Tina's Haemoptysis

osce-stations.blogspot.com/2018/02/tinas-haemoptysis.html

By Carlo Ross (3rd year Medical Student)

Name Tina Black

DOB 04/03/1997 (22 years)

Occupation History Student

History She freaked out this morning when she saw some blood in her
phlegm. She has had occasional fevers and has been feeling quite
sweaty at night, occasionally waking up drenched. Was previously
very fit and well. She denies any chest pain but has some back pain
which she puts down to how much she has been coughing recently.
She denies any weight loss, leg pain or swelling. No breathlessness or
palpitations either.

Only if asked, 12 weeks ago she returned from a volunteer

programme in rural India as part of her gap year. She met many of
the locals there and there were definitely quite a few people coughing
a lot.

Past Appendix taken 4 months ago. Very frustrated how this was initially
Medical missed so will talk angrily and at great length about this
History

Drug NKDA. On the pill

History

Family Father has Diabetes and grandfather had heart attack

History

Social She just finished her gap year and is starting a masters in History
History after the summer. She started smoking during her gap year 5
cigarettes a day. Binges on the occasional weekend

Introduction & consent

Name, age, occupation

Asks open question & clarifies it is not haematemesis

Establishes duration and trigger (if present)

Establishes character: fresh, streaks in phlegm, clots

Establishes amount and frequency

Establishes time course (worsening, continuous, intermittent)

1/2
Alleviating or exacerbating factors (specifically exertion, dust, smoke)

Associated symptoms: chest pain, cough, fever, shortness of breath (pulmonary

embolism), ankle swelling, wheeze, bone pain, nosebleeds (vasculitis)

Screens for red flags (haemoptysis, weight loss, hoarseness, night sweats)

Establishes if symptoms of anaemia are present: lethargy, palpitations,

shortness of breath

Asks for any recent illness, bleeding from elsewhere or any family
members/contacts with similar symptoms

Asks if patient smokes and clarifies how much and for how long

Checks risk factors for pulmonary embolism (calf pain/swelling, recent surgery,
long flight or coach trip, malignancy, oral contraceptive/pregnancy)

Elicits past medical history (specifically asking for lung disease, heart disease,
autoimmune disorders, clotting problems)

Elicits family history (specifically asking for lung disease, vasculitis, clotting
problems)

Elicits drug history

Asks if patient has had BCG vaccination

Asks for any foreign travel

Drug history and allergies

Alcohol and illicit drug use

Ideas
"Was there anything you thought it might be?"

Concerns
"What about it is worrying you in particular?"

Expectations
"Is there anything in particular you were hoping we would to today?"

Communication skills (empathy and avoids jargon)

Summarises back to patient

Gives reasonable differential diagnosis (Tuberculosis, Viral respiratory tract

infection, pulmonary embolism)

2/2
Sabine's Cough
osce-stations.blogspot.com/2015/11/sabines-cough.html

Name Sabine Edmund

DOB 02/12/1989 (25 years)

Occupation Speech therapist

History I have been coughing every night for the last few weeks
since I came back from Greece. I think I must have caught
something from there! The cough is non-productive. If asked
directly, I have noticed some shortness of breath which
affects me when I am outside and sometimes my eyes get a
little itchy. It really bothers me because I cannot sleep and I
need some cough medicine to stop it. Deny chest pain or
other symptoms.

Past Medical History If asked directly, eczema as a child. Denies recent surgery or
past clotting events

Drug History Nil

Family History If asked directly, mother had bad hayfever and eczema

Social History 5 cigarettes per day. Occasional alcohol. No recreational

drug use.

