8
Measures the Height and Weight. Calculates the BMI. Give reasons for assessing the
Waist Circumference.
9
Closure and Knowledge Questions.
OSCE Vital Signs: Obtain the Patient’s Pulse & Blood Pressure
1
Washes hands & maintains sanitation, appropriate dress and
grooming. Introduces self and asks permission
Asks about comfort, coffee intake, cigarettes, etc.
2
Demonstrates competency in obtaining a Carotid pulse and comments
3
4
Explains procedure to patient, positions and drapes (re-drapes as
needed). Locates brachial artery
Demonstrates selection of appropriate cuff size and applies cuff
properly. Describes what error will occur if the cuff is too large or too
small
5
Begins with palpation method for systolic pressure
6
Inflates cuff to appropriate level - > 30 degree of estimated systolic pressure
by palpation
7
Positions stethoscope and deflates appropriately (2mm/sec)
8
Reports patient’s blood pressure and interprets per the JNC 8 guidelines
Page 2 of 15
8
Closure and Knowledge questions
The Musculoskeletal System Examination
The following regional divisions are to be examined– Axial Skeleton & Appendicular Skeleton
OSCE Axial Skeleton Examination: Examine the Spinal column
1
2
3
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
Explains procedure to patient, positions and drapes (re-drapes as needed).
Observe the patient’s ability to ambulate. Comment on gait: normal, antalgic gait,
waddling gait, steppage gait, scissors gait, spastic gait, contracture, deformity,
symmetry.
4
Inspect the patient’s posture from the side and posteriorly. Identify bony landmarks.
Observe the curvatures of the spine – midline, scoliosis, kyphosis.
5
Palpate cephalocaudally for warmth and tenderness. Palpate for the spinous
processes, check for any “step-offs”. Palpate the sacroiliac joint.
6
Range of Motion of the Cervical Spine: Flexion and Extension, rotation (right and
left), lateral bending and nodding (atlantooccipital joint).
7
Range of Motion of the Lumbar Spine: flexion and extension, lateral bending and
rotation.
8
Special Maneuvers of the Lumbar Spine: Lasegue’s (bowstring), Sacroiliac stress
test.
9
Closure and Knowledge Questions.
OSCE Appendicular Skeleton Examination: Examine the Shoulder
4
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
Explains procedure to patient, positions and drapes (re-drapes as needed).
Inspect the shoulder, the shoulder girdle and scapulae. Look for any swelling,
deformity, muscle atrophy, fasciculations.
Palpate bony landmarks (the olecranon process and epicondyles), check for
tenderness.
5
Range of Motion (active and passive): flexion and extension, abduction and
adduction, internal and external rotation, and circumduction
1
2
3
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6
Special Maneuvers: Demonstrate the Apley scratch test, Painful Arc test, Neer
impingement sign, Hawkins impingement.
7
Closure and Knowledge Questions.
OSCE Appendicular Skeleton Examination: Examine the Hips
1
2
3
4
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
Explains procedure to patient, positions and drapes (re-drapes as needed).
Inspect the patient standing, observe the two phases of gait, look for the base of gait
width, Pelvic tilt, observe for muscle wasting, lordosis, leg length, deformity.
5
Palpate bony landmarks, tenderness.
Range of Motion (active and passive) of the Hips:
Flexion and extension, Abduction and adduction, External and Internal Rotation.
6
Describe the Trendelenberg gait.
7
Closure and Knowledge Questions.
OSCE Appendicular Skeleton Examination: Examine the Knees.
1
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
2
Explains procedure to patient, positions and drapes (re-drapes as needed).
3
Inspects the patient’s gait, inspect knees for symmetry, swelling, scars,
fasciculations, deformities, atrophy etc. and comments on findings
4
Palpates the knees for tenderness, swelling, warmth, crepitus, palpate anatomical
landmarks, etc. and comments on findings
5
Checks for range of motion of the knees bilaterally (Active and Passive).
