Common Conditions in OSCE Scenarios

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Introduction

This article aims to condense the high-yield clinical examination findings relevant to medical school OSCEs. We’ve included links to relevant Geeky Medics OSCE guides.

You may also be interested in our comprehensive OSCE revision checklist to help you prepare for OSCEs.

OSCE examiner’s perspective

Clinical examination stations frequently appear in OSCEs. However, the format of these can vary significantly between medical schools. 

Some medical schools will use real patients with real clinical signs. If this is the case, stable patients are usually used. For example, in a respiratory examination station, you’re highly unlikely to be asked to examine a patient with an active infection (e.g. pneumonia, tuberculosis) who is unwell. You’re much more likely to be given a stable patient who might present to outpatients (e.g. a patient with a thoracotomy scar or a stable pulmonary fibrosis patient).

Other medical schools will use simulated patients (actors/volunteers). These patients may have no ‘real’ signs, but the examiner may provide additional information during the station.

For simulation stations, patient simulators/manikins are usually used to portray acutely unwell patients. These manikins can often simulate real clinical findings (e.g. lung sounds).

You may also be asked to perform examinations on anatomical models (e.g., ophthalmoscopy training models, and prostate examination models). It’s worth being familiar with the models used in your clinical skills lab, as they are likely the same models used in the real OSCEs!

You might also be interested in our premium collection of 1300+ ready-made OSCE Stations, including clinical examination, communication skillsprescribingABCDE and data interpretation stations 🚑

Acute and emergency

These conditions/presentations frequently appear in simulation scenarios.

Condition Clinical examination findings
Adult choking
  • Around the bedside: evidence of cause (e.g. food, foreign body)
  • Airway and breathing: inability to speak or cough effectively, obvious distress, cyanosis, respiratory distress (e.g. use of accessory muscles, nasal flaring, paradoxical chest movement)
Anaphylaxis
  • Around the bedside: evidence of cause (e.g. antibiotics, food)
  • Airway and breathing: rapid and shallow breathing, wheezing, stridor, cough, angioedema of the eyes, lips, and throat, low SpO2
  • Cardiovascular: hypotension, tachycardia, anaphylactic shock
  • Disability: altered level of consciousness
  • Exposure: nausea, vomiting, flushed skin, urticaria (widespread, raised, erythematous and pruritic wheals on the skin), diaphoresis
Acute exacerbation of asthma
  • Around the bedside: oxygen, inhalers, spacer device, PEFR meter, nebuliser
  • Airway and breathing: increased respiratory rate, shallow respirations, use of accessory muscles, cyanosis, cough (often non-productive or scanty clear/white sputum), audible high-pitched wheeze, hyperinflation of the chest, polyphonic expiratory wheeze, decreased breath sounds, prolonged expiratory phase, low SpO2
  • Cardiovascular: tachycardia, hypotension (in severe cases), pulsus paradoxus (a decrease in systolic blood pressure >10 mmHg during inspiration; seen only in severe asthma exacerbations)
  • Disability: altered mental status (in severe cases)
  • It is important to note that in patients with well-controlled and non-acute asthma they may have a completely normal examination without any clinical signs
Infective exacerbation of COPD
  • Around the bedside: oxygen, nebuliser, sputum sample (often purulent)
  • Airway and breathing: increased respiratory rate, use of accessory muscles, cyanosis, wheezing, coarse crackles, reduced breath sounds, hyperinflation of the chest
  • Cardiovascular: tachycardia, right heart strain
  • Disability: altered mental status (in severe cases)
  • Exposure: fever, increased sputum production
Hypoglycaemia
  • Around the bedside: glucose gel/tablets, insulin syringes, medical alert bracelet (e.g. MedicAlert), glucometer
  • Airway and breathing: typically, normal unless severe hypoglycaemia leads to altered consciousness or seizures
  • Cardiovascular: tachycardia, palpitations
  • Disability: confusion, agitation, drowsiness, seizures, coma, speech abnormalities
  • Exposure: diaphoresis, tremor, pallor
  • Hypoglycaemia should always be considered in patients presenting with a reduced level of consciousness
Major trauma
  • The presentation of major trauma is variable depending on the mechanism of injury
  • Around the bedside: “blood on the floor, plus four more” – visible external bleeding, consider other compartments for blood loss (bilateral femur, pelvis, abdomen, chest)
  • Airways and breathing: head injury or significant blood loss may result in altered consciousness and an unsafe airway, increased respiratory rate with progressive hypovolaemic shock
  • Cardiovascular: tachycardia, normal or decreased blood pressure, decreased urine output*
  • Disability: anxiety, sense of impending doom, or altered mental status (especially in the context of major haemorrhage)
  • Exposure: identification of injury site or secondary injury
  • *Note: hypovolaemic shock is classified according to the volume of blood lost; heart rate, ventilation rate, systolic blood pressure and urine output will all vary depending on the stage of shock
Pneumothorax
  • Around the bedside: oxygen, chest tube kit, needle decompression set
  • Airway and breathing: rapid and shallow breathing, decreased or absent breath sounds on the affected side, hyperresonance on percussion, tracheal deviation (in tension pneumothorax), cyanosis
  • Cardiovascular: tachycardia, hypotension (in tension pneumothorax)
  • Disability: anxiety or altered mental status (in severe cases)
  • Exposure: signs of chest trauma
Pulmonary embolism
  • Around the bedside: oxygen, anticoagulant medications (e.g. heparin, DOACs)
  • Airway and breathing: increased respiratory rate, cyanosis, auscultation is typically normal but there may be decreased breath sounds over infarcted lung tissue
  • Cardiovascular: tachycardia, hypotension, signs of right heart strain (elevated JVP, right ventricular heave), syncope (in severe cases)
  • Disability: altered mental status due to hypoxia
  • Exposure: risk factors (e.g. recent surgery, immobilisation, cancer, previous DVT/PE)

