OSCE II Flashcards
Identify and locate the apex and base of the heart
- base is the junction between the heart and the great vessels; lies just below sternal angle
- apex is the tip of the LV; normally found in midclavicular line, about 5th
intercostal space
Identify and locate the “aortic area”
right 2nd intercostal space
. Identify and locate the “pulmonic area”
left 2nd intercostal space
Identify and locate the surface projection on the precordium of the right atrium
right heart border, from right 2nd ICS (intercostal space) to about 3rd or 4th
Right ICS
Identify and locate the surface projection on the precordium of the right ventricle
- RV occupies most of the anterior cardiac surface;
- RV is a wedge-like structure
behind and to the left of the sternum - with the inferior border just below the junction of the sternum and xiphoid process,
- the RV narrows superiorly and meets the pulmonary artery at left 3rd ICS near the sternum
Identify and locate the surface projection on the precordium of the left ventricle
LV is the left lateral border of the anterior cardiac surface
Four principal factors that influence arterial blood pressure.
LV stroke volume
Distensibility of Aorta and large arteries
Peripheral Vascular Resistance
Blood volume
Locate and count and describe the patient’s radial pulse
Technique = student should use finger pads (not tips), and describe beats/min, rhythm
Locate and count and describe the patient’s carotid pulse
Technique = student should only check for ONE carotid pulse at a time; should have
fingerpads in lower half to lower third of neck, usually medial to sternocleidomastoid
muscle, about at the level of the cricoid cartilage.
Ask the student to demonstrate how to determine the correct BP cuff size for their
patient, and demonstrate
Answer = width of cuff should be about 40% of the circumference of patient’s arm.
Length of bladder (not entire cuff) should be about 80% of circumference of patient’s
arm
Ask the student what happens to BP if one uses a BP cuff that is too small for a
patient
BP reading is falsely elevated when the BP cuff is too small
First describe the technique then correctly measure the patient’s BP by palpation in
one arm
Technique = appropriate size cuff is placed on SKIN (not over gown) about 2-3 cm above
antecubital fossa. Find radial pulse, then blow up cuff until pulse disappears and blow up
about 20 mm Hg. higher, then slowly release the air in the cuff (about 3 mm Hg per
second). Return of the pulse = estimate of SYSTOLIC BP. (Student must tell you their
reading)
Correctly measure (auscultate) BP in one arm
as above, except include that patient’s arm is relaxed and the brachial
artery is elevated to about heart level by the student while the patient is sitting. Student
should only blow up the cuff about 20 – 30 mm Hg above their BP by palpation. Air
should be released from the cuff slowly (about 3 mmHg per second). Student tells you
patient’s BP.
Ask student to describe what the maximal height of the internal jugular vein
represents.
reflection or indication of right atrial pressure, which reflects hydration or volume status of patient.
Identify the point of maximal height of the internal jugular vein on the patient and
measure the JVP.
Technique = student is on patient’s right side, student should have pt. lay back and
should adjust the exam table between 30 – 45 degrees, and should be able to point out the
height of the right internal jugular neck vein, turn patient’s head slightly to their left. To
measure, student places a ruler on sternal angle and uses a horizontal surface from the
point of maximal height of the right int. jugular vein. Student adds 5 cm to their
measurement to get the patient’s JVP.
