Summary
Summary OSCE REPIRATORY -POSTERIOR CHEST EXAMINATION
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this document provides a step by step overview to get you prepared for the upcoming osce exams and your daily ward rounds.
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IC3 OSCE Respiratory Posterior Chest“This is a respiratory station. You have 5 minutes to examine the hands and the posterior 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 positioned at a 45 degree angle Mr/Mrs A is appropriately positioned and
and undressed to the 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 ‘On general inspection Mr/Mrs A appears o O2 delivery, IV access, catheter
Inspects for well, with no evidence of respiratory distress bag, mobility aids, nebulisers,
o Equipment and no equipment around the bed.’ inhalers, peak flow meter, chest
o Patient drain, tracheostomy
Patient
o Appears unwell, tachypnoea,
dyspnoea, cachexia, chest
asymmetry, use of accessory
muscles, cyanosis, stridor, cough,
wheeze
Hands
• Systematic inspection of the hands ‘On examination of the hands, there are no Clubbing, cyanosis, tar staining, wasting
• Checks for Tremor/Asterixis signs of respiratory disease, respiratory and of small muscles, asterixis/tremor
• Check Pulse, Respiratory Rate & BP heart rate and within normal limits.’ Abnormal RR, HR, BP
Closer Inspection of Posterior Chest
Performed from behind the patient Scars
Inspects for ‘On closer inspection of the posterior chest • Thoracotomy, drain sites
o Scars wall, there are no scars, skeletal Skeletal abnormalities
o Skeletal abnormalities abnormalities or other stigmata of • Kyphoscoliosis
o Chest wall movements respiratory disease.‘ Chest wall movements
• Asymmetry, increased AP diameter
Palpation
Chest expansion
On anterior chest with both thumbs ‘Chest expansion was symmetrical and Chest expansion
placed lightly on chest wall, asks patient greater than 5cm. Tactile fremitus was Chest expansion is
to inspire deeply and observes distance normal.’ symmetrical/asymmetrical to X cm
& symmetry
Tactile fremitus
Tactile fremitus
Places ulnar aspect of hand in
Tactile fremitus increased
intercostal spaces and asks patient to
say ‘99’ at each point, compares sides
Percussion
• Asks patient to move arms forward so
that scapulae move anteriorly ‘The percussion note is D/SD/HR in X zone.’
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