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Knee OSCE Examination Quiz

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You have finished inspecting, palpating, moving and performing special tests on a patient's knee. How should you complete the examination?

Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the nerves and blood supply of both legs, and suggest investigations guided by the findings. Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the nerves and blood supply of both legs, and request blood inflammatory markers as the standard completion step. Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the pulses in both legs, and suggest investigations guided by the findings. Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check sensation, power and reflexes in both legs, and suggest investigations guided by the findings. Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the nerves and blood supply of both legs, and arrange an MRI scan as the standard completion step.

A Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the nerves and blood supply of both legs, and suggest investigations guided by the findings. ✓
B Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the nerves and blood supply of both legs, and request blood inflammatory markers as the standard completion step.
C Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the pulses in both legs, and suggest investigations guided by the findings.
D Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check sensation, power and reflexes in both legs, and suggest investigations guided by the findings.
E Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the nerves and blood supply of both legs, and arrange an MRI scan as the standard completion step.

The answer is A: Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the nerves and blood supply of both legs, and suggest investigations guided by the findings.

Explanation

Why A is correct

See Introduction. Option A is correct. A good finish shows courtesy, infection control and clinical reasoning. Thank the patient and let them dress, wash your hands, then summarise what you found. Next, say what else you would do. Examine the joints above and below the knee, because hip problems can present as referred knee pain (pain felt in the knee although the problem lies elsewhere), and the hip is also examined when you need to tell a knee flexion deformity from a hip one. Check the nerves and blood supply of both legs (a neurovascular assessment: pulses, sensation and power), which shows whether the injury or disease has affected the vessels or nerves running past the knee. Finally, choose investigations to fit your findings, for example an X-ray, an ultrasound or an MRI scan, picked to answer the question that your findings raise. A plain-language aid: look above and below, check the blood and nerve supply, and let the findings choose the tests.

Close: thank the patient, let them dress, wash your hands and summarise the findings
Joints above and below: hip problems can refer pain to the knee
Neurovascular check: pulses, sensation and power of both legs
Investigations: choose them to fit your findings

E includes the correct closing steps, adjacent joints and neurovascular assessment, but arranging an MRI scan as a standard completion step is not justified because imaging should be guided by the findings. B includes the correct closing steps, adjacent joints and neurovascular assessment, but inflammatory markers are not routine after every knee examination; they are requested when an inflammatory or infective cause is suspected. C includes the correct closing steps, adjacent joints and investigations, but checking the pulses alone omits the nerve supply; a full neurovascular assessment requires neurological function and blood supply. D includes the correct closing steps, adjacent joints and investigations, but checking sensation, power and reflexes without pulses leaves the blood supply unassessed.

Why the other options are incorrect

B. Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the nerves and blood supply of both legs, and request blood inflammatory markers as the standard completion step.: This plan includes the correct closing steps, adjacent joints and neurovascular assessment, but inflammatory markers are not routine after every knee examination. They are requested when an inflammatory or infective cause is suspected.
C. Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the pulses in both legs, and suggest investigations guided by the findings.: This plan includes the correct closing steps, adjacent joints and investigations, but checking the pulses alone omits the nerve supply. A complete neurovascular assessment must include neurological function and blood supply, so this is incomplete.
D. Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check sensation, power and reflexes in both legs, and suggest investigations guided by the findings.: This plan includes the correct closing steps, adjacent joints and investigations, but it checks sensation, power and reflexes without checking pulses. Blood supply must be assessed, so omitting pulses leaves the neurovascular assessment incomplete.
E. Thank the patient and let them dress, wash your hands, summarise your findings, examine the hip, ankle and foot, check the nerves and blood supply of both legs, and arrange an MRI scan as the standard completion step.: This plan includes the correct closing steps, adjacent joints and neurovascular assessment, but it makes MRI a routine final step for every knee. Imaging should be selected to answer the question raised by the findings, so an MRI scan is not the standard completion step.

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More questions from this set. Start the quiz to answer them and see each explanation.

1
A 24-year-old woman has twisted her knee playing netball. The knee looks only mildly swollen and the patellar tap is negative, but you suspect a small effusion. Which manoeuvre is best for detecting it?
2
A 19-year-old woman has a suddenly painful, swollen knee. Before palpating, you ask again about pain and watch her face. Which technique is best for assessing whether the joint is abnormally warm?

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