Rhabdomyolysis

  • Around the bedside: IV fluids, urine sample (dark or cola-coloured urine)
  • Airway and breathing: typically, normal unless associated with other conditions.
  • Cardiovascular: tachycardia, hypotension (if severe dehydration or shock), ECG changes consistent with hyperkalaemia (e.g. tall, tented T waves)
  • Disability: muscle weakness, pain, or swelling
  • Exposure: history of intense exercise, trauma, crush injuries, drug use (e.g. statins), seizures, hyperthermia

Sepsis

  • Around the bedside: IV fluids, antibiotics, blood cultures, urine output monitoring
  • Airway and breathing: rapid and shallow breathing, possible respiratory distress, low SpO2, possible cyanosis
  • Cardiovascular: hypotension, tachycardia, signs of septic shock (cold or warm extremities, decreased capillary refill)
  • Disability: altered mental status, confusion
  • Exposure: fever, chills, diaphoresis, possible source of infection (e.g. pneumonia, UTI, infected wound)

ST-elevation myocardial infarction

  • Around the bedside: ECG, defibrillator, medications (aspirin, GTN spray, morphine), oxygen
  • Airway and breathing: rapid and shallow breathing, possible respiratory distress (if heart failure present)
  • Cardiovascular: tachycardia or bradycardia, hypotension (in severe cases), diaphoresis, possible signs of heart failure (e.g. jugular venous distension, peripheral oedema), ECG with ST-segment elevation in at least two contiguous leads
  • Disability: anxiety

Stroke

  • Around the bedside: IV access, blood pressure monitoring, stroke assessment tools (e.g. NIHSS), glucose measurement
  • Airway and breathing: may have impaired airway protection or breathing
  • Cardiovascular: possible hypertension, arrhythmias (e.g. atrial fibrillation)
  • Disability: focal neurological deficits (e.g. unilateral weakness, speech difficulties, facial droop), altered mental status, possible seizure

Traumatic head injury

  • Around the bedside: cervical collar, CT scan, IV access
  • Airway and breathing: may have impaired airway protection, rapid and shallow breathing, signs of increased intracranial pressure (e.g. irregular respirations, Cheyne-Stokes breathing)
  • Cardiovascular: bradycardia (Cushing’s reflex), hypertension (Cushing’s reflex), possible hypotension (if associated with other injuries)
  • Disability: altered level of consciousness, focal neurological deficits, signs of basilar skull fracture (e.g. raccoon eyes, Battle’s sign), seizures
  • Exposure: visible head trauma, scalp lacerations, haematomas

Upper GI bleeding

  • Around the bedside: NG tube with visible blood, IV fluids and/or blood products
  • Airway and breathing: may be normal unless severe bleeding compromises the airway 
  • Cardiovascular: tachycardia, hypotension, signs of shock (cool, clammy skin), pallor
  • Disability: altered mental status (if severe hypovolaemia)
  • Exposure: melaena, hematemesis, signs of chronic liver disease (e.g. jaundice, ascites, spider angiomas)

Opioid overdose

  • Around the bedside: empty pill bottles, drug paraphernalia (e.g. needles, syringes), naloxone
  • Airway and breathing: respiratory depression (slow, shallow breathing), hypoventilation, apnoea in severe cases, cyanosis, low SpO2
  • Cardiovascular: bradycardia, hypotension
  • Disability: pinpoint pupils (miosis), altered mental status, drowsiness, unresponsiveness, coma
  • Exposure: track marks (in IV drug users), diaphoresis, signs of chronic IV drug use (e.g. skin infections, abscesses)

Paracetamol overdose

 

  • Around the bedside: empty medication bottles
  • Airway and breathing: typically normal unless co-ingested with other sedatives
  • Cardiovascular: tachycardia (in severe cases)
  • Disability: altered mental status (if severe liver failure or co-ingestion with other CNS depressants)
  • Exposure: nausea, vomiting, right upper quadrant abdominal pain (indicating liver involvement), jaundice (in late stages), diaphoresis

Cardiovascular

These conditions may appear in a cardiovascular examination station.