Introduces yourself 0 1

Confirms name & age of patient 0 1

Explains reason for consultation & builds rapport 0 1

Gains consent 0 1

Asks open question 0 1

Establishes onset and duration 0 1

Asks for variability in the day e.g. diurnal/worse at night (asthma) 0 1

Asks for alleviating factors (e.g. being at home/work) 0 1

Asks for exacerbating factors (e.g. exercise, seasonal (asthma, COPD), 0 1 2

pollen (asthma), chemicals, posture)

Establishes if dry or productive 0 1

Establishes severity and impact on life 0 1

1/2
Asks about any recent illnesses 0 1

Screens for red flags (haemoptysis, weight loss, hoarseness, night 0 1

sweats)

Screens for associated respiratory symptoms (fever, shortness of breath, 0 1 2

wheeze, chest pain - clarifying if pleuritic/burning suggestive of reflux
disease)

Screens for associated cardiovascular symptoms (orthopnoea, ankle 0 1

oedema, calf pain or swelling)

Screens for ENT associated symptoms (throat, coryza, rhinitis) 0 1

Elicits past medical history (specifically asthma, tuberculosis) and recent 0 1

surgery

Elicits family history (specifically asking for atopy, tuberculosis, 0 1

pulmonary fibrosis, clotting problems)

Elicits drug history (including use of ACE inhibitors, beta-blockers, 0 1

methotrexate)

Checks for allergies 0 1

Checks if patient smokes or drinks 0 1

Checks occupation of patient 0 1

Asks if occupation or other involves exposure to dust or animals 0 1

Explores and responds to ideas 0 1

Explores and responds to concerns 0 1

Explores and responds to expectations 0 1

Shows empathy 0 1

Avoids jargon 0 1

Summarises back to patient 0 1

Thanks patient 0 1

Patient global score 0 1 2

Gives reasonable differential diagnosis (Asthma, Reactive airway 0 1

disease, Viral upper respiratory tract infection)

2/2
Steve's Haemoptysis
osce-stations.blogspot.com/2018/02/steves-haemoptysis.html

By Chris Warner (4th year Medical Student)

Name Steve French

DOB 11/10/1945 (72 Years)

Occupation Farmer

History Noticed that there has occasionally been streaks of blood in his
sputum for the last month. Sputum is usually white. Had a cough for
the last 2 years which has become progressively more frequent.
Cough gets worse with viral illnesses and on exertion. He gets more
breathless on exertion now, can only walk to the kitchen (10m) before
needing to stop to take a break where he could previously walk 200m.
Unintentional weight loss if asked, two belt holes in the last 6 weeks.
No foreign travel. Possibly hoarse voice but no other symptoms

Past COPD, Hypertension

Medical
History

Drug Allergy to Penicillin. Takes Amlodipine, Simvastatin and 2 inhalers

History

Family None
History

Social Smokers 30 cigarettes per day for over 50 years. Drinks a can of
History cider each night. Lives alone

Introduction & consent

Name & age

Asks open question & clarifies it is not haematemesis

Establishes duration and trigger (if present)

Type: fresh, streaks in phlegm, clots

Amount and frequency

Time course (worsening, continuous, intermittent)

Alleviating or exacerbating factors (specifically exertion, dust, smoke)

Associated symptoms: chest pain, cough, fever, shortness of breath (pulmonary

embolism), ankle swelling, wheeze, bone pain, nosebleeds (vasculitis)

1/2
Screens for red flags (haemoptysis, weight loss, hoarseness, night sweats)

Establishes if symptoms of anaemia are present: lethargy, palpitations,

shortness of breath

Asks for any recent illness, bleeding from elsewhere or any family
members/contacts with similar symptoms

Asks if patient smokes and clarifies how much and for how long

Asks for any foreign travel

Checks occupation of patient & checks for asbestos exposure

Drug history and allergies

Alcohol and illicit drug use

Ideas
"Was there anything you thought it might be?"

Concerns
"What about it is worrying you in particular?"

Expectations
"Is there anything in particular you were hoping we would to today?"

Communication skills (empathy and avoids jargon)

Summarises back to patient

Gives reasonable differential diagnosis (lung cancer, COPD exacerbation,

pneumonia, fibrosis)

2/2
Fatima's Cough
osce-stations.blogspot.com/2015/11/fatimas-cough.html

Name Fatima Ahmad

DOB 07/06/1974 (41 years)

Occupation Decorator

History I have been coughing for almost two months now bringing
up yellow-greenish sputum. If asked directly, at first I
thought it was a chest infection but even after antibiotics
from the GP that never cleared up. It is pretty severe all day
and night and interferes with my sleep. I also wake up with
night sweats. There\'s occasionally been a pink tinge to my
sputum and I have had a kilogram of weight loss over the
last 2 months. I travelled to India around 3 months ago and
lived with my family in a crowded flat. I don\'t remember any
of them being ill. I deny any other symptoms. I am
convinced it is cancer due to my smoking.

