OSCE Respiratory examination PDF

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Summary

Year 3 + onwards OSCE Respiratory examination steps....

Description

Respiratory 1. Intro + consent

1. General inspection Cyanosis Shortness of breath Cough, wheeze, stridor Pallor Oedema Cachexia Objects/Equipment: O2 delivery, sputum pot, medications (inhalers, nebuliser), cigarettes, mobility aid, prescriptions

2. Hands Cyanosis tar staining bruising thinning of skin Finger clubbing: lung cancer, interstitial LD, CF, bronchiectasis

3. Arms Fine tremor- long standing use beta-2-agonist Flapping tremor- co2 retention Temperature

Pulse RR

4. Neck Raised JVP (pulmonary HTN) + Hepatojugular reflux test Tracheal position Cricosternal distance (3-4fingers)- in lung hyperinflation (asthma/COPD) Lymph nodes

5. Eyes Conjunctival pallor Ptosis, miosis, enophthalmos- Horner’s syndrome

6. Mouth Central cyanosis Oral candiasis- long term steroid use

7. Chest Scars Chest wall deformities- asymmetry, barrel chest (asthma/COPD) apex beat Chest expansion= reduced/asymmetrical

8. Vocal resonance PT say 99 Auscultate

^volume= ^tissue/solid = consolidation, tumour low Volume= fluid/air = pleural effusion, pneumothorax

9. Percussion Resonant hyper-resonant Dullness= tumour, consolidation, lobar collapse Stoney dullness= pleural effusion

10. Auscultation normal vesicular breathing/quiet breath sounds wheeze (asthma, COPD, bronchiectasis) stridor course crackles (bronchiectasis, pneumonia, pulmonary oedema) fine inspiratory crackles (pulmonary fibrosis)

11. Legs Sacral, pedal oedema DVT (swelling, temp, erythema)- SOB secondary to PE

12. Summarise I did a resp. exam on … On general inspection= comfortable at rest, no SOB Hands, face had no stigmata of resp disease No lymphadenopathy Pulse, RR

Chest no abnormalities Percussion- normal resonance Auscultation- normal breath sounds, vocal resonance normal In summary- findings were consistent with normal resp exam to complete exam= o2 saturation, vital signs (temp, BP), sputum sample, peak flow, CXR, ABG, full cardio exam (if indicated)...