Respiratory Patient OSCE Stations

Respiratory
by Medical Educator Respiratory

Respiratory Patient OSCE Stations offer a valuable learning experience specifically focused on respiratory medicine. These stations simulate real patient encounters, where you will be challenged to interact with patients presenting with respiratory symptoms, perform relevant examinations, interpret diagnostic tests, and formulate appropriate management plans.

Participating in Respiratory Patient OSCE Stations will sharpen your clinical reasoning, communication, and decision-making skills in the context of respiratory medicine. These assessments will enable you to gain confidence in recognizing respiratory disorders, understanding their underlying pathophysiology, and applying evidence-based treatment strategies.

Table of Contents

32 year old female

A 32 year old female presents with malaise and a small pleural effusion. The chest xray is otherwise normal. The pleural aspirate shows the following:

PH 7.4

Protein 34g/l

Glucose 1.1 mmol (3-7)

Culture: no growth

What is the aetiology of the effusion:

  • Exudate secondary to TB
  • Exudate secondary to pulmonary embolism
  • Exudate secondary to rheumatoid arthritis
  • Exudate secondary to Antiphospholipid antibody syndrome
  • It’s a transudate

Exudate secondary to rheumatoid arthritis

Exudative effusions generally have a protein>30g but it depends on the serum albumin. In this case the effusion has a very low glucose. This is typical of TB, an empyema (infected pleural effusion) and rheumatoid.

Empyemas need to be drained (where theres pus about let it out)à Intercostal chest drain. But… the PH is normal (often <7.2 in empyema) and the culture has not grown any bacteria. So its not an empyema.

It could be TB, but the otherwise normal Xray, rash and arthralgia make RA more likely.

36 year old woman

A 36 year homeless woman is admitted with breathlessness. Her ABG is shown below. Examination of her respiratory system reveals clear chest and a Respiratory rate of 40. Her ABG is shown below.

PH 7.55 (7.34-45)

PO2 9.1 (>10.5)

PCO2 2.8 (4-6)

HCO3 26 (22-28)

BE -1.8 (+/-2)

Regarding this patient, how do you explain her low CO2?

  • Anxiety
  • Raised RR secondary to hypoxia
  • Compensated change resulting from metabolic acidosis
  • Acute bronchospasm
  • Tachycardia

Compensated change resulting from metabolic acidosis

Her RR is very elevated. This means she’s working very hard to maintain her PO2. But even with resp of 40 she can only get a PO2 of 9.

This suggests a significant reduction in gas transfer: with NO chest signs means most commonly one thing: Pulmonary embolism. CO2 diffuses very efficiently over the lung membrane and therefore the CO2 falls disproportionately quicky compared to the rise in the O2 which in this case is limited by the PE.

What is the most likely diagnosis from the list?

  • Acute Asthma
  • COPD
  • Pulmonary embolism
  • Atypical Pneumonia
  • Tuberculosis

The most likely diagnosis is a PE. She’s not wheezy so its unlikely to be asthma.
COPD would not present in this acute fashion with no chest signs.
Tuberculosis would not present with such significant hypoxia.

72 year old smoker

A 72 year old smoker presents with weight loss and a cough.

On examination:

Chest Wall: hyperinflated

O2 sats: 94% air

Trachea: deviated to the right.

Breath sounds: Reduced at Right Base. Bronchial breathing at right base

Percussion note: dull

Whats the most likely explaination for the findings?

  • Right basal pneumonia
  • Right basal pneumonia with small effusion
  • Right basal pneumonia with atelectasis
  • Right lower lobe collapse
  • Pulmonary embolism

Right lower lobe collapse

Think: trachea is deviated: it must be pulled or pushed. Where are the chest signs? At the right base. This suggests this is where the pathology is.

Consolidation would give the auscultatory findings but it would not affect the trachea. In this case its most likely volume loss form a collapsed segment / lobe of lung which explains the findings. The hyper inflated chest wall suggests underlying COPD.

Patient with lung cancer

A patient with lung cancer has the following lung function tests:

FEV1 0.8L (29% Predicted)

FVC 2.8 L (92% Predicted)

What is the most likely aetiology of his lung function tests?

  • Asthma
  • COPD
  • Pleural Effusion
  • Metastatic spread to thoracic spine with vertebral collapse
  • Asbesdosis

COPD

As previously stated the FEV1/FVC ratio here is around 25%. This is a significant obstructive deficit. This makes COPD the most likely diagnosis.

A pleural effusion may give a reduction of the FVC (potential lung volume taken up by pleural fluid). Vertebral collapse and subsequent kyphosis and loss of lung volume characteristically causes a restrictive deficit (i.e. you lose some of your total lung capacity (TLC) the airways themselves are not damaged).

45 year old female secretary

A 45 year old female secretary presents with progressive shortness of breath over 12 months. She has no previous history of respiratory problems. She has never smoked or been in close contact with a smokers. Her symptoms do not vary through the day. On examination:

O2 sats: 92% air

Chest wall : Hyperinflated

Trachea: central.

Breath sounds: reduced throughout all lung fields

Percussion note: hyper resonant

Whats the most likely diagnosis?

  • Pulmonary fibrosis
  • Asthma
  • Alpha 1 anti trypsin deficiency
  • Unilateral pneumothorax
  • Bilateral Pneumothoraces

Alpha 1 anti trypsin deficiency

The features all sound like COPD:

Hyperinflated, low sats, reduced air entry, hyperresonant percussion note.

Bilateral pneumothoraces is a possibility, but…

a) unlikely to be bilateral and

b) unlikely to cause progressive SOB.

With no history of smoking but ?COPD… think of alpha 1 anti trypsin deficiency.