Summary of Common Conditions Seen in OSCEs

Key Investigations

Blood Tests

• Full blood count: anaemia is a common cause of SOB
  
• Us+Es and liver function tests: SOB can be a presenting feature of renal failure/hepatic failure if this has resulted in fluid overload and pleural effusions
  
• Brain natriuretic peptide: for heart failure

Cardiac Investigations

• ECG: for arrhythmias and left ventricular failure
  
• Echocardiogram: for valvular heart diseases and heart failure
  
• Cardiac catheter studies: for pulmonary hypertension

Respiratory Investigations

• Chest X-ray: for pneumonias, lung cancer, cardiomegaly and pleural effusions
  
• Lung function tests/spirometry: to distinguish between and diagnose obstructive and restrictive lung conditions
  
• Bronchoscopy: for bronchial/tracheal malignancies
  
• CT pulmonary angiogram and ventilation/perfusion scan: for pulmonary embolism
  
• High-resolution CT scan: for some lung cancers and pulmonary fibrosis

Others

• Nerve conduction studies: for Guillain–Barré syndrome and myasthenia gravis
  
• Spine/back X-rays: for kyphosis, scoliosis, etc.

Hints and Tips for the Exams

There May Be More Than One Aetiology

Patients who are suffering from SOB often have more the one coexisting condition to account for their symptoms; for example, heart failure may be exacerbated by anaemia.

Know Your Emergencies

Acute SOB is a common presenting symptom in A&E, so don’t be surprised if it appears as an OSCE station. You should know how to manage common medical emergencies causing SOB such as acute severe asthma, pulmonary embolism and pneumothorax.

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