CVS OSCE

Question 1

Hand Signs

Answer 1

Peripheral Cyanosis = HF, congenital heart disease

SplinterHaem. = Infective Endocard.

TAR STAINING

XANTHOMATA

OSLER NODES - tips, PAIN

JANEWAY LESIONS - central, non-tender

FINGER CLUBBING

ARACHNODACTYLY = Marfan’s = M/Ao valve prolapse / Ao dissection

CAP time; temperature

=> pulse | radial-radial | collapsing (?pain)

Question 2

End of Bed Examination

Answer 2

Pallor
Tachypnoea
Oedema
Cyanosis
-obvious malar flush

NEWS + surrounding items

Question 3

Examination of Pulses

Answer 3

1. RATE
2. RHYTHM
3. VOLUME
4. CHARACTER

Radial Wrist
radial-radial
collapsing

Brachial Pulse

=> TRACK MARKS

CAROTID ARTERIES for bruits

JVP + hepatojugular reflux check

Question 4

Assessment of Face

Answer 4

Malar Flush

Xanthalasma
Conjunctivae
CORNEAL ARCUS

Mouth: central cyanosis,

Question 5

Chest: INSPECTION

Answer 5

Surgical scars (check infraclavic and axilla too), lesions, wall deformities, visible pulsations

JVP: 45º, turn had to left, medial to SCM, double waveform
- check height from sternal angle

Question 6

CHEST: PALPATION

Answer 6

Apex Beat @ 5th intercostal space

HEAVE (hand): left of sternum = R ventricular hypertroph.

THRILLS (fingers horizontal):vpalpable murmurs 
5IC apex (mitral); 
4IC lower left steernal edge (tricuspid)
2IC space L sternum (aortic); 
2ICR sternum (pulm.);

Question 7

CHEST: AUSCULTATION

Answer 7

1. Palpate carotid for 1st sound
2. Meanwhile, Using diaphragm auscultate upwards

• Mitral valve: 5th intercostal space in the midclavicular line.
• Tricuspid valve: 4th intercostal space at the lower left sternal edge.
• Pulmonary valve: 2nd intercostal space at the left sternal edge.
• Aortic valve: 2nd intercostal space at the right sternal edge.

3. Rpt w/ bell
4. Carotid art. (diaphragm) = holding breath = listeningfor radiationof ejection systolic murmur d/t AoStenosis.
5. SIT FORWARD, AORTIC AREA, INSP AND EXP AND HOLD = early diastolic murmurd/t AoRegurg.
6. ROLL ONTO LEFT SIDE, MITRAL AREA, , INSP AND EXP AND HOLD = pansystolic murmur d/t Mitr.R.

=> auscultate into axilla to identify radiation

7. Bell over Mitral area, INSP AND EXP AND HOLD = mid diastolic murmur d/t Mitr.Sten.
8. BACK OF CHEST FOR CHEST OEDEMA
   * coarse craackles = pulm oedema d/t L.V.Failure
   * pleural effusion = absent air entry

Question 8

Extrathoracic Signs (Post exam)

Answer 8

LEGS = PITTING OEDEMA
* ankle= = pitting pedal oedema (RVFailure)

SACRAL OEDEMA

Question 9

Murmurs

Answer 9

DIAPHGRAGM
AO STENOSIS, ejection systolic
@ carotid arteries radiating

MITRAL REGURG, pansystolic murmur
@ axilla radiating

AO REGURG., early diastolic murmur
@ ao area during expiration

BELL
MITRAL STENOSIS, mid diastolic
@ mitral area expiration