Osce- COPD

COPD

1. Appropriate introduction (full name, role, age, occupation)
2. Explains purpose of interview
3. Presenting complaint
1. Ask about nature of breathlessness
2. Elicit the patient ideas, concerns, and expectations
4. History of presenting complaint
1. Ask about: onset
2. Duration
3. And variability of breathlessness
4. Provoking and relieving factors
5. Associated symptoms (wheeze, stridor, cough, sputum, hemoptysis, fever, night
sweats, anorexia, weight loss, chest pain, dizziness)
6. Severity (exercise tolerance - ADLs, sleep disturbance – orthopnea & paroxysmal
nocturnal dyspnoea)
7. Previous episodes of breathlessness
8. Smoking and pets
5. Establishes duration/initial Dx of COPD
6. Establishes/excludes:
1. Cough - nocturnal, day time
2. Sputum – volume, color, consistency
3. Hemoptysis (volume, frequency, altered or fresh blood)
4. Worsening wheeze
5. Fever
6. Chest pain – pleuritic, sharp, worse on movement, no relief
7. Disturbance of sleep
8. Allergens: smoking, pets, pollen, an dust
9. Fever
10. Dyspnoea
11. Hoarseness of voice
7. Establishes risk factor of atypical pneumonia: pets, occupation, foreign travel, contacts
8. Excludes other systemic upset (diarrhoea, confusion, rashes, arthralgia, myalgia)
9. Establishes systemic symptoms of neoplasia: lethargy, malaise, weight loss, appetite
10. Excludes cardiac symptoms: angina, oedema
11. Excludes risk factors for PE
1. OCP
2. Long distance journey
3. Smoking
4. Recent major surgery
5. Recent major fracture
6. Pregnancy
7. Previous history of PE or DVT
8. FMH of PE or DVT
9. History of coagulopathy