Most Common OSCE cases on chest diseases station

Pulmonology OSCEs are relatively easy to prepare because there are a limited number of cases that are repeated over and over again.
In this post, you will learn about the most common OSCE cases that are encountered in chest diseases station.

There are five cases in pulmonology which are most commonly encountered on chest station. These are:
1. Chronic Obstructive Pulmonary Disease (COPD)
2. Bronchiectasis
3. Fibrosing Alveolitis
4. Pleural Effusion
5. Bronchial asthma

Lets see each one by one

COPD

On inspection of COPD patients, you will find a barrel-shaped chest.
There may be pursed-lip breathing and the use of accessory muscles for respiration.
Since the diaphragm is depressed in emphysema patients, there would be indrawing of a lower costal margin on inspiration.
Auscultation reveals globally reduced breath sounds and there may be audible rhonchi.  

Bronchiectasis

On inspection of the patient’s surroundings, you may find inhalers and a sputum pot beside him. Sputum will be copious and purulent
Inspection of the patient may reveal finger clubbing
On auscultation, coarse crackles will be audible over the affected areas. After the patient coughs, the character of crackles will change, or they may even disappear. 

Fibrosing Alveolitis

Inspection of these patients may reveal clubbing of fingers. 
On palpation, chest expansion will be reduced with normal vocal fremitus. 
Percussion is also normal. 
Auscultation will reveal fine crepitations over both bases, which in contrast to bronchiectasis,  will not change character or clear out with a cough

Pleural effusion

Pleural effusion is a common case in OSCEs. 
There is reduced chest movement on the affected side. 
Palpation reveals reduced chest expansion & an absent vocal fremitus
Percussion note is stony dull
Auscultation reveals absent breath sounds on affected side. 
Anticipate being questioned about the types and causes of pleural effusionsLight’s criteria is an important viva question and will be asked for differentiation between exudative and transudative pleural effusion.

Asthma

This is least common exam scenario because demonstrable signs are present in acute asthma patients, and therefore it is unlikely that you get acute patients in exam.
Anyhow if you do get an asthma patient, the patient would be younger than COPD patients.
Enquire about common allergies like pollen, house dust mites or pets (if its along case station).
Inspection may reveal tachypnea. In more severe cases, pulsus paradoxus will be found.
Chest may be hyperinflated.
Auscultation will reveal expiratory polyphonic wheeze & prolonged expiration

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