RESP OSCE

Question 1

Respiratory order

Answer 1

RR

INSPECTION

PALPATON

PERCUSSION

AUSCULTATION

Question 2

Resp INSPECTION

Answer 2

Scarring

• chest drain
• pneumonectomy
• trachestomy

Shape of chest

• barrel chest
• pigeon chest
• sternal depression

Movement of chest + accessory muscles?
* symmetry
* paradoxical
\+SCM
\+ scalene
\+ platysma

Audible breathing sounds

• wheeze (expiratory)
• stridor (insp)

Question 3

Resp PALPATION

Answer 3

1. Tracheal deviation
   * pneumothorax =towards pathology
   * tension pneumo.; pleural effusion = away
2. Cricosternal distance = <3 fingers = lung hyperinflation
3. Chest expansion
   2x front
   3x back

+displaced apex
+

Question 4

Resp PERCUSSION

Answer 4

1. front
clavicle
sternal notch (2Intercostal space)
nipple/T4/ 4th IC space
lower sternal borders/ sides of xiphoid
axilla

2. back
apex
middle wings
lower border of wings
axilla

• hyper-resonance = more air = emphysema, pneumothorax
• dull = consolidation = pl. effusion, consoliidation, pulm fibrosis, lungcollapse, lobectomy

3. tactile vocal fremitus = ulnarside of hand

Question 5

Resp AUSCULTATION

Answer 5

• relax,and breathe deep in and out through their mouth
• compare both sides

1. front
clavicle
sternal notch (2Intercostal space)
nipple/T4/ 4th IC space
lower sternal borders/ sides of xiphoid
axilla

2. back
apex
middle wings
lower border of wings
axilla

*vesicular = normal
* bronchial = pause in. between and equal sounding
• wheeze
• stridor
• coars crackles
• fine inspiratory crackles
• pleural rub

3. Vocal resonance
   * increased vol = increased tiss. density
   * decreased vol = fluid or air outside the lung

Question 6

RESP limbs

Answer 6

• pallor = cyanosis
• tar staining
• skin changess = steroid use
• joint swelling
• finger clubbing
• fine tremor (salbutamol use); flapping tremor (30 seconds)
• temperature, pulse

Question 7

RESP face

Answer 7

• conjunctival pallor
• horner syndrome = ptosis, miosis, enopthalmos
• central cyanosis