2 Respiratory

Checklist
HELP:
H: Hello (introduction and gains consent)
E: Exposure
L: Lighting
P: Positions at 45 degrees, asks if the patient is in any
pain
Washes hands
Inspects from end of bed:
Looks at the front and back for thoracotomy scars
Sputum pots (bronchiectasis, COPD)
Oxygen cylinders (COPD)
Inhalers (COPD, asthma)
Immuosuppressants (pulmonary fibrosis)
Nebulisers (COPD)
Peak flow charts (asthma)
Hands:
Clubbing (suppurative conditions, lung cancer, fibrosis)
Tar staining
Wasting of small muscles
TremorCO2 retention flap
Radial pulse
Respiratory rate
Eyes:
Horner syndrome (Pancoast syndrome)
Anaemia
Face:
Plethora (polycythaemia)
Mouth:
CDD (central cyanosis, dental hygiene, dehydration)
Neck:
JVP (raised 4cm) in cor pulmonale
Palpates lymph nodes

MP

Checklist

MP

Tracheal deviation
Cricoidsuprasternal notch distance (three finger
breadths in hyperinflation)
Palpates:
Palpates apex beat
Measures chest expansion (68cm is normal) at three
places on the anterior and three on the posterior chest
Percusses:
Percusses at three positions on the anterior and three
on the posterior chest
Auscultates:
Auscultates at three positions on the anterior and
three on the posterior chest
Auscultates axillae to listen for right middle lobe signs
Auscultates for vocal fremitus
Palpates shins or ankles for peripheral oedema
Thanks patient
Offers to help patient get dressed
Washes hands
Presents findings
Offers appropriate differential diagnosis
Suggests appropriate further investigations and
management
OVERALL IMPRESSION:

OSCEs for Medical Finals, First Edition. Hamed Khan, Iqbal Khan, Akhil Gupta, Nazmul Hussain, and
Sathiji Nageshwaran.
2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.