OSCE PREFINAL EXAM

 OSCE- PREFINALS DEC 2023:

Case report : 

  I have tried to answer some of the questions regarding case discussion of our patient  

 1. How to clinically differentiate between coarse and fine crepitations ?

Ans-  well, crepitations or crackles  are adventitious respiratory sounds which occur when an obstructed airway due to accumulated  secretions opens in inspiratory phase.

The sudden opening of an obstructed airway causes an immediate re-equilibration of the pressures on both sides creating vibrations in the airway walls. 

Fine crackles -- 

A).  having a short duration and a higher pitch,           Often, fine crackles are repetitive, originate          in the basal part of the lung, and not altered          by coughing.

B) Coarse crackles  appear to be a longer                     duration and a   lower pitch.

     There is no specific location from where                  coarse crackles primarily originate. They are        often altered by coughing.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834319/#:~:text=Bronchial%20breath%20sounds%20are%20blasting,of%20pneumonia%20or%20pulmonary%20fibrosis.

2. Why are bronchial  breath sounds heard in lung fields on ascultation in this case and how to clinically differentiate between normal vesicular ans bronchial breath sounds?

Ans-- Bronchial breath sounds in the lung fields are heard in our patient due to consolidation secondary to hospital acquired pneumonia.

 Normal vesicular breath sounds are : 

Soft, low pitched, and rustling in quality

  a) Inspiratory phase remains  longer than the            expiratory phase 

  b)   Inspiration is higher pitch than expiration

   c) No pause between inspiration and expiration

Bronchial breath sounds : 

It is loud, hollow, and high pitch

Expiratory phase is longer than inspiratory phase

There is distinct pause between inspiration and expiration due to absent alveolar phase

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518345/

3 . What are changes occurring at level of alveoli       in acute respiratory distress syndrome ?

4. Death rattle ?

Ans.. Death rattle is  caused by an accumulation of secretions in the upper airway . This accumulation of  mucus cannot be easily coughed up or swallowed by the patient, often as a result of a diminished consciousness. The mucus is vibrated by breathing and this creates the typical “gurgling and wet” sound of death rattle. 

5. Management of the case and role of ECMO?

Ans :-  fluconazole  for oral candidiasis is being given, doxycycline also given 

ECMO -Extracorporeal membrane            oxygenation consists of a circuit where blood is drained through a catheter from the venous vascular system, circulated in a pump outside the body, and reinfused into the other venous or arterial vascular system depending on the ECMO circuit type for circulation in the body.

The ECMO machine performs the function of the lungs successfully so the lungs can rest and we can use very low settings on the breathing machine. This protects the lungs from additional damage that the high pressures from the breathing machine cause.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9363689/