Past Medical History Nil

Drug History If asked directly, took a course of unknown antibiotics

recently

Family History Father had heart attack at 45 years.

Social History 10 cigarettes per day. Occasional alcohol. No recreational

drug use.

Introduces yourself 0 1

Confirms name & age of patient 0 1

Explains reason for consultation & builds rapport 0 1

Gains consent 0 1

Asks open question 0 1

Establishes onset and duration 0 1

Asks for variability in the day e.g. diurnal/worse at night (asthma) 0 1

Asks for alleviating factors (e.g. being at home/work) 0 1

Asks for exacerbating factors (e.g. exercise, seasonal (asthma, COPD), 0 1 2

pollen (asthma), chemicals, posture)

1/3
Establishes if dry or productive 0 1

Elicits character of sputum (bloodstained, clots, green/yellow, offensive 0 1

smell)

Establishes severity and impact on life 0 1

Asks about any recent illnesses 0 1

Screens for red flags (haemoptysis, weight loss, hoarseness, night 0 1

sweats)

Screens for associated respiratory symptoms (fever, shortness of breath, 0 1 2

wheeze, chest pain - clarifying if pleuritic/burning suggestive of reflux
disease)

Screens for associated cardiovascular symptoms (orthopnoea, ankle 0 1

oedema, calf pain or swelling)

Screens for ENT associated symptoms (throat, coryza, rhinitis) 0 1

Elicits past medical history (specifically asthma, tuberculosis) and recent 0 1

surgery

Elicits family history (specifically asking for atopy, tuberculosis, 0 1

pulmonary fibrosis, clotting problems)

Elicits drug history (including use of ACE inhibitors, beta-blockers, 0 1

methotrexate)

Checks for allergies 0 1

Checks if patient smokes or drinks 0 1

Checks occupation of patient 0 1

Asks if occupation or other involves exposure to dust or animals 0 1

Asks for exposure to asbestos 0 1

Explores and responds to ideas 0 1

Explores and responds to concerns 0 1

Explores and responds to expectations 0 1

Shows empathy 0 1

Avoids jargon 0 1

Summarises back to patient 0 1

Thanks patient 0 1

Patient global score 0 1 2

2/3
Gives reasonable differential diagnosis (Tuberculosis, Atypical 0 1
pneumonia, Bronchiectasis)

3/3
Anamaria's Cough
osce-stations.blogspot.com/2015/12/anamarias-cough.html

Name Anamaria Pascucci

DOB 11/12/1952 (62 years)

Occupation Lift engineer

History I have progressively been coughing more and more and felt
more and more short of breath for the last few months. It is
even worse when I get a chest infection as I can\'t even get
any sleep then! It is usually always productive and (if asked
directly) tends to improve when I smoke and is worst in the
morning. I have never had blood in my sputum it is usually
always white or yellow. I deny any weight loss, hoarseness
or any other symptoms.

Past Medical History Asthma. Never been admitted and well controlled.

Drug History Salbutamol and steroid inhalers

Family History Nil

Social History 30 cigarettes per day. Occasional alcohol. No recreational

drug use. No exposure to asbestos.

Introduces yourself 0 1

Confirms name & age of patient 0 1

Explains reason for consultation & builds rapport 0 1

Gains consent 0 1

Asks open question 0 1

Establishes onset and duration 0 1

Asks for variability in the day e.g. diurnal/worse at night (asthma) 0 1

Asks for alleviating factors (e.g. being at home/work) 0 1

Asks for exacerbating factors (e.g. exercise, seasonal (asthma, COPD), 0 1 2

pollen (asthma), chemicals, posture)

Establishes if dry or productive 0 1

Elicits character of sputum (bloodstained, clots, green/yellow, offensive 0 1

smell)

1/2
Establishes severity and impact on life 0 1

Asks about any recent illnesses 0 1

Screens for red flags (haemoptysis, weight loss, hoarseness, night 0 1

sweats)

