OSCE Check Off Sheet

Completed Did not

EXAMINATION OF THE NOSE Correctly complete
Inspection and Palpation of Nose X X
Asks patient for consent to examine
 External Nose
 Symmetry, deformities, lesions
 Nasal Patency: occlude one side of nose and ask patient to
breathe in
 Internal Nose: using proper technique of otoscope
 Notes symmetry
 Nasal mucosa: color, swelling, bleeding, exudates (note
character)
 Inferior and middle turbinates: color, swelling, polyps
 Nasal septum: deviation, inflammation, perforation,
bleeding, ulcers
Palpation of Sinuses: X X
 Frontal tenderness
 Maxillary tenderness
___/11
9/11 required for competency

Instructor signature__________________________ Date______________

Some ROS to consider for nose complaints (not an exhaustive list)

Chronic nasal problems

Pain
Nasal discharge
Itching
Change in smell

Nose bleeds
 OSCE Check Off Sheet

Completed Did not

EXAMINATION OF THE EAR Correctly complete
Inspection of Auricle X X
 Asks patient for consent to examine
 Inspect: masses, lumps, deformities, skin lesions
 Palpation: Tug test if necessary, palpate mastoid
Inspection of Ear Canal and Tympanic Membrane X X
 Otoscopic Evaluation
 Inspect Ear Canal
 Note discharge, foreign body, redness and swelling,
cerumen
 Inspect Tympanic Membrane:
 Note color, contour, cone of light, handle of malleus,
short process of malleus, pars flaccida, pars tensa
 Test for mobility of TM with pneumatic otoscopy if
necessary
 Observe for fluid levels, erythema, perforations
Auditory Acuity X X
 Whispered voice test
Special Tests X X
 Weber Test (lateralization)
 Use a 512Hz tuning fork
 Strike the tuning fork and place on top of patient’s
head
 Determine if the sound is heard midline, or lateralizes
to one side
 Rinne Test (comparing air and bone conduction)
 Strike tuning fork and place on the mastoid bone
 When sound is no longer heard, place in front of ear
 Determine if AC>BC or BC>AC
___/11
9/11 required for competency

Instructor signature__________________________ Date______________

Some ROS to consider for ear complaints (not an exhaustive list)

Past history of ear disorders

Pain
Change in hearing acuity
Ringing in the ears
Drainage
 OSCE Check Off Sheet

Completed Did not

EXAMINATION OF THE MOUTH Correctly complete
 Have patient remove dentures before starting exam
 Asks patient for consent to examine
Inspection and Palpation X X
 Lips:
 color, moisture, lumps, ulcers, cracking, scaliness
 Oral Mucosa:
 Color, ulcers, white patches, nodules, Stenson’s ducts
 Gums:
 Color, swelling, ulcerations, bleeding
 Teeth:
 Number, discolorations, shape, positioning,
malocclusion
 Roof of Mouth:
 Color, architecture (torus palatinus)
 Tongue:
 Color, texture of dorsum of tongue
 Test for CN12- stick out tongue, look for symmetry
 Floor of Mouth:
 Lesions, ulcers, erythema, nodules, Wharton’s ducts
 Palpation of mouth (oral mucosa and tongue):
 Proper technique with gloves, explanation to patient
 Note: palpate for nodules or any observed lesions
 Pharynx:
 Ask patient to say “ah” – test CN10
 Landmarks: soft palate, anterior and posterior pillars,
uvula, tonsils, pharynx
 Color, symmetry, size (tonsils), exudates, swelling,
ulcers
___/11
9/11 required for competency

Instructor signature__________________________ Date______________

Some ROS to consider for mouth complaints (not an exhaustive list)

Past history or chronic mouth/throat problems

Pain/difficulty swallowing
Tooth pain/problems
Swelling
Post nasal drip
Sores/lesions
Change in taste
Change in voice
 OSCE Check Off Sheet

Completed Did not

EXAMINATION OF THE NECK Correctly complete
Inspection X X
 Symmetry, masses, scars, enlargement of parotid or
submandibular glands, visible lymph nodes, trachea,
thyroid, JVD (to be discussed in cardio)
Palpation of Lymph Nodes X X
Asks patient for consent to examine
 Proper technique using pads of fingers
 Preauricular
 Posterior auricular
 Occipital
 Tonsillar
 Submandibular
 Submental
 Anterior superficial cervical
 Posterior cervical
 Deep cervical
 Supraclavicular
 Note size, shape, delimitation, mobility, consistency,
tenderness
Palpation of Trachea X X
 Deviation
Palpation of Thyroid X X
 Proper technique, use landmarks,
Note: size, shape, consistency, nodules, tenderness
Auscultate X X
 Thyroid for bruits if enlarged
 Carotid bruits (to be discussed in cardiac)
___/9
8/9 required for competency

