Respiratory Conditions - Clinical Skills OSCE PDF

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Summary

RESP DESCRIPTION RISK FACTOR HISTORY INVESTIGATION MANAGEMENTLung Cancer Tumour of BronchusSmoking (90%) Passive Smoking Asbestos, Arsenic, Iron Oxide, Coal MiningCough, Chest Pain (full), Coughing up Blood, Malaise, Weight Loss, Hoarseness, SOB, Infection, COPD, Stridor: Monophobic Wheeze, Polyphon...

Description

RESP

Lung Cancer

Asthma

COPD

DESCRIPTION

Tumour of Bronchus

Chronic Lung condition, inflammation of bronchi (infiltration of Eosinophils, T and Mast cells) = oedema & hypersensitivity of airway Airflow obstruction : usually reversible

Obstructive Lung Disease: Combo of Bronchitis (cough & sputum production on most days at least 3 months during last 2 yrs) & Emphysema (Enlarged airspace distal to terminal bronchioles, with alveolar wall destruction Little/ No reversibility FEV1: FVC < 70%

RISK FACTOR Smoking (90%) Passive Smoking Asbestos, Arsenic, Iron Oxide, Coal Mining

Atopy: Allergy, Asthma/ Hayfever Non atopic, Aspirin Induced, Occupational, Food (High Na+, Low Mg2+), Atmosphere

Smoking Coal Mining Air Pollution Genetic (a1-antitrypsin deficiency) = causes emphysema Low birth weight

HISTORY

INVESTIGATION

MANAGEMENT

Cough, Chest Pain (full), Coughing up Blood, Malaise, Weight Loss, Hoarseness, SOB, Infection, COPD, Stridor: Monophobic Wheeze, Polyphonic (many block), Less appetite Monophonic wheeze

X Ray Bronchoscopy – Widening of Carina, can do bronchial wash) – useful if around hilium CT Scan (can also show mets), PET Scan FBC – (anaemia, LFT (liver involvement), High Ca2+ = Bone Metastasis Less Na = Due to adrenal involvement

Operate Adjunct Chemotherapy, Radiotherapy

Wheeze, Cough, Chest Tightness, SOB, Dyspnoea Worse at night

SOB (Dyspnoea) Cough (maybe productive – sputum) Regular exacerbation Tachypnoea Accessory muscle use Less chest expansion Resonant chest sound – hyperinflation Quiet breath sound Wheezes: Abnormal high/low pitch on expiration, polyphonic Cyanosis Prolonged expiration (FEV1 low) Pursed lip breathing

Peak Expiratory Flow: 2 weeks of measurements & 2 weeks at home (2 reading/day) Spirometry: 15% improvement in FEV1 or PEF following bronchodilator inhaler NO = raised levels Blood: High Eosinophils, CXR = normal (exclude pneumothorax)

Lung Function Tests: Spirometry: FVC < 80% FEV1/FVC < 0.7 Increased residual volume Chest X Ray: Possible Hyperinflammation Flat hemidiaphragm Cylindrical Heart Large arteries Bulllae ECG: Large p Waves ABG: Low PaO2, High PaCO2 No diurnal Variation

Avoid B-Blockers SABA PRN = 2 puff when required Low dose Corticosteroid + Long acting B2 agonist (with C) High dose inhaled corticosteroid Add Prednisolone If Sats...