MBBS OSCE · Respiratory / Emergency Medicine
OSCE — primary spontaneous pneumothorax and tension
OSCE on PSP recognition, BTS sizing, oxygen, aspiration vs chest drain, safe triangle, and clinical diagnosis/needle decompression of tension pneumothorax without waiting for CXR.
8 min stationVerification in progress
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Exam tags
NEET-PGINICETUSMLEPLAB
Brief (to candidate)
A tall thin 22-year-old smoker has sudden pleuritic pain and dyspnoea. RR 28, SpO₂ 92%, trachea central, right hyper-resonance. Later prompt: ventilated patient, sudden hypotension, high airway pressures, deviated trachea. 8 minutes.
Candidate instructions
- Diagnose PSP; classify PSP vs SSP vs traumatic/iatrogenic.
- Erect CXR; BTS size (≥2 cm at hilum = large).
- High-flow O₂ (unless CO₂ retainer); symptomatic/large → needle aspiration then small-bore drain if fails.
- Safe triangle for drain; underwater seal.
- Tension: clinical diagnosis — immediate needle decompression then definitive chest drain; do not wait for CXR.
- Lifestyle: stop smoking; no flying until resolved; no diving without definitive Rx.
Examiner checklist
| Domain | Expected |
|---|---|
| Diagnosis | PSP classic phenotype; exam signs |
| Sizing | BTS hilum 2 cm rule vs CHEST apex-cupola 3 cm |
| Pathway | Observe small asymptomatic; aspirate; drain; VATS if persistent leak/recurrence |
| Tension | Needle decomp landmarks; then ICC |
| Safety | Never clamp bubbling drain routinely without senior plan |
| Advice | Smoking cessation halves recurrence |
Common errors
- CXR before decompression in tension.
- Large-bore trauma drain as default for all PSP.
- Discharging without safety-net for worsening dyspnoea.
Model key actions
- PSP vs SSP classification drives recurrence risk and threshold for intervention.
- BTS: large 2 cm or more at hilum or symptomatic then aspirate; failed aspiration then small-bore drain in safe triangle.
- Tension: needle decompression then definitive ICC — clinical diagnosis.
- Smoking cessation; no air travel until CXR resolution; never dive without definitive management after recurrence risk counsel.
Common errors
- Waiting for CXR in tension pneumothorax.
- Observing a breathless large PSP without intervention.
- Clamping a vigorously bubbling drain without senior plan.
References3ShowHide
- [1]Roberts ME, et al. British Thoracic Society Guideline for pleural disease. Thorax, 2023.PMID 37553157
- [2]Smyth R, Shojaee S, Feller-Kopman D Primary Spontaneous Pneumothorax. Review, 2024.PMID 38354148
- [3]MacDuff A, Arnold A, Harvey J Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax, 2010.PMID 20696690