Screens for associated respiratory symptoms (fever, shortness of breath, 0 1 2

wheeze, chest pain - clarifying if pleuritic/burning suggestive of reflux
disease)

Screens for associated cardiovascular symptoms (orthopnoea, ankle 0 1

oedema, calf pain or swelling)

Screens for ENT associated symptoms (throat, coryza, rhinitis) 0 1

Elicits past medical history (specifically asthma, tuberculosis) and recent 0 1

surgery

Elicits family history (specifically asking for atopy, tuberculosis, 0 1

pulmonary fibrosis, clotting problems)

Elicits drug history (including use of ACE inhibitors, beta-blockers, 0 1

methotrexate)

Checks for allergies 0 1

Checks if patient smokes or drinks 0 1

Checks occupation of patient 0 1

Asks if occupation or other involves exposure to dust or animals 0 1

Asks for exposure to asbestos 0 1

Explores and responds to ideas 0 1

Explores and responds to concerns 0 1

Explores and responds to expectations 0 1

Shows empathy 0 1

Avoids jargon 0 1

Summarises back to patient 0 1

Thanks patient 0 1

Patient global score 0 1 2

Gives reasonable differential diagnosis (Chronic obstructive pulmonary 0 1

disease, Lower respiratory tract infection, Asthma)

2/2
Cole's Cough
osce-stations.blogspot.com/2015/11/coles-cough.html

Name Cole Abbe

DOB 03/04/1941 (74 years)

Occupation Healthcare assistant

History I have had a chronic cough for the last 6 months and now I
am fed up of it. I don\'t bring anything up with it. It occurs all
the time and I have never brought up any blood. I have not
noticed any shortness of breath but do find I tire more easily
with exercise. If asked directly I have noticed some hand
and foot joint pain, but assumed that was due to old age. I
deny any dryness of my eyes or mouth, whitening or pain in
my hands in the cold or any other symptoms.

Past Medical History Nil

Drug History Nil

Family History Both parents died young in a horrific road traffic accident.

Social History 5 cigarettes per day. Occasional alcohol. No recreational

drug use. Exposure to asbestos in previous house.

Introduces yourself 0 1

Confirms name & age of patient 0 1

Explains reason for consultation & builds rapport 0 1

Gains consent 0 1

Asks open question 0 1

Establishes onset and duration 0 1

Asks for variability in the day e.g. diurnal/worse at night (asthma) 0 1

Asks for alleviating factors (e.g. being at home/work) 0 1

Asks for exacerbating factors (e.g. exercise, seasonal (asthma, COPD), 0 1 2

pollen (asthma), chemicals, posture)

Establishes if dry or productive 0 1

Establishes severity and impact on life 0 1

Asks about any recent illnesses 0 1

1/2
Screens for red flags (haemoptysis, weight loss, hoarseness, night 0 1
sweats)

Screens for associated respiratory symptoms (fever, shortness of breath, 0 1 2

wheeze, chest pain - clarifying if pleuritic/burning suggestive of reflux
disease)

Screens for associated cardiovascular symptoms (orthopnoea, ankle 0 1

oedema, calf pain or swelling)

Screens for ENT associated symptoms (throat, coryza, rhinitis) 0 1

Screens for musculokeletal and rheumatological symptoms (arthralgia, 0 1

morning stiffness)

Elicits past medical history (specifically asthma, tuberculosis) and recent 0 1

surgery

Elicits family history (specifically asking for atopy, tuberculosis, 0 1

pulmonary fibrosis, clotting problems)

Elicits drug history (including use of ACE inhibitors, beta-blockers, 0 1

methotrexate)

Checks for allergies 0 1

Checks if patient smokes or drinks 0 1

Checks occupation of patient 0 1

Asks if occupation or other involves exposure to dust or animals 0 1

Asks for exposure to asbestos 0 1

Explores and responds to ideas 0 1

Explores and responds to concerns 0 1

Explores and responds to expectations 0 1

Shows empathy 0 1

Avoids jargon 0 1

Summarises back to patient 0 1

Thanks patient 0 1

Patient global score 0 1 2

Gives reasonable differential diagnosis (Pulmonary fibrosis possibly 0 1

secondary to asbestosis or connective tissue disease, Asthma)