6
Checks for joint effusion: bulge or balloon test, and patellar tap
7
Checks the stability of the anterior and posterior cruciate ligaments bilaterally via
the anterior and posterior drawer tests respectfully and the Lachmann test.
8
Performs valgus and varus stress tests to evaluate the stability of the medial and
lateral collateral ligaments
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9
Performs McMurray Test to evaluate for medial and lateral meniscal injuries.
10
Closure and Knowledge questions
Page 5 of 15
OSCE Cranial Nerves Examination:
Examine Cranial Nerves 1 -2
1
2
3
4
5
6
7
8
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
Explains procedure to patient, positions and drapes (re-drapes as needed).
Examine Cranial nerve I: Inspect the nasal cavities looking for blockage, discharge.
Check patency of the nostrils. Test smell in each nostril (No use of alcohol or
ammonia). Comment on findings.
Examine Cranial Nerve 11: Inspect the eyes looking for at size and shape of the
pupils, etc.
Check visual acuity on Snellen chart and comment on finding.
Check visual fields by confrontation and comment on finding
Describe findings in Horner’s syndrome.
Closure and Knowledge questions
OSCE Cranial Nerves Examination:
Examine Cranial Nerves 3, 4 and 6
1
2
3
4
5
6
7
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
Explains procedure to patient, positions and drapes (re-drapes as needed).
Inspect for ptosis, nystagmus, strabismus and comment on findings. Describe the
strabismus associated with each of CN III, IV & VI.
Test the extraocular movements of the eye and comment on findings including
direction of diplopia expected in each and concordant movement of eyes.
Check direct and consensual pupillary reflexes and comment on findings.
Check for the accommodation reflex (test pupillary constriction, convergence and
accommodation) and comment on findings.
Closure and Knowledge questions
Page 6 of 15
OSCE Cranial Nerves Examination:
Examine Cranial Nerves 5 and 7
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
Explains procedure to patient, positions and drapes (re-drapes as needed).
Inspect the face looking for any deformities. Test the sensory division of CN V:
Test pain & light touch in the three branches of the trigeminal nerve and comments
on findings.
1
2
3
Test the motor division of CN V: Test strength of the muscles of mastication and
comment on findings
Test reflexes of CN V: Test jaw jerk and comment on findings. Describe how to test
for the corneal reflex
Inspects the face for evidence of CN VII paralysis and explains the different
findings for a central versus a peripheral lesion. Comment on the sensory division of
the facial nerve.
4
5
6
7
Test strength of muscles innervated by the facial nerve and comment on findings
8
Closure and Knowledge questions
OSCE Cranial Nerves Examination:
Examine Cranial Nerves 8-12
1
2
3
4
5
6
7
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
Explains procedure to patient, positions and drapes (re-drapes as needed).
CN VIII: Inspects ear lesions or discharge. Perform Whispered voice test, 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 IX and X: Comment on the patient’s voice. Inspect for symmetrical soft palate.
Ask patient to say ‘ahhhh’ and comment on finding. Describe how to illicit a gag
reflex and neural pathway for this
CN XI: Inspect for muscle asymmetry, atrophy or fasciculations for the trapezius
and sternocleidomastoid. Assess strength of SCM and trapezius and comment on
findings
CN XII: Inspect the patient’s tongue in the floor of the mouth. Ask patient to
protrude tongue and move tongue from side to side and comment on
findings. Describe findings in CN XII lesion.
Closure and Knowledge questions
Page 7 of 15
OSCE Neuro: Sensory system Lower limb
1
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
2
Explains procedure to patient, positions and drapes (re-drapes as needed).
3
Inspect for any atrophic skin, ulcerations, excessive sweating. (which can affect our
tests).
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.
4
5
6
7
8
9
10
Test for pain bilaterally in the major dermatomes. Comment on findings.
