OSCE Flashcards
What are some signs indicative of Horner’s syndrome?
Ptosis (upper eyelid drooping)
Miosis (pupil shrinking)
Enopthalmos
Red eye
What might cause Horner’s syndrome?
Pancoast tumour
What is a pancoast tumour?
Apical lung tumours
How might a pancoat tumour cause horner’s syndrome?
Involvement of sympathetic fibers as they exit the cord at T1 and ascend to the superior cervical ganglion
Why might a pancoast tumour cause hoarsness of voice?
Involvement of the recurrent laryngeal nerve
How much space should there be between the sternal notch and cricoid cartillage?
3 fingers space
Ask patient to take a deep breath in and out
When is the cricosternal distance reduced?
In hyperexpansion
What are differentials for an acute dry cough?
Asthma
Drug induced (ACEi)
Rhinitis
Upper Respiratory Tract Infection (URTI) e.g laryngitis
Pulmonary oedema (secondary to heart failure)
COVID
What are differentials for an acute productive cough?
COPD
TB
Lower Respiratroy Tract Infection (pneumonia)
What are differentials for a chronic dry cough?
Asthma
GORD
Lung cancer
Pulmonary oedema (secondary to heart failure)
What are differentials for a chronic productive cough?
Bronchiectasis
TB
Lung Cancer
Cystic Fibrosis
What can you tell from sputum colour?
White/clear sputum–COPD
Yellow/greensputum–INFECTIVE
Green/rusty–PNEUMONIA,bronchiectasis
Pink and frothy- pulmonary oedema
What should you ask about timing in a cough history?
Acute/Chronic
Intermittent - asthma
Constant - COPD
What exacerbating factors should you ask about in a cough history?
Pollen - rhinitis
Lying down - pulmonary oedema
What are acute SOB differentials?
Cardiac:
Angina
Dissecting aortic aneurysm
Cardiac arrhythmia
Respiratory: Acuteasthma PE Inhaled foreign body Pneumothorax
What are the 5 Ps of Pleuritic chest pain?
Pulmonary Embolism Pneumonia Pericarditis Pneumothorax Pleurisy
What is pleurisy?
Inflammation of the pleura
What is pleurisy
Sharp chest pain that is worse when breathing
Why should you ask about recent surgery in a resp history?
RF for PE
What should you ask about if you are worried about asthma?
Eczema
Atopy
What should you ask about if you are worried about PE?
Clotting history
Recent travel
What vaccine are important to ask about in a resp history?
Flu
COVID
Pneumoccocal
TB
What drugs can cause resp symptoms as side effects?
ACEi –> Cough
Amiodarone and Methotrexate –> Pleural effusion, ILD
OCP –> PE
What conditions should ask about in a resp family history?
Asthma
COPD
Lung Cancer
Hay fever
What specific to resp should you ask about in the social history?
Pets
Travel (TB areas, Long haul flight)
Occupation e.g. farmer, coal miner, shipyard (asbestos exposure)
What sign do you get when there is a tumours in the right lung apex?
Pemberton’s sign
SVC syndrome
Flushing of face when patient lifts arms - pooling of blood