2/2
Lola's Chest Pain
osce-stations.blogspot.com/2015/11/lolas-chest-pain.html

Name Lola Mindy

DOB 20/07/1991 (23 years)

Occupation Hairdresser

History I am unbelievably talkative and will not stop talking about

irrelevant details unless I am interrupted. I began having this
sharp chest pain since this morning. I am convinced it is a
pulled muscle from hockey practice so I just want
painkillers, even though I haven't really been playing
regularly for the last week (if asked: since I tore my ACL in
my knee). It started quite suddenly and doesn't move
anywhere. It's been there all the time and hasn't really
changed since this morning. It's a little worse when I take a
deep breath in or when I've been coughing. I don't think
there's any blood or anything else when I have been
coughing. I have also quite been feeling quite breathless.
Changing position and exertion doesn't change the pain. It's
about an 8/10. If specifically asked, yes I have a dull pain in
my leg and tender, swollen and a little red but that's because
of the surgery, right? I have not had any other symptoms
including chest tightness, loss of consciousness, nausea or
vomiting, fever or recent infections.

Past Medical History Nil apart from in hospital for ACL injury (had surgery to
repair)

Drug History Oral contraceptive pill

Family History Nil

Social History I do not smoke but I drink every weekend with my hockey
buddies in excess. I travelled three weeks ago to a game in
France by coach. I have not been too mobile since the
surgery.

Introduces yourself 0 1

Confirms name & age of patient 0 1

Explains reason for consultation & builds rapport 0 1

Gains consent 0 1

Asks open question 0 1

1/3
Establishes site 0 1

Asks about onset 0 1

Elicits character of pain 0 1

Asks if pain radiates 0 1

Asks for associated symptoms of nausea, vomiting and shortness of 0 1 2

breath

Asks for palpitations, fever, cough 0 1

Excludes heartburn and abdominal pain 0 1

Enquires about exacerbating factors including physical activity, lying 0 1 2

down, coughing and chest tenderness

Enquires about alleviating factors including rest, leaning forward, 0 1

painkillers

Asks patient to rate severity of pain 0 1

Asks about previous chest pain 0 1

Asks about recent illnesses 0 1

Asks specifically for recent illness, surgery and calf pain or leg swelling 0 1 2

Asks about any family history of disease 0 1

Asks specifically if any family members have had any pulmonary 0 1 2

embolisms or clots

Establishes any drugs patient is on 0 1

Asks if patient has any allergies 0 1

Asks if patient smokes, drinks or takes recreational drugs 0 1 2

Asks about diet and lifestyle 0 1

Asks about any recent travel 0 1

Elicits patients occupation 0 1

Explores and responds to ideas 0 1

Explores and responds to concerns 0 1

Explores and responds to expectations 0 1

Shows empathy 0 1

Avoids jargon 0 1

Summarises back to patient 0 1

2/3
Thanks patient 0 1

Patient global score 0 1 2

Gives reasonable differential diagnosis (pulmonary embolism, 0 1

pneumonia, anxiety, musculoskeletal pain etc.)

3/3
Stoyan's Breathlessness
osce-stations.blogspot.com/2015/11/stoyans-breathlessness.html

Name Stoyan Vanfossen

DOB 04/07/42 (72 years)

Occupation Retired ship worker

History I am a slow and soft spoken man. I have had worsening

non-productive cough and breathlessness for about 2 years.
Now I can't stand it and need it fixed. There isn't any blood
when coughing, it affects me all of the time and isn't worse
at any time of day. The breathlessness is mainly when I
exert myself but nothing else makes it worse or better. I
haven't got any issues sleeping flat nor do I wake up
gasping for breath. I have not noticed any hoarseness of
voice or changes to sensation or weakness in my arms or
hands. I have not had any fever but I have had a little weight
loss of 2kg over 6 months, felt a bit under the weather,
fatigued and some joint and muscle pain but then I am quite
old now. I have not had any other symptoms including
swelling of my legs, palpitations, chest pain or rash.

Past Medical History Benign enlargement of prostate and hypertension. Denies

childhood infection of whooping cough.

