8/8/2019 GALS EXM

1/2

Year 3 OSCE Teaching Noor Jawad; Muslim Medics

Please note: these are not official mark schemes, and have just been made from our notes. Every effort has been made to ensure accuracy, but some errors may

remain. This is just our way of doing it, feel free to adapt it to what you feel comfortable doing!

The GALS ExaminationName:

Date:

Time taken to complete the examination:

Done

1. Introduces self and states role2. Consent and obtains patients name3. Offers a chaperone4. Exposure of patient (giving them privacy to do so)5. Asks the following questions: What is your occupation? Do you have any pain or stiffness in any joints, muscles

or your back? Do you have any difficulty climbing the stairs? Do you have any difficulty washing or dressing?

6. General inspection for obvious scars, deformities, abnormal posture or muscle wasting7. GAIT: asks patient to walk away and turn and come back, checking for:

Smoothness of movement, abnormalities in gait, normal heel-toe strike, normal turning speed, normalposture and arm swing

8. SPINE: inspect from the back, looking for: Any deformities such as scoliosis Level shoulders and iliac crests Normal cervical and lumbar lordosis

9. Checks muscle bulk in the paraspinals, shoulder girdle, gluteals, calves10. Inspects the popliteal fossa and Achilles tendon11. Feels supraspinatus and lightly squeezes trapezius to test for fibromyalgia12. Runs finger down back to check for tenderness13. Movements:

Side-to-side, rotate upper torso without moving hips Press ear to shoulder Open jaw and move side-to-side Flex and extend neck, rotate head

14. Places 2 fingers on vertebral processes and asks patient to bend over, distance should increase15. ARMS: General inspection for muscle wasting, fasciculations, skin rashes, nodules (on elbows), swelling,

deformity or erythema over the joints, Dupuytrens or thenar wasting in the hand, pitting psoriasis in the nails

16. Feels the temperature of the joints then squeezes across the metacarpals for tenderness17. Movements:

Put hands behind head and push elbows back, touch the small of back, pray with hands together thenback to back

Flex and extend elbows, pronation and supination, flex and extend wrists18. Hands:

Power grip Precision movements (thumb to each finger in turn) Paper test

19. LEGS: General inspection for muscle wasting, fasciculations, skin rashes, nodules, swelling, deformity orerythema over the joints, calluses or ulcers on soles

20. Feels the temperature of the joints then squeezes across the metatarsals for tenderness21. Movements:

Flex and extend hips, knees and ankles Internal rotation at hips and knees Inversion and eversion at the ankle Crepitus and bulge test at the knee

22. Thanks patient, offers to help them dress23. To complete my examination, would like to do a full neurological examination of the upper and lower limbs and

a full cranial nerve exam

24. Presents findings in a clear and fluent mannerTotal (out of 24)

Any Other Comments:

8/8/2019 GALS EXM

2/2

Year 3 OSCE Teaching Noor Jawad; Muslim Medics

Please note: these are not official mark schemes, and have just been made from our notes. Every effort has been made to ensure accuracy, but some errors may

remain. This is just our way of doing it, feel free to adapt it to what you feel comfortable doing!

The Script

Thank you for letting me examine this 21-year old student. The patient doesnt have any pain or stiffness in any of

his joints, muscles or back. He has no difficulty climbing stairs or washing and dressing. On general inspection, there

were no obvious scars, deformities, abnormal posture or muscle wasting. On examination of the patients gait, there

was smoothness of movement, no abnormalities in the gait, a normal heel-toe strike and normal turning speed.

Posture and arm swing were normal. On inspection of the spine, there were no obvious deformities such as

scoliosis. There was a normal cervical and lumbar lordosis, and the iliac crests were level. On inspection of the

muscle bulk, it was normal in the paraspinal, shoulder girdle, gluteal and calf muscles. There were no bulges in the

popliteal fossa and the Achilles tendon appeared to be normal. There was no evidence of fibromyalgia or vertebral

tenderness. All movements of the spine were normal. On bending over, the space between the lumbar vertebrae

increased as normal. On general inspection of the arms, there was no muscle wasting, fasciculations, skin rashes,

nodules. There was no swelling, deformity or erythema over the joints. There was no evidence of Dupuytrens or

thenar wasting in the hand, or pitting psoriasis in the nails. The joints were cool in temperature and there was no

tenderness on squeezing the metacarpals. All movements of the arms were normal. On testing the small muscles of

the hand, the power grip, precision fine movement and the paper test were normal. On general inspection of the

legs, there was no muscle wasting, fasciculations, skin rashes, nodules. There was no swelling, deformity or

erythema over the joints. There were no calluses or ulcers on the soles. The joints were cool in temperature and

there was no tenderness on squeezing the metatarsals. All active movements of the legs were normal. There was

no evidence of crepitus at the knee or fluid. In summary, this patient had normal gait, arms, legs and spine. To

complete I would like to do a full neurological examination of the limbs and a full cranial nerve examination.