FREE RESPIRATORY

OSCE GUIDE

THEORGANIZEDMEDIC.COM
 HI FUTURE
DOCTOR

LET'S BE FRIENDS
Respiratory OSCE
INTRODUCTION
Knock on the door
Wash hands and put on PPE if necessary
Introduce yourself:
‘I am a… year medical student’
Confirm name and DOB.
Address Pt by title followed by last name or ask Pt preferred name.
“How would you like me to address you?”
Briefly explain the procedure and gain consent to proceed.
“I am going to be… would that be ok?”
Get chaperone, and ask them to adequately expose their upper half - offer a
blanket to allow exposure only when required.
Ask if they’re in any pain before proceeding.

GENERAL INSPECTION
Bedside observations:
Cigarette packets
O2 tank
Nebuliser
CPAP machine
Ventilator
rebreather mask
tracheostomy (chest) tube.

1
N.B. THERE IS NO WATERMARK
ON PURCHASED ITEMS
Respiratory OSCE
INITAL INSPECTION
Body Habitus Patient is supine/seated/in tripod position

Respiration Rate
Rhythm is (regular, irregular)
Breathing is quiet/loud (stridor?)
Effort: good/poor/forced
Pursed lipped breathing? (yes/no)
Use of accessory muscles (yes/no)
Sternocleidomastoid/trapezius/scalenes/pectoral
Mj intercostals
Nasal Flaring (yes/no)
EYES Pallor
Xanthelasma
Mouth & lips Central cyanosis (yes/no)
Oral cavity
General Dentition
Hands, Peripheral Cyanosis

fingers, & Nail clubbing/koilonychia

Nicotine stains
nails
Capillary Refill
C02 flap – ask the patient to hold their arms out
straight with the wrists extended

N.B. THERE IS NO WATERMARK

ON PURCHASED ITEMS 2
Respiratory OSCE
INITAL INSPECTION
Radial pulse Bilaterally: rate/rhythm/amplitude

Neck Thyroid
Palpate trachea – should be midline!
Scars, masses, nodules, rashes
JVP

CHEST INSPECTION
osce tip : ask the patient to lie down and position
the bed at 45 degree angle
Deformities Scars (surgical & non-surgical)
rashes
nodules
SOI
pectus excavatum / pectus carinatum
chest Symmetrical (good)
Asymmetrical (unilateral impaired respiratory
expansion
movements left/right side)
Flail Chest Paradoxical breathing
Abnormal Look at the lower interspaces and supraclavicular

inspiratory retraction during inspiration.

Absent/present (location: right/left side)
Retractions

N.B. THERE IS NO WATERMARK

ON PURCHASED ITEMS 3
Respiratory OSCE
CHEST PALPATION
Identify tender areas: 'Do you have any pain anywhere?’
Neck Palpate
Trachea (should be midline)
Lymph nodes
Supraclavicular & Deep cervical
Palpate the manubrium, Sternum, costochondral cartilage and
along each costal margin
Chest Place your thumbs along each costal margin & your
hands along the lateral rib cage.
expansion test
As you position your hands, slide them medially a bit to
raise loose skin folds between your thumbs.
Ask the patient to inhale deeply.
Observe how far your thumbs diverge as the thorax
expands and feel for the extent and symmetry of
respiratory movement.
Tactile fremitus: ask patient to say “99/111/Err” each time your
hand touches their chest. Repeat in 3 locations of the chest on the
L & R. (normal/ increased)
axilla Palpate the axillary lymph nodes

N.B. THERE IS NO WATERMARK

ON PURCHASED ITEMS 4
Respiratory OSCE
CHEST PERCUSSION
Percuss 6 In a woman
to enhance percussion ; gently displace the breast
positions
with your left hand while percussing with the right.
bilaterally
CHEST AUSCULTATION
6 positions bilaterally
BREATH SOUNDS Vesicular (normal!)
Bronchovesicular
Bronchial
Tracheal

