Cardiovascular OSCE Exam Flashcards Preview

Phase 2B Medicine > Cardiovascular OSCE Exam > Flashcards

Flashcards in Cardiovascular OSCE Exam Deck (37)
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1

What are the 7 things you should do as part of your introduction?

Wash hands
Introduce yourself
Confirm patient details (name/DOB)
Explain the examination
Gain consent
Position patient at 45o with their chest exposed
Ask patient if they have any pain anywhere (before you begin)

2

What should you look for at the bedside?

GTN spray
Oxygen
Mobility Aids
Medications

3

On general inspection, what 5 things should you look for?

- Comfortable at rest?
- SOB at rest?
- Malar flush
- Scars / visible pulsations: look under the arms for thoracotomy scars / look for small scars from minimally invasive surgery
- Inspect the legs: scars from saphenous vein harvest for CAGB / peripheral oedema / missing limbs or toes

4

What is 'malar flush' and what might it indicate?

Plum red discolouration of cheeks.
Suggests Mitral Stenosis

5

What are the 2 positions for hand inspection?

Hands out, palms facing downwards
Hands out, palms facing upwards

6

What do you look for when patient has 'hands out, palms facing downwards'?

- Splinter haemorrhages -> bacterial endocarditis
- Finger clubbing

7

How do you test for finger clubbing?

- Ask the patient to place the nails of their index fingers back to back
- Healthy individual: observe a small diamond shaped window (Schamroth’s window)
- When finger clubbing is present this window is lost
- Finger clubbing has a number of causes including infective endocarditis and cyanotic congenital heart disease

8

What 8(!) features do you look for when patient has 'hands out, palms facing upwards'?

Colour – dusky bluish discolouration (cyanosis) suggests hypoxia

Temperature – cool peripheries may suggest poor cardiac output / hypovolaemia

Sweaty/clammy– can be associated with acute coronary syndrome

Janeway lesions – non-tender maculopapular erythematous palm pulp lesions – bacterial endocarditis

Osler’s nodes – tender red nodules on finger pulps / thenar eminence – infective endocarditis

Tar staining – smoker – risk factor for cardiovascular disease

Xanthomata – raised yellow lesions – often noted on tendons of wrist – caused by hyperlipidaemia

Capillary refill time – normal is <2 seconds – if prolonged may suggest hypovolaemia

9

When assessing the radial pulse, what 2 features are you assessing?

Rate & Rhythm

10

How would you identify a Radio-radial delay? What does this suggest?

Palpate both radial pulses simultaneously.
They should occur at the same time in a healthy adult.
Delay suggests Aortic Coarctation.

11

How would you identify a 'Collapsing pulse'. What does this suggest?

- Ensure the patient has no shoulder pain
- Palpate the radial pulse with your hand wrapped around the wrist
- Raise the arm above the head briskly
Feel for a tapping impulse through the muscle bulk of the arm as blood empties from the arm very quickly in diastole, resulting in the palpable sensation
- This is a water hammer pulse and can occur in normal physiological states (fever/pregnancy), or in cardiac lesions (e.g. AR / PDA) or high output states (e.g anaemia / AV fistula / thyrotoxicosis)
- Collapsing pulse = associated with Aortic Regurgitation

12

When assessing the brachial pulse, what 2 features are you assessing?

Volume & character

13

When measuring blood pressure, what should you consider?

Any abnormalities: Hypo / hypertension
Narrow pulse pressure -> ?Aortic stenosis
Wide pulse pressure -> ?Aortic regurgitation
* mention that you'd ideally measure BP in both arms

14

What features of the Carotid pulse should you assess?

Character & volume
* slow, rising character in aortic stenosis
* It’s often advised to auscultate the carotid artery for a bruit before palpating, as theoretically palpation may dislodge a plaque which could lead to a stroke
However, if you perform carotid auscultation at this point, remember that the ‘bruit’ may actually be a radiating murmur!

15

How would you assess / measure Jugular Venous Pressure (JVP)?

1. Ensure patient is positioned @ 45o.
2. Ask pt to turn their head away from you.
3. Observe neck for the JVP (located in line with the SCM)
4. Measure the JVP – number of cm from sternal angle to the upper border of pulsation

16

What might raised JVP indicate?

Fluid overload
Right ventricular failure
Tricuspid regurgitation

17

Explain how you'd carry out a Hepatojugular reflux assessment.

- Apply pressure to the liver
- Observe the JVP for a rise
- In healthy individuals this should last no longer than 1-2 cardiac cycles (it should then fall)
- If the rise in JVP is sustained and equal to or greater than 4cm this is a positive result

*This is very uncomfortable to perform correctly – an examiner will often prevent you performing it but remember to mention it!

18

What does a positive Hepatojugular reflux sign suggest?

Right sided heart failure / Tricuspid regurgitation.

19

What 3 features should you look for when assessing the eyes?

Conjunctival pallor – anaemia – ask patient to gently pull down lower eyelid

Corneal arcus – yellowish/grey ring surrounding the iris – hypercholesterolaemia

Xanthelasma – yellow raised lesions around the eyes – hypercholesterolaemia

20

What 4 features should you look for when assessing the mouth?

Central cyanosis – bluish discolouration of lips / underneath tongue

Angular stomatitis – inflammation of the corners of the mouth – iron deficiency

High arched palate – suggestive of Marfan syndrome – ↑ risk of aortic aneurysm/dissection

Dental hygiene – important if considering sources for infective endocarditis

21

List 4 types of scars and what they might be indicative of.

Thoracotomy – minimally invasive valve surgery
Sternotomy – CABG / valve surgery
Clavicular – pacemaker (can be either side, so remember to check both)
Left mid-axillary line – subcutaneous implantable cardioverter defibrillator (ICD)

22

What are the chest wall deformities you'd look for called?

pectus excavatum / pectus carinatum

23

On finding a visible (forceful) apex beat, what might this suggest?

HTN / Ventricular hypertrophy

24

Where & how would you find the apex beat?

5th Intercostal space, Mid-clavicular line
Palpate the apex beat with your fingers (placed horizontally across the chest)

25

What does lateral displacement of the apex beat suggest?

Cardiomegaly

26

What is a 'parasternal heave'?

- A precordial impulse that can be palpated.
- Present in pts with Right ventricular hypertrophy.

27

How would you identify a parasternal heave?

Place the heel of your hand parallel to the left sternal edge (fingers vertical) to palpate for heaves.
If heaves are present, you should feel the heel of your hand being lifted with each systole.

28

What is a 'thrill'?

A palpable vibration caused by turbulent blood flow through a heart valve (the thrill is a palpable murmur).

29

How would you assess for a 'thrill'?

- Assess for a thrill across each of the heart valves in turn.
- Place your hand horizontally across the chest wall, with the flats of your fingers & palm over the valve to be assessed.

30

Describe how you'd auscultate the 4 valves.

Palpate the carotid pulse to determine the 1st heart sound.
Auscultate using the diaphragm of the stethoscope

Aortic valve – 2nd intercostal space – right sternal edge

Pulmonary valve – 2nd intercostal space – left sternal edge

Tricuspid valve – 4th or 5th intercostal space – lower left sternal edge

Mitral valve – 5th intercostal space – midclavicular line (apex beat)

Repeat auscultation across the 4 valves with the bell of the stethoscope.