OSCE

Question 1

Signs of hypercholesterolaemia? (3)

Answer 1

Tendon xanthomata
Corneal arcus
Xanthelasma

Question 2

Painful red nodules on finger pulps associated with IE

Answer 2

Oslers nodes

Question 3

Small, painless erythematous nodules associayed with IE

Answer 3

Janeway lesions

Question 4

Signs of IE? (5)

Answer 4

Oslers nodes
Janeway lesions
Finger clubbing
Splinter haemorrhages
Heart murmur

Question 5

DDx central cyanosis? (2)

Answer 5

Hypoxic lung disease

Right to left cardiac shunt

Question 6

DDx peripheral cyanosis? (4)

Answer 6

Peripheral vascular disease
Raynaud’s
Heart failure
Shock

Question 7

DDx irregularly irregular pulse?

Answer 7

AF
Ventricular ectopics
Complete heartblock with variable escape rhythm

Question 8

Causes of AF? (6)

Answer 8

Ischaemic heart disease
Rheumatic heart disease
Thyrotoxicosis
Pneumonia
PE
Alcohol

Question 9

Lack of peripheral pulse during inspiration?

Answer 9

Pulsus paradoxus

Question 10

Signs of cardiac tamponade? (3)

Answer 10

Pulsus paradoxus
Kussmaul's sign
Raised JVP (with low BP)

Question 11

What is Kussmaul’s sign?

Answer 11

Rise in JVP during inspiration (opposite of normal)

Question 12

What causes a 4th heart sound?

Answer 12

Poorly compliant ventricles due to pressure overload (e.g. AS, HTN, HOCM)

Question 13

Causes of a heaving apex? (4)

Answer 13

Aortic stenosis
Hypertension
HOCM
Coarctation of the aorta

Question 14

CXR features of Left heart failure? (ABC + E)

Answer 14

Alveolar oedema
kerley B lines
Cardiomegaly
Pleural effusion

Question 15

Main systolic murmurs? (2)

Answer 15

Aortic stenosis

Mitral regurgitation

Question 16

Main diastolic murmurs? (2)

Answer 16

Aortic regurgitation

Mitral stenosis

Question 17

Rumbling mid-diastolic murmur best heart at the apex

Answer 17

Mitral stenosis

Question 18

ECG features of mitral stenosis? (2)

Answer 18

A Fib common

Bifid P waves

Question 19

Other examination features in Mitral stenosis? (3)

Answer 19

Malar flush
Opening snap
Tapping apex

Question 20

Pansystolic blowing murmur best heart at the apex, radiating to the axilla

Answer 20

Mitral regurgitation

Question 21

Classic triad of symptoms in aortic stenosis?

Answer 21

SOB + Syncope + angina

Question 22

Ejection systolic murmur best heard at the 2nd right intercostal space, radiating to the carotids

Answer 22

Aortic stenosis

Question 23

Early diastolic murmur best heard at the lower left sternal edge with the patient sitting up + breath held in expiration

Answer 23

Aortic regurgitation