Resp OSCE Exam Flashcards
What are the 8 steps required for your introduction in the Respiratory examination?
Wash hands Introduce yourself Confirm patient details Explain the examination Gain consent Expose the patient's chest Position patient at 45o Ask if the patient has any pain before you begin
On general inspection, what does a patient’s age indicate?
Young patients - more likely asthma / CF
Older patients - more likely COPD / interstitial lung disease / malignancy.
What bedside things might you look for?
Treatments / adjuncts
Oxygen - ILD, COPD
Inhalers - Asthma, COPD
Sputum pots - COPD, Bronchiectasis
What features might indicate that a patient is short of breath?
Tripod position Nasal flaring Pursed lips Use of accessory muscles Intercostal muscle recession Is the patient able to speak in full sentences?
What other features should you be looking for on general inspection in a respiratory examination?
Scars
Cyanosis (<85% Oxygen saturation)
Abnormalities in the chest wall.
Cachexia - v. thin pt, muscle wasting -> malignancy, CF, COPD
Describe the different coughs you might see.
Productive (Bronchiectasis / COPD if older / CF if younger)
Dry (Asthma if younger, ILD if older)
What might an expiratory wheeze indicate?
Asthma / COPD / Bronchiectasis
What might stridor (inspiratory) indicate?
Upper airway obstruction.
On inspection of the hands, what 5 features would you be looking for? What might these features indicate?
Tar stains -> smoker
Clubbing -> ILD / Lung ca / Bronchiectasis
Peripheral cyanosis -> Oxygen sats below 85%
Features of rheumatological disease - associated with pleural effusions & pulmonary fibrosis
Skin changes - bruising / thinning of the skin are associated with long term steroid use (ILD / COPD / Asthma)
What 6 features should you assess when inspecting the hands?
Temperature: low temp suggests peripheral constriction / poor perfusion
Pulse: rate & rhythm
Resp rate: normal = 12-20 /min
Pluses paradoxus: pulse wave volume decreases with inspiration (asthma / COPD).
Fine tremor: SE of beta 2 agonist use (eg. salbutamol)
Flapping tremor: CO2 retention (type 2 reps failure, e.g.. COPD).
