OSCE - Resp Exam Flashcards
Clinical signs suggestive of underlying pathology (8)
- cyanosis
- SOB
- cough
- wheeze
- stridor
- pallor
- oedema
- cachexia
What further clinical examinations / assessments may be performed in a resp exam?
- Vitals
- cardiovascular exam
- peak flow assessment
Describe some appropriate further investigations for a resp exam?
- sputum sample
- cxr
- abg
- high res CT chest
- lung function tests
Differential diagnoses for FINE INSPIRATORY CRACKLES?
- interstitial lung disease (idiopathic pulmonary fibrosis)
- congestive heart failure
- bronchiectasis
Examples of underlying disease processes associated with clubbing?
- lung cancer
- interstitial lung disease
- cystic fibrosis
- bronchiectasis
Fine tremor associated with use of what medication?
- beta 2 agonist (salbutamol)
Pulse abnormalities that may be observed?
- BOUNDING PULSE
–> underlying CO2 retention (Type 2 resp failure) - Pulsus paradoxus
–> pulse wave volume decrease significantly during inspiratory face
——> late sign of cardiac tamponade, severe acute asthma, exacerbation of COPD
- Ptosis (upper eyelid droops over eye),
- miosis (excessive shrinking of pupil)
- enophthalmos (eyes sunken in)
- anhydrosis (sweat glands make little or no sweat)
are features of what condition ?
Horner’s syndrome
- sympathetic trunk affected by pathology such as lung cancer
–> PANCOAST tumour: affecting apex of lung
Causes of tracheal deviation?
- deviates AWAY from
–> tension pneumothorax
–> large pleural effusions - deviates TOWARDS
–> large lobar collapse
–> pneumonectomy
Causes of abnormal cricosternal distance?
- distance of fewer than 3 fingers
- suggests lung hyperinflation
–> asthma
–> COPD
Causes of displaced apex beat? (3)
- RV hypertrophy (e.g. pulmonary HTN, COPD, Interstitial lung disease)
- large pleural effusion
- tension pneumothorax
Respiratory causes of reduced chest expansion?
Symmetrical vs Asymmetrical
Symmetrical
- pulmonary fibrosis reduces lung elasticity
- restricting overall chest expansion
Asymmetrical
- pneumothorax
- pneumonia
- pleural effusion
Dullness on percussion may indicate
Increased tissue density
- cardiac dullness
- consolidation
- tumour
- lobar collapse
Stony dullness on percussion indicates
Typically
- underlying pleural effusion
Hyper-resonance on percussion indicates:
suggestive of decreased tissue density
- pneumothorax
Abnormal tactile vocal fremitus
–> Increased vibration (3)
Suggests increase tissue density
- consolidation
- tumour
- lobar collapse
Abnormal tactile vocal fremitus
–> Decreased vibration (2)
Suggests presence of fluid or air outside lung
–> pleural effusion
–> pneumothorax
Harsh sounding breathing is known as and associated with:
Bronchial breathing
- associated with consolidation
Respiratory causes of lymphadenopathy? (3)
- lung cancer with metastases
- TB
- sarcoidosis
What might you assess for when completing a resp exam ? (3)
- Pitting sacral and pedal oedema
- congestive heart failure - CALVES
- DVT? (swelling, increased temperature, erythema, visible superficial veins) - Erythema nodosum
- sarcoidosis
Summarise further assessments and investigations you may perform?
Check oxygen saturation (SpO2) and provide supplemental oxygen if indicated.
Vital signs
Take a sputum sample.
Perform peak flow assessment if relevant (e.g. asthma)
CXR (if abnormalities were noted on examination)
ABG if needed
Perform a full cardiovascular examination if indicated (e.g. cor pulmonale)
what position do patients need to be in for examination of the posterior chest?
with arms folded across chest
what should you look in the legs for as part of a respiratory exam?
- pedal oedema
- calf swelling –> DVT
