OSPE Flashcards
Describe and demonstrate the surface marking and palpation of the trachea at the suprasternal notch
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Demonstrate how you would investigate symmetrical inflation of the lung and describe the anatomical basis
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Observe and describe the breathing pattern and the breathing rate
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Demonstrate percussion of upper/middle/lower lobes of right/left lungs
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Describe and demonstrate where you would auscultate upper/middle/lower lobes of right/left lungs using a stethoscope
Diaphragm of the stethoscope used to auscultate lobes whilst bell of the stethoscope is used to auscultate apex
ANTERIOR CHEST WALL (patient lies supine=lie on back, facing upwards)
-Apex: above middle third of clavicle
-Superior lobe: 3rd intercostal space in mid-clavicular line
-Middle lobe (in right lung only): 5th intercostal space in mid-clavicular line and below axilla in mid-axillary line
-Inferior lobe: 7th intercostal space in the mid-axillary line
POSTERIOR CHEST WALL (patient sits over the edge of the couch)
-Superior lobe:
-Inferior lobe:
Describe and demonstrate the surface markings of upper, middle and lower lobes of right/left lungs
Right upper lobe: Right middle lobe: Right lower lobe: Left upper lobe: Left lower lobe:
Describe and demonstrate the surface markings of the oblique and horizontal fissures of right/left lungs
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Describe and demonstrate the surface marking of the inferior margin of parietal pleura of right/left lungs
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Describe and demonstrate the surface marking of inferior margin of visceral pleura of right/left lungs
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Describe and demonstrate the triangle of safety for insertion of a chest drain
-The most common position for chest drain insertion is anterior to the mid-axillary line, avoiding the long thoracic nerve lying behind it
Anterior border: lateral border of the pectoralis major (anterior axillary fold)
Posterior border: anterior border of the latissimus dorsi (posterior axillary fold)
Inferior border: horizontal line at the 5th intercostal space at the mid-axillary line (superior to horizontal level of male nipple)
Superior border: apex below the axilla
Describe and demonstrate the surface marking of mediastinal pleura of right and left lung on the anterior chest wall
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Demonstrate the surface marking of upper/right/inferior/left borders of the heart
- Upper border-> sloping line from marking 2.5cm lateral of the left sternal border at the 2nd costal cartilage to a marking 1cm lateral of the right sternal border at the 3rd costal cartilage
- Right border-> curved line to the right from marking 1cm lateral of the right sternal border at the 3rd costal cartilage to marking 1cm lateral of the right sternal border at the 6th costal cartilage
- Inferior border-> line passing (diagonally) through xiphisternal joint from marking 1cm lateral of the right sternal border at the 6th costal cartilage to marking in the midclavicular line at the 5th intercostal space (apex beat position)
- Left border-> curved line to the left from marking in the midclavicular line at the 5th intercostal space (apex beat position) to marking 2.5cm lateral of the left sternal border at the 2nd costal cartilage
Demonstrate where you would auscultate for aortic/pulmonary/mitral/tricuspid valves using a stethoscope
- Aortic valve-> right 2nd intercostal space near sternum
- Pulmonary valve-> left 2nd/3rd intercostal space near sternum
- Mitral valve-> left 5th intercostal space at midclavicular line (apex beat position)
- Tricuspid valve-> left 5th intercostal space near sternum
Stethoscope placed downstream of the given valve (sound carried by bloodstream along direction of flow) to isolate the sound of the valve
Examine the radial/ulnar/brachial (2 sites)/carotid pulse and describe then (rate and rhythm)
- Radial->
- Ulnar->
- Brachial (mid arm)->
- Brachial (cubital fossa)->
- Carotid->
Describe the surface marking of the apex beat of the heart and demonstrate palpation
Pulsation caused by apex of left ventricle (inferolateral part of left ventricle forcing against the anterior chest wall during contraction)
- Location may vary from 4th intercostal space (in children) to 5th intercostal space (in adults) and is about 6-10cm from the midsternal line
- Patient sits over edge of seat
- Palpate with palm and middle 3 fingers of hand
- Middle finger aligned in left 5th intercostal space with other two fingers in intercostal spaces above and below
- Palpate from lateral side (MAL=mid-axillary line), moving anteriorly to the MCL (midclavicular line)
- Jogging on the spot for one minute increases rate and strength of heartbeat if the apex beat is difficult to palpate
- For palpating the apex beat in females, lay the hand underneath the breast along its lower border
Demonstrate the sites of routine venepuncture (antebrachial vein in the cubital fossa)
