Cardio OSCE

Question 1

What are the systolic murmurs and where do you hear them?

Answer 1

Aortic Stenosis (2nd right ICS)

Mitral regurgitation (4th ICS MCL)

(also pulmonary stenosis [2nd left ICS] and tricuspid regurgitation [4th left ICS])

Question 2

What are the diastolic murmurs and where do you hear them?

Answer 2

Mitral stenosis (4th ICS MCL)

Aortic regurgitation (2nd right ICS)

(also pulmonary regurgitation [2nd left ICS] and tricuspid stenosis [4th left ICS])

Question 3

What do you ask yourself in each area of the heart when auscultating?

Answer 3

• 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)

Question 4

Where are extra heart sounds best heard?

what does each mean and what are they referred to as?

Answer 4

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

Question 5

What do you do in the carotid area?

Answer 5

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

Question 6

What does raised JVP mean?

How many cm should it be from the sternal angle?

Answer 6

Fluid overload, right ventricular failure, tricuspid regurgitation

Should be less than 8 cm

Question 7

What does lateral displacement of Apex beat mean?

Answer 7

Cardiomegaly

Question 8

What are thrills?

What position is your hand for each of the heart valves?

Answer 8

Palpable vibration caused by turbulent blood flow through a heart valve

Vertical for aortic
Horizontal for pulmonary
Vertical for tricuspid
Horizontal for mitral

Question 9

Where do mitral murmurs typically radiate to?

What about aortic murmurs?

Answer 9

Left axilla

aortic= left carotid artery

Question 10

How to auscultate for mitral stenosis?

Answer 10

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

Question 11

How to auscultate for aortic murmurs?

What is the name of this area of the heart

Answer 11

Get patient to sit up and lean forward and get them to breath in, out and hold

Erbs point

Question 12

If you did find abnormalities, what follow up would you do?

Answer 12

ECG and echocardiogram

Question 13

What are you looking for at the start- general inspection

Answer 13

____ 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

Question 14

What is the part of the chest that lies in front of the heart?

Answer 14

Praecordium

Question 15

What are you looking for in the hands?

Answer 15

• 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

Question 16

What vital signs do you do in Cardio exam?

Answer 16

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

Question 17

What do you look for in the face?

Answer 17

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

Question 18

Auscultation

Where and what order

Answer 18

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)

Question 19

What do you say when listening to lung bases?

Answer 19

No crackles, crepitations or wheezes

Question 20

How to start the exam

Answer 20

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.

Question 21

How to end exam

Answer 21

Hand sanitizer

Okay ___ that concludes the exam, do you have any questions?

Okay thanks for your time, have a good rest of your day.