How To Ace Your CMTO OSCE Exam: Assessment 1

In this station, you’re going to be given a series of task (you’re NOT giving a clinical impression), just perform everything that is laid out on the stem. Unless stated, you do not need to obtain informed consent for this station. You are required to explain your findings to the client.

For each muscle, make sure you:

• Palpate the origin and insertion. (state the origin and insertion)
• Palpate along the entire length of the muscle (state the muscle).
• Get the client to contract the muscle to confirm it is the correct muscle.
  
• Use 2 landmarks to locate the required muscle or structure  (state the landmark) *Use both clinical and layman terms

1. Palpate Origin and Insertion:

   • Origin: Palpate the coracoid process and the supraglenoid tubercle.
   • Insertion: Palpate the radial tuberosity.
   • Example: "I will palpate from your shoulder to your elbow at the radial tuberosity to feel the biceps muscle."

2. Palpate Entire Length:

   • Palpate from the shoulder to the elbow along the biceps.
   • Example: "I will now palpate along the entire length of your biceps."

3. Muscle Contraction:

   • Have the client flex their elbow to contract the biceps.
   • Example: "Please bend your elbow and flex your biceps. Let me know if you feel any pain."

Examination Example

1. Greater Trochanter

   • What to do: Palpate the greater trochanter, the bony prominence on the side of the hip.
   • Landmarks: Travel from the iliac crest down to the trochanter.
   • Purpose: Check for tenderness or abnormalities.
   • Example: "I will now press on the (greater trochanter) located on the side of your hip. Please let me know if you feel any pain."

2. Head of Radius

   • What to do: Palpate the head of the radius, located just below the elbow on the thumb side.
   • Landmarks: Start at the lateral epicondyle and move to the radial head.
   • Purpose: Assess for tenderness or swelling.
   • Example: "I will gently press around your elbow. Tell me if you feel any discomfort."

3. Palpate C7

   • What to do: Locate and palpate the seventh cervical vertebra, the most prominent bone at the base of the neck.
   • Landmarks: Travel down from the base of the skull along the cervical spine.
   • Purpose: Identify any tenderness or irregularities.
   • Example: "I will touch the base of your skull and work my way down to the most prominent bone at the base of your neck to locate C7. Let me know if you experience any pain."

4. Palpate Distal Attachment of the Biceps Femoris

   • What to do: Palpate the distal attachment of the biceps femoris, found at the back of the knee.
   • Landmarks: Start from the ischial tuberosity and move to the fibular head.
   • Purpose: Check for tenderness or abnormalities.
   • Example: "I will press on the back of your knee. Please indicate if there’s any pain."

5. Biceps Deep Tendon Reflex (DTR)

   • What to do: Perform the biceps reflex test using a reflex hammer.
   • Landmarks: Palpate the biceps tendon in the antecubital fossa.
   • Purpose: Assess the reflex response of the biceps muscle.
   • Example: "I will tap the inside of your elbow with this hammer. Just relax your arm."

6. Myotome C5

   • What to do: Test the C5 myotome by having the client perform shoulder abduction against resistance.
   • Landmarks: Start from the acromion process to the deltoid muscle.
   • Purpose: Evaluate the strength of the deltoid muscle, which is controlled by the C5 nerve root.
   • Example: "I’ll apply some pressure to your arm as you lift it to the side. Please resist my push."

7. Valgus Knee Test

   • What to do: Perform the valgus stress test on the knee by applying pressure to the outside of the knee while stabilizing the ankle.
   • Landmarks: Start from the medial collateral ligament to the joint line.
   • Purpose: Assess the integrity of the medial collateral ligament (MCL).
   • Example: "I will push on the outside of your knee. Let me know if you feel any pain." *if there is no pain state that the test is negative,

8. Homan’s Sign

   • What to do: Perform Homan’s sign by dorsiflexing the foot while the leg is extended.
   • Landmarks: Start from the Achilles tendon to the calf muscle.
   • Purpose: Check for deep vein thrombosis (DVT) in the calf.
   • Example: "I will flex your foot upwards. Tell me if you feel any pain in your calf."

This is obviously just one example of what you may get on the exam, which is why it’s important that you go in, knowing at least 80% of what you’ve learned in school.

• Know your Anatomy 
• Know your orthopaedic test
• Know your landmarks  
• Be confident, charismatic and caring