Drug History Ramipril

Family History Father had type 2 diabetes, had 2 strokes, heart attack but
died of bowel cancer. My mother had depression because
her parents died in a car accident, underactive thyroid, type
2 diabetes and hypertension

Social History Nil smoker, alcohol or recreational drugs. I live on the

second floor and I am finding it difficult to even leave the
house, cook, get ready in the morning. I need help
desperately.

Introduces self 0 1

Confirms name & age of patient 0 1

Explains reason for consultation & builds rapport 0 1

Gains consent 0 1

Asks open question 0 1

1/3
Asks about onset (gradual/sudden) 0 1

Asks about duration and changes to breathlessness 0 1

Enquires about exacerbating factors including exertion, 0 1 2

chemicals/pollen, lying flat

Asks about variability over the day: constant/progressively worse/worse 0 1

in the morning or night

Enquires about severity by asking about exercise tolerance on flat and up 0 1 2

stairs and on rest

Asks about any recent illness or previous shortness of breath 0 1

Asks for cough and sputum and if present explores further 0 1 2

Asks for orthopnoea and paroxyasmal nocturnal dyspnoea and if present 0 1

explores further

Asks for added breath sounds such as wheeze and if present explores 0 1
further

Asks for chest pain and characterises chest pain if present 0 1

Asks for ankle oedema 0 1

Asks for any fever or contact with anyone with similar symptoms 0 1

Asks for any palpitations or dizziness 0 1

Checks for red flags: haemoptysis, weight loss, night sweats and 0 1 2
hoarseness

Checks if patient is current or ex-smoker and number of pack years 0 1 2

Asks about past medical history (specifically COPD and heart attacks) 0 1 2

Asks about any family history of disease (specifically asthma, lung 0 1

cancer, fibrosis)

Establishes any drugs or over the counter medication patient is on 0 1

Asks if patient has any allergies 0 1

Asks if patient drinks or takes recreational drugs 0 1

Elicits patients occupation and any possible exposure to asbestos 0 1 2

Asks if patient has travelled anywhere recently 0 1

Explores impact of shortness of breath on activities of daily living 0 1 2

Explores and responds to ideas 0 1

Explores and responds to concerns 0 1

Explores and responds to expectations 0 1

2/3
Shows empathy 0 1

Avoids jargon 0 1

Summarises back to patient 0 1

Thanks patient 0 1

Patient global score 0 1 2

Gives reasonable differential diagnosis (fibrosis, asthma, COPD, lung 0 1

cancer)

3/3
Rajit's Breathlessness
osce-stations.blogspot.com/2015/12/rajits-breathlessness.html

Name Rajit Kumar

DOB 22/09/82 (32 years)

Occupation Typist

History I have had 6 weeks of worsening breathlessness, cough,

mild fever and in the last 2 weeks night sweats additionally.
The breathlessness isn't associated with wheeze, is there all
the time but worse when I exert myself. Not made worse by
lying down or being at work or in the cold. It isn't severe just
annoying. The cough is there all the time and I produce
some yellow sputum when I cough. I sometimes wake up
completely drenched. Some of the people living with me
have had a bad cough too so it is probably just something
going around and I need antibiotics. I have not had any
chest pain, palpitations, leg swelling or have I been waking
up gasping for breath. I have not been in contact with any
sick animals or odd chemicals.

Past Medical History I did have some treatment for some chest infection (in
India) but never took all the antibiotics beyond the first
month's dose because the pharmacy closed down. I have
never been ill for this.

Drug History Paracetamol recently. Nil else.

Family History Nil

Social History I am from India but came here 1 year ago to study and work.
I smoke 5 cigarettes a day and have smoked for 10 years. I
don't drink and have never taken recreational drugs. I live in
a crowded flat with 10 other people. I am quite poor and
have never seen a doctor in this country before. I deny any
unprotected sex or having sex with men.

