OSCE practice - Respiratory

Introduction

• Introduce yourself. Elicit name, age and occupation. Establish rapport

Consent

• Explain the examination to the patient and seek consent

Position

• Sit the patient at a 45 degree angle and exposure the patient appropriately

Inspection

General

• Stand and observe the patient from the edge of the bed. Look for oxygen masks, nebulisers and sputum pots surrounding the patient
• General observations in the Respiratory Examination
• Breathing at rest - Comfortable, dyspnoea
• Added sounds - Cough, wheeze, stridor
• Presence of scars - Thoracotomy scar, operative scars
• Chest shape - Barrel chest, pectus excavatum, pectus carinatum
• Chest movements - Asymmetrical chest expansion, use of accessory muscles
• Intercostal recession - Asthma, COPD (with pursed lips)
• Respiratory rate - Count for 15 seconds and multiply by 4
• Normal 16-25 breaths per minute
• Tachypnoea >25 breaths per minute

Hands

• Feel the hands for any temperature change. Look in the hands for:
• Temperature - Warm and well perfused/poor perfusion
• Tremor - Resting tremor (Beta agonist - Salbutamol)
• Flapping Tremor - Asterixis - CO2 retention
• Peripheral cyanosis - Blue nail beds
• Nicotine stains - Evidence of smoking
• Clubbing ABCDEF
• Asbestosis/Abscess
• Bronchiectasis/Bronchial carcinoma
• Cystic fibrosis
• Decreased O2
• Empyema
• Fibrosing alveolitis
• CO2 retention
• Examine for an irregular jerking of the hands after the wrists have been cocked back in wrist extension

Pulsus

• Feek the raduak oykse abd asses tge rate and rhythm. Assess for the presence of a bounding pulse (CO2 retention)