OSCE Flashcards
What is pre-test probability?
Pretest probability is the probability of disease (i.e., prevalence) before application of the results of a physical finding.
What is usually the likelihood ratio to rule in, and rule out?
LR greater or equal to 3 –> rule in
LR less or equal to 0.3 –> rule out
LR between 0.3 and 3 do not tend to change probability much
What is likelihood ratio?
The likelihood ratio (LR) of a physical sign is the proportion of patients with disease who have a particular finding divided by the proportion of
patients without disease who also have the same finding.
What is the normal respiratory rate range?
12 - 20 breaths per minute (20 - 24 high normal)
What can tachypnea predict?
tachypnea predicts subsequent
cardiopulmonary arrest in hospitalized patients
What is Cheyne-Stokes breathing?
Cheyne-Stokes breathing consists of alternating periods of apnea and hyperpnea
Whats the difference between tachypnea and hyperapnea?
Tachypnea refers to rapid breathing, especially rapid and shallow breathing. Hyperpnea is abnormally deep breathing, with or without an increase in respiratory rate.
Cheyne-Stokes is usually associated with which heart condition and what other conditions?
stable congestive heart failure
Others: hemmorage, infarction, tumors, meningitis and head trauma
Whats the prognostic value of C-S breathing?
lower cardiac output, higher pulmonary capillaries wedge pressures, and shorter survival time
What is orthopenia?
Orthopnea describes dyspnea that appears when the patient lies down but is relieved when the patient sits up (
What is the clinical association with orthopenia?
congestive heart failure
Why inspect neck veins?
- To detect elevated central venous pressure
- To detect specific abnormalities of venous waveforms, which are characteristic of certain arrhythmias and some valvular, pericardial, and myocardial disorders
What are some disorders that may increase CVP, and diastolic pressures of the right side of the heart?
left heart disease, lung disease, primary pulmonary hypertension, and pulmonic stenosis
How can be the sternal angle be used as a reference for elevated CVP?
If the top level of the neck veins was more than 3 cm above the sternal angle, CVP is elevated
Which side of the neck should be assessed for CVP?
To measure the patient’s venous pressure, the clinician should examine the veins on the right side of the patient’s neck because these veins have a
direct route to the heart.
What are the waves seen on a venous pressure tracing?
There are three positive waves (A, C, and V) and three negative waves (x, x′, and y descents):
- A wave represents right atrial contraction
- x descent: right atrial relaxation.
- C wave represents right ventricular contraction
and closure of the tricuspid valve, which then bulges upward toward the neck veins - x′ descent occurs because the floor of the right atrium moves downward, pulling away from the jugular veins, as the right ventricle contracts
- V wave represents right atrial filling
- y descent begins the moment the tricuspid valve opens at the beginning of diastole, causing the atrium to empty into the ventricle and venous pressure to abruptly fall
What is the positive test for abdominojugular test?
If the CVP rises more than 4 cm water and remains elevated for the entire 10 seconds, the abdominojugular
test is positive
What is Kussmaul sign?
The Kussmaul sign is the paradoxic elevation of CVP during inspiration (should fall in normal)
What is clinically associated with Kussmaul breathing?
constrictive pericarditis
An elevated JVP is helpful in diagnosing what?
elevated left ventricular diastolic pressures and low ejection fraction
True or False: a normal JVP is helpful in ruling out low ejection fraction and elevated left ventricular diastolic pressures
False: it is not but abdominojugular test is
True or False: low JVP also suggest a low CVP
True
When palpating the heart what should be described?
the location, size, timing, and type of precordial movements
In the context of heart palpatation, what is the relevance of the supine position?
Supine position is used to locate all precordial movements and to identify whether these movements are abnormally hyperkinetic, sustained, or retracting.
In the context of heart palpatation, what is the significance of the left lateral decubitus position?
Used to measure the diameter of the apical pulse (but not to characterise)
What are the 4 locations to look for abnormal heart movements?
- Apex beat/impulse: cardiac impulse farthest
away from the sternum and farthest down on the chest wall (located near the midclavicular line in the fifth
intercostal space) - Left Lower Sternal Area (Fourth Intercostal Space
Near Left Edge of Sternum) –> for right ventricle and left atria mvmts - Left Base (Second Intercostal Space Near Left Sternum) –> for pulmonary artery
- Right Base (Second Intercostal Space Near Right Edge of Sternum) and Sternoclavicular Joint –> for ascending aortic aneurysm
What is sustained systolic mvmt/apex beat?
The sustained movement is an abnormal outward movement that begins at S1 but, unlike normal and hyperkinetic movements, extends to S2 or even
past it before beginning to descend to its original position.
What is the clinical associations of sustained systolic mvmt?
Sustained apical movements are always abnormal, indicating either pressure overload of the
left ventricle (e.g., aortic stenosis), volume overload (e.g., aortic regurgitation, ventricular septal defect), a combination of pressure and volume overload
(combined aortic stenosis and regurgitation), severe cardiomyopathy, or ventricular aneurysm.
What is a traditional sign of an enlarged heart?
an abnormally displaced apical impulse, ejection fraction reduced, LV end-diastolic volume and PCWP is increased
What is the significance if the apical impulse is greater than 4 cm?
Dilated heart
