OSCE-related things

Question 1

What 3 cardiac things might clubbing point to (eg in a cardio osce)?

Answer 1

infective endocarditis
cyanotic congenital heart disease (ToF, transposition of the great vessels)
Atrial myxoma

Question 2

Which of these is not a cause of a bounding pulse?
thyrotoxicosis
Anaemia
Atrial regurg
pulmonary hypertension
Pregnancy

Answer 2

pulmonary hypertension

Question 3

what would you find in both takayasu’s arteritis and coarctation of the aorta?

Answer 3

absent radial pulse

Question 4

Apex beat in COPD?

Answer 4

Difficult/not possible to feel

Question 5

What does a loud P2 along with pulsatile hepatomegaly suggest?

Answer 5

pulmonary HTN

Question 6

Cardiac investigations - 5 to suggest in an osce

Answer 6

ECG, bloods (FBC, BNP, fasting lipids/glucose), CWR, echo, cardiac catheterisation (to evaluate coronary arteries)

Question 7

Presentation - cardio exam

Answer 7

On peripheral inspection…
The pulse…
On examination of the precordium…
Significant negatives
Absence of CCF
Disease severity
Evidence of cause
Differential Dx
Hx

Question 8

4 drugs to optimise CV risk

Answer 8

statins, anti-HTN, DM, anti-plat

Question 9

Murmur of AS

Answer 9

ESM
 Right 2nd ICS
 Sitting forward in end-expiration
 Radiates to carotids

Question 10

Differentials of aortic stenosis

Answer 10

 Aortic sclerosis: no radiation, normal pulse character
 Mitral regurg
 HOCM: valsalva ↑s murmur, squatting ↓s murmur
 Right-sided: PS

Question 11

Which of these is not a cause of AS?
Age-related senile calcification
Bicuspid aortic valve
Aortic dissection
Rheumatic heart disease

Answer 11

Aortic dissection

These are:
Age-related senile calcification
Bicuspid aortic valve
Rheumatic heart disease

Question 12

3 Echo Features of Severe AS

Answer 12

 Valve area 40mmHg

 Jet velocity >4m/s

Question 13

Investigations in AS?

Answer 13

Echo and Doppler US - to assess severity, cause, LV function, other valves

Question 14

What should a warfarin medic alert bracelet make you think of?

Answer 14

valve replacement, mitral regurg. or stenosis

Question 15

Mx of AS?

Answer 15

Surgical valve replacement (+/-CABG)
TAVI: Transcatheter Aortic Valve Implantation
Balloon valvuloplasty

Question 16

Mx of mitral regurg?

Answer 16

General stuff (MDT, CV risk etc)
AF: rate control, warfarin
↓ Afterload: ACEi/b-blocker (esp carvedilol), diuretics
Valve replacement/ repair

Question 17

Causes of MR (4)?

Answer 17

LV dilatation
Annular calcification
Rheumatic heart disease
MV prolapse

Question 18

Signs in MR?

Answer 18

AF, displaced apex beat, soft S1 followed by a blowing pan systolic murmur, hear best in left lat. position in end expiration

Question 19

What is Rosenbach’s sign?

Answer 19

Systolic liver pulsations

Question 20

What is Corrigan’s sign?

Answer 20

Marked carotid pulsation (in aortic regurg)

Question 21

Indications for aortic valve replacement if stenosed?

Answer 21

NYHA >2
LV dysfunction
(Pulse pressure >100mmHg, T wave inversion, LV enlargement on CXR)

Question 22

ECG findings in mitral stenosis?

Answer 22

AF, P mitrale

Question 23

What type of murmur in mitral stenosis?

Answer 23

rumbling, mid diastolic, loud S1

Early diastolic opening snap