OSCE Cases
- General OSCE Tips
- Head & Neck OSCE Stations
- Respirology OSCE Stations
- Cardiovascular OSCE Stations
- Gastroenterology OSCE Stations
- Peripheral Vascular OSCE Stations
- Neurology OSCE Stations
- Musculoskeletal OSCE Stations
- Psychiatry OSCE Stations
- Urology OSCE Stations
- Geriatrics OSCE Stations
- Women’s Health OSCE Stations
- Pediatrics OSCE Stations
Peripheral Vascular OSCE Stations
You are seeing Ms. Richards, a 75 year old female, in the ER. She is distraught because she is presenting with a two hour history of complete left leg paralysis. Please perform a focused history and physical examination.
History
- Onset and duration of paralysis
- Associated sensory loss
- History of trauma to leg
- Leg swelling
- Pain in leg
- Parasthesias in leg
- Numbness in leg
- Shortness of breath
- Chest pain
- Head trauma
- Weakness elsewhere in the body
- Sensory loss elsewhere in the body
- Vision or speech changes
- Personal history of myocardial infarction and stroke
- Peripheral vascular disease
- Diabetes
- Dyslipidemia
- Hypertension
- Smoking history (quantity in pack-years)
- Medications/Allergies
- Family history of cardiac or cerebrovascular events
Physical Examination
Inspection
- Comments on color of affected limb (pale)
- Inspects for hair loss/lack of oil on affected limb
- Inspects for arterial and diabetic ulcers on feet bilaterally (small ulcer on bottom of 1st toe)
- Inspects for leg swelling
Palpation
- Palpates affected limb for tenderness
- Compares temperature in lower limbs
- Assesses sensation in both lower limbs
- Assesses power in both lower limbs
- Assesses capillary refill in affected limb
Auscultation
- Auscultates bilaterally for femoral and popliteal bruits
- Auscultates abdomen for aortic aneurysm
You are seeing Ms. Richards, a 45 year old female, in the ER for a two day history of right leg pain. Please perform a focused history and physical examination.
History
- Onset and duration of pain
- Severity of pain
- Location of pain
- Alleviating and aggravating factors
- History of trauma to leg
- Leg swelling
- Neurologic symptoms in affected limb
- Association with shortness of breath
- Fever
- Diaphoresis
- Chest pain
- Hemoptysis
- Personal history of clotting disorders
- Personal history of malignancy
- Pregnancy history
- Use of hormone replacement or oral contraceptive pill (patient uses OCP)
- History of immobilization
- Recent leg trauma
- Medications/Allergies
- Smoking history (quantity in pack-years)
- Family history of thromboembolic disease (DVTs, PEs)
Physical Examination
Inspection
- Inspects for swelling, edema
- Inspects for erythema and varicosity in affected limb
- Inspects for venous ulcers in lower limbs
- Inspects for joint effusions in affected limb
Palpation
- Palpates affected lower limb for tenderness
- Compares limbs for warmth
- Measures and compares calf circumference for each limb
- Assesses sensation in affected limb
You are seeing Mr. Perera, a 68 year old male, in an outpatient clinic. He’s coming in today because he’s been getting pain in his legs for the last few months, and it’s getting worse. Please take a focused history of his complaint.
History
- Onset and duration of pain
- Quality of pain
- Aggravating factors (pain is elicited by walking)
- Distance travelled that elicits pain (2 blocks)
- Alleviating factors
- Intensity of pain
- Radiation of pain
- Pain at night
- Neurologic symptoms, such as numbness or parasthesias
- Leg trauma
- Asks if both legs are affected (yes)
- Foot ulceration
- Lower limb infection
- Shortness of breath
- Recurrent chest pain
- Personal history of myocardial infarction and stroke
- Peripheral vascular disease
- Diabetes
- Dyslipidemia
- Hypertension
- Smoking history (quantity in pack-years)
- Family history of cardiac or cerebrovascular events
- Effect on daily activities