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OSCE examinations > Respiratory Examination > Flashcards

Respiratory Examination Flashcards

1
Q

Introduction

A 
Introduce yourself
Confirm patient name and DOB
Ask how they'd like you to address them
Explain what you plan to do, gain consent
Are they in any pain
PPE, handwashing
Adjust bed to 45 degrees
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2
Q

Step 1 General inspection (clinical signs)

  • what might you find
  • what does this mean
A

Age

  • young => asthma, CF?
  • old => COPD, ILD, malignancy

Complexion

  • pallor => anemia (haemorrhagic/chronic disease), poor perfusion (CCF)
  • cyanosed => poor circulation (peripheral VC, inadequate oxygenation)

Habitus
- pedal/abdomen edema => RV failure, cor pulmonale
- cachexic => malignancy, end stage COPD

Breathing
- SOB, can’t speak in full sentences, tripod, accessory muscle use => asthma, pulmonary edema, pulmonary fibrosis, lung cancer, COPD
- stridor => foreign body inhalation, subglottic stenosis
- wheeze => asthma, COPD, bronchiectasis

Cough
- productive => pneumonia, bronchiectasis, COPD, CF
- dry => asthma, ILD

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3
Q

Step 1 General inspection (objects, equipment)

  • what might you find
  • what does this mean
A

O2 delivery, ventilation
- nasal prongs, venturi, non rebreathe
- CPAP, BiPAP?

Sputum pot colour and contents
- white => COPD exacerbation
- yellow, green => bacterial infection (pneumonia?)

Medical equipment
- ECG
- medications (nebulisers, inhalers, catheters, IVs)

Charts
-NEWS, fluid balance, drug charts

Mobility
-wheelchairs, frames

Cigarettes, vapes
-COPD, lung cancer?

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4
Q

Step 2 Hands, general observations

  • what might you find, look for
  • what does this mean
A

Colour
- cyanosis => hypoxemia
- tar stains => smoker (COPD, lung cancer?)
- bruising, thin skin (long term steroid use) => asthma, COPD, ILD?
- joint swelling, deformity => RA with pleural effusions, pulmonary fibrosis

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5
Q

Step 2 Hands

-what is clubbing indicative of?

A

Cancer
-squamous
-mesothelioma (caused by asbestos)

Chronic suppuration
- bronchiectasis
- ILD
- empyema

Cystic fibrosis

Chronic autoimmune
-sarcoidosis

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6
Q

Step 2 Hands

-what can tremor and flap tell you

A

Fine tremor => B2ag use

Asterixis => CO2 retention (T2RF, COPD)

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7
Q

Step 2 Hand palpation

  • what info can you get from this
  • what does this tell you
A

Temperature, should be symmetrically warm
- cool => poor peripheral perfusion
- excessively warm => CO2 retention?

HR
- bounding => CO2 retention
- pulsus paradoxus (pulse wave volume decreases significantly on inspiration) => cardiac tamponade, severe acute asthma, COPD

RR
- bradypnoea => opiate OD?
- tachpnoea => acute asthma?
- asymmetrical => expiration prolonged in COPD exacerbations

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8
Q

Step 3 Neck, JVP

  • how would you measure this
  • what is abnormal and what does this mean?
A

45, turn head to left
- look for biphasic flicker in supraclavicular fossa
- measure the vertical distance between sternal angle and top of pulsation (up to 4cm)

Raised => venous HTN (cor pulmonale due to COPD, ILD)

Hepatojugular reflex
NORMALLY JVP REMAINS CONSTANT OR TEMPORARILY RISES
-sustained rise => decreased venous return

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9
Q

Step 4 Face, general observations

  • what might you find
  • what does this mean
A

Plethoric (congested red face) => polycythemia (COPD), CO2 retention (T2RF)

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10
Q

Step 4 Face (eyes)

