Alhamdulillah, the orthopaedic OSCE went well although I screwed up at the first station. (Of course, the exams always went well, but the students like me who always screwed them up!)
We had 2 stations for Orthopaedic and this exam has 20% contribution to the clinical part of BCh (Bachelor of Surgery). The Other 30% comes from Final Surgical OSCE in May and 50% from Surgical Long Case in June. We only have 5 minutes in each station.
Actually, the first station was EASY and SIMPLE. But for some reason, I could not perform the best. (Macam biasalah, gelabah macam apa… isk! The surgeon even asked me whether I was ok~)
Question 1: “The patient came in with complaint of pain on the right knee. Please examine the knee.”
Significant findings: Medial joint line tenderness and Positive Anterior drawer test and Lachman’s test. Impression/Diagnosis: Medial Meniscal tear and Anterior Cruciate Ligament tear of the right knee.
Question 2: “Examine the right hand of this patient.”
Me: There’s fixed-flexion deformity ….
Mr AC: How do you know that it’s a fixed-flexion?
Me: Ah, I mean, there’s flexion deformity of the DIP on the 4th digit.
Mr AC: ok, go on.
Me: There’s marked wasting of dorsal interossei muscles and wasting of hypothenar muscles. But no scar, swelling or sinus on the right hand.
Mr AC: How many dorsal interossei muscles are there?
Me: Er… (Counting the muscles on my hand) Four? Uh! No, Seven.
Mr AC: Good. What’s your impression?
Me: Ulnar nerve injury of the right hand.
Mr AC: Please convince me that it’s an ulnar injury.
Me: Em, he has positive Froment’s sign.
Mr AC: What do you mean by that?
Me: He used his right Flexor Pollicis Longus instead of right adductor pollicis muscle to hold the paper against resistance.
Mr AC: What else?
Me: Weak adduction and abduction of the phalanges.
Mr AC: Some more?
Mr AC: How about the sensory?
Me: The sensory is intact. No discrepancy of the sensation on both hands.
Mr AC: So, what is…. (The bell rang!). You may go now.
Was quite disappointed because I did not get the chance to give my provisional diagnosis – Low ulnar lesion of the right hand.
BUT still, Alhamdulillah ‘ala kulli haal.