Instructor signature__________________________ Date______________

Some ROS to consider for neck complaints (not an exhaustive list)

Chronic past neck disorders

Pain, tenderness
Masses, growths or lumps
Change in voice/hoarseness
Sense of lump/mass in throat with swallowing
 OSCE Check Off Sheet

Completed Did not

Pulmonary Examination Correctly complete
 Exam completed in sitting position for posterior chest and
repeated in supine position for anterior chest
General Survey of Chest X X
 Assess respiration: rate rhythm, depth
 Assess for respiratory difficulty
 Cyanosis
 Clubbing of the nails
 Listen to Breathing
 Wheezing
 Stridor
 Inspect neck
 Accessory muscle use
 Trachea midline
 Shape of the chest (AP diameter)
Inspection of Chest X X
 Deformities or asymmetry
 Masses/lesions
 Retraction of muscles
 Impaired respiratory movement
Palpation of Chest X X
 Asks patient for consent to examine
 Identify masses
 Chest expansion/respiratory excursion
 Perform Tactile Fremitus (4 spots)
 Palpate and compare symmetric areas of the lungs
Percussion of Chest X X
 Completes anteriorly and posteriorly
 Uses proper technique
 Palpates using ladderlike patterns noting sound quality,
dull, resonant, hyperresonance
 Determine level of diaphragm (posterior)
Auscultation of the Chest X X
 Uses proper technique
 Auscultates using a ladderlike pattern noting:
Sound quality (Vesicular, bronchovesicular,
bronchial)
 Completes anteriorly and posteriorly
 Notes any adventitious sounds
(Rales, rhonchi, wheeze, friction rub)
 Special Techniques:
 E-A egophony
 Bronchophony
 Whispered pectoriloquy
 OSCE Check Off Sheet

Completed Did not

CARDIAC EXAMINATION Correctly complete
General Survey: X X
 Assess patient’s color, respiratory rate, blood pressure,
pulse and mood
Inspection of Chest X X
 Chest abnormalities
 Abnormal pulsations: bulges, heaves
 Apical impulse (PMI) and Location
 Hepato-jugular-reflux
 Estimating Jugular Venous Pressure (JVP)
 Assess carotid pulse
 Palpates
 Auscultate for bruits
Palpation of Chest X X
 Asks patient for consent to examine
 Palpates and notes character: lifts, thrills
 Palpates for PMI (supine/left lateral decubitus)
 Location
 Diameter
 impulse
 Palpates for right ventricular impulse at right sternal border
and epigastric area
Auscultation: X X
 Performs in supine position
 Proper use of the bell and diaphragm
 Listens in 6 spots with bell and diaphragm,
 Special Maneuvers:
 Left Lateral Decubitus w/ bell
 Sitting up, leaning forward, after full exhalation
 Notes S1 and S2
Notes any abnormal beats (S3, S4)
Notes rate and rhythm
Auscultation of carotid artery (bruit)
 If any murmurs auscultated, note:
Location, timing, duration, shape, intensity, pitch,
quality
 Special Maneuvers:
Standing and Squatting
Valsalva Maneuver
____/14
12/14 required for competency

Instructor signature__________________________ Date______________

 ABDOMINAL EXAMINATION

General:
● Wash hands, explain steps to patient, get consent
● Lay patient supine
● Patient considerations
○ Warm the stethoscope
○ Ask if they need to pee
○ Ticklish?
○ Point to any areas that are painful

Inspection:
● General appearance: patient is comfortable
● Symmetry, Shape of abdomen: protuberant, scaphoid, flat, rounded
● Bulging of flanks, masses, peristalsis, pulses
● Umbilicus: contour, location
● Inspect skin: ecchymosis, scars, rashes, lesions
Auscultation:
● Auscultate all four quadrants
● Auscultate for bruits: abdominal aorta, renal arteries, iliac, and femoral arteries
Percussion:
● Light percussion in all four quadrants
● Percuss for liver and spleen
Palpation:
● Light palpation in all for quadrants for tenderness, guarding, rigidity
● Deep palpation for organs and masses noting size, shape, consistency, tenderness
● Palpate liver, spleen, kidneys, bladder, aorta

