OSCE

Question 1

Differentials for CP

Answer 1

CV - MI, angina, aortic dissection, pericarditis, myocarditis
Resp - pulmonary embolism, PTX
Non cardio resp - GERD, anxiety/ panic attack, MSK, costochondritis, pleurisy, gastritis

Question 2

Workup for CP

Answer 2

Examinations - Vitals, CV, resp, abdo (r/o referred pain), chest wall palpation (msk pain)
Bedsides- ECG, pulse oxymetry, bedside echo
Bloods - troponin, d-dimer, FBC (anemia), U&E (general , contrast studies), CRP/ ESR, LFTS, Lipase
Labs - ABG, coags, group and hold
Imaging - CXR, CTPA, echo
+/- CT aorta

Question 3

Differentials for syncope

Answer 3

Life threatening
- Structural: valvular diseases like AS, cardiac masses like myxoma, cardiomyopathy, pericardial diseases like constrictive pericarditis
- Arrthymics: bradyarrhytmias like AV block or sick sinus syndrome, tachyarrhytmias like VT

Benign
- Neurally mediated: vasovagal, post specific trigger, carotid sinus HSN
- Postural: Autonomic NS failure, hypovolemia

Question 4

CP killers

Answer 4

ACS,
PE
Aortic dissection
Tension PTX
Pericardial tamponade
Esophageal rupture

Question 5

Syncope killers

Answer 5

Cardiac arrhythmias - VT/fib, bradyarrhytmias, sick sinus syndrome
Structural heart disease - AS, HOCM, massive MI, cardiac tamponade, myxoma
PR
Aortic dissection
Severe neurologic - SAH, stroke/tia, seizure

Question 6

Syncope w/u

Answer 6

Examiantion: hydration/ fluid status, CV, neurologic, orthostatic vitals
Bedsides: ECG, Holter/ telemetry , glucose, U/A
Bloods - FBC for anaemia and infection, UEC, glucose, beta hcg
Labs: ABG, toxicology screen
Imaging: CXR, echo, CT head, carotid doppler, EEG

Question 7

Key CV symptoms

Answer 7

CP
Dysponea
Palpitations
Syncope
Oedema
Intermittent claudication
Systemic symptoms

Question 8

Important PMH for CH hx

Answer 8

HTN
Hyperlipidemia
Angina, MI
HF
Obesity
CKD
AF
Stroke
PVD
Rheumatic fever
DM
FH- cardiac disease
smoking

Question 9

Meds relevant for CV hx

Answer 9

Beta blockers
CCB
ACE i
diuretics
MRA
Statins
Antiplatelets
anticoags
SGLT2 i
GTN
NSAIDS
St johns wort

Question 10

Differentials for dyspnea

Answer 10

Respiratory - Asthma, COPD, ILD
- PE, PTX
- Pneumonia, TB, whooping cough

Non resp
neoplastic: lung ca, pharyngeal/ largyngeal ca
cardiac: arrhythmia, valvular heart disease, heart failure- APO, ACS
Neuromus: kyphoscoliosis, phrenic nerve palsy, myasthenia gravis
Systemic: anaemia, acute renal failure, metabolic acidosis, liver cirrhosis, sepsis

Question 11

Differentials for palpitaions

Answer 11

Arrhythmias: extrasystoles (SV or ectopics), SVTs (AF, Aflutter), VT
Psychosomatic: anxiety, panic attacks, depression
Drugs: caffine, etoh w/d, nicotine
Hyperthyroidism, anaemia, electrolyte imbalances
Fever, inf
menopause
Structural cardiac- MI, cardiomyopahty, valvular, HF

Question 12

Run through CV exam

Answer 12

https://geekymedics.com/cardiovascular-examination-2/

Question 13

differentials for lower limb edema

Answer 13

Increase in hydrostatic pressure: local- DVT, cellulitis, inflammation, trauma, chronic venous insufficiency
Systemic- HF, cor pulmonale, pelvic mass

Decrease in colloid osmotic pressure: nephrotic syndrome, liver cirhosis, severe malnutrition

Question 14

Differentials for HTN

Answer 14

Idiopathic
secondar
renal: glomerulonephritis, chronic pyelonephritis, b=diabetic nephropathy, RCC, PCKD, obstructive uropathy
Vascular: renal art stenosis, coarctatoin of aortia
Endocrine: primary hyperaldosteronism, pheochromocytoma, cushing’s, acromegaly, hypo/hyperthyroidism
Drugs: cocp. CS, NSADIS, ETOH
Other: CT disorders, OSA, Ges HTN and pre-eclampsia