Respiratory Examination in NHS for OSCE

As a healthcare professional in the UK, it is essential to have a thorough understanding of the respiratory examination for the Objective Structured Clinical Examination (OSCE). This exam is a standardized assessment tool used to evaluate the clinical competence of healthcare professionals, including doctors, nurses, and physician assistants. In this blog, we will provide step-by-step guidelines for performing a respiratory examination in the National Health Service (NHS) setting for the OSCE.

Step 1: Introduction and Consent As with any clinical examination, the first step is to introduce yourself to the patient, explain the purpose of the examination, and obtain their consent to proceed. Explain that you will need them to undress from the waist up and that you will be examining their chest.

Step 2: Inspection Begin by inspecting the patient's chest. Look for any obvious abnormalities, such as scars, deformities, or asymmetry. Observe the respiratory rate, depth, and rhythm. Note any use of accessory muscles, such as the sternocleidomastoid or intercostal muscles, and any signs of respiratory distress, such as pursed lips, nasal flaring, or cyanosis.

Step 3: Palpation Next, palpate the chest to assess for tenderness, crepitus, or masses. Use your hands to assess chest expansion by placing them on either side of the patient's chest, at the level of the 10th rib, and asking them to take a deep breath. Note any areas of reduced expansion, which may indicate an underlying respiratory condition.

Step 4: Percussion Percuss the chest to assess the underlying lung fields. Begin at the top of the chest and work your way down, comparing the sounds heard on each side. The normal sound is resonant, while dullness may indicate the presence of fluid or consolidation.

Step 5: Auscultation Finally, auscultate the chest using a stethoscope. Begin at the upper lobes and work your way down, comparing sounds heard on each side. Listen for breath sounds, including vesicular, bronchial, or Broncho vesicular sounds. Also, listen for added sounds such as crackles, wheezes, or rubs.

Step 6: Additional Examinations Depending on the OSCE scenario, additional examinations may be necessary. For example, you may need to assess for the presence of a pleural effusion by performing a percussion and auscultation test. Or you may need to perform a peak flow measurement to assess the patient's respiratory function.

Step 7: Summary and Management Plan Once you have completed the examination, summarize your findings to the patient and explain any implications for their health. Depending on the findings, you may need to formulate a management plan or refer the patient for further investigation or treatment.

In conclusion, performing a respiratory examination in the NHS setting for the OSCE requires a systematic and thorough approach. By following these step-by-step guidelines, you can ensure that you perform a comprehensive and accurate examination, which will help you pass your OSCE and provide high-quality patient care in your future practice.

 

Dr.Muhammad Arsalan Khan
Diabetes Specialist
MBBS, MSc (Diabetes & Endocrinology) - DUHS
CCD-BMJ-AKU-RCP (London)