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OSCE Prep 6
Respiratory Exam
| Mixed | Mixed |
|---|---|
| What do you look for in general inspection? | Does the pt look unwell, cachetctic, in pain? Do they use accessory muscles, work of breathing Any inhalers or nebulisers or are they on oxygen Scars |
| What do you listen for in first minutes? | Audible stridor, hoarseness, pattern of speech |
| What is stridor? When do we hear? | - Loud, harsh, high pitched respiratory sound - Usually on inspiration - Upper airway obstruction |
| What is erythema nodosum | Erythema nodosum is a condition that causes painful patches of skin that look red or darker than the surrounding skin. |
| What causes erythema nodosum? | Resp infections like tuberculosis or crohn's disease |
| What do you examine on hands? | Inspect, palpate for warmth and venodilation Flapping tremore and fine tremor palpate radial pulse (rate an rhythm) |
| What do you inspect in face? | Central cyanosis |
| What do you inspect in hands? | Tar staining, nail clubbing |
| What are respiratory causes of clubbing? | Bronchial carcinoma Mesothelioma Chronic suppurative lung disease -Bronchiectasis -Lung abscess -Empyema PF CF |
| What is 'Ruddy' complexion | Ask Chris |
| What is Horner's Syndrome link to resp? | Apical lung cancer, press on sympathetic nerves thus cause horner's syndrome (pancoast's tumor) |
| What might cause fine tremor? | Excessive use of B-agonists |
| What might cause flapping tremor? | – Severe ventilatory failure with CO2 retention |
| What are some shape symmetry abnormalities to look for? | – Deformity (kyphoscoliosis / pectus excavatum) – Increase in A-P diameter (‘barrel shaped’) |
| What are prominent veins on chest wall caused by? | SVC obstruction |
| What are barrel shaped chest associated with? | chest wall appears wider and taller than normal. Associated with chronic lung diseases such as asthma and COPD. |
| Why palpate neck? | For lymphadenopathy |
| Why palpate chest? | Subcutaneous (‘surgical’) emphysema (if appropriate) Palpate for rib fractures if appropriate (e.g. history of chest trauma) |
| What is surgical emphysema? Sensation? | air in subcutaneous tissues and crackling sensation |
| What might be a associated with surgical emphysema? | Pneumothorax |
| What can cause the displacement of trachea away from the lesion | -Large pleural effusion -Tension pneumothorax |
| What can cause the displacement of trachea towards the lesion | Lobar collapse Pneumonectomy PF |
| Percussion result resonant might be caused by: | normal lung |
| Percussion result hyper resonant might be caused by: | Emphysema, large bullae or pneumothorax |
| Percussion result dull might be caused by: | Collapse, consolidation or fibrosis |
| Percussion result 'stony' or very dull might be caused by: | Pleural effusion or haemothorax |
| When do we need tactile vocal fremitus? | If percussion note dull or very dull |
| Increased fremitus means: | Consolidation or fibrosis |
| Decreased fremitus means: | Pleural effusion, pneumothorax or collapse |
| When do we have diminished vesicular breath sounds? | • When normal lung displaced by air, e.g: Obesity Pleural effusion Pneumothorax* Collapse Hyperinflation – emphysema - in COPD |
| When do we have bronchial breath sounds (abnormal) | When damage to small airways / alveoli Harsh in nature Gap between inspiration and expiration Expiratory component dominates Find in consolidation – when alveoli and small airways fill with dense material (e.g. with pneumonia) or fibrosis |
| What are the causes of crackles? | Pulmonary oedema / pulmonary fibrosis / bronchial secretions / COPD / pneumonia / lung abscess / TB / bronchiolitis / bronchiectasis |
| Fine late crackles are a feature of what? | Cryptogenic Fibrosing Alveolitis |
| Causes of pleural rub? | PE / pneumonia / vasculitis |
| what does wheeze imply? and what are the causes? Localised and generalised | Implies airway (small) narrowing Generalised – Asthma / COPD Localised – lung tumour |
| What happens in severe airwats obstruction? | 'Silent chest' |
| When vocal resonance ? | If area of dullness on percussion |
| Increased resonance means: | consolidation or fibrosis |
| Decreased resonance means: | pleural effusion, pneumothorax or collapse (i.e. can interpret as per tactile vocal fremitus) |
Created by:
Mustafak