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PCM III Final*** > Cardiac OSCE > Flashcards

Cardiac OSCE Flashcards

1
Q

What is pulsus alternans?

A

alternating strong and weak pulse palpable at radial or femoral arteries

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2
Q

What causes a water hammer pulse?

A

Due to large stroke volume and backflow of blood from the aorta into LV

*indicative of aortic regurgitation.

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3
Q

What can a paradoxical pulse be used for?

A

to assess pericarditis or tamponade when there is varied pulse strength/amplitude with respiration

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4
Q

What is Kussmaul’s sign?

A
  • Normal JVP shows decline in inspiration but the a wave amplitude increases
  • If there is an increase in JVP, or even no change in JVP on inspiration, this is a positive Kussmaul’s and may indicate impaired venous return to the right heart.
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5
Q

When might you see a hyperkinetic high amp impulse?

A
  • hyperthyroidism
  • severe anemia
  • pressure overload of LV from HTN or aortic stenosis
  • volume overload of LV from AR
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6
Q

Aortic Stenosis

A
  • Harsh quality
  • RIGHT 2nd ICS/3rd ICS
  • Radiates to suprasternal notch and carotids
  • Delayed pulses (pulsus tardus et parvus)
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7
Q

Mitral Regurgitation

A
  • Blowing quality, holosystolic
  • Prominent at apex, radiates to LEFT axilla
  • Loudness correlates with degree of valve insufficiency
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8
Q

Pulmonary Stenosis

A
  • Harsh, loud, ejection click
  • LEFT 2nd ICS/3rd ICS
  • Radiates to the LEFT shoulder
  • Increases with inspiration
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9
Q

Tricuspid Insufficiency

A
  • Blowing quality, increases with inspiration
  • Holosystolic
  • Lower LEFT sternal border
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10
Q

Aortic Regurgitation

A
  • Blowing, decrescendo murmur
  • LEFT 2nd ICS to the 4th ICS
  • Auscultate with diaphragm
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11
Q

Mitral Stenosis

A
  • Rumbling, low pitched
  • Best heard at apex
  • Auscultate with bell
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12
Q

Pulmonary Insufficiency

A
  • Blowing quality
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13
Q

Tricuspid Stenosis

A
  • Increases in intensity with inspiration

- Decreases in intensity with expiration and valsalva

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14
Q

What are the following special tests used for?

  1. Left lateral decubitus
  2. Sitting and leaning forward
  3. Straining/valsalva
  4. JVP
A
  1. Patient on left side with left arm above head; Palpate PMI and auscultate for systolic murmurs; Increases chance of hearing mitral stenosis and extra heart sounds
  2. Increases chance of hearing aortic regurgitation
  3. Increases chance of hearing mitral regurgitation
  4. Hepatojugular reflex
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15
Q

What does valsavla help with?

A

differentiate between aortic and mitral prolapse or HCM

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16
Q

What is hepatojulular reflex used for?

A

adjunct to measuring JVP

17
Q

How can you differentiate between aortic stenosis and MVP?

A

sitting and squatting test

PCM III Final*** (25 decks)

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