Condition

Clinical examination findings

Atrial fibrillation

  • Most commonly tachycardia with an irregularly irregular pulse; may be an irregularly irregular rhythm with bradycardia (e.g. AF with AV block)
  • Radial-apical deficit: difference between rate of apex heartbeat and peripheral pulse 
  • Palpable peripheral pulses may be weak or variable due to irregular ventricular response
  • May be associated with signs of heart failure (e.g. elevated JVP, pedal oedema, bibasal crackles)
  • Signs of anticoagulation (e.g. MedicAlert, bruising, warfarin booklet, bedside INR machine)

Atrial flutter

  • Tachycardia with a regular or irregularly regular pulse
  • The pulse is typically a fraction of the atrial rate (e.g. 2:1 – 150, 3:1 – 100, 4:1 – 75)
  • Characteristic sawtooth pattern on ECG
  • Signs of anticoagulation (e.g. MedicAlert, bruising, warfarin booklet, bedside INR machine)

Coronary artery bypass graft (CABG)

  • Sternotomy scar: midline sternotomy scar
  • Harvesting scar: internal mammary artery or saphenous vein)
  • Cardiovascular risk factors: tar staining (smoking), corneal arcus/xanthelasma (hyperlipidaemia), obesity, hypertension

Hypertrophic cardiomyopathy

  • Implantable cardioverter defibrillator (ICD)
  • Systolic ejection (crescendo-decrescendo) murmur; increases with Valsalva 
  • Sustained, forceful apex beat 
  • S4 gallop 
  • Syncope or pre-syncope
  • Holosystolic murmur: indicative of mitral regurgitation (due to systolic anterior motion of the mitral valve)

Pacemaker/implantable cardioverter defibrillator

  • Palpable device and visible scar in the subclavian region
  • Presence of a MedicAlert bracelet
  • CXR: device leads
  • ECG: pacemaker spikes

Prosthetic heart valve (aortic/mitral)

  • Midline sternotomy scar
  • Signs of anticoagulation (e.g. MedicAlert, bruising, warfarin booklet, bedside INR machine)
  • Metallic audible metallic click
  • Murmurs are associated with reduced valve function

Heart failure (stable)

  • Dyspnoea at rest
  • Raised JVP
  • Narrow pulse pressure
  • Pedal oedema
  • S3/S4 on auscultation
  • Right ventricular heave
  • Displaced apex beat
  • Bibasal end-inspiratory crackles +/- wheeze
  • Reduced air entry & stony dullness on percussion (pleural effusion)
  • Hepatomegaly +/- ascites

Ischaemic heart disease (stable)

  • Signs of cardiovascular risk factors: nicotine staining (smoking), corneal arcus/xanthelasma (hyperlipidaemia), obesity, hypertension
  • Glyceryl trinitrate spray
  • Midline sternotomy scar (if previous CABG)

Tetralogy of Fallot (repaired)

  • Midline sternotomy scar 
  • Clinical signs of complications (e.g. pulmonary valve pathology)
  • Underlying genetic condition (e.g. Down’s syndrome) 
  • Digital clubbing may be present

Murmurs

Condition

Clinical examination findings

Aortic stenosis

  • Murmur: Harsh, crescendo-decrescendo, ejection systolic murmur with radiation to the carotids and apex
  • Sustained, heaving apex beat
  • Slow rising, delayed pulse (pulsus parvus et tardus)
  • Narrow pulse pressure
  • Ejection click
  • Soft or absent S2
  • Often presents with syncope, angina and exertional dyspnoea
  • Severe cases may show signs of left ventricular hypertrophy and heart failure

Mitral regurgitation

  • Murmur: High pitched, blowing, pan-systolic murmur with radiation to the left axilla and apex 
  • Displaced, hyperdynamic apex beat 
  • Soft or absent S1 
  • Associated with AF (irregularly irregular pulse) and pulmonary hypertension (RV heave, loud S2) 
  • Mitral valve prolapse may present with a mid-systolic click accompanied by a late systolic murmur 
  • Chronic MR can lead to left atrial enlargement and heart failure
  • Acute MR (e.g. due to chordae tendineae rupture secondary to myocardial ischaemia) is a medical emergency

Aortic regurgitation

  • Murmur: high pitched, blowing, early diastolic murmur with decrescendo
  • Displaced apex beat
  • Wide pulse pressure 
  • Collapsing (water-hammer) pulse 
  • Murmur is called an ‘immediate diastolic murmur’ as it immediately follows the 2nd heart sound
  • May present with signs of heart failure and left ventricular dilation
  • Chronic AR can lead to left ventricular hypertrophy

Mitral stenosis

  • Murmur: rumbling mid-diastolic murmur, with opening snap
  • Tapping apex beat
  • Malar flush (rosy cheeks due to CO2)
  • Loud S1
  • Associated with AF (irregularly irregular pulse) and pulmonary hypertension (RV heave, loud S2) 
  • The most common cause of mitral stenosis is rheumatic fever
  • Often presents with dyspnoea, orthopnoea and haemoptysis
  • Severe cases can lead to right-sided heart failure

Respiratory

These conditions may appear in a respiratory examination station.