Check for vibration sense in big toes bilaterally using a 128 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
downward movement before testing. Comments on findings
Discriminative sensations: Test for two-point discrimination, point localization and
Extinction.
Check for Romberg sign. Comment on findings and explain significance of a
positive Romberg sign.
Closure and Knowledge questions
Page 8 of 15
OSCE Neuro: Sensory system Upper limbs
1
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
2
Explains procedure to patient, positions and drapes (re-drapes as needed).
3
4
5
6
7
8
Inspect for any atrophic skin, ulcerations, excessive sweating. (which can affect our
tests).
Test for light touch of the upper 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 128 Hz tuning fork at the
distal bony prominence of the thumb. Assess for ability to tell when vibration
ceases. Comment on findings
Check for proprioception in the thumb bilaterally, holding the thumb laterally at
distal phalange, and asking the patient to close eyes. Give preview of upward and
downward movement before testing. Comments on findings.
Discriminative sensations: Test for stereognosis and number identification
(graphesthesia). Describe the difference between astereognosis and graphanesthesia
9
Test for two-point discrimination, point localization and Extinction.
10
Closure and Knowledge questions
Page 9 of 15
OSCE Neuro: Motor system & Reflexes & Co-ordination upper limb
1
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent Explains procedure to patient, positions and drapes
2
Explains procedure to patient, positions and drapes (re-drapes as needed).
3
4
5
6
7
8
9
Inspects the upper limbs commenting on deformities, length discrepancy, symmetry,
muscle wasting, fasciculation, check fullness and convexity of the thenar and
hypothenar eminences, etc.
Tests for muscle tone of the upper limbs bilaterally and comments on 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 adduction, 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 Hoffmann response bilaterally and comment on findings. Describe a
positive response and its significance.
Coordination: Rapid alternating movements of arms; Point-to-point movements:
arms-finger- nose test, Pronator drift.
Closure and Knowledge questions
Page 10 of 15
Motor system & Reflexes & Co-ordination lower limb
1
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent Explains procedure to patient, positions and drapes
2
Explains procedure to patient, positions and drapes (re-drapes as needed).
3
4
5
6
7
Inspects the lower limbs commenting on deformities, length discrepancy, symmetry,
muscle wasting, fasciculation, etc.
Tests for muscle tone of the lower limbs bilaterally 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
8
Coordination: Rapid alternating movements of legs; Point-to-point movements: legsheel to shin test, Gait (walk across room, heel-to-toe, etc)
9
Closure and Knowledge questions
Page 11 of 15
OSCE Rubric: The Abdominal System.
1) Examination for Extra Abdominal Signs and Inspection of the Abdomen.
1
Washes hands & maintains sanitation and Explains procedure to patient
2
Positions appropriately and drapes (re-drapes as needed).
3
4
5
6
7
8
Inspects CNS for orientation in time, place and person. Inspects the face and eyes (lifts
eyelids or asks patient) and examines the mucosa, look for periorbital edema, inspect
and palpate for parotid enlargement, etc. Inspects the mouth’s odor and mucosa.
Comment on findings.
Inspects and palpates neck for Supraclavicular lymphadenopathy. Inspects the chest
for Gynaecomastia, Spider naevi, Loss of hair, Reduced skin turgor. Comment on
findings.
Inspects the hands for Clubbing, Palmar erythema, Flapping tremor (asterixis),
Dupuytren’s contracture. Inspects arms for Bruising, Scratch marks. Inspects Lower
limbs for Peripheral edema (press the bony prominences). Comment on findings.
Inspects the contour of then (size and shape), look for scars, asymmetry, visible
peristalsis, striae, bruising, distention e.g. in ascites, full flanks, everted umbilicus,
caput medusa etc. Comment on findings.
Asks patient to raise both head and shoulders off table to demonstrate any ventral
hernia and rule out any masses in the abdominal wall. Comment on findings.
