Respiratory OSCE
History taking
WIPE
Cardinal symptoms
- Cough
- Sputum
- Blood
- SOB/wheeze
- Chest pain
Cough
Questions to ask:
Associations w. cough? (sputum, fever)
Blood on coughing?
Character of cough?
Duration of coughing?
Exacerbating and relieving factors?
First time coughing or is there previous hx?
Sputum
Haemoptysis
SOB
Questions to ask:
When did it start?
Acute or chronic?
Triggers? Exercise tolerance?
Severity?
Timing? (e.g. night for asthma)
Associations?
PND or orthopnea?
MMRC Scale
Always ask about atopy!!!
- Rash?
- Red, itchy, puffy eyes?
- Runny nose?
Wheeze
Pleuritic chest pain
S pleural membrane
O acute
C sharp and generally localized
R to C3,4,5 dermatomes if diaphragmatic pleura affected.
A DVT, pneumonia, Pneumothorax
T
E X - inspiration; + - leaning forwards
RoS:
- Fever
- Edema, chest pain
- Wgt loss, night sweats
- Hoarseness
- Atopy
PMH
Co-morbidities
CVD?
Pulmonary disease?
Recurring RTI?
HTN?
Renal disease (i.e. proteinuria)
Drug hx
Surgery?
TB vaccination
Ventilated?
DRUG ALLERGIES
Drugs
- ACE-I
- NSAIDs
- Inhalers
- Non selective B-blockers
- AIA
- COCP
Social Hx
F Hx
ICE
Physical examination
1) WIPE
- Ask about pain/discomfort!!!
- Pt to be sitting
- Place, person, time!!!
2) General observation
2a. Patient
2b. Surroundings
3) Hands
Offer to check BP
4) Face
4a. Gross inspection
4b. Eyes
- conjunctival pallor
4c. Nose
- polyps
- Deviated semptum
4d. Cheeks
- Facial swelling (per SVC obsn)
4e. Mouth
- Peripheral cyanosis
- Central Cyanosis
- Candidiasis
- Enlarged tonsils
- Dental carries
4f. Hoarseness
Say EEEEEEEEEE
4f. Palpate sinuses
4g. Palpate LN
5) Neck
Expose the patient
6) Chest
General inspection
Scars
Use of accessory muscles?
Barrel shaped chest?
Pectus carnitum/excavatum
Movement of chest wall (anterior AND posterior)
Kyphoscoliosis
Apex beat
- Displaced toward lesion = atelectasis
- Displaced away from it = Tension Pneumothorax
- Non palpable = COPD (barrel chest)
Unorthodox, but given the risk of undiagnosed tn pneumotx, I would prioritize this right after general inspection.
Then tell the pt to sit up so you can have a go at his back.
Examination posterior
Chest wall expansion
- Hoover's sign?
Tactile fremitus
Percussion --> Auscultation:
Get pt to hug a pillow!!!
Examination Anterior:
Same as posterior minus chest wall expansion.
Percussion --> Auscultation
7) And finally...
- Sacral/Pedal edema
- DVT
- Erythema nodosum
8) Reverse WIPE:
- Wash your filthy hands.
- Thank the patient.
- AND FOR THE LOVE OF GOD MAN, GIVE THE PATIENT HIS DAMN SHIRT BACK
- Summarize findings.