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Describe and demonstrate the surface marking of the arch of the aorta
Within superior mediastinum behind manubrium with the 3 main branches (brachiocephalic trunk, left common carotid artery and left subclavian artery) arising within the superior mediastinum
- Starts and ends at the level of the sternal angle
- Beginning mark at the right 2nd costal cartilage, top of arch marked midway between jugular notch and sternal angle and ending mark at left 2nd costal cartilage
Recognise radiographs, CT and MRI imaging of the thorax and describe the views obtained
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Identify major anatomical structures on radiographs, CT and MRI imaging
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Describe the position of the inguinal ligament and superficial and deep inguinal rings in bony models
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Sex male and female pelvic girdles using pelvic inlet and subpubic angle
Pelvic inlet:
- Pelvic inlet in females is circular
- Pelvic inlet in males is heart-shaped
Subpubic angle (angle formed by arms of pubic arch):
- Females have a greater subpubic angle (80-85 degrees)
- Males have a smaller subpubic angle (50-60 degrees)
Ischial spines:
-do not project as medially into the pelvic cavity in females as they do in males
Surface mark and palpate: liver, gall bladder and spleen on the anterior abdominal wall
Liver:
Gall bladder:
-where the transpyloric plane meets the right mid-clavicular line (tip of the right 9th costal cartilage or where the lateral border of the rectus abdominis muscle crosses the costal margin)
Spleen:
- lies along the left 9th, 10th and 11th ribs between the erector spinae muscles and the mid-axillary line
- palpate 10th rib and surface mark (costal margin meets mid-axillary line at level of 10th rib so use this as a reference)
- palpate 11th rib and surface mark (lies below 10th rib and floating end is easy to palpate)
- palpate 9th rib and surface mark (lies above 10th rib)
- surface mark lateral border of erector spinae muscles and the mid-axillary line
Describe and demonstrate 9 regions of the abdomen
Divided by the midclavicular plane, the subcostal plane and the intertubercular plane
The nine abdominal regions:
- Right hypochondriac region
- Epigastric region
- Left hypochondriac region
- Right lumbar region
- Umbilical region
- Left lumbar region
- Right inguinal region
- Suprapubic region
- Left inguinal region
Describe and demonstrate position of subcostal plane, transpyloric plane, transtubercular plane and supracristal plane
Subcostal plane: horizontal plane passing across the right and left costal margins in the mid-axillary line and at the level of the body of the L2/L3 vertebrae
Transpyloric plane: horizontal plane through ends of right and left 9th costal cartilage and at level of the L1 vertebra, halfway between the jugular notch and pubic symphysis
Transtubercular plane: horizontal plane through right and left iliac tubercles, passing through the body of the L5 vertebra (L5 level)
Supracristal plane:
Describe and demonstrate 4 quadrants of the abdomen
- Divided by the sagittal plane and the transumbilical plane
- sagittal plane: vertical line through umbilicus from xiphisternum to pubic symphysis)
- transumbilical plane: horizontal line through umbilicus
The four abdominal quadrants:
- right upper quadrant (RUQ)
- left upper quadrant (LUQ)
- right lower quadrant (RLQ)
- left lower quadrant (LLQ)
Surface locate the position of the stomach, duodenum, appendix and caecum, ascending and descending colon and urinary bladder on the anterior abdominal wall
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Surface mark the right and left kidneys and ureters on the posterior abdominal wall
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Palpate the lower poles of kidneys through the anterior abdominal wall
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Palpation of abdominal wall: superficial and deep palpation
Superficial palpation: light
- using the fingertips
- palm of hand moulds over the abdominal surface and fingers flex at metacarpo-phalangeal joints
Deep palpation: deep
- flat of hand over abdominal wall, applying firm steady pressure
- may use both hands where the upper hand exerts pressure and lower hand feels the organ/mass
Percussion of underlying organs: liver
-Percussion from the midclavicular line to the costal margin (defines the upper and lower borders of the liver)
Auscultation of bowel sounds
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Demonstrate palpation of arterial pulses:
1) abdominal aorta in the umbilical region
2) femoral artery
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Map the dermatomes of the abdominal region (T8, T10 and T12)
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Describe sites of referred pain from visceral organs
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Recognise radiographs, CT and MRI imaging of the abdomen and pelvis and describe the views obtained
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Identify major abdominal and pelvic anatomical structures on radiographs, CT and MRI imaging
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