• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 in general practice

Patient: This patient has come to see their general practitioner for a check up

Task:

– Examine this patients respiratory system

– Please provide a running commentary whilst you are examining

– During the examination the examiner will present you with information to interpret

– After 6 minutes you will be asked a series of questions by the examiner.

You are a patient who has come into see your GP for a check up. You are happy to be examined.

Please feel free to stop the examination is the patient causes pain or discomfort to yourself.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school / Year / grade
Clarifies who they are talking to
Asks patient for preferred name


Examination étique Examination étique
Washes hands
Exposes patient correctly
Patient positioned at 45 degrees
Examination from left hand side


Inspection General inspection
General appearance
Pursed lip breathing
Use of accessory muscles
Oxygen (nasal, mask, high flow)
Inhalers / medications at bedside
Walking aids at bedside
Respiratory rate


Hands Comments on hands
Temperature
Peripheral cyanosis
Tar staining
Finger clubbing
Koilonychia


Arm Arm
CO2 retention tremor (flapping tremor)
Fine physiological tremor (e.g salbutamol)
Radial pulse (bounding is a sign of CO2 retention)


Face Face
Conjunctival pallor
Central cyanosis


Neck Neck
Examines for cervical lymph nodes
JVP
Trachea position


Inspection Closer inspection
Scars (thoracotomy scars)
AP diameter for hyperinflation (seen in COPD)
Deformity of spine (scoliosis can cause T2RF)


Palpation Palpation
Chest expansion (comment on symmetry)


Percussion Percussion
Starts percussion at supraclavicular fossa
Percusses at 6 sites
Directly compares at same intercostal level L to R
Comments on percussion as = responds, dull, stony dull
Both anterior and posterior chest examined


Auscultation Auscultation
Asks patient to breathe in and out through an open mouth
Listens over 6-10 areas anteriorly
Directly compares at same intercostal level L to R
Vocal resonance
Whispering pectoriloquy
Both anterior and posterior chest examined


Posterior chest Posterior chest
Checks for the presence of sacral oedema


Peripheral examination Peripheral examination
Examines for pitting oedema


Closing Closing examination
Invites patient to get re-dressed
Washes hands


Patient Patient
Candidate did not cause any pain to patient
Candidate was polite throughout examination


Question To conclude your examination, what investigations would you like to do?
Peak flow
Spirometry
CXR
ABG


Ausculation
Please listen to the following auscultation for this patient and comment on your findings

Normal breath sounds


Question
Please review the following image and comment on the clinical sign shown

Finger / digital clubbing


Question What are the respiratory causes of finger clubbing?
Chronic suppurative lung disease (e.g bronchiectasis, cystic fibrosis ,empysema)
Bronchial carcinoma
Mesothelioma
Cryptogenic (idiopathic) fibrosing alveolitis / pulmonary fibrosis
Other appropriate answer


Question What are the main causes of dullness to percussion?
Effusion
Pleural thickening
Lung collapse
Fibrosis
Consolidation



Score