OSCE

Question 1

What are some signs indicative of Horner’s syndrome?

Answer 1

Ptosis (upper eyelid drooping)
Miosis (pupil shrinking)
Enopthalmos
Red eye

Question 2

What might cause Horner’s syndrome?

Answer 2

Pancoast tumour

Question 3

What is a pancoast tumour?

Answer 3

Apical lung tumours

Question 4

How might a pancoat tumour cause horner’s syndrome?

Answer 4

Involvement of sympathetic fibers as they exit the cord at T1 and ascend to the superior cervical ganglion

Question 5

Why might a pancoast tumour cause hoarsness of voice?

Answer 5

Involvement of the recurrent laryngeal nerve

Question 6

How much space should there be between the sternal notch and cricoid cartillage?

Answer 6

3 fingers space

Ask patient to take a deep breath in and out

Question 7

When is the cricosternal distance reduced?

Answer 7

In hyperexpansion

Question 8

What are differentials for an acute dry cough?

Answer 8

Asthma
Drug induced (ACEi)
Rhinitis
Upper Respiratory Tract Infection (URTI) e.g laryngitis
Pulmonary oedema (secondary to heart failure)
COVID

Question 9

What are differentials for an acute productive cough?

Answer 9

COPD
TB
Lower Respiratroy Tract Infection (pneumonia)

Question 10

What are differentials for a chronic dry cough?

Answer 10

Asthma
GORD
Lung cancer
Pulmonary oedema (secondary to heart failure)

Question 11

What are differentials for a chronic productive cough?

Answer 11

Bronchiectasis
TB
Lung Cancer
Cystic Fibrosis

Question 12

What can you tell from sputum colour?

Answer 12

White/clear sputum–COPD
Yellow/greensputum–INFECTIVE
Green/rusty–PNEUMONIA,bronchiectasis
Pink and frothy- pulmonary oedema

Question 13

What should you ask about timing in a cough history?

Answer 13

Acute/Chronic
Intermittent - asthma
Constant - COPD

Question 14

What exacerbating factors should you ask about in a cough history?

Answer 14

Pollen - rhinitis

Lying down - pulmonary oedema

Question 15

What are acute SOB differentials?

Answer 15

Cardiac:
Angina
Dissecting aortic aneurysm
Cardiac arrhythmia

Respiratory: 
Acuteasthma
PE
Inhaled foreign body
Pneumothorax

Question 16

What are the 5 Ps of Pleuritic chest pain?

Answer 16

Pulmonary Embolism
Pneumonia
Pericarditis
Pneumothorax
Pleurisy

Question 17

What is pleurisy?

Answer 17

Inflammation of the pleura

Question 18

What is pleurisy

Answer 18

Sharp chest pain that is worse when breathing

Question 19

Why should you ask about recent surgery in a resp history?

Answer 19

RF for PE

Question 20

What should you ask about if you are worried about asthma?

Answer 20

Eczema

Atopy

Question 21

What should you ask about if you are worried about PE?

Answer 21

Clotting history

Recent travel

Question 22

What vaccine are important to ask about in a resp history?

Answer 22

Flu
COVID
Pneumoccocal
TB

Question 23

What drugs can cause resp symptoms as side effects?

Answer 23

ACEi –> Cough
Amiodarone and Methotrexate –> Pleural effusion, ILD
OCP –> PE

Question 24

What conditions should ask about in a resp family history?

Answer 24

Asthma
COPD
Lung Cancer
Hay fever

Question 25

What specific to resp should you ask about in the social history?

Answer 25

Pets
Travel (TB areas, Long haul flight)
Occupation e.g. farmer, coal miner, shipyard (asbestos exposure)

Question 26

What sign do you get when there is a tumours in the right lung apex?

Answer 26

Pemberton’s sign
SVC syndrome
Flushing of face when patient lifts arms - pooling of blood