OSCE Toolbox | A-E Assessment 1 - Scenario

By Leya Luhar • April 23, 2026 • Last reviewed: 2026-04-23 •

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Summary Expert

In this scenario, a student pharmacist conducts a structured A–E assessment on a manikin/actor. The student must systematically assess each component, document findings, initiate appropriate immediate management, and present their findings and provisional diagnosis to the assessor.

Please ensure that this scenario and mark scheme align with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.

You will need a student pharmacist and an actor for this OSCE station.

Revision Topics

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Student Instructions

Actor Instructions

This may reveal scenario objectives!

Mark Scheme

Introduction and Approach

0 / 1

Introduces themselves and explains what they are about to do

+1

e.g. “Hi Mr Hayes, I’m the pharmacist. I’m going to carry out a quick assessment to check how you’re doing, is that okay?”

A — Airway

0 / 1

Assesses the airway and confirms patency

+1

The student should look and listen for signs of airway obstruction, including stridor, snoring, gurgling, or an inability to speak.

B — Breathing

0 / 8

Measures or requests the respiratory rate

+1

Raised and indicates respiratory distress

Measures or requests SpO₂ via pulse oximetry

+1

SpO₂ is 91% on room air - this is below the target range of 94–98% for a non-carbon dioxide retaining patient and is a feature of acute severe asthma per BTS guidance

Administers or requests supplemental oxygen appropriately

+1

The student should initiate controlled oxygen therapy targeting SpO₂ 94–98% - a 2-4L/min nasal cannulae is a suitable option. A 15L non-rebreathe mask is also acceptable.

Assesses tracheal position

+1

Tracheal deviation away from the midline in a breathless patient suggests tension pneumothorax, which requires immediate needle decompression and is a medical emergency. In this scenario the trachea is central, helping to exclude this diagnosis

Assesses chest expansion bilaterally

+1

Reduced or asymmetrical expansion may indicate pneumothorax, pleural effusion, or lobar collapse. In this scenario expansion is symmetrical but may appear reduced bilaterally due to air trapping from bronchospasm

Performs chest auscultation and reports findings

+1

Bilateral expiratory wheeze, equal air entry, no crackles — the student should auscultate all zones and report what they hear.

Measures or requests peak expiratory flow (PEF)

+1

Correctly interprets PEF result in the context of acute asthma severity

+1

PEF is 52% of predicted - per BTS criteria, a PEF of 33–50% of predicted indicates acute severe asthma.

C — Circulation

0 / 4

Measures or requests heart rate

+1

Heart rate is 112 beats per minute - tachycardia is a feature of acute severe asthma per BTS criteria (HR >110 bpm). The student should note this and include it in their severity assessment

Measures or requests blood pressure

+1

Blood pressure is 138/84 mmHg - within acceptable range. No pulsus paradoxus to note in this scenario. The student should record and report this

Assesses capillary refill time and peripheral perfusion

+1

Capillary refill time is 2 seconds - normal. No signs of cyanosis or peripheral shutdown. The student should check both hands and report findings

Auscultates heart sounds

+1

Muffled heart sounds could suggest cardiac tamponade, and a new murmur may indicate an alternative or concurrent cardiac cause for the patient's presentation. In this scenario heart sounds are normal

D — Disability

0 / 3

Assesses level of consciousness using ACVPU

+1

A reduced level of consciousness (V, P, or U on AVPU) in a patient with asthma would indicate life-threatening disease and require immediate escalation and critical care review

Checks blood glucose

+1

Blood glucose is 5.8 mmol/L - within normal range. Important to check as hypoglycaemia can mimic or exacerbate respiratory distress and altered consciousness

Assesses pupils - size, equality, and reactivity to light

+1

Unequal, dilated, or unreactive pupils would suggest raised intracranial pressure or a neurological event and would require immediate escalation.

