Lower Limb Neurological Examination – OSCE guide (New Version)

Lower Limb Neurological Examination – OSCE guide (New Version)


hi there Dave Margiela and one of the medical students oh can I just confirm your name and date of there yes it’s a hairy hook so plate 493 okay Harry do you mind if today we examine your lower limbs it’s going to involve me moving your legs a bit and asking you to walk I’ve got me okay that’s perfect okay for this examination I’m going to need you just to roll your shorts up for me and if you just lie back on the bed when you’re ready okay thank you are you in any pain at all okay I’m just going to start by having a look from the end of the bed so I’m going to start off by assessing your walking are you able to walk an aided yes okay can you just swing your legs inside of the bit for me okay just cross your arms over your chest like this and just stand up without using your hands fantastic thank you so if you can start by walking towards the couch and turn round and now if you walk with one foot in front of the other please okay and now walk on your tiptoes okay and I walk on your heels can ask you to put your feet together your hands by side I’m going to ask you to close your eyes as well I’m here to capture if you feel unsteady and just open your eyes up for me thank you I’m just going to check the tone in your legs now can you just let your legs go floppy for me so I’m just going to move your ankle now if you can just let your foot go floppy I’m just going to lift your leg same on the other side thank okay Harry I’m just going to test the strength in your legs now so if you can start by just lifting this leg up for me okay and stop me from pushing it down good and just lift this other way for me and stop me from pushing it down good okay and push this one against the bed for me okay and push this one against the bed for me good so if you push your legs together and push them apart I’m just going to bend one of your legs okay and if you can bring your ankle towards your bottom for me okay and stop me from straightening your leg good okay the same on the other side bring your ankle towards your bottom and stop it from straightening your leg good okay once again we’re going to bend it now if you kick out against me try and straighten your leg good and kick out against major in and straighten your leg excellent okay so now if you can bring your toes in towards you and stop me from pushing down good and same on the other side bring them towards you and stop me from pushing them down good now push down against my hand okay and push down against my hand okay now bring your big toe in towards you and stop from pushing it down good and stop me from pushing it down now if you can just push your foot in against my hand okay and push your foot in and get to my hand and push your foot out to get to my hand and out again to my hand I’m going to test your reflexes now which is going to involve me tapping just with a small tendon hammer on pops of your legs okay so I want you to let them let your legs go floppy for me okay let me take the weight same on the other side just let it go floppy let me take the weight and if you can bend this leg and just let it flop out to the side for me and just relax your ankle to let it your floppy for me same on the other side for me head up to the side okay I’m just going to run blunt end of this mural tip just against the soloing feet it might be a little bit ticklish okay okay thank you very much I’m going to test the sensation in your legs now I’m going to start off by using this piece of Miss whisper cotton wool okay so it’s going to kill like this can you feel that yes so I want you to say yes when you can feel it in your legs and I want you to close your eyes for this okay okay yes yes yes yes yes yes yes yes yes yes did that feel the same on both sides yes it is okay now you do the test sensation with a pin it’s going to feel sharp it won’t taste the skin okay all right so it’s going to feel like this can you feel that yes okay now I want you to close your eyes now when you say yes when you can feel it on your legs looking yes yes yes yes so I’m going to test the vibration sensation in your legs now I’m going to use this tuning fork okay it’s going to feel like this can you feel that vibrating yep okay okay that’s one so I’m going to test that vibration sensation in your legs I want you to say yes when you can feed it vibrating now if you just close your eyes for me yes and tell me when it stops stopped good okay and the same again tell me when you can feel it vibrating yes and tell me when you feel the vibration stopped stopped good I’m going to test the joint sensation now it’s going to involve me moving your big toe up and down okay so good this will be up yep and that we down and I want you to close your eyes and tell me whether I’m moving it up or down or okay up down up good to the same on this side so this is up looking that’s down I want you to tell me whether I’m moving up or down sure up up down good thank you we’re going to test some of your coordination now I want you to put this ankle on the other knee bring it down your leg lift it off and go back to uni and run it down your leg and keep going in a circle that’s as quick as you can that’s fine now with the other ankle I want you to touch your knee run it down your leg lift it off and go back and keep doing this circuit that’s not a tester thank you so now I’m just going to ask you to tap your feet against my hands as quick as you can that’s great thank you that completes the examination thank you very much for your shoes and socks back on thank you thank you I performed a lower limb neurological examination on Harry a 21 year old gentleman on inspection there was no abnormal posturing or deformities noted and no muscle wasting or fasciculations tone was normal throughout and Pao was 5 out of 5 in all muscle groups bilaterally reflexes were normal and present at the knees ankles and the planters were down going bilaterally the coordination was intact and sensation was normal in all modalities tested the gait was normal unassessed so in summary this is a normal lower limbs neurological examination to complete my examination I would examine the cranial nerves and the upper limbs neurologically

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