Clinical Skills - CV Flashcards
Part of PHA M01 - Clinical Skills OSCE Station
What is the normal range of systolic blood pressure? (1)
90-140mmHg
What is the normal range of diastolic blood pressure? (1)
60-90mmHg
What is the normal range for pulse? (1)
60-100bpm
What is the reference range for temperature? (1)
36-37.5°C
What is the reference range for respiratory rate? (1)
12-20 bpm
What are the normal ranges for oxygen saturation? (2)
94-98%
89-92% (COPD)
How is BP measured? (2)
Measured in mmHg.
Give as 2 figures: Systolic and Diastolic pressure.
What is systolic pressure? (1)
Pressure when your heart pushes blood out.
What is diastolic pressure? (1)
Pressure when your heart rests between beats.
What systolic and diastolic range is considered as hypertensive? (2)
Systolic >140mmHg (either/or) Diastolic > 90mmHg
What systolic and diastolic range is considered as hypotensive? (2)
Systolic <90mmHg (either/or)
Diastolic < 60mmHg
How do you measure a cuff? (2)
Cuff bladder length = 80% of arm’s circumference.
Width of Bladder = 40% of arm’s circumference.
Describe Phase 1’s Korotkoff’s sounds. (2)
Faint clear tapping sounds which gradually increases in intensity.
Systolic pressure heard for 2 consecutive beats. (Intra-arterial pressure)
Describe Phase 2’s Korotkoff’s sounds. (1)
Softening sounds becomes swishing.
Describe Phase 3’s Korotkoff’s sounds. (1)
Return of sharper sounds which becomes crisper but never fully regain intensity of phase 1 sounds.
Describe Phase 4’s Korotkoff’s sounds. (1)
Distinct, abrupt, muffling sounds becomes soft and blowing.
Describe Phase 5’s Korotkoff’s sounds. (1)
All sounds disappear completely.
Explain the process of measuring a patient’s blood pressure. (14)
Ensure px is rested and comfortable. Consider caffeine, exercise and stress factors. Ensure seated if possible with legs uncrossed.
Check equipment + identify which arm is used.
Support px’s arm at about the level of the heart.
Select appropriate cuff size (80-40 rule)
Apply cuff to upper arm (2-3cm above brachial artery pulse)
Palpate brachial/radial artery and measure (30 sec x2 = regular, 60 sec = irregular) - record pulse rate.
Inflate cuff until pulse is impalpable.
Inflate cuff 10-20mmHg further.
Deflate cuff until pulse returns (rough estimate of systolic)
Allow rest for 15-30 seconds before reinflating cuff in step 7.
Place stethoscope over brachial artery (Diaphragm)
Deflate cuff slowly (2-3mmHg/sec) until regular sounds are heard - systolic pressure (Korotkoff’s sound phase 1 - note gauge)
Continue to deflate cuff until sounds disappear completely - diastolic pressure (Korotkoff’s sound phase 5 - note gauge). Record reading.
Deflate cuff completely + thank px.
Outline the relevant parts of a cardiovascular examination. (10)
Task 2 in OSCE!!
General Inspection
Set of Basic observations (inc ECG)
Inspection of the Hands
Palpation of the Pulses
Inspection of the Face
Inspection of the JVP
Inspection of the Chest
Palpation of the Chest
Auscultation of the Heart
Additional Checks
Perform a general inspection. (6)
Environment
General Health of the Patient
Obvious Pain
Colour (Pale - anaemia, flushed - raised BP/infection, cyanosed - hypoxia)
Weight (over/under)
Conditions associated with CVD (Marfans/Down Syndrome)
Perform a hands inspection. (6)
Temp. (infection/perfusion)
Capillary refill (perfusion)
Splinter Haemorrhage (Infective endocarditis)
Clubbing (chronic disease/ IE)
Pale Palmar Creases (Anaemia)
Tar Staining (Smoking)
Perform a pulse inspection. (6)
Radial Pulses
Brachial Pulses
Carotid Pulses (not together)
Dorsalid pedal
Posterior Tibial
(comparing both left to right for rate, rhythm and volume for 30 seconds x 2 = regular, 60 sec = irregular)
Perform the inspection of the face. (6)
Xanthelasma
Corneal Arcus
Jaundice
Pale Conjunctiva
Mouth + Teeth for Infection
Central Cyanosis
Perform the inspection of the JVP. (3)
Px lays at 45° angle.
Head positioned left lateral.
Identify JVP - if raised around +4cm (HF)
Perform the inspection of the chest. (7)
Expose chest.
Inspect anterior (front) and lateral (side) of chest for:
Deformities,
Pacemakers,
Scars (Trauma/prev. surgery)
Bruising/trauma (chest wall injury)
Visible heaves (heart enlargement)
Perform a chest palpation. (10)
Palpate for chest wall tenderness.
Apex beat (5th intercostal space midclavicular):
- Prominent beat (Left ventricular hypertrophy)
- Displaced laterally (pneumothorax)
- Difficulty detection (obesity/hyperinflation)
Heaves:
- Enlarged heart (R. ventricular hypertrophy)
- Felt on the left parasternal region.
Thrills: Palpable murmur
- Palpate across 4 heart valves
- Suggest palpable murmurs.
Perform a heart auscultation. (8)
Listen with the diaphragm + bell.
Diaphragm - higher pitched sounds
Bell - lower pitched sounds
S1 = closure of the tricuspid + mitral valves
S2 = closure of the aortic + pulmonary valves
S3 + S4 = add. sounds
S1 & S2 = normal heart sounds (‘lub-dub’)
S3 & S4 = abnormal heart sounds (shouldn’t be hearing this e.g. splitting, murmurs an add. heart sounds)
Name the 4 heart valves and locate each one. (4)
Aorta - 2nd intercostal space right sternal edge.
Pulmonary - 2nd intercostal space left sternal edge.
Tricuspid - between 4th + 5th intercostal space
Mitral - 5th intercostal space midclavicular line.
Perform additional checks. (10)
Auscultate base of lungs (posterior)
Palpate for sacral oedema (HF)
Inspect both lower legs:
For DVT:
- Leg Swelling
- Palpate calves for tenderness DVT
- Increased temp. of leg
- Inflammation
For HF:
- Oedema in foot and ankle