Condition

Clinical examination findings

Pneumonia

  • Around the bedside: sputum pot, oxygen, prescription (e.g. antibiotics)
  • Inspection: increased work of breathing, cyanosis, cough (often productive of purulent sputum)
  • Peripheries: tachycardia
  • Chest auscultation: focal coarse crackles, reduced air entry, egophony, bronchial breath sounds
  • Chest percussion: dullness to percussion, increased tactile vocal fremitus
  • Vital signs: low SpO2 , tachypnoea, tachycardia, fever
  • In older patients or patients with severe pneumonia, they may also show signs of confusion or altered mental status
  • Pathogen-specific clinical signs (e.g. erythema multiforme associated with mycoplasma pneumonia)

Pleural effusion

  • Inspection: increased work of breathing (large effusion)
  • Palpation: reduced chest expansion (large effusion), tracheal deviation (severe cases)
  • Chest percussion: ’stony dull’ percussion note over the level of the effusion, decreased tactile fremitus
  • Chest auscultation: decreased or absent breath sounds and vocal resonance over the effusion
  • Clinical features of underlying cause: lung cancer (nicotine staining, clubbing, lymphadenopathy), heart failure (peripheral oedema, raised JVP), infection (fever, productive cough)
  • A ‘pleural rub’ (characteristic creaking or rubbing sound during respiratory movements) may be heard in cases of inflammation (e.g. infection, malignancy)
  • Patients with pneumonia may develop a parapneumonic effusion (an accumulation of exudative fluid in the pleural cavity)

Pleurisy

  • Inspection: shallow, rapid breathing
  • Chest auscultation: Pleural rub (creaking or rubbing sound during respiratory movements)
  • Chest percussion: normal unless associated with pleural effusion

Chronic Obstructive Pulmonary Disease (stable)

  • Around the bedside: oxygen, inhalers, spacer, PEFR meter
  • Inspection: increased work of breathing, cough, wheeze
  • Peripheries: tachycardia, nicotine staining
  • Chest auscultation: coarse crackles, reduced breath sounds +/- wheeze
  • Vital signs: 88-92 SpO2, tachypnoea
  • Clinical features of heart failure (cor pulmonale)

Bronchiectasis

  • Around the bedside: oxygen, inhalers, sputum pot
  • Inspection: increased work of breathing, cough
  • Peripheries: clubbing
  • Chest auscultation: bi-basal coarse crackles
  • Vital signs: SpO2 low, tachypnoea
  • Clinical features of underlying cause (e.g. CF)

Cystic fibrosis

  • Around the bedside: oxygen, inhalers, nebulisers, sputum pot, peak expiratory flow chart
  • Inspection: increased work of breathing, cough, vascular access device (e.g. Portacath, PICC line)
  • Peripheries: clubbing
  • Chest auscultation: coarse crackles
  • Vital signs: SpO2 low, tachypnoea

Interstitial lung disease

  • Around the bedside: oxygen, inhalers
  • Inspection: increased work of breathing, cough
  • Peripheries: clubbing
  • Chest auscultation: bilateral fine end-inspiratory crackles
  • Vital signs: SpO2 low, tachypnoea
  • Clinical features of underlying secondary cause: systemic sclerosis (telangiectasia, sclerodactyly, Raynaud’s phenomenon), rheumatoid arthritis (joint swelling +/- deformities), systemic lupus erythematous (malar rash)

Lobectomy

  • Inspection: thoracotomy scar – posterolateral (mid-spinal line to anterior axillary line) or anterolateral (mid-axillary line to lateral sternal border)
  • Palpation: reduced chest expansion on the affected side
  • Chest auscultation: absent breath sounds over the affected lobe
  • Evidence of underlying pathology requiring lobectomy (e.g. COPD, lung cancer)

Lung cancer

 

  • Around the bedside: oxygen
  • Inspection: cachexia, increased work of breathing, cyanosis, cough
  • Peripheries: clubbing, nicotine staining
  • Palpation: cervical lymphadenopathy
  • Chest auscultation: reduced/absent breath sounds over tumour
  • Clinical features of a pleural effusion
  • Wheeze (if the large airways are obstructed)
  • Pleural drain

Lung transplant

  • Inspection: clamshell incision, increased work of breathing, cushingoid appearance due to steroids
  • Around the bedside: anti-rejection medication

Gastrointestinal

Abdominal examination

These gastrointestinal conditions may appear in an abdominal examination station.