  • what might you find
  • what does this mean
A

Conjunctival pallor => anemia

Ptosis, miosis (excess pupil constriction), enopthalmos (retraction of eye into orbit) => Horners syndrome (sympathetic trunk damaged <= pancoast tumour compression)

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11
Q

Step 4 Face (mouth)

  • what might you find
  • what does this mean
A

Central cyanosis => hypoxemia

Oral candida above erythmatous mucosa => steroid inhaler use, immunosuppresion

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12
Q

Step 5 Chest (inspection)

  • what might you find
  • what might this be indicative of?
A

Scars
Radiotherapy associated skin changes (lung cancer)
-dry skin, scale, hyperkeratosis
-depigmentation, telangiectasia

Asymmetry => pneumonectomy, thoracoplasty
Pectus excavatum, carinatum
Hyperexpansion (wider and taller than normal) => asthma, COPD

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13
Q

Step 6 Trachea

  • how would you assess its position
  • what could this tell you
A

Warn patient before hand, might be painful
Dip index finger into thorax next to trachea, gently apply pressure
Compare this space to other side

Deviation away => tension pneumothorax, large pleural effusions
Deviation towards => lobar collapse, pneumonectomy

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14
Q

Step 6 Trachea
Cricosternal distance
-how would you assess this
-what could this tell you

A

Distance between suprasternal notch and cricoid cartilage
-3-4 finger distance is normal

Smaller => hyperinflation (asthma, COPD)

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15
Q

Step 7 Chest palpation

  • what would you assess
  • what would this tell you
A

Apex beat
-displaced => LVH (pulmonary HTN, COPD, ILD), large pleural effusion, tension pneumothorax

Symmetrical reduced chest expansion => pulmonary fibrosis
Asymmetrical reduced chest expansion => pneumothorax, pneumonia, pleural effusion

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16
Q

Step 8 Chest percussion

  • what are you looking for
  • what can this tell you
A

NORMALLY RESONANT
Dullness => consolidation, tumour, lobar collapse
Stony dullness => pleural effusion
Hyper resonant => pneumothorax

Vocal fremitus

  • increased resonance => consolidation, tumour, lobar collapse
  • decreased resonance => fluid, air outside lung (pleural effusion, pneumothorax)
17
Q

Step 9 Chest auscultation

  • what would you find
  • what does this mean
A

Quality
- vesicular => normal
- bronchial => harsh sounding, inspiration, expiration equal (consolidation)

Volume
-quiet => reduced air entry (pleural effusion, pneumothorax

Added sounds
- wheeze => coarse (asthma, COPD, bronchiectasis)
- stridor => high pitched from turbulent flow (foreign body inhalation, subglottis stenosis)
- coarse => discontinuous brief popping (pneumonia, bronchiectasis, pulmonary edema)
- fine crackles => Velcro (pulmonary fibrosis)

18
Q

Step 10 lymph node palpation

  • which ones would you palpate
  • what are you looking for
A

Examine from behind the patient
Tilt chin downwards slightly
-inspect for lymphadenopathy/abnormalities
-use both hands to assess symmetry in both sides
-use pads of fingers to roll nodes over surrounding tissue

Submental, submandibular 
Preauricular, postauricular
Superficial, deep cervical
Anterior, posterior chain
Occipital 
Supraclavicular

Lung cancer with mets
TB
Sarcoidosis

19
Q

Step 11 Posterior chest

  • what are you doing
  • what are you looking for
A

Ask patient to hug their knees

  • inspect
  • expansion
  • percussion, vocal fremitus
  • auscultation

Same as anterior thorax

20
Q

Step 12 Peripheral edema

  • what are you testing
  • what does this mean
A

Pitting sacral, pedal edema (RVF)
Erythema nodosum (swollen fat under skin causing bumps and patches) => sarcoidosis, TB, pneumonia,
Signs of DVT

21
Q

Completion of examination

Further examinations

A 
SaO2
Sputum sample if coughing
Peak flow
CXR if abnormalities found
ABG
CV exam to rule out CV causes

OSCE examinations (142 decks)

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