OSCE CASES - RS

Question 1

COPD +ve & -ve findings

Answer 1

+ve findings
- Prolonged expiratory phased + pursed lip breathing
- Use of accessory muscles
- Reduced crichosternal distance (sign of hyperinflation)
- Ascultation
o Reduced air entry bilateral
o Polyphonic expiratory wheeze in all zones
- Tar staining

-ve findings
- Requiring O2
- Retaining CO2
- Finger clubbing
- Cor pulmonale (raised JVP)

Question 2

COPD +ve & -ve findings

Answer 2

+ve findings
- Prolonged expiratory phased + pursed lip breathing
- Reduced crichosternal distance (sign of hyperinflation)
- Ascultation
o Reduced air entry bilateral
o Polyphonic expiratory wheeze in all zones
- Tar staining

-ve findings
- Requiring O2
- Retaining CO2
- Finger clubbing
- Cor pulmonale (raised JVP)

Question 3

COPD DD & RF

Answer 3

DD
- Chronic asthma
- Bronchiectasis

RF
- Chronic asthma
- Alpha 1 antitrypsin deficiency

Question 4

COPD signs of decompensation

Answer 4

• Pulmonary HTN
  o SOB
  o Angina
  o Palpitations
  o Oedema & ascites
• Lung Ca
  o Cough; haemoptysis

Question 5

COPD investigations

Answer 5

• Bedside: basic obs, peak flow
• Bloods: FBC, CRP, ESR, ABG
• Imaging: CXR (hyperinflation), ECHO (cor pulmonale)
• Special test: spirometry, sleep test (Pickwickian syndrome)

Question 6

COPD MX

Answer 6

Conservatory
- Stop smoking

Medical
- Inhalers, inhaler with spacer or neb, home O2
- SABA: salbutamol 5mg
- LAMA: ipatropium bromide 500mcg
- Steroids: prednisolone 30mg oral for 5 days
- Abx (if indicated): amox 500mg TDS for 5 days
- Other: NIV*, RS stimulants & IV theophylline

Surgical
- Lung resection

*for persistent hypercapnic RS failure