Condition

Clinical examination findings

Chronic liver disease

  • Skin: jaundice, excoriations (due to pruritus), spider naevi (>5 is abnormal, physiological in pregnancy), bruising
  • Hands and nails: palmar erythema, Dupuytren’s contracture: palmar thickening, leukonychia, clubbing, asterixis/flapping tremor due to encephalopathy
  • Endocrine: gynaecomastia, hypogonadism 
  • Abdominal findings: abdominal distension, ascites, caput medusae (paraumbilical dilation of subcutaneous veins), hepatomegaly (in advanced stages of cirrhosis the liver may be small), splenomegaly (portal hypertension causing splenic congestion) 
  • Other: peripheral oedema
  • Underlying cause of disease:
    • Bronzed skin in haemochromatosis
    • Kayser-Fleischer rings and neurological symptoms in Wilson’s disease
    • Young age and associated emphysema in Alpha-1 antitrypsin deficiency

Ulcerative Colitis

  • Eyes: anterior uveitis (iritis), episcleritis, scleritis
  • Skin: erythema nodosum, pyoderma gangrenosum
  • General appearance: weight loss, conjunctival pallor
  • Abdomen: abdominal tenderness (often felt in the LLQ), stoma
  • Perianal: perianal fistula and abscess formation
  • Musculoskeletal conditions: pauci-articular arthritis, enthesitis, tenosynovitis, dactylitis
  • Other: primary sclerosing cholangitis, gallstones, autoimmune hepatitis

Crohn’s disease

  • Eyes: anterior uveitis (iritis), episcleritis
  • Mouth: oral ulceration
  • Skin: erythema nodosum, pyoderma gangrenosum
  • General appearance: weight loss, conjunctival pallor
  • Abdomen: abdominal tenderness (often in the RLQ due to terminal ileum involvement), stoma
  • Perianal: perianal fistula and abscess formation
  • Musculoskeletal: pauci-articular arthritis (most common extra-intestinal symptom), enthesitis, tenosynovitis, dactylitis
  • Other: primary sclerosing cholangitis, gallstones

Liver transplant

  • Surgical scars: ‘Mercedes-Benz’ scar
  • Complications of steroids: Cushingoid appearance, fingerpick marks on the fingers from diabetes, thin skin
  • Complications of tacrolimus: skin malignancy, hypertension, diabetes, and tremor
  • Complications of ciclosporin: hypertension, hirsutism, and gum hypertrophy
  • Clinical features of underlying disease leading to transplantation (e.g. chronic liver disease)

Rectal (PR) examination

These gastrointestinal conditions may appear in a rectal (PR) examination station:

 

Clinical examination findings

Internal haemorrhoids

  • May see prolapsed haemorrhoids if Grade III-IV, DRE will show soft, compressible masses

External haemorrhoids

  • Visible thrombosed haemorrhoids as bluish, painful nodules at the anal verge, DRE will show tender lumps at the anal verge

Anorectal varices

  • Dilated vein around the anus with enlarged, tortuous and palpable veins on DRE; patients typically have other signs of portal hypertension (e.g. GI bleeding, ascites, splenomegaly)

Anal cancer

  • Typically seen as an ulcerating lump around the anus; firm, irregular mass palpable on DRE

Rectal cancer

  • Cachexia, abdominal mass, tenderness in the abdomen, hepatomegaly (if metastatic); DRE showing blood on glove or a palpable mass if low-lying

Anal condyloma 

Warts

  • Associated with HPV 6 and 11
  • Soft, verrucous. cauliflower-like lesions which are light pink or flesh-coloured, found around or within the anus

Anal skin tags

  • Occur due to previous episodes of inflammation or thrombosed haemorrhoids 
  • Small, soft, skill-coloured protrusions around the anus

Anal fissure

  • Visible tear or ulcer in the anal canal; pain and anal sphincter spasm may make rectal examination difficult 
  • Consider IBD if multiple, recurrent, or non-midline fissures

Anal fistula

  • External opening of the fistula, possible discharge, tract palpable under the skin
  • Consider IBD!

Perianal abscess 

  • Erythema, swelling, fluctuant, tender indurated mass
  • Consider IBD!

