How to examine a patch lesion- OSCE guide

1 Elicit history of Itching, numbness, course of the lession.

2. Inspect and note: site. size, shape, number, margins (ill or well-defined).surface (flat or raised), pigmentation,scaling, central clearing.

3. Examine for sensory loss and regional nerve thickening (if relevant).

4. Comment on the possible diagnosis.

5. Do one specific test to confirm the diagnosis, e.g. sensory loss in Hansen's patch.

Note

1. Patch refers to a flat lesion with a colour different from the surrounding skin. It is large and > 2 cm in diameter. It is called a macule,  it is < 2 cm.

2.. Common causes of patch lesions are dermatophytosis. leprosy and psoriasis.

OSCE guide for Hess test (tourniquet test)

1. Expose one upper limb adequately.

2.Use adequate lighting.

3.Tie the sphygmomanometer ruff around the arm.

4.Mark out a circle of 3 cm diameter on the forearm about I cm below the cubital fossa (where there are no petechiae).

5. Raise the cuff pressure to midway between systole and diastole.

6. Maintain pressure for 5 to 7 minutes.

7. Deflate the cuff and wait for 2 to 3 minutes (for congestion to disappear).

8. Count the number of petechiae in the marked out area

Note

1.The diameter of an old one rupee coin is about 3 cms and it can be conveniently used to draw the circle

2. Normally, upto 10 petechlae can occur in the mentioned area. More than 20 arc definitely abnormal. Note that petechiac can vary in size from pin point to pin head or larger.

3.. The tourniquet test is positive in most cases of thrombocytopenia and in increased capillary fragility. It is anessential part of examination in any patient with bleeding disorder.

These steps are very important for those students who are preparing for USMLE and MRCP

OSCE guide for examination of thoracic outlet syndrome

OSCE steps for examination of thoracic outlet

1. Expose the- neck and upper torso well.

2. Palpate the supraclavicular fossae for tender spots,masses, muscle spasm and vascular thrill.

3. Perform Adson manoeuvre

• Patient sits with forearms supine and resting on the thighs.
• Palpate the radial pulse on the right side.
• Ask the patient to look up. turn the chin to the right and breathe deeply.
• Note transient disappearance of the radial pulse during deep inspiration.
• Repeat the lest on the left side.

4. Observe and note any small muscle wasting or sensory loss of C8segment.

5. Ask the patient to abduct and externally rotate the shoulder, and note Intensification of sensory symptoms and signs

This examinations steps are very important for those students preparing for USMLE and MRCP clinical examination