OSCE 10 - Cardiovascular exam

Question 1

diaphragm of steth used for

Answer 1

high pitched sounds (i.e. – S1, S2, AR, MR, Friction Rubs)

Question 2

bell of steth used for

Answer 2

low pitched sounds (i.e. – S3, S4, MS, carotid bruit)

Question 3

proper steps to CV exam

Answer 3

Inspection, Palpation Percussion, Auscultation

[i PaPer Ausca]

Question 4

inspeciton - general appearance (several)

Answer 4

Consciousness, cyanosis, flushing, respiratory patterns,

anxiety/distress, body habitus, diaphoresis, neck veins (JVD)

Question 5

barrel chest indicative of

Answer 5

COPD

Question 6

pigeon chest

Answer 6

pectus carinatum

Question 7

funnel chest

Answer 7

pectus excavatum

Question 8

PMI - what does it estimate? positions for assessment? where is it palpated usually

Answer 8

Used to estimate location of apex/left
border. Can assess either supine or left lateral decubitus position. Usually
palpated near the 4th-5th intercostal space in the Mid-clavicular line. May need
to have patient lift her breast. PMI may not be readily felt in healthy
heart/patient.

Question 9

percussion - used for ? method?

Answer 9

Estimate cardiac size when PMI not detectable

Start far left where “resonant” and move medially to find cardiac “dullness”

Question 10

listening posts - valves and location

Answer 10

Aortic Valve – R 2nd ICS at SB
 Pulmonic Valve – L 2nd ICS at SB
Tricuspid Valve – L 4th ICS at SB
Mitral Valve – L 5th ICS at
MidClavicular
line

Question 11

S1

Answer 11

Closure of the Tricuspid and Mitral Valves

Question 12

S2

Answer 12

closure of aortic and pulmonic valves - may split with inspiration (nml)

Question 13

S3

Answer 13

Dull, low pitch, best heard with bell. Due to high pressures and abrupt
deceleration of inflow across the mitral valve at the end of the rapid filling
phase.
Physiologic in children/young adults, pathologic >40 y/o – Kent-Tuck-Y

Question 14

S4

Answer 14

Dull, low pitch, best heard with bell. Atrial gallop from forceful contraction of
atria against a stiffened (low compliant) ventricle. Can be normal in trained
athletes. – Ten-Nes-See

Question 15

systolic murmurs fall between

Answer 15

S1 & S2

Question 16

Diasotlic murmurs fall between

Answer 16

S2 & S1

Question 17

murmur grades

Answer 17

Grade 1 – Very faint
Grade 2 – Quiet, but heard easily with stethoscope
Grade 3 – Moderately loud
Grade 4 – Loud with palpable thrill
Grade 5 – Very loud w thrill – may be heard with stethoscope partly off chest
Grade 6 – Heard with stethoscope entirely off the chest

Question 18

assessment of caortid pulse - what do you NOT want to do?

Answer 18

Medial to the SCM. Assess for thrills and bruits.
***Do not assess both carotid pulses simultaneously! Pressure on the carotid
baroreceptors may cause a hypotensive reflex and possible fainting.

Question 19

peripheral pulses (6)

Answer 19

Radial
 Brachial
 Femoral
 Popliteal
 Dorsalis Pedis
 Posterior Tibial

Question 20

pulses grades and what they indicate

Answer 20

Graded on scale of 4
4+ Bounding
3+ Strong, full, increased
2+ Average intensity, expected, normal
1+ Diminished, barely palpable
0 Absent, not palpable

Question 21

capillary refill - what does it test? normal? if positive, what can it indicate?

Answer 21

Test of digital perfusion (e.g. arterial occlusion, hypovolemic shock, hypothermia)
Apply pressure to the fingernail/toenail for several seconds, causing it to blanch.
Then release. Note the time it takes for the color to return. Normal capillary refill
time is 2 seconds or less.

Question 22

grading for edema

Answer 22

Documentation: +0/4  +4/4 pitting edema
 Graded on Four point scale
 0 Absent
 1+ Barely detectable, slight pitting (2mm); disappears rapidly
 2+ Slight indentation (4mm); 10-15 seconds
 3+ Deeper indentation (6mm); may be >1 minute
 4+ Very marked indentation (8mm); 2-5 minute

Question 23

examination for edema - locations and time

Answer 23

Examined by pressing firmly for 5 seconds over the

1. Dorsum of the foot
2. Anterior tibia or
3. Behind medial malleolus