Neurosciences

These conditions may appear as part of neurological examination stations:

 

Clinical examination findings

Multiple sclerosis

  • Optic neuritis: blurred vision, eye pain, relative afferent pupillary defect
  • Internuclear ophthalmoplegia (INO): inability to perform conjugate lateral gaze, nystagmus in abducting eye, ophthalmoplegia in adducting eye
  • Cerebellar signs: nystagmus, intention tremor, scanning dysarthria (slow, irregular speech)
  • Sensory abnormalities: paraesthesia, dysaesthesia, Lhermitte’s sign (sudden sensation resembling an electric shock that passes down the back; usually triggered by bending the head forward towards the chest)
  • Motor signs: hypertonia, hyperreflexia, clonus, muscle weakness
  • Uhthoff’s phenomenon: transient worsening of neurological symptoms when the body becomes overheated in hot weather, hot water or exercise 
  • Equipment: possible use of urinary catheter (if bladder dysfunction), mobility aids (e.g. wheelchair)

Ischaemic stroke (established)

  • Motor dysfunction: most commonly unilateral weakness (face, arms, and legs)
  • Facial weakness: unilateral weakness of facial muscles without forehead sparing
  • Spasticity and contractures: increased muscle tone and joint stiffness
  • Reflexes: hyperreflexia
  • Sensory abnormalities: loss of sensation or abnormal sensations on one side of the body
  • Visual field defects: homonymous hemianopia
  • Cognitive and language deficits: dysphasia, hemi-neglect neglect
  • Dysphagia

Parkinson’s disease

  • Facial expression: hypomimia (reduced facial expression)
  • Speech: hypophonia (soft speech)
  • Posture: Stooped posture
  • Tremor: Asymmetrical resting tremor (4-6 Hz), typically “pill-rolling”
  • Movement: Bradykinesia (slowness of movement), cogwheel rigidity
  • Gait: Slow, shuffling gait with reduced arm swing, postural instability, hesitancy, and difficulty turning
  • Handwriting: micrographia (small, cramped handwriting)

Essential tremor

  • Tremor: symmetrical action tremor (postural or kinetic), typically affecting the hands
  • Absence of other neurological signs to suggest alternative diagnosis

Radial nerve palsy

  • Motor dysfunction: wrist drop, wak extension of the elbow, wrist, and thumb
  • Sensory loss: loss of sensation in the posterior arm, forearm, and dorsum of hand
  • Reflexes: absent triceps and supinator reflexes

Median nerve palsy

  • Deformity: ‘Hand of benediction’ deformity (inability to flex index and middle fingers when making a fist)
  • Motor Dysfunction: weak forearm pronation, wrist flexion/abduction, and finger flexion (preservation of flexion at the distal interphalangeal joints of ring and little fingers)
  • Sensory Loss: loss of sensation in the thenar eminence and median distribution of the hand

Ulnar nerve palsy

  • Deformity: ‘Claw hand’ (inability to extend ring and little fingers when extending fingers)
  • Motor dysfunction: Weak wrist flexion/adduction, weak flexion of the distal interphalangeal joints of the ring and little fingers, paralysis of most intrinsic hand muscles
  • Sensory loss: sensory loss in the ulnar distribution of the hand (medial wrist, medial one and one-half digits)

LMN facial nerve palsy

(e.g. Bell’s palsy)

  • Facial weakness: unilateral weakness of facial muscles (with forehead involvement), loss of nasolabial fold
  • Additional findings: hyperacusis, inability to close eye

Obstetrics and gynaecology

These conditions may appear in obstetric & gynaecology examination stations.

Condition Clinical examination findings

Polycystic ovarian syndrome

  • Central obesity
  • Hirsutism
  • Acne
  • Hair thinning or male-pattern baldness
  • Acanthosis nigricans

Pelvic inflammatory disease

  • Lower abdominal pain and tenderness
  • Abnormal vaginal discharge (yellow or green, purulent)
  • Fever and chills
  • Dysuria
  • Cervical motion tenderness during bimanual
  • Adnexal tenderness

Bacterial vaginosis

  • Thin, white or grey, watery PV discharge
  • ‘Fishy’ odour, often more noticeable after intercourse
  • Vaginal itching or irritation (less common)

Uterine fibroids

  • Symptoms of iron deficiency anaemia (fatigue, shortness of breath)
  • Pelvic pressure or pain
  • Irregularly shaped, enlarged uterus on bimanual exam
  • Bloating
  • Constipation

Placental abruption

  • “Woody” / tense uterus
  • Hemodynamic instability (e.g. light-headedness, hypotension, tachycardia)
  • Foetal distress or death

Ectopic pregnancy

  • Sudden, severe, unilateral abdominal pain (typically lower abdomen but consider in all cases of acute abdomen in women of childbearing age)
  • Shoulder tip pain (referred pain from diaphragmatic irritation due to hemoperitoneum)
  • Nausea/vomiting
  • Positive pregnancy test with low or plateauing hCG levels
  • Adnexal mass or tenderness on PV exam

Endocrine

These conditions may appear in endocrine examination stations.

