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Respiratory Examination for Medical Student OSCE

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1. General inspection

   1. Well / sick

   2. RR

   3. Accessory muscles of ventilation?

   4. Cheyne-Stokes respiration

   5. Barrel chest

   6. Cyanosis?

   7. Asthma paraphernalia

   8. Sputum, + colour

2. Hands

   1. Clubbing

      1. A: abscess

      2. B: bronchiectasis, bronchial carcinoma

      3. C: CF

      4. E: Empyema (pus in pleural cavity)

      5. F: fibrosing alveolitis

      6. Mesothelioma

   2. Nicotine staining

   3. Peripheral cyanosis

   4. Wasting of intrinsic muscles: T1 lesion (Pancosts)

   5. CO₂ retention flap: asterixis

   6. Tremor: ? agonist or:

   7. Pulse rate

3. Face

   1. Horner’s syndrome: ptosis and constricted pupils

   2. Central cyanosis

 

1. Neck

   1. Tracheal deviation

   2. Carotid Pulse

   3. Tracheal tug: severe airflow limitation, giving descent of trachea with inspiration

   4. Hyperinflation

   5. JVP: consider CCF / Right-sided heart failure / Cor pulmonale

2. Chest: front and back (can do apex beat if you think its indicated)

   1. Chest expansion – high and low

   2. Vocal fremitus (ulnar surfaces)

   3. Percussion

      1. Normal

      2. Resonant: hyperexpanded chest, pneumothorax

      3. Dull: liver, consolidation

      4. Stony dull: pleural effusion

   4. Auscultation: check symmetry

      1. Change in intensity – inspiratory or expiratory

      2. Change in nature – bronchial breathing, high pitched, blowing

      3. Added sounds: wheeze (poly / monophonic; inspiratory or expiratory)¹; crackles (fine / coarse²; early / late / pan-inspiratory); rub³ (pleurisy, from pulmonary infarct, pneumonia etc)

      4. Vocal resonance (muffled: normal lung; louder: consolidation)

      5. If abnormality found: whispering pectoriloquy⁴

3. Legs:

   1. Oedema (+sacrum)

   2. Erythema nodosum: red nodules, normally on shins:

      1. TB

      2. Sarcoidosis

      3. Streptococcus pneumoniae (rare sign)

4. Obs

   1. O₂ sats: on air?

5. Further tests

   1. CURB65 score: predicts mortality in community-acquired pneumonia and infection of any site.

      1. C Confusion (AMT 8 or less)

      2. U Urea (>7mmol/L)

      3. R Resp rate (>30)

      4. B Blood pressure (DBP <60 mmHg, SBP <90mmHg)

      5. 6 Age (>65)

      6. 5 = max score, mortality risk 57.0%

2 CURB criteria: severe pneumonia. With one criterion, but age >60 or hypoxia PO₂ <8 kPa, treat with cefuroxime.

1.  

   1. SPOTX: sputum, peak flow, O₂ sats, temperature chart, CXR

   2. Examine heart for cor pulmonale

   3. Bloods: inflammatory markers

   4. Check for alkalosis / acidosis - ABG

About the Author

by: Admin
Total views: 0
Word Count: 1027
Date: Fri, 22 Jan 2010 Time: 3:55 PM
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