Respiratory Examination OSCE PDF

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Respiratory Examination 1. Setting up examination = Wash hands, Introduce yourself, identify patient, Permission, Position = 45 degrees, Pain = check if in any pain, Exposure = shirt open 2. General observation = are they comfortable at rest or unwell, oxygen, sputum pots, inhalers, drips, GTN spray, medication, walking aids, catheter a. Are they thin, do they look cachectic (malignancy/TB), cyanosis, SOB, using accessory muscles to breath, hoarse voice? 3. Hands and nails a. Look for clubbing = lung cancer, fibrosing alveolitis, lung abscess, bronchiectasis, empyema b. Tar staining on fingers from smoking c. Capillary refill time d. Peripheral cyanosis (in absence of central = reduced peripheral circulation) e. Palmar erythema, Dupuytren’s contracture f. Red, warm, clammy palms may indicate CO2 retention i. Check for asterixis for 30s (CO2 retention, liver failure) 4. Check radial pulse and respiratory rate a. Tachycardia = severe asthma, infection b. Normal resp rate should be less than 15 bpm, increased in fever and severe lung disease c. Stridor = inspiratory noise caused by large airway obstruction d. Use of accessory muscles implies increased work of breathing 5. Face, mouth and eyes a. Pallor (pull down lower lid) = anaemia b. Check underside of tongue for central cyanosis (late sign of hypoxaemia) c. Dropping of eyelid (ptosis) or smaller pupil on one side = Horner’s syndrome (interruption of the sympathetic chain due to lung cancer at lung apex) d. Dusky appearance and face/neck swelling = mediastinal mass pushing on SVC e. Look for oral candidiasis in mouth, associated with corticosteroid and antibiotic use 6. Neck a. Check JVP = can eb raised in cor pulmonale or SVC obstruction, and acutely raised in tension pneumothorax and PE b. Examine lymph nodes by standing behind the PT 7. Inspection = chest shape and wall movements, scars, drains, pacemakers a. Barrel-shaped chest = hyperinflation from chronic airway obstruction b. Kyphosis and scoliosis can restrict lung movement 8. Trachea

a. Deviation assessed by placing 3 fingers (gentle, with warning) into sternal notch, should be felt under middle finger if central i. Deviates towards pathological side in fibrosis, simple pneumothorax and away in tension pneumothorax, massive pleural effusion b. Severe airflow obstruction = trachea descends (tug) on inspiration 9. Check for expansion = hands around anterior chest a....