History

  • cough
    • productive?
      • amount
      • color
      • odor/taste
      • hemoptysis
  • fever, chills, rigors, SOB, chest pain (worse on inspiration), diaphoresis
  • travel, infectious exposure, medications, EtOH
  • underlying conditions: smoker, diabetes, cystic fibrosis, immunocomprimised, asthma, COPD, TB

Physical Exam

Inspection

    • ill-looking
    • SOB
    • diaphoresis
    • chills/rigors
    • respiratory distress

cough

palpation

    • decreased chest expansion or asymetry
    • lymphadenopathy
    • increased tactile fremitus

percussion

    • dull
    • decreased diaphragmatic excursion

auscultation

    • bronchial breath sounds in periphery
    • decreased air entry
    • crepitations ( coarse crackles )
    • bronchophony -voice heard abnormally clearly over consolidated lung
    • egaphony - listen to patient's chest as they make "e" sound, if +'ve will hear an "a" sound
    • whispering pectoriloquay - pt whispers "1, 2, 3, 4", if clear then extreme consolidation

Investigations to order

  • CBC
  • Blood cultures
  • mantoux (TB)
  • serology (mycoplasma, viruses)
  • sputum
    • gram stain, C&S
  • CXR
    • typical: discrete/lobar consolidation, air bronchograms
    • atypical: diffuse/patchy/interstitial infiltrates
  • Lung Sounds Breath sound recordings, waveforms and lesson notes

Other OSCE modules

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