Makindo Medical Notes

Related Subjects: |OSCE Eye Exam |OSCE Ear Exam |OSCE Abdominal Exam |OSCE Testicular Exam |OSCE Inguinal Exam |OSCE Upper limb Neurology |OSCE Lower limb Neurology

👋 Introduction

• 🧼 Wash your hands before starting.
• Introduce yourself, confirm patient’s name & DOB.
• Explain: “I’d like to examine the nerves in your legs by checking muscle strength, sensation, reflexes and coordination.”
• Gain consent, ensure privacy and patient comfort.

🧰 Equipment Needed

• Gloves
• Reflex hammer ⚡
• Cotton wool/tissue (light touch)
• Disposable pin/neurotip (pinprick)
• 128 Hz tuning fork (vibration sense)

🧠 Clinical Pearls:
– Foot drop = L4/L5 lesion or peroneal nerve palsy.
– Babinski sign = UMN lesion above S1.
– Absent ankle jerk = S1 radiculopathy.
– Stocking distribution loss = peripheral neuropathy (e.g. diabetes).

📚 Background

🪜 Step 1: Inspection

• Check both legs for symmetry, wasting, fasciculations, scars, deformity.
• If possible, observe gait (limping, foot drop, steppage gait).

💪 Step 2: Motor Examination

• Hip: Flexion, extension, ab/adduction against resistance.
• Knee: Extension (quadriceps), flexion (hamstrings).
• Ankle & Foot: Dorsiflexion (tibialis anterior), plantarflexion (gastrocnemius/soleus), inversion/eversion, great toe extension (EHL).

🖐️ Step 3: Sensory Examination

• Light Touch: Cotton wool over dermatomes L1–S1.
• Pinprick: Neurotip along same dermatomes.
• Proprioception: Move great toe up/down with eyes closed.
• Vibration: 128 Hz tuning fork on toe/ankle.

⚡ Step 4: Reflexes

• Patellar Reflex: (L3–L4).
• Achilles Reflex: (S1–S2).
• Plantar Response: Flexor = normal. Extensor (Babinski) = UMN lesion.

🌀 Step 5: Coordination & Gait

• Heel-to-Shin: Smooth, accurate movement = intact cerebellar function.
• Gait: Observe stride, balance, foot clearance. Look for ataxic, spastic, or high-steppage gait.

✅ Step 6: Closure

• Thank patient, redress, ensure comfort.
• Summarise: “On examination there was weakness of ankle dorsiflexion and reduced sensation over L5 distribution, suggestive of possible radiculopathy.”
• Wash hands and document thoroughly.

⭐ Key OSCE Points

• Systematic approach: Inspection → Motor → Sensory → Reflexes → Coordination.
• Always compare left vs right.
• Explain steps clearly to keep patient at ease.
• Relate findings back to spinal levels.

🚫 Common Pitfalls

• Skipping inspection/gait (often gives the first clue).
• Not comparing both sides → miss subtle asymmetry.
• Rushing reflexes → can miss hyporeflexia.
• Not correlating UMN/LMN signs with possible lesion site.

📚 References

• Clinical Examination – Talley & O’Connor
• Geeky Medics OSCE Guide
• OSCEstop – Online practice stations