Rheumatology examination checklist Checklist for the Rheumatology OSCE PDF

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Rheumatology examination checklist Checklist for the Rheumatology OSCE...

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Musculoskeletal Examination Checklist Achieved Unachieved

Item Wash your hands Greet & Introduce yourself to the patient Explain performance of examination to the patient and obtain consent. Expose the examined parts appropriately (examined joint, the joint above and joint below) Compare both sides Ensure proper position of patient and stand to the right of the patient Ask if the patient has any pain before proceeding

GALS examination: General appearance -

Consider patient’s BMI, nutritional status, state of hydration, Distress. Cushinoid facies, Cachexia, Pallor Gait and posture while standing and walking (Inspect the patient from front, sides, and behind).

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Alopecia Heliotrope rash, periorbital edema Pallor, jaundice, or redness in the eyes Malar rash, discoid rash, telangiectasia Nose: saddle-shaped nasal deformity Mouth: fish mouth, oral ulcers, oral moniliasis Ear: tophi

Face & Hair

The neck cervical and supraclavicular lymph nodes, V-sign, Shawl sign

The back: -

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Inspection: Spinal alignment, scoliosis, cervical lordosis, thoracic kyphosis, lumbar lordosis, alignment of shoulders and iliac crests while standing and walking Ask the patient to do: Cervical movements (flexion, extension, lateral flexion, rotation) Lumbar movements (flexion, extension, lateral flexion, rotation)

In local back examination only) 

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Palpate for tenderness or swelling along the spine, paraspinal muscles, iliac crest and sacroiliac joints.

 Special tests:

Modified Shober’s test (forward bending) Faber’s test Open and closed book test The sciatic nerve stretch test (straight leg raising test) 1

Hands & Arms: -

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Inspection: Dorsum of hand: Gottron’s papules, calcifications, dactylitis, tophi, purpuric eruptions, Nails (ridging, onycholysis, splinter hemorrhages, yellow-pink discoloration, nail bed abnormalities) Palms: palmar erythema, Dupuytrens contracture, mechanic’s hands, vasculitic rash, Muscle wasting (Thenar and hypothenar). Deformities of joints (swan neck, boutonniere, z-shaped thumb, ulnar deviation of MCPs, jaccoud’s arthropathy, arthritis mutilans) Color changes of fingers (Raynaud’s phenomenon, gangrene) Subcutaneous nodules Ask the patient to: Put their hands behind their head and point their elbows out to the side Hold their hands out in front of them, with their palms facing down and fingers outstretched Turn their hands over (supination) Make a fist, opposition of fingers Perform: Grip strength Precision grip MCP squeeze

In local examination only: -

Palpate the joint line, check patient facies for pain and detect any palpable swelling: -Wrists. -Squeeze test (MCP) -Bimanually palpate the joints of the hand (MCPJ/PIPJ/DIPJ/CMCJ) - Range of motion (active and against resistance)

Special tests: - Perform Tinel’s test and Phalen’s test

Lower limbs: -

Inspection: Color changes of toes Muscle wasting, trophic changes LL edema Purpuric eruptions, keratoderma blenorrhagica. Forefoot and hindfoot abnormalities Perform Passive knee flexion, extension passive internal rotation of the hip MTP squeeze Patellar tap 2

Other affected Systems: -

 Chest examination Auscultation of equal air entry bilaterally (check for effusion) Auscultation of abnormal sounds (crepitations, wheezes)

 Abdominal examination -

Palpation for organomegaly Percussion for ascites

 Cardiac examination -

Auscultation of heart sounds and murmurs.

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Muscle tone Muscle power: proximal muscle weakness in myositis or steroid induced myopathy. Reflexes Sensations

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 Neurological examination

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