osce

Question 1

asthma explain

Answer 1

what condition is
Reversible narrowing of the airways due to inflammation and bronchoconstriction.

findings on inspection
Tachypnoea, use of accessory muscles, possible wheeze heard, maybe speaking in short phrases.

tracheal position
Central.

findings on palpation
Slightly reduced bilaterally in bad attack.

findings on percussion
Often normal (may be slightly hyper-resonant)

findings on auscalation
Widespread polyphonic wheeze, prolonged expiration; quiet breath sounds in “silent chest” (severe).

Question 2

pneumothorax explain

Answer 2

what condition is
Air in the pleural space causing lung collapse (partial or complete).
findings on inspection
Simple: usually central
Tension: deviated away from affected side

tracheal position
Simple: usually central

Tension: deviated away from affected side

findings on palpation
Reduced chest expansion on affected side

Reduced/absent vocal fremitus/tactile vocal fremitus

findings on percussion
Hyper-resonant on affected side.

findings on auscalation
Absent or markedly reduced breath sounds on affected side.

Question 3

pulmonary oedema explain

Answer 3

what condition is
Fluid in the lung interstitium and alveoli, often due to left-sided heart failure.

findings on inspection
Tachypnoea, possible orthopnoea, distress, maybe pink frothy sputum, peripheral oedema.
tracheal position
Central.

findings on palpation
Chest expansion may be reduced bilaterally; vocal fremitus often normal or slightly increased.

findings on percussion
Often normal or slightly dull at bases if fluid level high.

findings on auscalation
Bilateral fine inspiratory crackles, usually starting at lung bases.

Question 4

consolidation explain

Answer 4

what condition is
Alveoli filled with pus/fluid (e.g. pneumonia) instead of air.

findings on inspection
Tachypnoea, possible cough, fever; reduced movement over affected area.

tracheal position
Usually central (may deviate towards side of large volume loss, but not in simple lobar pneumonia).

findings on palpation
Reduced chest expansion over affected area
Increased vocal fremitus over consolidated lung

findings on percussion
Dull over the area of consolidation.

findings on auscalation
Bronchial breathing over consolidation

Increased vocal resonance (e.g. “99” louder)

Possible crackles.