Interstitial lung disease examination


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 in respiratory clinic

Patient: This patient has come for a check up. The consultant has asked you to examine the patient and present to them.

Task:

– Examine this patients respiratory system

– Please provide a running commentary whilst you are examining

– During the examination the examiner will present you with information to interpret

– After 6 minutes you will be asked a series of questions by the examiner.

You are a patient who has come into see your GP for a check up. You are happy to be examined.

Please feel free to stop the examination if the candidate causes pain or discomfort to yourself.

The mark scheme includes information points for you to give the candidate.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school / Year / grade
Clarifies who they are talking to
Asks patient for preferred name


Examination étique Examination étique
Washes hands
Exposes patient correctly
Patient positioned at 45 degrees
Examination from left hand side


Inspection General inspection
General appearance
Pursed lip breathing
Use of accessory muscles
Oxygen (nasal, mask, high flow)
Inhalers / medications at bedside
Walking aids at bedside
Respiratory rate


Hands Comments on hands
Temperature
Peripheral cyanosis
Tar staining
Finger clubbing
Koilonychia


Interpretation
Please review the following image and comment on the clinical sign shown

Finger / digital clubbing


Arms Arms
CO2 retention tremor (flapping tremor)
Fine physiological tremor (e.g salbutamol)
Radial pulse (bounding is a sign of CO2 retention)


Face Face
Conjunctival pallor
Central cyanosis


Neck Neck
Examines for cervical lymph nodes
JVP
Trachea position


Inspection Closer inspection
Scars (thoracotomy scars)
AP diameter for hyperinflation (seen in COPD)
Deformity of spine (scoliosis can cause T2RF)


Palpation Palpation
Chest expansion (comment on symmetry)


Percussion Percussion
Starts percussion at supraclavicular fossa
Percusses at 6 sites
Directly compares at same intercostal level L to R
Comments on percussion as = responds, dull, stony dull
Both anterior and posterior chest examined


Auscultation Auscultation
Asks patient to breathe in and out through an open mouth
Listens over 6-10 areas anteriorly
Directly compares at same intercostal level L to R
Vocal resonance
Whispering pectoriloquy
Both anterior and posterior chest examined


Interpretation
Please listen to the following auscultation of this patient and comment on your findings

Fine end inspiratory crepitations


Posterior chest Posterior chest
Checks for the presence of sacral oedema


Peripheral examination Peripheral examination
Examines for pitting oedema


Closing Closing examination
Invites patient to get re-dressed
Washes hands


Patient Patient
Candidate did not cause any pain to patient
Candidate was polite throughout examination


Question Please present your findings
Finger clubbing present
Fine end inspiratory crepitations


Question Given your examination, what is your most likely diagnosis?
Interstitial lung disease (allow idiopathic pulmonary fibrosis)


Question To conclude your examination, what investigations would you like to do?
Spirometry
CXR
ABG


Question
Please review the following image commenting on the type of investigation and explain the type of trace shown by A, B and C

Spirometry trace
A = Normal trace
B = Obstructive defect
C = Restrictive defect


Question
In the patient you have just examined, which spirometry trace (A, B, C) would you expect them to have

C



Score