OSCE systems: Genitourinal and Respiratory Flashcards
Respiratory system: Based on initial questions, what would shortness of breath (dyspnoea) indicate?
conditions such as asthma, chronic obstructive pulmonary disease (COPD) and emphysema
Respiratory system: Based on initial questions, what would a dry (unproductive) cough indicate?
Maybe cardiac origin, lung neoplasm, gastroesophageal reflux disease (GORD)
Respiratory system: Based on initial questions, what would a wet (productive) cough indicate?
infection, cystic fibrosis
Respiratory system: Based on the rate of breathing, what would a slow breathing pace be termed and what might it indicate?
Bradypnoea could be diabetic coma, drug-induced respiratory depression increased ICP
Respiratory system: Based on the rate of breathing, what would a rapid shallow breathing pace be termed and what might it indicate?
Tachypnoea could be restrictive lung disease, pleuritic chest pain, elevated diaphragm
Respiratory system: Based on the rate of breathing, what would a rapid deep breathing pace be termed and what might it indicate?
Hyperpnoea could indicate recent exercise, anxiety, metabolic acidosis
Respiratory system: Based on the rate of breathing, what would be signs of respiratory distress?
respiratory rate greater than 20-25 per minute;
use of accessory muscles to breathe (SCM, scalenes, nasal flaring, intercostal recession)
grunting, audible breathing, pursed lip breathing
cyanosis or pallor
tachycardia
skin colour :
cyanosis
pallor
erthema
Respiratory system: What is central cyanosis and what is the likely cause of this?
Cyanosis is the abnormal discolouration of the skin and mucous membranes, caused by a deoxygenated haemoglobin level above 5g/ litre. Central cyanosis is seen in the tongue, mucous membranes of the mouth and lips and is most likely caused by diseases of the heart and lungs or abnormal haemoglobin conditions. Hands and feet are at normal temperature
Respiratory system: What is peripheral cyanosis and what is the likely cause of this?
This is cyanosis of the peripheral limbs caused by decreased local circulation and increased extraction of oxygen in the peripheral tissues. this is caused by congestive heart failure, circulatory shock, exposure to cold temperatures, and abnormalities of peripheral circulation. Peripheral tissues so affected are cold to the touch.
Respiratory system inspection: Where do you find the apices of the lungs?
2-4 cm above clavicles
Respiratory system inspection: Where do you find the anterior inferior border of the lungs?
approximately sixth rib at mid-clavicular line
Respiratory system inspection: Where do you find the lateral inferior border of the lungs?
approximately the eighth rib at the midaxillary line
Respiratory system inspection: Where do you find the posterior inferior border of the lungs?
approximately level of T10 spinous process
Respiratory system inspection: Where do you find the fissures of the lungs?
level with approximately T3 spinous process posteriorly and rib 6 mid clavicular line anteriorly
Respiratory system inspection: Where do you find the tracheal bifurcation of the lungs?
approximately in line with T4 spinous process posteriorly and sternal angle anteriorly
Respiratory system inspection: What would be the cause of asymmetry of the lungs?
pleural effusion- causes asymmetrical expansion and unilateral lagging on eth affected side caused by COPD, asthma, obstruction, cardiac failure, multiple sclerosis
Respiratory system inspection: What would be the cause of poor inflation of the lungs (bilateral or unilateral)?
intercostal retraction (intercostal mm sucked in with inspiration) is something blocking/restricting upper airways…asthma, COPD, upper airway obstruction
Unilateral impairment or lagging could be due to pleural disease- asbestosis, silicosis, or phrenic nerve damage or trauma.
Respiratory system inspection: Looking at the hands, what would be the cause of clubbing?
Clubbing is the thickening of the connective tissue in the distal phalanges and is common in cardiovascular and respiratory conditions, thought to be related to increased PDGF and vascular endothelial growth factor due to decreased oxygenation of distal tissues. Maybe it is genetic.
Respiratory system inspection: Looking at the hands, what would be the cause of atrophy of thenar eminence?
can occur in apical lung cancer (Pancoast) due to pressure on the brachial plexus.
peripheral neuropathy
Respiratory system inspection: Looking at the hands and forearms, what would be the cause of asterixis?
asterixis is the inability to hold elbows and wrists extended (a tremor) as a reaction to hyperextension… like a clonus. Due to metabolic encephalopathy (chronic renal failure, severe congestive heart failure, acute respiratory failure, and commonly decompensated liver failure )
Due to high CO2 retention.
Respiratory system inspection: Looking at the hands and nails, squeeze the top of the nail and release. what are you looking for?
finger should blanch with pressure and colour should return within 1-2 seconds.
Respiratory system inspection: Looking at the eyes. what are you looking for?
conjunctival pallor
Horner’s syndrome
ptosis (drooping eyelid)
miosis (constricted pupil)
anhydrosis (lack of sweating on the affected side)
This could be due to a Pancoast tumour affecting the sympathetic chain.
Respiratory system inspection: Looking at the nose. What are you looking for?
any observable septal asymmetry or obstruction. inspect turbinates for swelling, polyps, obstruction, and ulcers.
Respiratory system inspection: Looking at the nasal mucosa. What are you looking for?
color, discharge, bleeding.
the nasal mucosa could show signs of viral rhinitis (mucosa reddened, swollen)or allergic rhinitis (pale blueish or red)