Closure and Knowledge Questions
2) Examination of the Abdomen: Auscultation, Percussion & Palpation
1
Washes hands & maintains sanitation and Explains procedure to patient
2
Positions appropriately and drapes (re-drapes as needed).
3
Auscultates for bowel sounds, Bruits, and comments on findings and their
significance. Comment on findings.
4
5
Before percussion asks where it hurts. Percusses lightly in all quadrants. Comment on
your findings. Comment on findings.
All palpation should start from areas of least pain. Performs light palpation in all
quadrants, for tenderness and superficial masses. Performs deep palpation in all
quadrants. Comment on findings.
Page 12 of 15
6
Performs deep palpation for the aorta and abdominal masses if present e.g. tumors.
Comment on findings.
7
Assesses for Peritonitis by performing the cough test, assess for guarding, rigidity,
rebound tenderness, etc. Comment on findings.
8
Closure and Knowledge Questions
3) Examine the Liver
1
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
2
Explains procedure to patient, positions and drapes (re-drapes as needed).
3
Inspects for and comments on systemic manifestation of liver disease: jaundice,
palmer erythema, asterixis, ascites
4
Inspects the abdomen and comments on symmetry, visible peristalsis, striae, caput
medusa
5
Percusses lever and identifies upper and lower border. Gives liver span in
cm. Comments on findings
6
Palpates lower border – starts in RIF, asks patient to inhale deeply, and describes
liver findings i.e. nodularity, tenderness, consistency
7
Checks for a Murphy sign and comment on findings. Describe the significance of a
positive sign
8
Closure and Knowledge questions
4) Examine the spleen
1
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
2
Explains procedure to patient, positions and drapes (re-drapes as needed).
3
Inspects and comments on systemic manifestation of splenic disease: pallor,
conjunctival pallor, etc.
4
Inspects the abdomen and comments on symmetry,
Page 13 of 15
5
Palpates lower border of spleen– starts in RIF, asks Pt to inhale deeply, bimanual,
roll patient to right
6
Demonstrates splenic percussion sign and Traube’s space resonance and comments
on findings
7
List at least three ways to differentiate an enlarged spleen from an enlarged kidney
8
Closure and Knowledge Questions
5) Examine the kidneys
1
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces
self and asks for consent
2
Explains procedure to patient, positions and drapes (re-drapes as needed).
3
Perform a general inspection for systemic manifestation of kidney disease:
(periorbital edema, generalized edema, uremic fetor, pallor, etc.
4
Inspects the abdomen and comments on findings: masses, asymmetry, etc.
5
Auscultates for renal artery bruits. Comments on findings and significance
6
Bimanual palpation with ballottement & attempted entrapment of kidneys on deep
inspiration, comments on findings.
7
Palpate & percuss costovertebral angle for tenderness. Comments on findings.
8
Closure and Knowledge Questions
Page 14 of 15
6) Examine for appendicitis
1
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces self
and asks for consent
2
Explains procedure to patient, positions and drapes (re-drapes as needed).
3
Inspects for and comments on findings: scars, asymmetry, visible peristalsis etc.
4
Auscultates for bowel sounds and comments on their significance
5
Performs light palpation and comments on findings i.e. guarding, rigidity, etc.
6
Assess for rebound tenderness at McBurney’s point, clearly informs patient of
procedure and comments on findings
7
Demonstrates Rovsing’s, Psoas and Obturator sign, listing each by name and
explaining procedure to patient. Comment on findings.
8
Closure and Knowledge questions
7) Examine for ascites
1
Washes hands & maintains sanitation, appropriate dress and grooming. Introduces self
and asks for consent
2
Explains procedure to patient, positions and drapes (re-drapes as needed).
3
Inspects and comments on findings: distended, full flanks, everted umbilicus, etc.
4
Percusses for dullness in flanks and comments on findings
5
Asses for shifting dullness and comments on findings
6
Checks for fluid wave and comments on findings
7
Closure and Knowledge questions
Page 15 of 15