#7550 - Neuro Upper Gait Presentations At Osce - Medical Finals & OSCEs Notes

Presentations at OSCE

Neuro upper limb examination:

I have done an upper limb neurological examination of [name]’s, a [age] [gender]’s, [occupation]. On inspection I noted

• no paraphernalia of neurological disease

• paraphernalia of neurological disease, a [paraphernalia] etc.

• paraphernalia of disease, a [blood sugar testing kit], etc.

and

• no signs of disease in the upper limbs such as wasting or fasciculation

• signs of disease in the upper limbs:

  • [muscle fasciculation]

  • [muscle wasting]

  • [an abnormal position]

  • [scars]

  • [skin changes]

  • [resting tremor]

  • [pill rolling fingers]

  • [Dupuytren’s contractures, perhaps indicating alcohol excess]

  • [winging of scapulae]

On testing the tone and power, I found

• [Decreased/increased] tone [symmetrically/in the left/right arm]

• that was [rigid/spastic] as it was present [throughout the range of movement/on initial movement only]

• [There was cogwheeling in the wrists]

• Normal tone [symmetrically/in the left/right arm]

• Decreased power [symmetrically/in the left/right arm]

• Normal power [symmetrically/in the left/right arm]

• [Bradykinesia]

In terms of reflexes, I found

• Normal symmetrical reflexes

• [decreased/increased] reflexes [symmetrically/in the left/right arm]

• I did not elicit the [bicuspid/tricuspid/supinator reflexe(s)]

Testing coordination, I found

• Normal coordination

• Abnormal coordination

  • [past-pointing]

  • [dysdiadokinesia]

  • [intention tremor]

  • [bradykinesia]

On testing sensation, I found

• No sensory abnormalities

• A glove and stocking peripheral defect to [level]

• Fine touch loss in the [side][dermatome]

• Proprioceptive loss on the [side] to [level]

• Vibration sense [normal/impaired to [level]/in the left/right arm/symmetrically]

In conclusion I suggest that....

Gait examination

I have examined the gait of [name]’s, a [age] [gender]’s, a [occupation]. On inspection I noted

• no paraphernalia of neurological disease

• paraphernalia of neurological disease, a [paraphernalia] etc.

• paraphernalia of disease, a [blood sugar testing kit], etc.

• paraphernalia of mobility problems, [crutches, a wheelchair, etc.]

and

• No signs of neurological disease

• [muscle wasting][muscle fasciculation]

• [scars][ulcers][varicose veins]

• [truncal ataxia]

• [resting tremor][pill rolling tremor]

• Overall, the patient had [tremor][akithisia][spasticity][hypomimia]

On asking [name] to walk, I noted that the gait was

• [Slow]

• [Shuffling]

• [Festinating]

• [Had reduced range of movement]

• [broad-based]

• [unstable]

• [scissoring]

I also noticed that

• [s/he had festination]

• [that s/he had a reduced height of step]

• [s/he did not swing her arms]

• [there was foot drop]

• [s/he froze]

• [s/he had difficulty initiating movement/turning]

• [there was...