Introduces yourself 0 1

Confirms name & age of patient 0 1

Explains reason for consultation & builds rapport 0 1

Gains consent 0 1

Asks open question 0 1

1/3
Asks about onset (gradual/sudden) 0 1

Asks about duration and changes to breathlessness 0 1

Enquires about exacerbating factors including exertion, 0 1 2

chemicals/pollen, lying flat

Asks about variability over the day: constant/progressively worse/worse 0 1

in the morning or night

Enquires about severity by asking about exercise tolerance on flat and up 0 1 2

stairs and on rest

Asks about any recent illness or previous shortness of breath 0 1

Asks for cough and sputum and if present explores further 0 1 2

Asks for orthopnoea and paroxyasmal nocturnal dyspnoea and if present 0 1

explores further

Asks for added breath sounds such as wheeze and if present explores 0 1
further

Asks for chest pain and characterises chest pain if present 0 1

Asks for any fever or contact with anyone with similar symptoms or sick 0 1
animals

Asks for any palpitations or dizziness 0 1

Checks for red flags: haemoptysis, weight loss, night sweats and 0 1 2
hoarseness

Checks if patient is current or ex-smoker and number of pack years 0 1 2

Asks about past medical history (specifically hayfever, eczema, COPD 0 1 2

and heart attacks)

Asks about any family history of disease (specifically eczema, asthma, 0 1

lung cancer/fibrosis)

Establishes any drugs or over the counter medication patient is on 0 1

Asks if patient has any allergies 0 1

Asks if patient drinks or takes recreational drugs 0 1

Elicits patients occupation and any possible exposure to asbestos 0 1

Asks if patient has travelled anywhere recently 0 1

Explores impact of shortness of breath on activities of daily living 0 1 2

Explores and responds to ideas 0 1

Explores and responds to concerns 0 1

Explores and responds to expectations 0 1

2/3
Shows empathy 0 1

Avoids jargon 0 1

Summarises back to patient 0 1

Thanks patient 0 1

Patient global score 0 1 2

Gives reasonable differential diagnosis (tuberculosis, typical pneumonia, 0 1

asthma, lung cancer)

3/3
Korvin's Breathlessness
osce-stations.blogspot.com/2015/11/korvins-breathlessness.html

Name Korvin Wuest

DOB 14/03/93 (21 years)

Occupation Student

History I have exams coming up and I am very anxious about them.

I believe I have the flu and I need antibiotics otherwise I will
not be able to revise. I claim that it just will not go (if
pressed has lasted 3 months and is only getting worse). I
feel breathless a lot of the time, especially outside in the
cold or at night where my chest feels a little tight too. Nights
are really bad because I also cough so much but I don't
bring up any sputum or blood. I always get infections every
winter, I don't know why, but I wasn't this bad last winter. If
specifically asks admits to an odd sound when I breathe out
which I cannot describe. Denies any history of eczema,
fever, contact with animals, contact with people with similar
symptoms, travel, fainting and any other symptoms.

Past Medical History Hayfever. Nil else including no recent surgery

Drug History Paracetamol for recent symptoms. Nil else

Family History Younger sister with eczema. Nil else.

Social History Moved to a new flat in 2 months ago (October) where a

flatmate currently smokes. I believe I would have good
support from flatmates should I have an asthma attack. Nil
smoking, drugs, alcohol.

Introduces yourself 0 1

Confirms name & age of patient 0 1

Explains reason for consultation & builds rapport 0 1

Gains consent 0 1

Asks open question 0 1

Asks about onset (gradual/sudden) 0 1

Asks about duration and changes to breathlessness 0 1

Enquires about exacerbating factors including exertion, 0 1 2

chemicals/pollen, lying flat
1/3
Asks about variability over the day: constant/progressively worse/worse 0 1 2
in the morning or night and seasonal variation

Enquires about severity by asking about exercise tolerance on flat and up 0 1 2

stairs and on rest

Asks about any recent illness or surgery or previous shortness of breath 0 1

Asks for cough and sputum and if present explores further 0 1 2

Asks for orthopnoea and paroxyasmal nocturnal dyspnoea and if present 0 1

explores further

Asks for added breath sounds such as wheeze and if present explores 0 1
further

Asks for chest pain and characterises chest pain if present 0 1

Asks for any fever or contact with anyone with similar symptoms or sick 0 1
animals

Asks for any palpitations or dizziness 0 1

Checks for red flags: haemoptysis, weight loss, night sweats and 0 1 2
hoarseness

