osce diagnostics questions and answers latest upda
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OSCE DIAGNOSTICS QUESTIONS AND ANSWERS LATEST
UPDATE A+ GRADED
FINDICAATERS - the diagnostic sieve
Functional
Inflammatory/ infection
Neoplasia
Degenerative
Infectious
Congenital
Auto immune
Arterial/ venous / blood
Trauma
Endocrine/ metabolic / nutrition
Referred
pSycosocial
Diagnostic reasoning model
1. Case Hx
2. Key questions
- Red flags
- Not within scope, non neuromuscular —> referral
3. Whole body screening - FMS, SFMA, active regional
4. Is it Pain - Patho-anatomical
- Then find the driver of the pain?
- Centrally mediated pain could be out of scope (check yellow flags), check timeline if
pain persists well past tissue healing time (CRPS, Fibro)
- If peripherally mediated?
- Then carry out special tests, clearing tests, seek clinical prediction rules
- Does this injury need imaging or does it need referral more management eg -
Reactive/ arthritis or rheumatism
- Come to a probable diagnosis "named condition
5 - Is it dysfunctional (can be both Pain & dys), this is if you suspect the underlying
aetiology of the pain or presentation is a dysfunction
- Regional focus
- check patterns and archetypes, morphotypes, what are their meaningful tasks,
observation, gait
- Passive movements: quality, range, end feel, pain-behaviour
- Special tests
- Pain provocation
Notes - Both pathoanatomical and dysfunction can be parallel and and reciprocal
processes, we need to figure out
, - did the injury cause the dysfunction or the dysfunction cause or lead to the injury,
- Either way addressing the dysfunction is helpful so long as the injury is not acute as
normal splinting around acute pain is normal but we need to be aware that antalgic
patterns that persist can lead to dysfunction and poor healing: IE stress shielding cycle
of tendon injury.
EXAMPLE OF WORKING HYPOTHESIS:
"Patient has sore neck from 'tweaking it' at work two weeks ago, but the pain seems to
persist when he is studying for long periods"
Neck muscle sprain exacerbated by 'dysfunction' of sitting position, from this working
hypothesis, we can then go back and test it with orthopedic tests, neuro, active and
passive exam, look at his study posture etc.
Must Know Generic Red Flags
1 - Onset of new complaint under age 20 years or over 50 years
2 - Persistent night pain (cancer)
3 - Constant unremitting pain (Cancer)
4 - Pain that does not change with position or movement (Cancer, RA)
5 - Loss of appetite (GI, Chronns)
6 - Past history of Malignancy
7 - Shortness of Breath (COPD)
8 - Constant unexplained fatigue (cancers)
9 - Chest Pain (Angina)
10 - Constant and severe extremity pain (DVT)
11 - Swelling in the extremities and abdomen with Hx of injury (CVD)
12 - Changes in colour of the hands and feet (Raynauds, Scleroderma)
13 - Frequent Sever Abdominal pain (Ulcerative Cholitis, Chronns, Cholosystitis,
Dysmaneuria)
14 - Changes in Bladder Function (Cauda Equina, Connus Medularis Syndromes)
15 - Fever and or Night sweats (cancer, Sleep Apnea, Dyspnea related illnesses CVD,
Resp)
16 - Recent onset of headache without history of injury or trauma (Subarractoid
hemorrhage, CeAD)
17 - Sudden severe Neck Pain with no Hx of trauma or injury (VBI, CeAD, cranial
hemorrhage)
18 - Changes in Vision, speech and/ or hearing (Neurological illness, dementia, CTE,
complications of late Pagets, Giant Cell arteritis, subcranial meningioma)
19 - Changes in balance and coordination (cerebellar ataxia, VBI, Vertigo)
20 - Sudden Weakness (Neuropathy, DVT, TOS, other neuro)
21 - Progressive neurological Sx (Dementia, Brain tumour)
22 - Neurological Sx over more than one dermatome (Spinal cord injury, MS, Cauda
Equina, Neuropathy)
23 - Bilateral neurological Sx (Cauda Equina, Sever Spinal Cord damage —> polio, MS,
Guillane Barr Syndrome, Myasthenia Gravis, mm Dystrophy,
Musculoskeletal Red Flags
M - edical Hx of malignancy
U - sed and abuse drugs, HIV, immunosupression
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