Makindo Medical Notes

Related Subjects: |Breast Anatomy and Examination (OSCE) |Shoulder examination(OSCE) |Testicular examination(OSCE) |Hernia Examination (OSCE) |Rectal examination (OSCE) |Liver Examination (OSCE) |Cerebellar Examination (OSCE) |Upper and Lower Limb Neurology (OSCE) |Gastroenterology Examination (OSCE) |Respiratory Examination (OSCE)

Introduction

• Wash your hands thoroughly before starting the examination.
• Introduce yourself and confirm the patient’s name, date of birth, and reason for the visit.
• Explain the procedure and obtain informed consent.
• Ensure the patient is in a comfortable, well-lit room with adequate privacy and exposure of the chest.

Equipment Needed

• Examination gloves
• Stethoscope
• Pens and paper for documentation
• Optional: Pulse oximeter

Step 1: General Inspection

• Observe the patient’s overall appearance and note their respiratory rate and effort.
• Look for signs of respiratory distress, such as the use of accessory muscles, cyanosis, or digital clubbing.
• Assess the chest wall for symmetry, deformities, scars, or signs of previous surgery.

Step 2: Palpation

• Chest Wall Palpation: Gently palpate the anterior and posterior chest for tenderness, masses, or crepitus.
• Chest Expansion: Place your hands on the patient’s back at the level of the lower scapulae. Ask the patient to take a deep breath and note any asymmetry in chest expansion.
• Tactile Fremitus: Have the patient repeat a phrase such as “ninety-nine” while you feel over the lung fields for vibratory sensations. Compare both sides for differences.

Step 3: Percussion

• Percuss systematically over all lung fields, comparing the left and right sides.
• Note the quality of the percussion note:
  • Resonant: Normal lung parenchyma
  • Dull: Possible consolidation or pleural effusion
  • Hyper-resonant: May indicate pneumothorax or emphysema

Step 4: Auscultation

• Using your stethoscope, listen to breath sounds in the anterior, lateral, and posterior lung fields.
• Assess the quality of breath sounds:
  • Vesicular: Normal, soft, and low-pitched
  • Bronchial: Harsh, tubular sound (suggestive of consolidation when heard in peripheral lung areas)
  • Adventitious sounds: Listen for crackles (rales), wheezes, or rhonchi.
• Check for additional findings such as:
  • Egophony: A change in the quality of the voice sounds (E to A change) over areas of consolidation
  • Whispered pectoriloquy: Increased clarity of whispered sounds indicating lung consolidation

Step 5: Special Tests (If Applicable)

• Vocal Resonance: Ask the patient to repeat phrases while you auscultate over different lung areas to assess sound transmission.
• If indicated, test for a pleural rub by listening carefully during deep breathing for a creaking sound.

Step 6: Closure

• Thank the patient for their cooperation.
• Provide a brief summary of your findings and explain any further investigations or management plans if necessary.
• Ensure the patient is comfortable and appropriately dressed before concluding the exam.
• Wash your hands again and document your findings clearly in the patient’s notes.

Key Points for OSCE

• Follow a systematic approach: Inspection → Palpation → Percussion → Auscultation.
• Communicate clearly with the patient and explain each step to reduce anxiety.
• Always compare both sides of the chest to detect asymmetry or subtle abnormalities.
• Accurately document all findings.

Common Pitfalls

• Not adequately exposing the chest, which may result in missed findings.
• Rushing through the examination, leading to an incomplete assessment.
• Overlooking subtle signs of respiratory distress, such as reduced chest expansion or accessory muscle use.
• Failing to explain the procedure clearly, causing patient discomfort or anxiety.

References & Further Reading

• Clinical Examination by Talley & O'Connor.
• Geeky Medics OSCE Resources
• OSCEstop – Online OSCE practice resources.

Pathological Conditions and Exam Findings