Adventitious Crackles
fine/coarse
sounds
inspiratory/expiratory
early/late
location & distribution
change after cough/position
Wheeze
Ronchi
Stridor
Transmitted Pectoriloquy (+ve): whisper 99 – 99 loud/clear on whisper

vocal sounds Egophony (+ve): “ee..” (E sounds like A)

Bronchophony (+ve): say 99 - louder voice sound

N.B. THERE IS NO WATERMARK

ON PURCHASED ITEMS 5
Respiratory OSCE
LATERAL INSPECTION
AP diameter vs LCD: looks increased/average/less than average

BACK INSPECTION
DEFORMITIES Scoliosis
kyphoscoliosis
Scars
rashes
nodules
SOI
Chest Asymmetrical
unilateral impaired respiratory movements
expansion
left/right side
SYMMETRICAL
Abnormal Observe interspaces during inspiration
Absent/present
Retractions
location: right/left side
Impaired Present (Yes/No)

Respiratory Bilateral vs Unilateral lag/delay

movements

N.B. THERE IS NO WATERMARK

ON PURCHASED ITEMS
6
Respiratory OSCE
BACK PALPATION
Identify tender areas: 'Do you have any pain anywhere?’
Palpate the spine down the paraspinal line, observe for pain
(scoliosis, kyphoscoliosis)
Lung Place your hands on the L & R axilla at the level of the
10th ribs
excursion
Slide your thumbs medially towards the Paraspinal line
(Chest
just enough to raise a loose fold of skin on each side
expansion between your thumb and the spine. Ask the patient to

test) inhale deeply.

Watch the distance between your thumbs as they move
apart during inspiration.
Assess symmetry and range of expansion and
contraction.
Tactile fremitus: ask patient to say “99/111/Err” each time your
hand touches their chest. Repeat in 3 locations of the chest on the
L & R. (normal/ increased)
BACK PERCUSSION
ask the patient to hug themselves
Percuss 7 positions of the back bilaterally (compare left to right)
Flat / Dull / Resonant (normal) / Hyperresonance / Tympanic

N.B. THERE IS NO WATERMARK ON PURCHASED ITEMS

7
Respiratory OSCE
BACK PERCUSSION
Diaphragmatic During quiet respiration, from the lung apex, percuss
downward in progressive steps until dullness clearly
excursion
replaces resonance (DBL).
NORMAL IS
Ask the patient to fully inhale.
3-5.5cm Continue to percuss DOWNWARD in progressive steps until

(ask female dullness clearly replaces resonance.

Ask the Pt to fully exhale.
patient to
Continue to percuss UPWARD in progressive steps until
hold up their
dullness clearly replaces resonance.
breasts) Note the distance between LOD on Inspiration and
expiration

BACK AUSCULTATION
7 positions bilaterally
BREATH SOUNDS Vesicular (normal!)
Bronchovesicular
Bronchial
Tracheal

Transmitted ONLY AT THE BASE OF THE LUNGS

Pectoriloquy (+ve): whisper 99 – 99 loud/clear on whisper
vocal sounds
Egophony (+ve): “ee..” (E sounds like A)
Bronchophony (+ve): say 99 - louder voice sound

N.B. THERE IS NO WATERMARK

ON PURCHASED ITEMS 8
Respiratory OSCE
BACK AUSCULTATION
6 positions bilaterally
Adventitious Crackles
fine/coarse
sounds
inspiratory/expiratory
early/late
location & distribution
change after cough/position
Wheeze
Ronchi
Stridor

TEST FOR Sacral oedema

Peripheral Oedema
OEDEMA
ABBREVIATIONS
AP – Anterior Posterior
SOI – Signs of inflammation
LCD – Lateral Chest Diameter
LOD – Level of dullness
DBL – Diaphragmatic basal level

N.B. THERE IS NO WATERMARK

ON PURCHASED ITEMS 9
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