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Home / Station 2: Acute dyspnea with wheeze

NAC OSCE preparation

Station 2: Acute dyspnea with wheeze

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Acute dyspnea with wheeze

11 minutes

Discipline: Internal Medicine
Station type: History + acute management
Setting: Urgent care clinic

Your task

Take a focused respiratory history, then explain immediate management and disposition. Do not perform a physical examination.

Information available at entry

HR 118/minBP 138/84 mm HgRR 30/minSpO₂ 91% room airT 37.1°CPEF about 40% personal best

Coach prompt: Assess asthma severity and start time-critical treatment.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 2 of 30

Standardized-patient profile

NameMs. Amina Hassan

Age29

Pronounsshe/her

RolePatient

Demeanour: Breathless, speaks in short phrases.

Opening statement: “My asthma suddenly got much worse and my inhaler is barely helping.”

History and standardized-patient responses

Current attack

Candidate explores	Standardized-patient response
Onset/trigger	Worsening over six hours after cleaning a dusty basement.
Severity	Chest tightness, cough and wheeze; cannot cross the room comfortably.
Speech/fatigue	Short phrases and increasing fatigue.
Reliever response	Repeated salbutamol gives only brief relief.
Alternatives	No fever, pleuritic pain, hives, facial swelling or choking.

Past risk/control

Candidate explores	Standardized-patient response
Previous severe attack	ICU admission three years ago; never intubated.
Recent care	ED visit two months ago; two steroid courses this year.
Control	Night symptoms three times weekly and frequent reliever use.
Adherence	Often misses inhaled corticosteroid; technique not checked.

Other

Candidate explores	Standardized-patient response
Smoking/vaping	Vapes nicotine daily.
Medication/allergy	Budesonide-formoterol and salbutamol; no allergies.

Physical findings

Accessory-muscle use, diffuse wheeze and reduced air entry.
No urticaria or focal crackles.
Alert but visibly fatigued.

Examiner prompts

Severity?

Severe exacerbation with hypoxemia, short-phrase speech, tachypnea, low peak flow and prior ICU risk.

Immediate treatment?

Oxygen for hypoxemia, repeated inhaled short-acting bronchodilator plus anticholinergic, systemic corticosteroid, close reassessment and emergency transfer; consider IV magnesium if refractory.

Impending failure signs?

Silent chest/very poor air entry, exhaustion, altered consciousness, cyanosis, rising CO₂, bradycardia or worsening hypoxemia.

Differential diagnosis

Severe asthma exacerbation
Anaphylaxis
Pneumonia
PE
Pneumothorax
Vocal cord dysfunction

Investigations

Continuous oximetry and serial clinical assessment
Peak flow when feasible
Blood gas if tiring or not responding
Imaging only if alternative/complication suspected

Management

Immediate bronchodilator and oxygen for hypoxemia
Systemic corticosteroid
Add inhaled anticholinergic
Urgent ED/critical-care escalation
Post-stabilization inhaled corticosteroid-containing plan, technique and action plan

Communication behaviours

Keep questions short
Explain treatment while it is occurring
Do not falsely reassure before reassessment

Critical safety actions

Escalate before exhaustion
Past ICU admission increases risk
Never leave a severely hypoxemic patient unmonitored

Model closing summary

This is a severe asthma exacerbation with hypoxemia, marked tachypnea, short-phrase speech, low peak flow and previous ICU admission. I would start oxygen, repeated inhaled bronchodilator plus anticholinergic and systemic corticosteroid immediately, arrange monitored emergency transfer, reassess frequently and escalate to IV magnesium and critical-care support if response is inadequate.

Common pitfalls

Focusing on chronic control before stabilization
Equating little wheeze with improvement
Routine imaging instead of treatment
No reassessment

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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