Checks if patient is current or ex-smoker and number of pack years 0 1 2

Asks about past medical history (specifically hayfever, eczema) 0 1 2

Asks about any family history of disease (specifically eczema, asthma) 0 1

Establishes any drugs or over the counter medication patient is on 0 1

Asks if patient has any allergies or any new pets 0 1 2

Asks if patient drinks or takes recreational drugs 0 1

Elicits patients occupation 0 1 2

Asks if patient has travelled anywhere recently 0 1

Explores impact of shortness of breath on activities of daily living 0 1 2

Explores and responds to ideas 0 1

Explores and responds to concerns 0 1

Explores and responds to expectations 0 1

Shows empathy 0 1

Avoids jargon 0 1

Summarises back to patient 0 1

Thanks patient 0 1
2/3
Patient global score 0 1 2

Gives reasonable differential diagnosis (asthma, pneumonia, allergic 0 1

rhinitis)

3/3
Jung's Breathlessness
osce-stations.blogspot.com/2015/11/jungs-breathlessness.html

Name Jung Trombley

DOB 19/01/47 (67 years)

Occupation Taxi driver

History For at least 8 months I have been experiencing worsening

shortness of breath, excessive coughing and I have been
producing a lot of mostly clear sputum which is
occasionally green. If pressed this is above what I usually do
as a smoker. I can only walk about 200 metres now but I'm
not surprised by this as I am old. I also notice that I'm
wheezing so I must have asthma. I deny any other
symptoms including chest pain, waking up at night gasping
for breath, palpitations, fainting, weight loss, night sweats
and fever.

Past Medical History Type 2 Diabetes and high blood pressure for 5 years
controlled by diet alone

Drug History Vitamin D tablets

Family History Father had heart attack at 70 years. Nil else

Social History In third floor flat with no lift. I struggle to get shopping and
therefore also cook for myself. I am okay with all other
activities. My neighbour sometimes helps me with food. I
smoke 40 a day and have done so all my life since I was 18.
I drink occasionally. I smoked a lot of cannabis during my
teenage years.

Introduces yourself 0 1

Confirms name & age of patient 0 1

Explains reason for consultation & builds rapport 0 1

Gains consent 0 1

Asks open question 0 1

Asks about onset (gradual/sudden) 0 1

Asks about duration and changes to breathlessness 0 1

Enquires about exacerbating factors including exertion, 0 1 2

chemicals/pollen, lying flat
1/3
Asks about variability over the day: constant/progressively worse/worse 0 1
in the morning or night

Enquires about severity by asking about exercise tolerance on flat and up 0 1 2

stairs and on rest

Asks about any recent illness or previous shortness of breath 0 1

Asks for cough and sputum and if present explores further 0 1 2

Asks for orthopnoea and paroxyasmal nocturnal dyspnoea and if present 0 1

explores further

Asks for added breath sounds such as wheeze and if present explores 0 1
further

Asks for chest pain and characterises chest pain if present 0 1

Asks for ankle oedema 0 1

Asks for any fever or contact with anyone with similar symptoms or sick 0 1
animals

Asks for any palpitations or dizziness 0 1

Checks for red flags: haemoptysis, weight loss, night sweats and 0 1 2
hoarseness

Checks if patient is current or ex-smoker and number of pack years 0 1 2

Asks about past medical history (specifically hayfever, eczema, COPD 0 1 2

and heart attacks)

Asks about any family history of disease (specifically eczema, asthma, 0 1

lung cancer/fibrosis)

Establishes any drugs or over the counter medication patient is on 0 1

Asks if patient has any allergies 0 1

Asks if patient drinks or takes recreational drugs 0 1

Elicits patients occupation and any possible exposure to asbestos 0 1 2

Asks if patient has travelled anywhere recently 0 1

Explores impact of shortness of breath on activities of daily living 0 1 2

Explores and responds to ideas 0 1

Explores and responds to concerns 0 1

Explores and responds to expectations 0 1

Shows empathy 0 1

Avoids jargon 0 1
2/3
Summarises back to patient 0 1

Thanks patient 0 1

Patient global score 0 1 2

Gives reasonable differential diagnosis (COPD, asthma, lung cancer, 0 1

pneumonia)

3/3