Condition

Clinical examination findings

Hypothyroidism

  • Bradycardia
  • Dry/coarse skin
  • Non-pitting oedema (myxoedema)
  • Thinning of hair
  • Delayed relaxation of deep tendon reflexes
  • Goiter (depending on cause)
  • Hoarse voice

Hyperthyroidism

  • Tachycardia
  • Tremor
  • Warm/moist skin
  • Hyperreflexia,
  • Goiter
  • Exophthalmos (in Graves’ disease), lid lag
  • Pretibial myxoedema (in Graves’ disease)

Cushing’s

  • Hypertension, central obesity
  • Moon facies
  • Buffalo hump and supraclavicular fat pads
  • Thin skin with easy bruising
  • Purple abdominal striae
  • Proximal muscle weakness
  • Hirsutism
  • Acne

Addison’s disease

  • Hyperpigmentation (especially in skin creases, gums, and scars)
  • Hypotension (postural)
  • Vitiligo
  • Dehydration
  • Weight loss
  • Hypoglycaemia

Type 1 diabetes mellitus

  • Dehydration
  • Weight loss
  • Fruity breath (in DKA)
  • Kussmaul breathing (in DKA)
  • Altered mental status (in severe DKA)
  • Signs of autoimmune diseases (e.g. vitiligo, thyroid disorders)

Type 2 diabetes mellitus

  • Obesity
  • Acanthosis nigricans
  • Hypertension
  • Signs of hyperglycaemia complications (e.g. retinopathy, neuropathy, nephropathy)

Renal and urology

Abdominal examination

These renal conditions could appear as part of abdominal examination stations.

Condition

Clinical examination findings

Polycystic kidney disease

  • Abdomen: bilateral enlarged ballotable kidneys, hepatomegaly (due to the growth of hepatic cysts) 
  • Evidence of treatment: peritoneal dialysis catheter or fistula for haemodialysis, renal transplant in-situ
  • Cardiovascular: hypertension, berry aneurysms (may present with signs of subarachnoid haemorrhage if ruptured), anaemia
  • Urinary: haematuria

Renal transplant

  • Skin: thin skin, bruising, fingerpick marks on the fingers from diabetes (Cushingoid – secondary to steroid use) 
  • Evidence of treatment: peritoneal dialysis catheter or fistula for haemodialysis, transplant rejection prophylaxis (e.g. tacrolimus, ciclosporin), palpable transplanted kidney (most renal transplants are sited in the extraperitoneal right iliac fossa)
  • Complications of tacrolimus: skin malignancy, hypertension, diabetes and tremor
  • Complications of ciclosporin: hypertension, hirsutism, and gum hypertrophy
OSCE examiner’s tip

Renal transplant patients are frequently used in OSCEs. They are usually very stable, and they have excellent clinical signs.

Rectal examination

These urological conditions could appear as part of rectal examination stations.

Condition

Clinical examination findings

Normal prostate

  • Texture: smooth (no nodules), palpable central sulcus
  • Tenderness: non-tender 
  • Size: normal size (about the size of a walnut) with symmetrical lobes

Prostate cancer

  • Texture: hard indurated nodules on an otherwise smooth surface, obliteration of the central sulcus 
  • Tenderness: non-tender 
  • Size: enlarged prostate, lobar asymmetry
  • May be associated with inguinal lymphadenopathy 
  • Most prostate cancers are located in the peripheral zone (posterior lobe); therefore, the prostate may feel normal in early disease

Benign prostatic hyperplasia (BPH) 

  • Texture: firm, smooth (no nodules), rubbery or elastic texture, palpable central sulcus
  • Tenderness: non-tender
  • Size: Symmetrically enlarged
  • Most BPH arises in the transitional zone
  • BPH is associated with storage and voiding lower urinary tract symptoms 

Prostatitis

  • Texture: boggy, warm, and swollen prostate 
  • Tenderness: extremely tender; may prohibit DRE
  • If the prostate is ‘fluctuant’ consider the presence of an abscess
  • Acute bacterial prostatitis is associated with concurrent constitutional symptoms (fevers, chills, malaise), acute dysuria and cloudy urine 

Ear, nose and throat

Ear

These urological conditions could appear as part of ear examination/otoscopy stations.

Condition

Clinical examination findings

Acute otitis externa

Swimmer’s ear

  • Tender tragus, pulling up and back on the auricle causes pain
  • Crusting of the external ear canal
  • Otorrhoea
  • Caution: malignant/necrotising acute otitis externa may occur in diabetes or immunosuppression 

Acute otitis media 

  • Fever
  • Otorrhoea (if there is tympanic membrane rupture)
  • Tympanic membrane erythema and bulging
  • Loss of light reflex
  • Retracted and hypo-mobile tympanic membrane +/- effusion 

Cholesteatoma 

  • Retraction pocket with squamous epithelium and debris (brown irregular mass) or white, pearly mass behind the tympanic membrane 

Auricular cellulitis 

  • Erythema, swelling, and warmth of the external ear, particularly the involving the lobule
  • Commonly occurs following minor trauma

Perichondritis 

  • Tenderness, erythema, swelling, and warmth of the external ear – sparing the lobule

Nose

These urological conditions could appear as part of nasal examination stations.

