MBBS OSCE · Infectious Diseases / Respiratory

OSCE — assessment of suspected community-acquired pneumonia

An 8-minute OSCE station assessing the candidate's structured assessment, severity grading (CURB-65) and initial management of a patient with suspected CAP. Marks for the sepsis-6 bundle and antibiotic timing.

8 min stationVerification in progress
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Exam tags

NEET-PGINICETUSMLEPLAB

Brief (to candidate)

A 68-year-old diabetic man is referred with 3 days of fever, purulent cough and breathlessness. He is confused, respiratory rate 32, SpO2 90% on air, BP 86/54. You have 8 minutes to assess him, grade severity, and outline immediate management.

Candidate instructions

  1. Take a focused, structured history and examine, using an ABCDE approach.
  2. Grade severity using an appropriate score.
  3. Outline the immediate management, including investigations and drug therapy with doses and timing.
  4. State your disposition (ward vs ICU) and discharge/safety-net advice.

Examiner checklist (mark each domain / 10)

DomainKey actions expected
ABCDE / resuscitationAirway; high-flow O2 to target SpO2 94–98% (88–92% if CO2 retainer); IV access; fluids for hypotension
Severity — CURB-65Reproduces all 5 components; calculates score = 5; states severe → ICU[3]
Sepsis-6 (hour-1)Cultures; lactate; urine output; antibiotics; 30 mL/kg balanced crystalloid; noradrenaline if refractory shock
Empirical antibioticsIV ceftriaxone + azithromycin; within 4 hours; add MRSA/antipseudomonal cover if risk; covers typical AND atypical
InvestigationsCXR, blood cultures, sputum, urinary antigens, viral PCR, ABG/lactate, CRP/U&E
Diagnosis & differentialStates CAP with sepsis; mentions TB/PE/COVID-19 as differentials where relevant
Communication & safety-netClear plan; ICU referral; follow-up CXR at 6–8 weeks; vaccination on recovery

Model key actions

  • Oxygen target and rationale; fluid resuscitation with reassessment.
  • CURB-65 = 5 → severe CAP → ICU.[3]
  • IV ceftriaxone + azithromycin within 4 hours; de-escalate on cultures; duration 5–7 days once improving.[1]
  • Recognise and request drainage if a complicated parapneumonic effusion develops (pH under 7.2).
  • Vaccinate on recovery (pneumococcal, influenza, COVID-19).

Common errors

  • Not applying a severity score (treating a score-5 patient on a ward).
  • Beta-lactam without a macrolide (misses atypicals).
  • Delaying antibiotics for tests.
  • Not considering TB/PE/COVID-19; not planning follow-up imaging.
References2Show
  1. [1]Metlay JP, et al. Diagnosis and Treatment of Adults with Community-Acquired Pneumonia. ATS/IDSA 2019. Am J Respir Crit Care Med, 2019.PMID 31573350
  2. [3]Lim WS, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 2003.PMID 12728155
OSCE — assessment of suspected community-acquired pneumonia · MBBS OSCE · NeetVellum