W4 Skills OSCE

Question 1

[SKILLS OSCE]
What is this?

Answer 1

Pneumonia of the right middle lobe

Question 2

[SKILLS OSCE]
When would this be seen? What would be the diagnosis?
What’s the treatment?

Answer 2

Laryngotracheobronchitis (Croup)

Single dose of oral Dexamethasone corticosteroid (can give IV or IM)
Nebulized epinephrine is effective for moderate-severe croup

Question 3

[SKILLS OSCE]
What is this?

Answer 3

Bronchopneumonia
—results in peribronchiolar inflammation following inhalation of causative organism.
—Can spread through spaces between the alveoli and cause consolidation on an entire lobe.
—On x-ray, see multiple small nodular opacities which tend to be patchy and confluent (separated by areas of normal parenchyma).
—Often bilateral, asymmetric, and involves the lung bases.

Question 4

[SKILLS OSCE]
What is this?

Answer 4

Emphysema
Flat diaphragm
Big back lung volume
Vertical heart
Patient SOB

A pulmonary bleb is a small collection of air between the lung and the outer surface of the lung (visceral pleura) usually found in the upper lobe of the lung.

Emphysematous lung tissue can be particularly weak. Because the lung’s air sac tissue is weakened, it’s easier for air to escape the ruptured alveoli.

Question 5

[SKILLS OSCE]
What is this?

Answer 5

Emphysema

Question 6

[SKILLS OSCE]
What is this?
How would you treat?
How do you diagnose?

Answer 6

Bronchiectasis
2w amoxi, augmenting or doxy
+ PT, bronchodilator, flutter, bronchoscopy

DX: CT — measure against pulmonary artery

CXR: plate-like scarring, or tram tracks = dilated airway with thickened walls

Question 7

[SKILLS OSCE]
What is this

Answer 7

Orbital complications are the most common complications encountered with acute bacterial sinusitis. Infection can spread directly through the thin bone separating the ethmoid or frontal sinuses from the orbit or by thrombophlebitis of the ethmoid veins

Question 8

[SKILLS OSCE]
What is this?
Tx:

Answer 8

Pleural effusion of the lower left lobe
Blunting of the costophrenic angle
Cardiac silhouette outline not visible

Transudative or exudative
Transudative — treat the underlying cause
Exudative — thoracentesis if unknown, larger sample of parapneumonal effusion, no thoracentesis if bilateral transudative

Question 9

[SKILLS OSCE]
What is this?
Treatment?

Answer 9

Chest X-Ray ARDS (after tiger snake bite)
“Whited out” — white fluffy clouds
Foamy macrophages
Proliferative bronchiolitis
Corticosteroids

Question 10

[SKILLS OSCE]
What is this?

Answer 10

Cryptogenic organizing
pneumonitis (COP)

interstitial and parenchymal disease with discrete, peripheral alveolar infiltrates and ground-glass infiltrates.
Nodular opacities are also commonly seen

Question 11

[SKILLS OSCE]
What is this?

Answer 11

Pneumothorax-Pneumomediastinum

Question 12

[SKILLS OSCE]
What is this?

Answer 12

Constrictive bronchioloitis

Question 13

[SKILLS OSCE]
Wheezing — emergent
PE Westermark sign

Answer 13

It represents decreased vascularization at the lung periphery due to mechanical obstruction or reflex vasoconstriction in PE
oligemia = reduction in pulmonary blood flow

Question 14

[SKILLS OSCE]
What is this?

Answer 14

ARDS
White fluffy clouds

Question 15

[SKILLS OSCE]
What is this?

Answer 15

Restrictive lung disease?

Question 16

[SKILLS OSCE]
What is this?
Describe what you see — 4
Treat with?

Answer 16

Sarcoidosis
—Bilateral hilar LAD
—Enlarged mediastinal lymph nodes
—Reticular opacities
—Pulmonary fibrosis

STEROIDS

Question 17

What is this?

Answer 17

Alveolar edema

Question 18

What is this ?

Answer 18

Pulmonary / alveolar edema