1 / 18

OSCE: Respiratory Medicine

OSCE: Respiratory Medicine. History. SOB Chest Pain Wheeze Cough Sputum Occupational exposure Exercise tolerance Home NEBS, 02 Childhood illnesses Weight loss Ankle swelling. Examination. Hyperinflated chest Quiet breath sound and/or wheeze Purse lip breathing

jun
Télécharger la présentation

OSCE: Respiratory Medicine

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. OSCE: Respiratory Medicine

  2. History • SOB • Chest Pain • Wheeze • Cough • Sputum • Occupational exposure • Exercise tolerance • Home NEBS, 02 • Childhood illnesses • Weight loss • Ankle swelling

  3. Examination • Hyperinflated chest • Quiet breath sound and/or wheeze • Purse lip breathing • Accessory muscle use • Paradoxical lower rib movement • Peripheral cyanosis • Raised JVP • Tar staining • Clubbing • Cachexia • Oedema • Quiet heart sounds; reduced dullness on percussion.

  4. Investigations • Spirometry • CXR • CT thorax – high res/ staging/ CTPA • Bronchoscopy • ECG • Echocardiogram • Pulse oximetry • PEFR • Sputum culture • Alpha 1 antitrypsin • Sleep study • ABG • Routine bloods

  5. Past OSCE questions • Pneumothorax – take a short history from a patient with sudden onset chest pain. Interpret CXR of collapsed lung. Know causes of pneumothorax – spontaneous, PPV, malignancy, COPD. • Asthma – (1) Newly diagnosed asthmatic; talk to the patient for 5 minutes. (2) 22 year old female, known asthmatic, attends A&E with SOB – discuss management. (3) The same patient is now stable and ready for discharge – spend 10 minutes talking to the patient. • Known 63 year old male with COPD visits GP surgery for a routine check up – carry out a focused examination.

  6. 54 year old M attends A&E with cough and recurrent chest infections. Take a focused history. • 65 year old F attends your GP practice complaining of 3/12 Hx of hoarse voice. Take a focused history. • 32 year old F was admitted with a PE and is ready for discharge. Counsel her on Mx. • 19 year old M with sudden onset R sided chest pain. Take a focused history and examination.

  7. Common management • COPD • Asthma • Pneumothorax • PE

  8. Common management options in respiratory disease • Lifestyle factors - smoking cessation!! • Follow up with MDT • Short acting beta agonists act on smooth muscle to dilate airways – poor side effect to benefit ratio in COPD. Long acting eg salmeterol also available. • Anticholinergics – (cholinergic nerves in COPD increase smooth muscle tone in COPD). Dilation of airways and increase in mucocillary clearance. Eg Ipratropium bromide (Atrovent) and tiotropium bromide (Spiriva) • Theophylline – relax smooth muscle and increase diaphragmatic strength. Extra pulmonary benefits ie increasing cardiac output. Narrow therapeutic index – need to monitor levels. • Corticosteroids. • Antibiotics • NEBS • Oxygen therapy • NIV

  9. Case 1 • 30 yr old asthmatic patient becomes suddenly breathless and complains of chest pain. • RR 30 • Pulse 120 • O2 sats 80% room air • BP 85/60

  10. O/E • O/E - Trachea deviated to left, absent breath sounds on the right and hyper resonance on percussion.

  11. Case 2 68 F, day 1 post-DHS. She presents with dyspnoea. Her current medications include aspirin /simvastatin/ frusemide/ rampiril tablets, and salbutamol/ atrovent/ pulmicort nebs. Immediate Mx Differential Dx Investigations

  12. ABG • PH 7.35-7.45 • PaO2 >10.6 • PaCO2 4.7-6.0 • HCO3 24-30 • Acidosis? - ?cause • Hypoxic? • Hypercapnic • Compensation

  13. ABG 1 • PH 7.36 • PO2 6.7 • PCO2 10.3 • HCO3 42.4

  14. ABG 2 • PH 7.08 • PO2 22.1 • PCO2 14.3 • HCO3 20.3

  15. ABG 3 • PH 7.57 • PO2 10.2 • PCO2 2.3 • HCO3 24

  16. ABG 4 • PH 6.94 • PO2 13 • PCO2 2.8 • HCO3 3.0

  17. Thanks Any Questions?

More Related