Certain topics are more important in a subject and keep on repeating in OSCEs. It is a smart move to know about these so that you focus more on them during preparation.
The same holds true for pulmonology cases. In fact, there are very limited cases in pulmonology that are repetitively encountered in this station. Therefore know and master them, and you would be able to score maximum here.
Pneumonectomy or Lobectomy
These are commonly encountered in UK centers. So that you do not miss it, it is a good practice to check the back of the patient for scars at the very beginning of the examination (during the inspection).
Lung fibrosis / Fibrosing alveolitis
You will be able to pick velcro-type crepitations during auscultation (read a very useful post on lung sounds). Since this is a common case, prepare causes of upper, middle & lower zone fibrosis beforehand because that may well be a question asked from you. Also, look for Cushingoid features as an effect of corticosteroid treatment.
Watch this short but useful video on thoracic scars.
Bronchiectasis
In the case of bronchiectasis, there are coarse crepitations. With practice, you will be able to differentiate coarse from fine crepitations of cardiac failure/pulmonary edema. (watch this very useful video on crepitations)
Also, take a look at the sputum pot beside the patient which will have copious purulent sputum typical of bronchiectasis.
Pleural effusion
In the case of pleural effusion, typical findings are reduced chest movement, reduced expansion, reduced vocal fremitus/resonance, stony dull percussion, and absent breath sounds on the affected side. Look for a scar from a previous pleural biopsy / pleurocentesis.
Bronchogenic carcinoma
Bronchogenic Ca is also an OSCE case. It can be with or without signs of superior vena cava obstruction (SVCO).
Look for associated pleural effusion and radiotherapy scar.
Consolidation or collapse of lung
Since such patients are symptomatic so cannot be kept in the exam hall for long. Therefore it is less likely to get these cases but there is no harm in preparing.
Share Your Thoughts in the comments below. We would love to know about your valuable experience if you have already been through this exam.
“If you only do what you can do, you will never be more than who you are.”
