OSCE - respirology

  1. Functional respiratory inquiry

    • Smoking (pack years), SOBOE, sputum production (mucus, pus, blood)
    • Pain (pleuritic, bony/ MSK), Pigeons
    • Asthma (wheeze, nocturnal/morning cough), atopy, alpha 1 antitrypsin
    • Cough, CXR (known abnormalities)
    • Exercise tolerance (quantify), environmental exposures
    • Dyspnea (provocative and palliative factors)
  2. flat percussion
    large pleural effusion
  3. dull percussion
  4. hyperresonant percussion

  5. describe an approach to evaluation of quality of CXR
    • start by checking name and date on film
    • note orientation and adequacy of penetration
    • 2 views needed to localize lesions
    • heart size and mediastinal size should be assessed on a posteroanterior (PA) view (not >50%)
    • assess rotation by looking at relationship of the sternoclavicular joints to the midline
    • note upright vs. supine
  6. ABC's of CXR interpretation
    Airway: trachea and mainstem bronchi

    Breathing: lung fields, fissures, costophrenic angles, peribronchial changes, pleural changes (thickening, effusion)

    Circulation: vasculature in the lungs, pulmonary artery and aortic knuckle, left ventricle, heart size, hila

    Soft tissues and skeleton: bilateral breast shadows in females, subcutaneous emphysema, midiastinal enlargement, ribs, clavicle humerus
  7. DDx for SOB
    • Vascular: PE, CHF (pulmonary edema, large pleural effusion, ascites), acute coronary syndrome
    • Infectious: Pneumonia
    • Trauma: pneumothorax, FB aspiration
    • Metabolic: DKA
    • Idiopathic/Iatrogenic: Exacerbation of COPD/asthma, massive atelectasis
    • Neoplastic: large pleural effusion, significant ascites
    • Substance abuse and psych: anxiety (dx of exclusion)
  8. DDx for SOBOE
    • Vascular: CHF
    • Infectious: TB
    • Autoimmune/Allergic: sarcoidosis
    • metabolic: anemia, asbestosis
    • idiopathic/iatrogenic: COPD, massive atelectasis, pulmonary fibrosis, abdominal distension
    • Neoplastic: large pleural effusions
  9. treatment of COPD includes
    • bronchodilators
    • inhaled steroids
    • cardiac medications
  10. describe COPD
    • includes several dz entities: chronic bronchitis, emphysema, asthma, bronchiectasis
    • progressive airway obstruction with acute exacerbations
    • FEV1/FVC decreases as severity increases
    • may result in cor pulmonale
    • most pts have a combo of chronic bronchitis and emphysema (not just one or the other)
  11. DDx for cough
Card Set
OSCE - respirology
4th year osce respirology