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Respiratory Examination (OSCE)

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🫁 Respiratory Examination – OSCE Candidate Guide
Instructions to Candidate: Please examine this patient’s respiratory system. You have 7 minutes. Present your findings at the end. 🧼 Preparation: Wash hands, introduce yourself, confirm patient’s name + DOB. Explain exam, gain consent, expose chest (with dignity), position at 45°, offer a chaperone. 👀 General / End-of-bed Inspection: Look for signs of distress (accessory muscles, pursed-lip breathing, cyanosis). Note cachexia, oxygen therapy, inhalers, sputum pots, mobility aids, chest drains. Examiner tip: Verbalise – “From the end of the bed, I see…” ✋ Hands: Clubbing (lung cancer, bronchiectasis, fibrosis). Nicotine/tar stains. Peripheral cyanosis, temperature, cap refill. Tremor (fine = β₂ agonists, flapping = CO₂ retention). 🫀 Pulses & Neck: Radial pulse – rate, rhythm, volume. JVP (pulmonary HTN, cor pulmonale). Tracheal position (central/pulled/pushed). Cervical & supraclavicular lymph nodes (malignancy, TB). 👕 Chest Inspection: Scars: thoracotomy, VATS, drains, pacemaker. Deformities: pectus, scoliosis, barrel chest. Chest expansion symmetry, accessory muscles. 🫁 Palpation: Trachea (again) + cricosternal distance. Chest expansion (upper/mid/lower zones). Tactile vocal fremitus (↑ consolidation, ↓ effusion/pneumothorax). Apex beat (displaced by cardiomegaly or mediastinal shift). 🥁 Percussion: Compare side-to-side, anterior, lateral, posterior (≥3 zones). Interpret: Dull = consolidation/effusion Stony dull = effusion Hyperresonant = pneumothorax 🎧 Auscultation: Anterior, lateral, posterior zones. Normal vesicular vs bronchial breathing. Added sounds: crackles (fibrosis/oedema/bronchiectasis), wheeze (asthma/COPD), pleural rub. Vocal resonance (egophony, whispering pectoriloquy). 🔎 Other Checks: Leg oedema (cor pulmonale, RHF). Sacral oedema (if immobile). DVT signs (if PE suspected). 🙏 Closure: Thank patient, reposition, wash hands. To complete my exam I would: Check sputum pot, peak flow diary. Examine ENT (e.g. for clubbing/cyanosis links), cardiovascular exam. Order investigations: CXR, ABG, Spirometry/PFTs, Sputum culture, Bloods (FBC, CRP, U&E). Present findings clearly to examiner.

🫁 Respiratory Examination – OSCE Candidate Guide

Instructions to Candidate: Please examine this patient’s respiratory system. You have 7 minutes. Present your findings at the end.

🧼 Preparation: Wash hands, introduce yourself, confirm patient’s name + DOB. Explain exam, gain consent, expose chest (with dignity), position at 45°, offer a chaperone.
👀 General / End-of-bed Inspection: Look for signs of distress (accessory muscles, pursed-lip breathing, cyanosis). Note cachexia, oxygen therapy, inhalers, sputum pots, mobility aids, chest drains. Examiner tip: Verbalise – “From the end of the bed, I see…”
✋ Hands:
- Clubbing (lung cancer, bronchiectasis, fibrosis).
- Nicotine/tar stains.
- Peripheral cyanosis, temperature, cap refill.
- Tremor (fine = β₂ agonists, flapping = CO₂ retention).
🫀 Pulses & Neck:
- Radial pulse – rate, rhythm, volume.
- JVP (pulmonary HTN, cor pulmonale).
- Tracheal position (central/pulled/pushed).
- Cervical & supraclavicular lymph nodes (malignancy, TB).
👕 Chest Inspection:
- Scars: thoracotomy, VATS, drains, pacemaker.
- Deformities: pectus, scoliosis, barrel chest.
- Chest expansion symmetry, accessory muscles.
🫁 Palpation:
- Trachea (again) + cricosternal distance.
- Chest expansion (upper/mid/lower zones).
- Tactile vocal fremitus (↑ consolidation, ↓ effusion/pneumothorax).
- Apex beat (displaced by cardiomegaly or mediastinal shift).
🥁 Percussion: Compare side-to-side, anterior, lateral, posterior (≥3 zones). Interpret:
- Dull = consolidation/effusion
- Stony dull = effusion
- Hyperresonant = pneumothorax
🎧 Auscultation:
- Anterior, lateral, posterior zones.
- Normal vesicular vs bronchial breathing.
- Added sounds: crackles (fibrosis/oedema/bronchiectasis), wheeze (asthma/COPD), pleural rub.
- Vocal resonance (egophony, whispering pectoriloquy).
🔎 Other Checks:
- Leg oedema (cor pulmonale, RHF).
- Sacral oedema (if immobile).
- DVT signs (if PE suspected).
🙏 Closure: Thank patient, reposition, wash hands. To complete my exam I would:
- Check sputum pot, peak flow diary.
- Examine ENT (e.g. for clubbing/cyanosis links), cardiovascular exam.
- Order investigations: CXR, ABG, Spirometry/PFTs, Sputum culture, Bloods (FBC, CRP, U&E).
Present findings clearly to examiner.

💡 Key OSCE Points

• Always compare sides. • State vitals you’d like to add (RR, O₂ sats). • Don’t forget hands (clubbing, nicotine stains, CO₂ flap). • Finish with “To complete my exam I would check O₂ sats, PEFR, ABG, and CXR.”

⚠️ Common Pitfalls

Insufficient exposure (missing scars, deformities).
Rushing: skipping fremitus or posterior auscultation.
Not explaining → patient discomfort.
Forgetting to observe rate and pattern at the start.

🧾 Pathological Findings & Classic Exam Signs

Pathology	Etiology	History / Inspection	Mediastinum	Percussion	Auscultation
🫁 Consolidation	Lobar pneumonia	Cough, fever, pleuritic pain	Central	Dull, ↑ tactile fremitus	Bronchial breathing, crackles, ↑ vocal resonance
⬇️ Collapse	Obstructed bronchus	Dyspnoea, ↓ expansion	Towards affected	Dull	Absent breath sounds
💧 Pleural Effusion	Fluid in pleural space	Progressive SOB	Away from effusion	Stony dull	↓ breath sounds, ↓ VR, pleural rub
💨 Pneumothorax	Air in pleural space	Sudden SOB, pleuritic pain	Towards affected (simple)	Hyper-resonant	Absent breath sounds
🚨 Tension Pneumothorax	Air under pressure	Acute distress, hypotension	Away from affected	Hyper-resonant	Absent breath sounds
🌪️ Asthma	Bronchospasm	Wheeze, nocturnal cough	Central	Resonant	Expiratory wheeze
🌫️ COPD	Chronic bronchitis/emphysema	Chronic cough, cyanosis	Central	Hyper-resonant	Wheeze, ↓ breath sounds
🌿 Pulmonary Fibrosis	ILD / occupational	Progressive SOB, clubbing	Central	Dull	Fine “Velcro” crackles

📚 References

Talley & O’Connor – Clinical Examination
Geeky Medics Respiratory OSCE
OSCEstop Revision Guides

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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