Clinical Skills Resp CV

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Author:
mewinstanley@googlemail.com
ID:
82313
Filename:
Clinical Skills Resp CV
Updated:
2011-04-27 19:22:40
Tags:
osce medicine year respiratory cardiovascualr heart lungs
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Description:
OSCE revision for Resp & CV
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  1. Respiratory Exam
    • Introduction, Consent & Explain procedure
    • 1. Inspection
    • Note: Relaxced/distressed
    • Resp Rate: norm= 8-12/min
    • Hands: Peripheral Cyanosis
    • Clubbing
    • Palmar creases/Erythemma
    • Radial pulse
    • Flapping tremor (?)
    • Face: Central Cyanosis - lips & tongue
    • Pallor of conjunctiva (anaemia)
    • Chest: shape (kyphosis, scoliosis, barrel)
    • Symmetry
    • Scars
  2. Resp Exam Cont.
    • 2. Palpation
    • Position of Trachea - Central
    • Apex beat - 5th intercost, mid clavicular
    • Chest Expansion (2 @ front, 3 @ back) Thumbs @ midline
    • Vocal Fremitus (111, diminished vibration on pathology)
  3. Resp Exam Cont.
    • 3. Percussion
    • Tap Clavicles
    • intercostals & axillae
    • Dull over liver & heart

    • 4.Auscultation
    • Deap Breaths THRU THE MOUTH
    • Listen for crackles, wheeze, bronchial breaths
    • normal = vesicular
    • Vocal Resonance (111, louder on pathology)

  4. Resp Exam Cont.
    Continue onto back and do same

    • Examine lymph nodes (cervical and supraclavicular)
    • for malignancy
  5. Cardiovascular Exam
    • 1. Inspection
    • General: unwell/breathless/uncofortable
    • Hands: Tar stains
    • Cyanosis
    • Clubbing
    • Anaemia (pale creases)
    • Splinter Haemorrhages (Infect. Endocarditis)
    • Face: Mallor flush (red cheeks)
    • Conjuctiva - pale, anaemia
    • Eyelids - Xanthalasma (hyperlipidaemia)
    • Corneal Arcus
    • Tongue for Central Cyanosis

    Pulse & B.P

    • JVP: Right internal jugular vein, indicates RH fail
    • estimate height from sternum
    • Antagonise w. hepatojugular reflux
    • Chest: Scars
    • Visible Pulsations
  6. CV Exam Cont.
    • 2. Palpation
    • Apex Beat - norm 5th midclavicular
    • RV Heave - @ L. sternal edge, during expiration
    • Thrills - Palpable murmur (aortic stenosis)
  7. CV Exam Cont.
    • 3. Auscultation
    • Over 4 valve areas, use diaphrag then bell
    • Apex - Mitral Area
    • L. Lower Sternal edge - Tricuspid
    • 2nd Int on L. Side - Pulmonary
    • 2nd Int on R. Side - Aortic
    • S1 = Mitral & Tricuspid closing (APEX)
    • S2 = Aortic & Pulmonary closing (A & P)

    Carotid (Bruits)

    Amplify by turning patient on left side/leaning forward

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