Respiratory Lab OSCE

Question 1

What are some characteristics to assess for upon inspection of the anterior chest?

Answer 1

Anterior Chest
Respiratory distress (wheezing, stridor, labored breathing)
Work of breathing: accessory muscle use, intercostal indrawing, abdominal breathing, flail chest, rate/depth
Swelling, erythema, atrophy, deformities, scars/lesions
Central or peripheral cyanosis
Clubbing
Trachea midline
Thorax: pectus excavatum, pectus carinatum,increased AP diameter (barrel chest)
Symmetrical chest expansion

Question 2

What are some characteristics to assess for upon inspection of the posterior chest?

Answer 2

Deformities: kyphosis, scoliosis
Work of breathing: accessory muscle use, intercostal indrawing, abdominal breathing
Swelling, erythema, atrophy, deformities,scars/lesions
Symmetrical chest expansion

Question 3

What is the difference between hyperpnea and hyperventilation?

Answer 3

oHyperpnea: deep breathing
oHyperventilation: rapid breathing

Question 4

What is Cheyne-Stokes breathing?

Answer 4

Cheyne-Stokes: cyclic crescendo-decrescendo respiratory effort (rate and volume) followed byperiods of apnea

Question 5

What is Kussmaul breathing?

Answer 5

Kussmaul: deep breathing with metabolic acidosis; rate may be fast, slow or normal

Question 6

What is ataxic breathing?

Answer 6

Ataxic breathing: irregular and unpredictable breathing which may be shallow or deep andmay stop for periods of time

Question 7

Identify signs of respiratory distress.

Answer 7

Signs of respiratory distress
Accessory muscle use
Tripod position
Pursed-lip breathing
Intercostal in-drawing
Tracheal tug
Stridor
Displacement of trachea from midline
Cyanosis:
Chest expansion
Skin color
ocentral cyanosis: lips, frenulum, buccal mucosa
operipheral cyanosis: fingers, toes, ears, nose
Clubbing
Chest deformities
pectus excavatum: marked depression in the lowerportion of the sternum that can impair cardiac andrespiratory function
pectus carinatum: protrusion of the sternum and ribs
Barrel chest: increase AP diameter of the chest resultingin round shaped thorax
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Abnormal spinal curvatures

Question 8

What is flail chest?

Answer 8

Flail chest: multiple sequential rib fractures form an independently mobile segment of chest wall

Question 9

What is paradoxical movement?

Answer 9

Paradoxical movement: chest moves inward during inspiration and outward on expiration as in flail chest

Question 10

what should be assessed for upon palpation?

Answer 10

Anterior/posterior chest wall
Tenderness
Masses
Tactile fremitus
Assess for chest expansion
i.Unilaterally reduced posterior chest expansion: lung collapse or pneumonia

Question 11

What does decreased fremitus suggest?

Answer 11

Decreased fremitus: pleural effusion, thickenedchest wall, pneumothorax, emphysema

Question 12

What does increased fremitus suggest?

Answer 12

Increased fremitus: consolidation of lung tissue,pneumonia, tumor, fibrosis

Question 13

What does crepitus suggest?

Answer 13

Crepitus: crackling sensation over skin surface –subcutaneous emphysema

Question 14

Upon percussion, where is a flat sound normal? A dull sound? A resonant sound? A hyper-resonant sound? A tympanic sound?

Answer 14

Percussion Findings:
Flatness (bone)

Dullness (diaphragm, masses, fluid)
Cardiac dullness is normal on left 3rd to 5th intercostal spaces

Resonance (lung)

Hyper-resonance (hyperinflated lungs)

Tympany (abdomen)

Question 15

What is diaphragmatic excursion?

Answer 15

Diaphragmatic excursion: determine level of diaphragmwith inspiration and expiration on the posterior thorax, normal 3-5.5 cm

Question 16

What are the 3 special tests of the lungs? Describe each.

Answer 16

Transmitted Voice sounds
Bronchophony
oAuscultate posterior chest. “Ninety-nine”should be soft and muffled. If loud and clear,consider lung consolidation
Egophony
oEvaluates intensity of spoken voice. Have ptsay “eee.” Should hear soft, muffled “eee.” If“aaa” is heard, consider lung consolidation
Whispered pectoriloquy
oPerformed when a (+) bronchophony isauscultated. Have pt whisper “1, 2, 3.” Soundshould be faint and

Question 17

If bronchovesicular or bronchial breath sounds are heard in locations where vesicular sounds are expected, suspect that air filled lung has been replaced by….

Answer 17

If bronchovesicular or bronchial breath sounds are heard in locations where vesicular sounds are expected, suspect that air filled lung has been replaced by fluid filled or solid lung tissue

Question 18

Where are vesicular breath sounds found? What are the qualities of this breath sound?

Answer 18

Vesicular (soft)
Duration: longer than inspiration
Location: over most of both lungs

Question 19

Where are bronchovesicular breath sounds found? What are the qualities of this breath sound?

Answer 19

Bronchovesicular (medium intensity)
Duration: equal in inspiration and expiration
Location: in the 1st and 2nd intercostal spaces anteriorly,intrascapular area posteriorly

Question 20

Where are bronchial breath sounds found? What are the qualities of this breath sound?

Answer 20

Bronchial (loud)
Duration: longer in expiration, silent gap betweeninspiration and expiration
Location: central, around sternal area

Question 21

Where are tracheal breath sounds found? What are the qualities of this breath sound?

Answer 21

Tracheal (very loud)
Duration: equal in inspiration and expiration, silent gap
Location: trachea, upper portion of parasternal aspectsto ICS 2

Question 22

Basilar atelectasis may clear with cough or…

Answer 22

Basilar atelectasis may clear with cough or deep breath

Question 23

What kind of adventitious breath sounds are discontinuous? What do these sound like?

Answer 23

Discontinuous: intermittent, non-musical

i. Crackles (formerly rales)
ii. Fine, soft, high-pitched, brief
iii. Scratching sound

Question 24

What kind of adventitious breath sounds are continuous? What do these sound like?

Answer 24

Continuous: musical and prolonged

iv. Wheezes: relatively high pitched, suggests lowerairway obstruction
v. May have end inspiratory or end expiratory character

Question 25

What is the difference between rhonci and stridor?

Answer 25

Rhonchi: low pitch with snoring quality. Denotes secretions/fluid in airways
Stridor: high pitch on inspiration, typically appear airway (above sternal notch) denoting obstruction eitherintrinsically or extrinsically.