Special techniques:
● Shifting dullness (percuss from flanks towards umbilicus)
● Fluid wave (have patient hold their hand midline and tap each flank for fluid wave)
● Mcburner’s point, Rovsing, Obturator, Psoas sign
● Murphy's sign
● Assess for ventral hernias, CVA tenderness
● DRE
 Examination of the Anus, Rectum and Prostate Check Off List

Action Completed Did not

correctly complete
Explain procedures to patient & obtain patient consent
Wash hands and put on gloves
Anus (external)
Position patient correctly, with options including: X
1. On left side with hip and knees flexed
2. Lithotomy (AFAB)
3. Standing, bending forward
---- Spread buttocks with left hand when performing exam
Inspection: X
Lumps
Ulcers
Inflammation
Rashes
Excoriations
Fissures
Lesions
Palpate: X
Lumps
Lesions
Tenderness
Rectum (internal)
Palpation: X
Lubricate gloved index finger of right hand
Explain next steps in procedure to patient, provide reassurance
Gently insert finger, pointing toward the umbilicus
Note sphincter tone
Note any abnormalities of rectal wall, such as: X
Tenderness
Induration
Irregularity
Nodules
Withdrawal finger gently
Provide tissue to patient
Note fecal matter - test for occult blood
Prostate (internal)
Palpation: X
Turn hand (to left & right) during rectal exam to feel prostate
Identify: X
Lobes (2)
Median sulcus
Prostate size
Prostate shape & symmetry
Prostate consistency
Nodules
Tenderness
 Examination of Breast/Axillae Check Off List

Action Completed Did not

correctly complete
General: X
Put patient at ease
Explain and demonstrate procedure to patient before performing
Drape patient properly
Obtains consent to perform exam
Inspection: X
Patient sitting disrobed to waist
Patient assessed in 4 positions X X
Bv h Arms at side
Arms overhead
Hands pressed on hips
leaning forward
Look for- X
Appearance of skin
Color changes Edema, peau d’orange
Venous pattern changes
Siza and Symmetry
Contour ( masses , retraction/dimpling)
Characteristic of the nipple (Size, shape direction, inversion)
Palpation: X
Proper positioning- have pt supine. Patients arm should be behind
head
Technique- X
Use pads of fingers
Use circular motion
Move systematically vertical strip pattern
Include tail of Spence
Note- X
consistency
Tenderness
nodules
Describe nodule location, size, shape, consistency, delimitation,
tenderness, mobility
Palpate nipple noting elasticity
Compress areola for discharge
Axillae: X
Inspect for rash, irritatiom. infection, pigment changes
Palpate for lymph nodes: lateral, central, pectoral (anterior),
subscapular (posterior)
If palpable lymph nodes- Note: size, shape, consistency, mobility
and tenderness
Breast Self Exam: X
Have patient demonstrate technique to you
Discuss importance of BSE
 PELVIC EXAMINATION

To begin:

● Introduce yourself to patient

● Wash hands, put on gloves
● Tell the patient what you’re about to do- inspection, speculum exam, bimanual
● Set up pap smear
● Make sure patient is in proper position (lithotomy)
● Properly draped with drape over thighs and knees
● Watch patient’s facial expression with each step of the procedure for discomfort

Inspection:
● Inspect: mons pubis, labia majora/minora, clitoris, urethra, perineum for inflammation,
ulceration, nodules, swelling or discharge
● Examine opening of the vagina for: discharge, skene’s glands, bartholin’s glands
● Ask the patient to bear down or squeeze vaginal walls while your finger is in the area for
any protruding structures from the vaginal walls.

Speculum exam:
● Warm the speculum
● Add lube to speculum
● Introduce at a 30 degree angle and ask patient to bear down to relax while you gently
apply pressure to the inferior introitus
● Turn the speculum with proper maneuver downwards, open it up and visualize cervix
● LOCK the speculum by turning the knob that’s on the right side of speculum
● Do the PAP smear
● Note color, position, ulcers/nodules, inflammation, polyps, or bleeding/discharge from
cervix.
● Withdraw speculum noting the appearance of the vagina while doing so.

Bimanual exam:
● Lube first ring and middle finger and insert into the vagina
● Palpate abdomen with other hand while identifying:
○ cervix
○ uterus
○ adnexa
● Verbalize rectovaginal exam and rectal exam