Respiratory OSCE

Question 1

What are Cheyne-Stokes? Kussmaul?

Answer 1

a. cyclic crescendo-decrescendo respiratory effort (rate and volume) followed by periods of apnea
b. deep breathing with metabolic acidosis; rate may be fast, slow or normal

Question 2

What are the Look, Listen, Feel signs of airway obstruction?

Answer 2

Question 3

With consolidation, what do we see with:

1. Mediastinal shift
2. Chest wall movments
3. Breath sounds
4. Added sounds
5. Percussion node (inc duller, dec more resonant)
6. Tactile fremitus, vocal resonance

Answer 3

Question 4

With a pleural effusion, what do we see with:

1. Mediastinal shift
2. Chest wall movments
3. Breath sounds
4. Added sounds
5. Percussion node (inc duller, dec more resonant)
6. Tactile fremitus, vocal resonance

Answer 4

Question 5

With lobar collapse, what do we see with:

1. Mediastinal shift
2. Chest wall movments
3. Breath sounds
4. Added sounds
5. Percussion node (inc duller, dec more resonant)
6. Tactile fremitus, vocal resonance

Answer 5

Question 6

With pneumothorax, what do we see with:

1. Mediastinal shift
2. Chest wall movments
3. Breath sounds
4. Added sounds
5. Percussion node (inc duller, dec more resonant)
6. Tactile fremitus, vocal resonance

Answer 6

Question 7

With pleural thickening, what do we see with:

1. Mediastinal shift
2. Chest wall movments
3. Breath sounds
4. Added sounds
5. Percussion node (inc duller, dec more resonant)
6. Tactile fremitus, vocal resonance

Answer 7

Question 8

What do we see in a flail chest?

Answer 8

Question 9

What does crepitus with a tactile fremitus test indicate?

Answer 9

subcutaneous emphysema (cracking sensation over skin)

Question 10

If a pt has air filled lungs replaced by fluid or a solid lung tissue, what might you expect to hear?

Answer 10

bronchovesicular or bronchial breath sounds where you should hear vesicular sounds

Question 11

Where do you hear Vesicular breath sounds?

Answer 11

• Duration: longer than inspiration
• Location: over most of both lungs

Question 12

Where do you hear bronchovesicular breath sounds?

Answer 12

• Duration: equal in inspiration and expiration
• Location: in the 1st and 2nd intercostal spaces anteriorly, intrascapular area posteriorly

Question 13

Where do you hear bronchial breath sounds?

Answer 13

• Duration: longer in expiration, silent gap between inspiration and expiration
• Location: central, around sternal area

Question 14

Where do we hear tracheal lung sounds?

Answer 14

• Duration: equal in inspiration and expiration, silent gap
• Location: trachea, upper portion of parasternal aspects to ICS 2