Cardio OSCE Flashcards
What are the systolic murmurs and where do you hear them?
Aortic Stenosis (2nd right ICS)
Mitral regurgitation (4th ICS MCL)
(also pulmonary stenosis [2nd left ICS] and tricuspid regurgitation [4th left ICS])
What are the diastolic murmurs and where do you hear them?
Mitral stenosis (4th ICS MCL)
Aortic regurgitation (2nd right ICS)
(also pulmonary regurgitation [2nd left ICS] and tricuspid stenosis [4th left ICS])
What do you ask yourself in each area of the heart when auscultating?
- Do I hear S1? (louder in tricuspid and mitral areas)
- Do I hear S2? (louder in aortic and pulmonary areas)
(can feel pulse to know when systole is)
- Interval btwn S1 and S2 (systole) is shorter than S2 and S1 (diastole)
Where are extra heart sounds best heard?
what does each mean and what are they referred to as?
With the bell with patient on left side listening to the left ventricle/ apex of heart
S3 is when blood from atria flows into ventricle and hits left over blood that stayed in there
S4 is when blood from atria is squeezed into non-compliant LV
S3 or S4 can be referred to as gallops
What do you do in the carotid area?
Palpate the carotid pulse
- Carotid pulse feels regular and strong
Auscultate for carotid bruits with BELL
- Tell them to take breath in, out and hold
- Bruits heard during systole
- No sign of carotid bruits
What does raised JVP mean?
How many cm should it be from the sternal angle?
Fluid overload, right ventricular failure, tricuspid regurgitation
Should be less than 8 cm
What does lateral displacement of Apex beat mean?
Cardiomegaly
What are thrills?
What position is your hand for each of the heart valves?
Palpable vibration caused by turbulent blood flow through a heart valve
Vertical for aortic
Horizontal for pulmonary
Vertical for tricuspid
Horizontal for mitral
Where do mitral murmurs typically radiate to?
What about aortic murmurs?
Left axilla
aortic= left carotid artery
How to auscultate for mitral stenosis?
Stay on the patient’s right and put the bell on their mitral valve and get them to roll onto their left side- then get them to breathe in, out and hold and listen to S2
How to auscultate for aortic murmurs?
What is the name of this area of the heart
Get patient to sit up and lean forward and get them to breath in, out and hold
Erbs point
If you did find abnormalities, what follow up would you do?
ECG and echocardiogram
What are you looking for at the start- general inspection
____ appears healthy and well or ____ appears calm and comfortable
No signs of breathlessness or respiratory distress
No signs of pallor or peripheral cyanosis
Observing body habitus, no signs of cachexia
(look at front, under arms and back of patient) No obvious scars or bruising
What is the part of the chest that lies in front of the heart?
Praecordium
What are you looking for in the hands?
- Hands feel nice and warm and well perfused
- No signs of peripheral cyanosis
- No signs of splinter haemorrhages
- Capillary refill normal (<2 secs)
- No signs of xanthomata
- No signs of clubbing
- No palmar crease pallor or palmar erythmia
- No signs of Janeway lesions or oslers nodes
- Can’t see any tar staining
What vital signs do you do in Cardio exam?
Radial pulse (60-100) - radial pulse is regular and strong
Resp rate (12-20)
No Radio-radial delay
BP (ask if they have a preferred arm)
Palpate carotid pulse
- carotid pulse regular and strong
Auscultate carotid pulse with bell
- breathe in, out and hold
- no carotid bruits
JVP
- JVP not distended
What do you look for in the face?
Mouth
- Look in mouth with torch and get them to stick their tongue out and then up
- No central cyanosis, no signs of marfan syndrome
- Get them to show their teeth and then use torch to look around at back teeth and gums
- dental hygiene good
- No signs of angular stomatitis
Eyes
- Conjunctival pallor
- Xanthelasma
- Corneal arcus
Auscultation
Where and what order
Start at carotid arteries and note absence of carotid bruits
feel carotid pulse while auscultating over the 4 areas (with diaphragm) telling them to breathe in, out, and hold for each area, then do the whole thing again with bell
Aortic accentuation- listen during expiration (for aortic regurgitation)
Put steth over mitral area and listen during expiration (for mitral regurgitation/ stenosis)
What do you say when listening to lung bases?
No crackles, crepitations or wheezes
How to start the exam
Hi, my name’s Grace, I’m a first year medical student, how are you going? (hand sanitizer)
Before we start, do you mind if I just clarify your full name and DOB
So today, I’m going to be doing a cardiovascular exam. That just involves me having a look listen and feel of your hands, your chest, your face and your back to get an idea of how your heart is working, is that okay?
Perfect! If you could remove your shirt, I’ll clean my stethoscope and we can get started.
Tell patient to lye back on bed and make sure it is 45 degrees
Okay ___ throughout the exam, I’ll be telling the examiner what I’m looking at so if you have any questions at any stage, feel free to stop me and ask.
How to end exam
Hand sanitizer
Okay ___ that concludes the exam, do you have any questions?
Okay thanks for your time, have a good rest of your day.