E — Exposure

0 / 1

Performs an exposure assessment including temperature, skin inspection, and relevant examination

+1

Temperature 37.2°C - no fever in this case. No rash, urticaria, or angioedema - important to exclude anaphylaxis as a differential diagnosis. Abdomen soft and non-tender. The student should expose the patient appropriately while maintaining dignity

Immediate Management

0 / 2

Initiates or recommends appropriate immediate pharmacological management

+1

Per BTS acute asthma guidance, immediate management of acute severe asthma includes: (1) high-dose inhaled salbutamol 5mg via nebuliser driven by oxygen; (2) ipratropium bromide 0.5mg via nebuliser if poor response or severe/life-threatening; (3) systemic corticosteroids - prednisolone 40–50mg orally or hydrocortisone 100mg IV if unable to swallow. The student should state at least salbutamol nebuliser and corticosteroids to gain this mark

Escalates appropriately - calls for senior medical support or the medical emergency team

+1

Acute severe asthma requires prompt medical review — the pharmacist should not manage this in isolation. The student should state that they would call for the doctor or emergency team while initiating treatment

Verbal Presentation to Assessor

0 / 4

Presents findings in a structured and concise manner using a recognised handover framework (e.g. SBAR)

+1

e.g. “Situation: Robert Hayes, 48-year-old male with known asthma, presenting with acute breathlessness. Background: admitted 4 hours ago, not responding to own inhaler. Assessment: A — patent, speaking in short sentences; B — RR 26, SpO₂ 91%, PEF 52%, bilateral wheeze; C — HR 112, BP 138/84, CRT 2s; D — alert, BM 5.8; E — apyrexial, no rash. Recommendation: acute severe asthma, requiring nebulised salbutamol, systemic corticosteroids, controlled oxygen, and urgent medical review.”

States a correct provisional diagnosis — acute severe asthma exacerbation

+1

The student should use clinical findings to arrive at this diagnosis - not just state the background history. Key supporting features: SpO₂ 91%, RR 26, HR 112, PEF 52%, bilateral wheeze, speaking in short sentences. Life-threatening features are absent, confirming severe rather than life-threatening classification.

Adopts a systematic A–E approach throughout and states findings aloud

+1

The student should work methodically through each component in order - jumping ahead without completing each stage or failing to verbalise findings is a common error

The student did not say anything that could harm the patient

+1

This includes but is not limited to: failing to escalate to medical staff, or providing an incorrect diagnosis that would lead to inappropriate management

Time Management

0 / 1

Completed the scenario in time and achieved 70% of marks

+1

References

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Comments(0)

Patient name	Robert Hayes
Age	48
Location	Medical ward, bay 3, bed 2
Reason for admission	Admitted 4 hours ago with worsening shortness of breath and wheeze. Known asthma. Not responding to own salbutamol inhaler at home.
Background	Known asthma for 15 years. Current medications: beclometasone 400 micrograms inhaler twice daily, salbutamol 100 micrograms inhaler as required. No known drug allergies.
Equipment at bedside	Oxygen mask and tubing, pulse oximeter, peak flow meter and mouthpiece, blood pressure cuff, stethoscope, nebuliser mask

Component	Findings
Airway	Patent - no stridor, no evidence of obstruction. Patient able to speak in short sentences only. If the student asks: “I can get words out but it’s hard to speak”
Breathing	Respiratory rate: 26 breaths per minute SpO₂: 91% on room air Use of accessory muscles visible Central trachea Peak expiratory flow (PEF): 52% of predicted Chest: bilateral expiratory wheeze on auscultation, no crackles, equal air entry bilaterally Normal resonance on percussion Chest expansion equal bilaterally
Circulation	Heart rate: 112 beats per minute, regular Heart sounds normal, no murmurs Blood pressure: 138/84 mmHg Capillary refill time: 2 seconds Skin: warm, no cyanosis
Disability	AVPU: Alert Blood glucose: 5.8 mmol/L Pupils: equal and reactive to light
Exposure	Temperature: 37.2°C No rash, no urticaria, no angioedema Abdomen: soft, non-tender No peripheral oedema

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