Heart OSCE

Question 1

MR how does it sound?

Answer 1

Blowing/holosystolic radiating to left axilla

Question 2

TR how does it sound?

Answer 2

blowing quality/holosystolic

Question 3

MS how does it sound?

Answer 3

rumbling, low pitched

Question 4

What is associated w/ PS?

Answer 4

Increases w/ inspiration

Question 5

What does expiration do to heart sounds?

Answer 5

Left side gets louder, right side gets quieter

Question 6

Explain how squatting causes MVP and HCM to DECREASE in intensity?

Answer 6

Squatting increases venous return, PVR, SV and BP while standing has the opposite effect

Question 7

When does TS increase in intensity?

Answer 7

Inspiration

Question 8

PS how does it sound?

Answer 8

harsh, loud, ejection click radiating into left shoulder

Question 9

AR what does it sound like?

Answer 9

blowing, decrescendo murmur

Question 10

Aortic Stenosis where?

Answer 10

2nd/3rd R ICS

Question 11

Where is PS?

Answer 11

2nd/3rd L ICS

Question 12

How do you position volume overloaded patients to test for JVP?

Answer 12

Elevate head to 60-90*

Question 13

What does inspiration do to heart sounds?

Answer 13

Right side gets louder, left side gets quieter

Question 14

Where is AR?

Answer 14

2nd-4th ICS on LEFT

Question 15

What is associated w/ TR?

Answer 15

Increases w/ inspiration

Question 16

What conditions, other than HF, is JVP increased in?

Answer 16

• TS
• Chronic PAH
• SVC obstruction
• Tamponade
• Constrictive pericarditis

Question 17

What murmur is better heard by leaning forward?

Answer 17

AR

Question 18

When does TS decrease in intensity?

Answer 18

Expiration & valsalva

Question 19

What side of stethoscope to use for MS?

Answer 19

BELL

Question 20

What is associated w/ AS?

Answer 20

delayed pulses (pulsus tardus et parvus)

Question 21

What side of stethoscope to use for AR?

Answer 21

Diaphragm

Question 22

What murmur increases INTENSITY w/ valsalva?

Answer 22

HCM

Question 23

Where is MR?

Answer 23

Prominent @ apex

Question 24

TR (insufficiency) where?

Answer 24

Lower left sternal border

Question 25

MS where?

Answer 25

APEX

Question 26

What murmur is better heard by straining/valsalva?

Answer 26

MR

Question 27

PR how does it sound?

Answer 27

blowing quality

Question 28

What murmur is better heard w/ left lateral decubitus position?

Answer 28

MS (and extra heart sounds)

Question 29

What is associated w/ MR?

Answer 29

Loudness correlates w/ degree of valve insufficiency

Question 30

What murmur increases DURATION w/ valsalva?

Answer 30

MVP

Question 31

What is JVP like in COPD?

Answer 31

elevated w/ expiration but collapses on inspiration

Question 32

How do you position septic/hypovolemic patients to test for JVP?

Answer 32

Lie them flat

Question 33

AS how does it sound?

Answer 33

harsh quality (crescendo/decrescendo) radiating into suprasternal notch and carotids

Question 34

How does VSD sound?

Answer 34

Holosystolic murmur @ LLSB

Question 35

What causes fixed splitting?

Answer 35

ASD

Question 36

What causes reverse (paradoxical) splitting?

Answer 36

LBBB AS CoA PDA

Question 37

What causes widened physiological split?

Answer 37

RBBB PS VSD MR

Question 38

What causes A2 w/ increased intensity?

Answer 38

Systemic HTN | Aortic root dilation

Question 39

What causes P2 w/ increased intensity?

Answer 39

PAH Dilated pulmonary a. ASD

Question 40

What causes A2 to be diminished or absent?

Answer 40

Calcific AS

Question 41

What causes P2 to be diminished or absent?

Answer 41

Increased AP diameter (aging) | PS

Question 42

Where is PDA murmur best heard?

Answer 42

LUSB that is continuous throughout systole/diastole (machine-like) and crescendo/decrescendo

Question 43

What murmur can be seen in newborns w/ low Apgar score?

Answer 43

TR

Question 44

Where is CoA murmur heard?

Answer 44

Posterior chest (b/w scapulae)

Question 45

Where is Still's murmur heard?

Answer 45

Systolic murmur w/ maximum intensity @ LLSB (musical) Tends to be louder in hyperdynamic (anxiety/fever) states

Question 46

What does ASD sound like?

Answer 46

Rare to have sx, but systolic murmur @ LUSB (fixed/widely split S2)

Question 47

What is single most common heart lesion?

Answer 47

Bicuspid aortic valve