Just. Catching. My. Breath. OSCE by Michael

You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.


One of your registrars has just been treating a 32yo patient who presented with an exacerbation of their asthma. They have been given 3 lots of salbutamoI nebulisers, ipratropium and prednisolone. Your registrar has asked you to examine and assess the patient.

Instructions for the candidate

You are the consultant in a tertiary ED. You are to perform a respiratory examination and explain the findings to your registrar.

Domains being examined

  • Medical Expertise
  • Communication
  • Health Advocacy
  • Scholarship and Teaching
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

You have assessed and treated the patient who came in with a moderate exacerbation of asthma. They are currently improved, and you were hoping to move the patient to the short stay unit with an aim to discharge later in the day. You are seeking the consultant's opinion on examination findings.

You are a normally well 32yo. You have mild asthma, for which you use salbutamoI puffer as required. You use it infrequently, but sometimes get exacerbations in winter. You are not on a preventer. You have had a cold for 3/7 and increasing wheeze over the last day. You have been using 2 puffs of ventolin every 4 hours today. You do not use a spacer routinely.

You are currently more comfortable and able to talk short-moderate sentences in one breath. You have no pain. If a PEFR is requested, you ned instruction on how to perform it.

For the examiner

Obs on request:
HR 92
BP 115/75
RR 18
SaO2 95% RA

PEFR 450

If the examination and explanation is done quickly, the registrar could ask how to explain spacer use to the patient.

Domains Assessment Objectives

Medical Expertise
Efficient and thorough respiratory examination focused on presenting complaint

Establish rapport, clear instruction to patient
Clear and concise explanation of findings to registrar

Health Advocacy
Asthma education if opportunity arises - asthma action plan, regular puffers, possible use of preventer, spacer education

Scholarship and Teaching
Clear demonstration of respiratory examination and explanation of findings and interpretation to registrar
Clear teaching of techniques (eg pulsus paradoxus, PEFR)

Other Assessment Notes

Bonus marks for PEFR or point-of-care spirometry

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