CVS OSCE revision

Question 1

What is the effect on BP reading if the cuff is too small?

Answer 1

Overestimates BP

Question 2

What is the effect on BP reading if the cuff is too big?

Answer 2

Underestimates BP

Question 3

What is the effect on BP if the arm is a) above the heart and b) below the heart?

Answer 3

a) Underestimate

b) Overestimate

Question 4

What are Korotkoff sounds?

Answer 4

Turbulent blood flow

Question 5

What is cyanosis?

Answer 5

Blue discolouration to the skin.

Question 6

What is the difference between central and peripheral cyanosis?

Answer 6

Central cyanosis: Caused due to problems of the central pumping system – heart lungs. Blue discolouration to the tongue and lips due to presence of deoxygenated blood in the arteries i.e. respiratory problem

Peripheral cyanosis: Problems in vasculature and circulation. Blue discolouration to the peripheries due to inadequate supply of blood i.e. circulation problem.

Question 7

Give some causes of peripheral and central cyanosis

Answer 7

• Peripheral – hypothermia, anaemia.

* Central – tetralogy of fallot, atrial stenosis, transposition of aorta and pulmonary valves, emphysema, asthma.

Question 8

What are the layers of the pericardium?

Answer 8

Fibrous pericardium (most peripheral)
Serous pericardium - parietal and visceral layers (fluid in-between)

Question 9

What is an aortic aneurysm?

Answer 9

An aneurysm is a dilation (expansion) of an artery, which is greater than 50% of the normal diameter. An aortic aneurysm is due to a underlying weakness of the walls (such as Marfan’s syndrome), or a pathological process (such as aortic dissection).

The main concern with an aortic aneurysm is rupture of the aorta, which if not treated, will lead to death.

Question 10

What are the borders of the heart?

Answer 10

• Right border – Right atrium
• Inferior border – Left ventricle and right ventricle
• Left border – Left ventricle (and some of the left atrium)
• Superior border – Right and left atrium and the great vessels

Question 11

What is the oblique pericardial sinus?

Answer 11

A blind ending passageway (‘cul de sac’) located on the posterior surface of the heart.

Question 12

Where is the transverse pericardial sinus found and what is its clinical significance?

Answer 12

Superiorly on the heart. It can be used in coronary artery bypass grafting.

Question 13

What is the triangle of Koch and what are its borders?

Answer 13

The triangle of Koch is a triangle in the right atrium which is an important anatomical landmark to help find the location of the atrioventricular node.

The borders are:
•The opening of the coronary sinus.
•The anterior portion of the tricuspid valve annulus.
•The tendon of Todaro – a tendinous structure connecting the valve of the inferior vena cava to the central fibrous body posteriorly.

Question 14

During BP measurement, we are listening to blood pressure as it is ejected from which ventricle?

Answer 14

Left

Question 15

Heart sound :S1, LUBB

Answer 15

This is SYSTOLE of ventricles, DIASTOLE of atrium, closure of AV valves.

Question 16

Heart Sound: S2 dupp

Answer 16

DIASTOLE of ventricles, SYSTOLE of atria, closure of semilunar valve

Question 17

Why is S1 louder?

Answer 17

Ventricles are much stronger in contraction

Question 18

Locations you can measure a persons pulse?

Answer 18

1. temporal artery
2. carotid artery
3. axillary artery
4. radial artery
5. femoral artery
6. popliteal artery
7. post tibial artery
   8 dorsalis predi artery

Question 19

What is the first Korotkoff sound?

Answer 19

The first Korotkoff sound is the snapping sound first heard at the systolic pressure. Clear tapping, repetitive sounds for at least two consecutive beats is considered the systolic pressure.

Question 20

What is the second Korotkoff sound?

Answer 20

The second sounds are the murmurs heard for most of the area between the systolic and diastolic pressures.

Question 21

What is the third Korotkoff sound?

Answer 21

The third sound was described as a loud, crisp tapping sound.

Question 22

What is the fourth Korotkoff sound?

Answer 22

The fourth sound, at pressures within 10 mmHg above the diastolic blood pressure, was described as “thumping” and “muting”.

Question 23

What is the fifth Korotkoff sound?

Answer 23

The fifth Korotkoff sound is silent as the cuff pressure drops below the diastolic blood pressure. The disappearance of sound is considered diastolic blood pressure – 2 mmHg below the last sound heard.

Question 24

What part of the heart does the left circumflex artery supply?

Answer 24

Left atrium & left ventricle

Question 25

What part of the heart does the right coronary artery supply?

Answer 25

Right atrium & right ventricle

Question 26

What does the right marginal artery supply?

Answer 26

Supplies the right ventricle and apex

Question 27

The left marginal supplies what?

Answer 27

Left ventricle

Question 28

The left anterior descending supplies what part of the heart?

Answer 28

The right and left ventricle and interventricular septum

Question 29

The posterior interventricular septum supplies where?

Answer 29

Right and left ventricles and interventricular septum

Question 30

Which ECG leads and what artery is associated with changes to the inferior aspect of the heart?

Answer 30

II, III, AVF

RCA

Question 31

Anteroapical - ECG leads and artery

Answer 31

V3, V4

Distal LAD

Question 32

Anteroseptal - ECG leads and artery

Answer 32

V1, V2

LAD

Question 33

Anterolateral - ECG leads and artery

Answer 33

I, AVL, V5, V6

Circumflex artery

Question 34

Extensive anterior

Answer 34

I, AVL, V2 - 6

Proximal LCA

Question 35

True posterior

Answer 35

Tall R in V1

RCA