IC3 OSCE Respiratory Anterior Chest
“This is a respiratory station. You have 5 minutes to examine the hands and the anterior chest. I will then ask you to
present your findings and answer a question”.
Examination Expected/Normal Comments Potential/Abnormal Comments
Introduction
Hand hygiene
• Cleans hands with alcohol gel
Introduction, explanation and consent Hi my name is X. I’m a third year medical
• Introduces self with name and level, student at RCSI. What’s your name? Nice to
explains what he/she will be doing and meet you. I’ve been asked to examine your
obtains consent for same chest today. That will involve looking at your
chest and listening to your lungs. Would that
be ok?
Position and exposure
• Patient position sitting up in bed or sitting Mr/Mrs A is appropriately positioned and
at bedside and exposed to waist. exposed for this examination.
Enquires about pain Are you in any pain?
• Prior to examining
General Inspection
Equipment
Performed from the end of the bed O2 delivery, IV access, catheter bag,
Comments on mobility aids, nebs, inhalers, peak flow
‘On general inspection Mr/Mrs A appears
o Equipment meter, chest drain, tracheostomy
well, with no evidence of respiratory distress
o Patient Patient
and no equipment around the bed.’
Appears unwell, tachypnoea, dyspnoea,
cachexia, chest asymmetry, use of
accessory muscles, cyanosis, stridor,
cough, wheeze, Pemberton’s sign
Hands
Systematic inspection of the hands ‘There is grade X clubbing.’
Checks for Tremor/Asterixis Grade 1: Fluctuation & softening of nail bed
o Extends the arms, spreads the fingers, Grade 2: Loss of the <165° angle between
dorsiflexs the wrist and observes for the nailbed and fold
“flapping” tremor at the wrist. If not ‘On examination of the hands, there are no Grade 3: Increased convexity nail fold
immediately apparent, may ask patient signs of respiratory disease, and the Grade 4: Thickening of distal finger
to keep arms straight while examiner respiratory and heart rates are within normal Cyanosis, tar staining, wasting of small
gently hyperextend patient’s wrist with limits.’ muscles, asterixis/tremor
sweeping motion. The respiratory/heart rate is
Checks Pulse, Resp Rate & offers BP check increased/decreased to X bpm.
Face and Neck
Eyes Eyes
Central cyanosis o Horner’s, chemosis, pallor
o Asks patient to lift tongue to roof of Central cyanosis
mouth and looks underneath o Present
JVP ‘On examination of the face, there is no
JVP
o Examines at 45°, head turned to left. evidence of respiratory disease.’
o Raised at a distance of ‘X’cm
Measures from the sternal notch. Trachea
Tracheal deviation & tug ‘JVP is not visible.’ o Displaced to R/L
o Palpates anterior inferior neck just Ipsilateral- collapse, fibrosis
above jugular notch by gently pressing ‘The trachea is central with no evidence of Contralateral-mass, effusion,
fingertips between the lateral tracheal tracheal tug.’ pneumothorax
wall and medial sternocleidomastoid. o Tracheal tug present
o Watches for tug during inspiration Pemberton’s
Offers to assess for Pemberton’s o Present
Closer Inspection of Anterior Chest
Scars
Comments on Sternotomy (CABG/valve surgery)
Scars Thoracotomy (lobe/pneumonectomy)
‘On closer inspection of the chest, there are
Radiotherapy tattoos
“This is a respiratory station. You have 5 minutes to examine the hands and the anterior chest. I will then ask you to
present your findings and answer a question”.
Examination Expected/Normal Comments Potential/Abnormal Comments
Introduction
Hand hygiene
• Cleans hands with alcohol gel
Introduction, explanation and consent Hi my name is X. I’m a third year medical
• Introduces self with name and level, student at RCSI. What’s your name? Nice to
explains what he/she will be doing and meet you. I’ve been asked to examine your
obtains consent for same chest today. That will involve looking at your
chest and listening to your lungs. Would that
be ok?
Position and exposure
• Patient position sitting up in bed or sitting Mr/Mrs A is appropriately positioned and
at bedside and exposed to waist. exposed for this examination.
Enquires about pain Are you in any pain?
• Prior to examining
General Inspection
Equipment
Performed from the end of the bed O2 delivery, IV access, catheter bag,
Comments on mobility aids, nebs, inhalers, peak flow
‘On general inspection Mr/Mrs A appears
o Equipment meter, chest drain, tracheostomy
well, with no evidence of respiratory distress
o Patient Patient
and no equipment around the bed.’
Appears unwell, tachypnoea, dyspnoea,
cachexia, chest asymmetry, use of
accessory muscles, cyanosis, stridor,
cough, wheeze, Pemberton’s sign
Hands
Systematic inspection of the hands ‘There is grade X clubbing.’
Checks for Tremor/Asterixis Grade 1: Fluctuation & softening of nail bed
o Extends the arms, spreads the fingers, Grade 2: Loss of the <165° angle between
dorsiflexs the wrist and observes for the nailbed and fold
“flapping” tremor at the wrist. If not ‘On examination of the hands, there are no Grade 3: Increased convexity nail fold
immediately apparent, may ask patient signs of respiratory disease, and the Grade 4: Thickening of distal finger
to keep arms straight while examiner respiratory and heart rates are within normal Cyanosis, tar staining, wasting of small
gently hyperextend patient’s wrist with limits.’ muscles, asterixis/tremor
sweeping motion. The respiratory/heart rate is
Checks Pulse, Resp Rate & offers BP check increased/decreased to X bpm.
Face and Neck
Eyes Eyes
Central cyanosis o Horner’s, chemosis, pallor
o Asks patient to lift tongue to roof of Central cyanosis
mouth and looks underneath o Present
JVP ‘On examination of the face, there is no
JVP
o Examines at 45°, head turned to left. evidence of respiratory disease.’
o Raised at a distance of ‘X’cm
Measures from the sternal notch. Trachea
Tracheal deviation & tug ‘JVP is not visible.’ o Displaced to R/L
o Palpates anterior inferior neck just Ipsilateral- collapse, fibrosis
above jugular notch by gently pressing ‘The trachea is central with no evidence of Contralateral-mass, effusion,
fingertips between the lateral tracheal tracheal tug.’ pneumothorax
wall and medial sternocleidomastoid. o Tracheal tug present
o Watches for tug during inspiration Pemberton’s
Offers to assess for Pemberton’s o Present
Closer Inspection of Anterior Chest
Scars
Comments on Sternotomy (CABG/valve surgery)
Scars Thoracotomy (lobe/pneumonectomy)
‘On closer inspection of the chest, there are
Radiotherapy tattoos
