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5 adventitious breath sounds skin#
5 adventitious breath sounds full#

pleural effusions/pulmonary fibrosis).įinger clubbing involves uniform soft tissue swelling of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and the nail bed. Joint swelling or deformity: may be associated with rheumatoid arthritis which has several extra-articular manifestations that affect the respiratory system (e.g.asthma, COPD, interstitial lung disease).

5 adventitious breath sounds skin#

Skin changes: bruising and thinning of the skin can be associated with long-term steroid use (e.g.

Tar staining: caused by smoking, a significant risk factor for respiratory disease (e.g.

Colour: cyanosis of the hands may suggest underlying hypoxaemia.

Observe the hands and note your findings: The hands can provide lots of clinically relevant information and therefore a focused, structured assessment is essential.

Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications.

Fluid balance: fluid balance charts will give an indication of the patient’s current fluid status which may be relevant if a patient appears fluid overloaded or dehydrated.Vital signs: charts on which vital signs are recorded will give an indication of the patient’s current clinical status and how their physiological parameters have changed over time.Mobility aids : items such as wheelchairs and walking aids give an indication of the patient’s current mobility status.Cigarettes or vaping equipment: smoking is a significant risk factor for lung cancer and chronic lung disease (e.g.inhalers/nebulisers in asthma/COPD), catheters (note volume/colour of urine) and intravenous access.

Other medical equipment: ECG leads, medications (e.g.

Sputum pot: note the volume and colour of the contents (e.g.

Look for other forms of respiratory support such as CPAP or BiPAP. Venturi mask, non-rebreathing mask, nasal cannulae) and the current flow rate of oxygen (e.g.

Oxygen delivery devices: note the type of oxygen device (e.g.Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status: lung cancer) and other end-stage respiratory diseases (e.g. Cachexia is commonly associated with underlying malignancy (e.g. Cachexia: ongoing muscle loss that is not entirely reversed with nutritional supplementation.Pulmonary oedema often occurs secondary to left ventricular failure. ascites) and is often associated with right ventricular failure. Oedema: typically presents with swelling of the limbs (e.g.It should be noted that healthy individuals may have a pale complexion that mimics pallor. haemorrhage/chronic disease) or poor perfusion (e.g. Pallor: a pale colour of the skin that can suggest underlying anaemia (e.g.Stridor has a wide range of causes, including foreign body inhalation (acute) and subglottic stenosis (chronic). Stridor: a high-pitched extra-thoracic breath sound resulting from turbulent airflow through narrowed upper airways.Wheeze is often associated with asthma, COPD and bronchiectasis. Wheeze: a continuous, coarse, whistling sound produced in the respiratory airways during breathing.

A dry cough may suggest a diagnosis of asthma or interstitial lung disease.

Cough: a productive cough can be associated with several respiratory pathologies including pneumonia, bronchiectasis, COPD and CF.

5 adventitious breath sounds full#

The inability to speak in full sentences is an indicator of significant shortness of breath. Shortness of breath is a common feature of most respiratory pathology, however possible underlying diagnoses in an OSCE could include asthma, pulmonary oedema, pulmonary fibrosis, lung cancer and COPD.

Shortness of breath: signs may include nasal flaring, pursed lips, use of accessory muscles, intercostal muscle recession and the tripod position (sitting or standing leaning forward and supporting the upper body with hands on knees or other surfaces).

peripheral vasoconstriction secondary to hypovolaemia) or inadequate oxygenation of the blood (e.g.

Cyanosis: bluish discolouration of the skin due to poor circulation (e.g.

Age: the patient’s approximate age is helpful when considering the most likely underlying pathology, with younger patients more likely to have diagnoses such as asthma or cystic fibrosis (CF) and older patients more likely to have chronic obstructive pulmonary disease (COPD), interstitial lung disease or malignancy.

Inspect the patient from the end of the bed whilst at rest, looking for clinical signs suggestive of underlying pathology: You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.