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Home / Station 28: Respiratory examination with pleural effusion

NAC OSCE preparation

Station 28: Respiratory examination with pleural effusion

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

Respiratory examination with pleural effusion

11 minutes

Discipline: Physical Examination
Station type: Focused respiratory exam
Setting: Medical assessment unit

Your task

Perform a focused respiratory examination for unilateral dyspnea and present your findings.

Information available at entry

HR 102/minBP 124/72 mm HgRR 24/minT 37.4°CSpO₂ 92% room air

Coach prompt: Demonstrate a complete respiratory examination and localize a pleural process.

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 28 of 30

Standardized-patient profile

NameMs. Claire Bennett

Age61

Pronounsshe/her

RolePatient

Demeanour: Cooperative; mildly breathless.

Opening statement: “My breathing has become worse over two weeks, especially on the right side.”

History and standardized-patient responses

Information if requested after exam

Candidate explores	Standardized-patient response
Symptoms	Progressive dyspnea, dry cough and right pleuritic discomfort.
Systemic	Five-kilogram unintentional weight loss.
History	Thirty pack-year smoking history.

Physical findings

Reduced right hemithorax expansion.
Trachea central.
Stony dull percussion at right base to mid-zone.
Reduced tactile fremitus and vocal resonance over the same area.
Markedly diminished breath sounds over right lower zone.
No wheeze; left lung clear.
No calf swelling.

Examiner prompts

Summarize findings.

Right pleural effusion, moderate to large, without obvious tension shift.

Differential?

Malignancy, parapneumonic effusion/empyema, heart failure, pulmonary embolism and other exudative/transudative causes.

Next steps?

Chest imaging and ultrasound-guided diagnostic thoracentesis when appropriate, with urgent drainage if infected or causing compromise.

Differential diagnosis

Malignant pleural effusion
Parapneumonic effusion or empyema
Heart-failure effusion
Pulmonary embolism
Tuberculous pleuritis

Investigations

Chest radiograph
Bedside thoracic ultrasound
CT chest based on context
Ultrasound-guided thoracentesis with cell count, protein/LDH, pH/glucose, Gram stain/culture and cytology as indicated

Management

Oxygen if hypoxemic
Urgent drainage for respiratory compromise or complicated infection
Treat underlying cause
Smoking-related malignancy pathway if suspected
Avoid blind procedures

Communication behaviours

Explain need to examine front and back
Preserve modesty
Warn before percussion or repositioning

Critical safety actions

Assess instability before completing exam
Use ultrasound guidance for pleural procedures
Do not miss empyema or malignancy

Model closing summary

Examination demonstrates reduced expansion, stony dull percussion, reduced fremitus and markedly diminished breath sounds over the right lower chest, localizing a moderate-to-large right pleural effusion. Given weight loss and smoking history, malignancy is important, but infection, heart failure and pulmonary embolism remain considerations. I would obtain chest imaging and ultrasound, assess oxygenation and arrange image-guided diagnostic drainage where indicated.

Common pitfalls

Calling dullness consolidation without integrating reduced breath sounds/fremitus
Omitting trachea
Planning blind thoracentesis
Ignoring oxygen saturation

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

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