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The reviews are in
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Don't take our word for it
"The stations you provide are strikingly similar to those I came across during my medical school finals (some even verbatim!), and I have tried many other exam platforms. I'm truly grateful for your priceless support throughout my final couple of years at medical school!"
Raza Q π¬π§
"It has absolutely everything for medical school, so many histories with detailed differential diagnoses, how to approach emergencies, commonly prescribed drugs..every kind go examination youβll ever need in osces"
John R π¬π§
"Thank you SO MUCH for the amazing educational resource. Iβve tried lots of platforms and books with mock OSCE stations and yours is by far and away the best Iβve tried"
Ed M π³πΏ
"Get this right away. So helpful for OSCEs but also general clinical learning and understanding. Wish I had brought it sooner"
Emma W π¬π§
"Without a doubt, your platform outshines all other OSCE resources currently available. In all honesty, I can confidently attribute my success in securing a distinction in my finals to OSCEstop."
Harish K π¬π§
"OSCEstop distinguishes itself from many other platform banks by offering a wealth of questions that mimic the demanding and complex aspects of our finals. This platform played a crucial role in ensuring I was ready for the level of difficulty that awaited me in my final exams."
Ask Patientβs name, DOB and what they like to be called
Explain examination and obtain consent
Expose knees and below
General inspection: patient, e.g. age, pain/discomfort, signs of trauma; around bed, e.g. mobility aids, splint
Look
Gait: speed, stability, gait cycle phases, limb position/movement; check for normal heel-strike/toe-off
Deformities of joint/bones/alignment (examine standing)
Front: hallux deformities(lateral angulation of big toe = hallux valgus), lesser toe deformities (flexed PIP joints = hammer toes; flexed DIP joints = mallet toes; flexed PIP joints and DIP joints with pes cavus = claw toes)
Sides: foot arches (pes planus = flat foot; pes cavus = high arch, usually with clawed toes)
Behind: alignment of hindfoot (5Λ valgus normal)
Tip-toe standing inspection: re-inspect foot arch if there was pes planus (if it corrects on tip-toe standing, it is flexible pes planus; if it does not correct, it is rigid pes planus); observe for big toe flexion (no flexion = hallux rigidus)
Now ask patient to lie down:
Skin: scars, sinuses, swellings, callosities on heels, nail psoriatic changes, feel up extensor surface of lower leg (psoriasis plaques, rheumatoid nodules, gouty tophi)
Muscles: wasting, measure calf circumference 10 cm below tibial tuberosity and compare with contralateral side
Toe deformities
Gout
Hallux valgus (bunion)
Feel
Ask about any pain and then start by examining the normal side.
Skin: palpate general area for temperature and soft tissue swelling/tenderness
Ligaments: deltoid ligament (anteroinferior to medial malleolus), anterior talofibular ligament (anterior to lateral malleolus), calcaneofibular ligament (inferior to lateral malleolus), and posterior talofibular ligament (posterior to lateral malleolus)
Bony landmarks β assess joints for tenderness and feel for bony swellings, effusions, synovitis, deformities
Ankle: medial malleolus, lateral malleolus, anterior joint line
Hindfoot and midfoot: feel around joints in an βnβ pattern (distolateral β proximolateral β across dorsum β proximomedial β distomedial)
Forefoot: feel all joints in circle (tarsometatarsal joints, metatarsal heads, MTP joints and IP joints)
Plantar fascia: feel for thickening, tenderness, fibromatosis
Movements are best assessed with patientβs legs hanging over bed.
Ankle movements (actively, and passively while feeling for crepitus): dorsiflexion 20Λ and plantar-flexion 40Λ; inversion and eversion at subtalar joint (stabilise ankle with one hand and move heel with the other)
Midtarsal movements: hold calcaneus with one hand and abduct (10Λ) and adduct (20Λ) forefoot with your other hand
Curl toes (canβt curl toes in = tendon/small joint involvement)
Abduct (spread) toes and adduct toes (hold paper between)
Move MCP joints and IP joints passively (assess for limited movement and crepitus)
Special tests
Tibialis anterior
Foot inversion and dorsiflexion against resistance
Tibialis posterior
Foot inversion and plantar-flexion against resistance
Peroneus longus and brevis
Foot eversion against resistance
Anterior drawer test
Hold calcaneum still and push lower leg posteriorly (tests anterior talofibular ligament)
Syndesmosis test
Squeeze mid-lower leg to test syndesmosis (pain at distal tibia/fibula joint = syndesmosis injury)
Simmondsβ test
Ask patient to kneel on a chair with feet hanging over edge, then squeeze both calves. Feet should plantar-flex (no plantar-flexion = Achilles tendon rupture).
Mulderβs sign
Squeeze metatarsal heads together in horizontal plane with one hand while applying pressure to the interdigital space with other hand (pain Β± Mulderβs click in 2nd/3rd or 3rd/4th webspace = Mortonβs neuroma)
Function
Balance β stand on one leg (often poor with peroneal weakness/ligament sprains)
To complete
Thank patient and restore clothing
βTo complete my examination, I would examine the knees and perform a distal neurovascular examination.β
Summarise and suggest further investigations you would consider after a full history
You review a patient with an acutely hot swollen and painful first metatarsal phalangeal (MTP) joint. What is your main differential and how would you treat them?