Respiratory examination in a woman with cough and fever
PLAB 2 practice station

The task

You are a doctor on an acute medical ward. Mrs Grace Adeyemi, aged 58, was admitted with a cough, fever and right-sided chest pain. She is sitting up on the bed. Perform a respiratory examination. Say aloud what you are doing at each step. The examiner will report the findings when you say what you are doing, so describe each step as you go. At the end, summarise your findings and say what you think is going on and what you would do next.

What this station tests

• Compare both sides on percussion and auscultation and examine the back as well as the front.
• Dullness, bronchial breathing and increased vocal resonance indicate consolidation.
• Always act on abnormal vital signs. Here the NEWS2 is 2 + 3 + 1 + 1 = 7, which needs an emergency response.
• Check for pain, obtain consent and offer a chaperone before exposing the chest.
• Present findings first, then your impression and a plan.

Sources for the clinical content

• NICE NG250: Pneumonia: diagnosis and management
• NICE NG253: Suspected sepsis in people aged 16 or over: recognition, assessment and early management
• Royal College of Physicians: National Early Warning Score (NEWS) 2

An original practice scenario with invented patients. Not an exam question.

Practise next

• Cardiovascular examination in a breathless man
• Abdominal examination with a painful groin lump
• Neurological examination of the legs after back pain
• Examination of a swollen painful knee
• Thyroid examination in a woman with weight loss