Medical Council of Canada

Physical examination couplet station example

Physical examination couplet station example

This page gives you an overview of the different parts of a physical examination couplet station. The candidate instructions, posted outside the door and also available in the station, and the examiner’s checklist are provided. At the bottom of the page, we provide the patient-encounter probe questions and the answer key.

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 6 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

 

If UNSATISFACTORY, please specify why:
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: _________________________________________________________

 

Did this candidate demonstrate a lapse in professional behaviour? Yes No
Disrespectful to others (e.g., to patient, nurse)
Over-investigated / over-managed the patient
Actions raised ethical and / or legal concern
Briefly describe the behaviour for any of the above reasons or any other observed lapse:_________________________________________________________

Patient-Encounter Probe questions

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?
________________________________________________________________

Patient-Encounter Probe answer key

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

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