Condition

Clinical examination findings

Epistaxis

  • Anterior bleeds visible at Kiesselbach’s plexus
  • Posterior bleeds are usually more profuse and may drip down the throat

Nasal polyps

  • Smooth, pale, oedematous masses in the nasal cavity

Allergic rhinitis

  • Pale, bluish, oedematous nasal mucosa, allergic shiners (dark circles under the eyes), nasal crease (from frequent rubbing)
  • Commonly associated with asthma or atopic dermatitis

Bacterial sinusitis

  • Tenderness over the affected sinuses
  • Purulent nasal discharge
  • Swelling and redness over the involved sinuses
  • Possible fever
  • Transillumination of the sinuses may show fluid levels or opacification 

Throat

These urological conditions could appear as part of oral cavity/throat examination stations.

Condition

Clinical examination findings

Laryngitis

  • Erythematous and swollen vocal cords seen on laryngoscopy
  • Reduced vocal cord mobility

Tonsilitis

  • Enlarged tonsils with exudates
  • Tender cervical lymph nodes
  • Fever

Peritonsillar abscess (Quinsy)

  • Uvular deviation away from the affected side
  • Unilateral tonsillar swelling
  • Fluctuance on palpation
  • Trismus
  • Fever

Psychiatry

These conditions could appear as part of mental state examination stations.

Condition

MSE examination findings

Depression

  • Appearance: patient may show signs of self-neglect, poor grooming, or signs of self-harm 
  • Behaviour: poor eye contact, psychomotor retardation (slow blinking), withdrawn body language
  • Speech: monotonous, minimal, slow, or slurred
  • Mood and affect: low mood, hopelessness, guilt, blunted affect
  • Thought: negative thoughts, possibly including suicidal ideation; rarely persecutory delusions 
  • Perception: hallucinations in severe depression with psychotic features 
  • Cognition: decreased attention, concentration, and memory; orientation usually intact 
  • Insight and judgement: insight can vary; judgement may be impaired especially with severe depression
  • Mnemonic – SIGECAPS: sleep changes, loss of interest, guilt, lack of energy, impaired cognition, appetite changes, psychomotor agitation or retardation, suicidal ideation

Anxiety

  • Appearance: variable; may be well-kempt or show self-neglect if anxiety impacts daily function; may show hyperactivity (hyper-vigilance) or psychomotor retardation (‘frozen’ with fear)
  • Behaviour: poor eye contact, avoidant, and agitated 
  • Speech: tremulous, rapid in severe anxiety
  • Mood and affect: anxious, tense, frustrated
  • Thought: obsessions, rumination, and excessive worries
  • Perception: generally normal; may experience heightened sensitivity to stimuli
  • Cognition: generally intact but may have reduced concentration and attention
  • Insight and Judgement: insight usually good but anxiety may be disproportionate to the threat; judgement can be impaired by anxiety.
  • Mnemonic – WATCHERS: worry, anxiety, tension of muscles, impaired concentration, hyper-arousal, energy loss, restlessness, sleep disturbance 

Mania

  • Appearance: inappropriately dressed for the weather, flamboyant or bizarre clothing
  • Behaviour: psychomotor agitation, energetic, talkative, and hyperactive
  • Speech: pressured, rapid, difficult to interrupt
  • Mood and Affect: elevated, expansive, or irritable mood
  • Thought: flight of ideas, grandiosity, or delusional thinking
  • Perception: hallucinations or paranoia 
  • Cognition: impaired, particularly in verbal memory and fluency
  • Insight and judgement: impaired insight and judgement are hallmarks of mania
  • Mnemonic – DIGFAST: distractibility, irresponsible actions, grandiosity, flight of ideas, activity increase (hyperactive), sleep deficit, talkative
  • Patients with bipolar disorder may present with features of mania or depression 

Schizophrenia

  • Appearance: variable; may show signs of antipsychotic medication side effects (ADAPT: acute dystonia, akathisia, Parkinsonism, tardive dyskinesia) 
  • Behaviour: engaging with hallucinations, disorganised motor behaviour, catatonia
  • Speech: neologisms, incoherent, excessive, monotonous, loose associations, word salad, tangential, clang associations
  • Mood and affect: blunted, flat, or inappropriate affect; incongruent emotions
  • Thought: disorganised thought, thought possession (insertion, withdrawal, broadcasting)
  • Perception: hallucinations (auditory most common), delusions (grandiosity, ideas of reference, paranoia, persecutory)
  • Cognition: impaired attention; orientation usually intact.
  • Insight and judgement: limited insight, impaired judgement

 

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