Physical examination couplet station example

Physical Examination Station

What the candidate reads

Candidate’s Instructions
Joseph Trans, 12 years old, has been brought to your office with a history of right hip pain which occasionally radiates to the knee.

In the next 5 minutes, conduct a focused and relevant physical examination.

As you proceed, explain to the examiner what you are doing and describe any findings.
At the next station, you will be asked to answer questions about this patient.

What the examiner completes

Examiner’s Checklist
Fill in the bubble for each item completed satisfactorily

	1.	Observes patient walking
	2	Examines stance
		- looks at leg lengths and measures
		- checks for Trendelenburg sign [standing on each leg alternately]
	3.	Examines hips
		- palpation
		- flexion
		- extension [patient on side or front]
		- internal rotation
		- external rotation
		- abduction
	4.	Examines knees
		- palpation
		- flexion

Did the candidate respond satisfactorily to the needs/problem(s) presented by this patient?

If unsatisfactory, please specify why:
(For items 4-6, please explain below)

Satisfactory

Borderline

Good

Excellent

Unsatisfactory

Borderline

Poor

Inferior

Inadequate medical knowledge and/or provided misinformation
Could not focus in on this patient's problem
Demonstrated poor communication and/or interpersonal skills
Actions taken may harm this patient
Actions taken may be imminently dangerous to this patient
Other

Do you have concerns regarding this candidate's ethical and/or professional behavior?
Yes (please specify) No

What the candidate receives

Post-Encounter Probe

Q1. Examine the antero-posterior / frog x-ray of both hips of this patient. List the abnormalities, if any. If normal, state so.

________________________________________________________________

Q2. What is the most likely diagnosis?

________________________________________________________________

Q3. What is the appropriate management of this patient?

________________________________________________________________

What the Post-Encounter Probe marker receives

Answer Key
Candidates are provided with the antero-posterior / frog x-ray of both hips for this patient.

Q1.	Examine the antero-posterio / frog x-ray of both hips of this patient. List the abnormalities, if any. If normal, state so.
		Score
A1.	Posterior inferior slip of epiphysis of metaphysis	4
	Slipped epiphysis	3
	Mention made in any way of opposite side (bilateral approx. 50% in this condition)	1
	Abnormality of the hip	1
	Maximum	4

Q2.	What is the most likely diagnosis?
		Score
A2.	Slipped epiphysis OR slipped capital femoral epiphysis	4
	Arthritis	1
	Septic hip	0
	Trochanteric bursitis	0
	Tendinitis	0
	Legg-Calvé-Perthes	0
	Maximum	4

Q3.	What is the appropriate management of this patient?
		Score
A3.	Medication OR urgent referral to orthopedic surgeon within 1 week	3
	Crutches until sees orthopedic surgeon	1
	Elective referral to orthopedic surgeon	0
	Decrease activity, stop gym before consultation	0
	Anti-inflammatory medication only	0
	Maximum	3