OSCE Time!

CHEST EXAM

Introduction

1. Wash hands
2. Hi, im ..........., im a first year medical student and im just going to do a routine chest examination on you today, is that ok?
3. Can I check your name and date of birth?
4.  Do you mind if I just uncover your chest?
5. get the patient to sit at 45 degree angle
6. If you have any questions, feel free to ask

 

Inspection

7. Mr X looks generally well, there are no signs of discomfort or difficulty in his breathing. He isn’t using any accessory muscles and his respiratory rate is normal. Chest expansion looks symmetrical.
8. Im just going to have a general check over you before I concentrate on your chest.

Feet

9. No sign of pedal oedema

 

Hands

10. No Nicotine stains, Clubbing or Peripheral cyanosis. Normal hand temperature
11. Please can you hold your arms up and put your hands back, like this.
12. “There is no tremor flap that would indicate CO2 retention”

 

Face

13. Eyes - “no signs of anaemia or jaundice”
14. Mouth – “no central cyanosis”

 

Neck

15.  “patient does not have raised JVP and there are no signs of infection or inflammation”

 

Chest

16. The chest looks normal with no scars, spider nervae, gynamaastia or hair loss.

 

 

Palpation

17.  “the trachea is central the apex beat can be found in the  5^th intercostal space on midcavicular line- There is no mediastinal shift”
1. “chest expansion is symmetrical”
18.  “vocal fremitus is normal”

Percussion

19.   “on percussion, lungs are symmetrical and  hepatic dullness and gastric resonance are present in the correct areas”

 

Ausculatation

20.   “breath sounds are vesicular and symmetrical, there are no crackles or wheezes.

21.  “I would repeat auscultation on patients back to assess inferior lobes”

22.  Thankyou very much Mr X.

Summary

23.  Mr X has presented for a routine chest examination. On general inspection he loks generally well, with no respiratory distress. His chest expansion is symmetrical with no accessory muscle use. There are no concerning peripheral stigmata. No medisatinal shift is detactble and vocal fremitis is normal. On percussion lungs are symmetrical and hepatic dullness and gastric resonance are present in the correct areas. Breath sounds are normal vesicular with no wheezes or crackles. Mr X has a healthy chest.