The Respiratory Osce

Question 1

List the 6 sections the respiratory OSCE can be broken up into.

Answer 1

1) Set up
2) Inspection
3) Palpation
4) Percussion
5) Auscultation
6) Scope for further examination

Question 2

List the steps included in set up

Answer 2

Explaining the exam

Positioning and Exposure

Question 3

List the steps included in Inspection

Answer 3

Overall inspection
Peripheral examination (to include CO2 retention flap)
Respiratory Rate
Chest inspection

Question 4

List the steps included in Palpation

Answer 4

Palpate for lymph nodes
Palpate for trachea
Palpate for chest expansion

Question 5

List the step(s) included in Percussion

Answer 5

Percussion of front and back (and examine further to elicite extent of problem in the case of an abnormality)

Question 6

List the steps included in Scope for Further Examination

Answer 6

• Be aware of potential signs for tactile vocal fremitus, vocal resonance and whispering pectoriloquy.
• State further tests (peak flow, sputum inspection, oxygen saturations)

Question 7

What is included in 1) Positioning and Exposure

Answer 7

45 degrees;
complete exposure of chest, back and front for inspection, (although breasts can be covered for the remainder of the time in women.

Question 8

What is included in 2) Overall inspection

Answer 8

Inspect patient overall and comment on build, posture demeanour and any abnormality.

Question 9

List the steps included in the section ‘Auscultation’

Answer 9

Auscultate all areas of chest (for a whole respiratory cycle)

Question 10

What is included in 3) Peripheral Examination

Answer 10

Examine hands (nails, palms and testing for CO2 flap);
Examine mouth (lips, tongue and mucous membranes)

Question 11

What is included in 4) Chest inspection

Answer 11

Inspect chest cand comment on resting respiratory excursion, symmetry and shape, scars and skin lesions

Question 12

What is included in 5) Respiratory Rate

Answer 12

Assess respiratory rate without undue attention of patient.

Question 13

What is included in 6) palpation for lymph nodes

Answer 13

Palpate for supraclavicular lymph nodes

Question 14

What is included in 7) palpate for trachea

Answer 14

confirm position of trachea in the sternal notch

Question 15

What is included in 8) Chest expansion

Answer 15

Assess symmetry and excursion of maximum chest expansion by palpation of back and front

Question 16

What is included in 9) Percussion

Answer 16

Percusses a minimum of three locations back and front and in the axillary area, comparing sides and encompassing all lobes;
Examines further to elucidate extent of problem in the presence of an abnormality.

Question 17

What is included in 10) Auscultation

Answer 17

Auscultates all areas of chest as in percussion using the diaphragm and listening throughout the whole respiratory cycle in each area;
Examines further in the event of an abnormality.

Question 18

What is included in 11) Be aware of potential signs of tactile vocal fremitus, vocal resonance and whispering pectoriloquy.

Answer 18

Tactile Vocal Fremitus-

Vocal Resonance-

Whispering Pectoriloquy-

Question 19

What is included in 12) State further tests

Answer 19

Peak flow,
Inspection of sputum
Oxygen saturations