[OSCE] Cardiac

Question 1

What is the order of a cardiovascular exam?

Answer 1

IPPA

Inspect

Palpate

Percuss

Auscultate

Question 2

What is pulsus alternans and when would it be found?

Answer 2

Alternating strong and weak pulses palpable at radial or femoral As.

Found during palpation stage of CV exam

Question 3

What is a paradoxical pulse? What can it be indicative of?

Answer 3

Varied pulse strength and amplitude as pt breathes

Can indicate pericarditis or tamponade

Question 4

In the L lateral decubitus position, a diffuse point of maximal impulse (PMI) with a diameter >3cm signals ____

Answer 4

L ventricular enlargement

Question 5

In the L lateral decubitus position, a diffuse point of maximal impulse (PMI) with a diameter >4cm is 5x more likely to indicate ____

Answer 5

L ventricular overload

L lateral decubitus position (pt on L side with L arm above head) increases chance of hearing mitral stenosis/other murmurs

Question 6

What kind of cardiac impulse can be indicative of hyperthydroidism, severe anemia, pressure/volume overload?

Answer 6

Hyperkinetic, high amplitude

Question 7

In the murmur grading scale, which murmurs have thrill?

Answer 7

+4/6, +5/6, +6/6

Question 8

Sitting and leaning forward increases the chance of hearing what murmur?

Answer 8

Aortic regurgitation

Question 9

Straining/Valsalva increases chance of hearing what murmur?

Answer 9

Mitral regurgitation

Question 10

How does the valsalva maneuver affect murmur characterization for MVP and HCM?

Answer 10

MVP - increased murmur duration

HCM - Increased murmur intensity

Question 11

What indicates a positive abdominojugular/hepatojugular reflex?

Answer 11

Sustained increasse in JVP by >4cm w/in 3-5 seconds after pressure is removed

Question 12

How to test the abdominojugular/hepatojugular reflex?

Answer 12

Ask pt to relax and breathe normally

Apply firm pressure 20-35 mmHg with palm to mid-abdomen for 15-30 sec

Observe JVP waveform before, during, and after abd compression

Question 13

How do you use the sitting/squatting test to differentiate between aortic stenosis and MVP/HCM?

Answer 13

During squatting, MVP/HCM will have a delay in click and cecrease in murmur intensity

Aortic stenosis will not change

Question 14

How would you measure JVP on a hypovolemic/septic pt? Hypervolemic pt?

Answer 14

Hypovolemic - may have to lie flat before neck veins are visible

Hypervolemic - May have to elevate 60-90 degrees

Question 15

How would JVP appear in pts with obstructive lung disease?

Answer 15

JVP may appear elevated but veins collapse on inspiration

Does NOT indicate heart failure

Question 16

Elevated JVP is 95% ____ for increased L ventricular EDP and low LV EF

Answer 16

Specific