Respiratory
Ian Mann, Alastair Noyce in The Finalist’s Guide to Passing the OSCE, 2021
Respiratory disease is common and, as such, the patient load is heavy. It is relatively easy to become complacent when performing an examination. It is not uncommon that individuals will restrict themselves to an examination either of the anterior or of the posterior chest. There are many peripheral stigmata of respiratory disease that the people should be familiar with. A normal adult respiratory rate is 12-18 breaths per minute. Vocal resonance and tactile vocal fremitus are two methods of assessing the same thing, namely the way in which sound is transmitted through the lung parenchyma. There is marked poor air entry throughout, with a widespread mild polyphonic wheeze and a prolonged expiratory phase of the respiratory cycle.
Consolidation of the Lung
K. Gupta in 100 Short Cases for the MRCP, 2020
Examine this patient's respiratory system and tell me what your clinical findings are. Go through the routine of examination of the respiratory system. Look for central and peripheral cyanosis. Tachycardia and clubbing may be present. On inspection: - Movement of chest wall is reduced on the affected side. - Trachea is central and apex beat is not shifted. On palpation vocal fremitus is increased and chest expansion is reduced on the affected side. The percussion note is impaired on the affected side (dullness). Carefully listen on auscultation for: - Bronchial breathing. - Fine or coarse crackles. - Pleural rub. - Whispering pectoriloquy. - Increase in vocal resonance.
• Respiratory system 42
Shabana Bora, Theresa Heah, Shivangi Thakore in OSCEs for Medical and Surgical Finals, 2005
The easiest way to examine the actual thorax is to start anteriorly and assess palpation, percussion, tactile vocal fremitus or vocal resonance and auscultation before repeating it all posteriorly. Remember to begin all these tests at the apices and move from side to side symmetrically down to the bases, not forgetting the axillae and lateral chest walls. Your examination technique is important and you should ensure that whilst assessing for chest wall expansion your thumbs are in the air at right-angles to the chest wall and not touching the patient’s chest. Whilst percussing the chest, demonstrate a good tapping technique, and whilst assessing for tactile vocal fremitus, use the ulnar border of both hands simultaneously, one on each half of the chest wall. At the end of your examination, say that you would like to check the observation chart, do a peak flow measurement and, if appropriate, look in the sputum pot.
Clinical protocol for occlusal adjustment: Rationale and application
Published in CRANIO®, 2018
Background: Occlusal adjustment can optimize the result of orthodontics, orthognathic surgery, and comprehensive restoration, and resolve adverse forces to the dentition that affect the entire masticatory system. Mounted diagnostic casts and computerized occlusal analysis offer complementary advantages for evaluating occlusal problems. Predictable occlusal adjustment is facilitated by precise, measured documentation of occlusal force by computerized occlusal analysis. Clinical presentation: A conservative, structural correction of a pronounced, chronic occlusal problem by additive and subtractive occlusal adjustment was performed after a previous failed occlusal adjustment. The patient’s chief concerns were significant anterior teeth fremitus in maximum intercuspation and “pain in the teeth and a poor bite” after 30+ adjustments over 2.5 years. Clinical Relevance: Confirmation of specific criteria for a therapeutic occlusion resolved the anterior teeth fremitus and uneven bite. Traumatic occlusal contact on posterior teeth may elicit protective mandibular repositioning affecting anterior teeth relationships and should be considered during comprehensive diagnosis.
Related Knowledge Centers
- Pleural Effusion
- Pleural Friction Rub
- Rhonchi
- Liver
- Pneumothorax
- Bronchial Hyperresponsiveness
- Hydatid Cyst