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OSCE > Cardiac history and examination > Flashcards

Cardiac history and examination Flashcards

1
Q

Symptoms to review in cardiac Hx

A 
Chest pain
Dyspnoea (SOB) + nocturnal dyspnoea
Orthopnoea
Ankle oedema
Cough, sputum, haemoptysis
Dizziness
Light-headedness
Presyncope & syncope
Palpitations
Nausea
Claudication
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2
Q

Risk factors for IHD

A 
Male
Age
Smoking
HTN
DM
FH
Cholesterol
Inactivity, Obesity
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3
Q

Taking Chest Pain Hx

A

SOCRATES

  • Don’t forget to ask if GTN helps before
  • Don’t forget to check for Hx of angina
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4
Q

Symptoms suggesting Chest pain NOT cardiac

A

Character: Sharp stabbing, Knife-like, aggravated by respiration

Location: left submammary, left hemithorax

Exacerbation: Pain after completion of exercise or on body motion

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5
Q

SOB Hx

Remember could be cardiac OR resp

A

sOCRATES

O: is it acute, chronic or acute on chronic

A: cough, sputum, swollen ankles, rapid weight gain (oedema), palpitations

T: at rest? at night?

E: positional? does rest or medications help

S: how much ADLs affected, Exercise tolerance

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6
Q

Questions for exercise tolerance

A

How far can you walk on flat before stop and rest

what limits how fr you can walk (pain? sob?)

SOB on starts/hills?

Discomfort or chest tightness on walking?

Getting worse? sudden or gradual?

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7
Q

Questions for Palpitations

A

Have you had the awareness of your heart racing?

What provokes this?

Does it build up gradually or start suddenly?

How long does this last? What makes it stop?

Can you tap the rhythm for me?

Any other symptoms with palpitations?

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8
Q

Syncope questions

5Cs and 5Ps

A 
Precipitation
Prodrome
Postion
Palpitations
Post-event phenomena
Colour
Convulsions
Continence
Cardiac problems
Cardiac death FH
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9
Q

System check cardio

A

Similar episodes in past?

Previous cardiac surgery
HTN
Hypercholesterolaemia
Anaemia
Dibetes
Angina
MI
TIA/Stroke
Peripheral vascular dis (e.g. claudication)
HF
Rheumatic fever
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10
Q

Cardiac DH

A

Antihypertensives
Steroids (Cause HTN and fluid retention)
Sinus Tachy (Salbutamol, Theophyline, Nifedipine, Thyroxine)
OTC and illicit drugs

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11
Q

Social history

A 
Occupation
Smoking
Alcohol (can cause AF, HF, HTN and tachy)
Diet
Coffee
Stress (palpitations)
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12
Q

FH

A

IHD, CVA, MI before age of 65

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13
Q

General inspection Cardio

A

Around the bed: GTN

Appearance: colour, breathing, comfort, position, build)

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14
Q

Cardio hand inspection

A 
Tar staining
Temp
Cap refill 
sweating (inc sympathetic drive)
Pallor of creases
Clubbing
Splinter haemorrhages
Oslers nodes and laneway lesions
Tendon Xanthomas
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15
Q

Arms and neck inspection

A

Check radial pulses simultaneously (rate and rhythm only done for one)
Assess brachial pulse, ask about shoulder pain and check for collapsing pulse

Look for JVP
- position patient at 45 degrees
- compress liver to observe rise of low JVP
- sit upright to look for high JVP
(palpating carotid will also help to identify waves of JVP - synchronise)

Assess carotid pulses individually

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16
Q

Eyes, mouth and face

A

let patient expose conjunctiva (pallor - anaemia)
Corneal arcus, Xanthelasmata (hypercholesterolaemia)

Malar flush (mitral stenosis)

Central cyanosis
high palate (marfan's)
Dental carries (Predispose endocarditis)
17
Q

Cardio inspection & Signs

A

Expose patient chest

  • sternotomy scar
  • pectus excavatum/carinatum
  • kyphoscoliosis
  • Pacemaker
18
Q

Palpation of chest

A 
apex beat (5th intercostal, midclav)
parasternal heaves (parasternal pulsation due to LV hypertrophy)
Trills (murmurs)
19
Q

Auscultation (remember to palpate carotid whilst doing so if murmurs are heard)

A 
Aortic valve (R parasternal, 2nd intercostal space)
Pulmonary valve (L parasternal, 2nd intercostal space)
Tricuspid ( L sternal border fourth intercostal space)
Bicuspid (fifth intercostal, midclav)

Left axilla for mitral incompetence

with bell ascultate apex with patient rolled 45 degrees on left (mitral stenosis)

Sit patient forward, and auscultate with diaphragm at 4/5 intercostal sternal border on held inspiration (aortic regurgitation)

Auscultate lung bases & assess sacral oedema whilst sitting forward

Auscultate carotids with patient sat backk for murmur transmission or bruits

20
Q

Additional examinations

A

Lie patient flat if they can tolerate and check hepatomegaly (tricuspid regurgitation)

If ascites suspected then shifting dullness (percussions from centre to left flank. if dull note heard keep finger there and roll and if percussion becomes resonant percussions back to umbilicus until you get dullness again)

Check ankles for pitting oedema - if present then ALWAy’s check ascites

21
Q

Tests to do but not in OSCE

A

Femoral pulses and check radio femoral delay (coarctation)

BP in both arms lying and standing in one arm

Ophthalmoscopy for HTN retinopathy

12 lead ECG

OSCE (9 decks)

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