The Cardiovascular Osce

Question 1

What can the cardiovascular osce be divided into?

Answer 1

3 sections: pre-chest, chest and post-chest

Question 2

List each step required in the pre-chest part of the cardiovascular OSCE

Answer 2

positioning and exposure
overall examination
peripheral examination
arterial pulses
blood pressure
JVP

Question 3

List each step required in the chest part of the cardiovascular OSCE

Answer 3

Inspection
Precordial Palpation
Ausultation

Question 4

List each step required in the post-chest part of the cardiovascular OSCE

Answer 4

Auscultate carotid arteries
Auscultate back
Inspect for pitting oedema

Question 5

What is involved in 2) positioning and exposure?

Answer 5

Lie the patient at 45 degrees;

Ask patient to expose chest while maintaining dignity

Question 6

What is involved in 3) an overall inspection?

Answer 6

Inspect patient overall,

Comment on build, posture, demeanour, any abnormality

Question 7

What is involved in 4) Peripheral Examination

Answer 7

Examine Hands (nails/palms);
Examine Eyes (conjunctivae/ cornea)
Examine Mouth ( lips, tongue, teeth, mucous membrane) AND inspect palate for signs of Marfans

Question 8

What is involved in 5) Arterial Pulses

Answer 8

Accurately assess radial rate, rhythm and symmetry.
Assess a larger pulse for character and volume.
Locate major pulses in both arms and legs
AND comment on varicose veins or previous surgery

Question 9

What is involved in 6) Blood pressure

Answer 9

Undertake manual or electronic blood pressure measurement

Question 10

What is involved in 7) chest inspection

Answer 10

Inspect chest,

Comment on symmetry and shape, scars, skin lesions, visible pulsations etc.

Question 11

What is involved in 8) chest inspection

Answer 11

Inspect chest,

Comment on symmetry and shape, scars, skin lesions, visible pulsations etc.

Question 12

What is involved in 7) JVP (Jugular Venous Pulse)

Answer 12

Identify JVP,

assess internal jugular venous pulse pressure

Question 13

What is involved in 9) Precordial Palpation

Answer 13

Palpate precordium for the apex beat (and accurately locate the apex beat);
Palpate the right ventricular impulse for thrills
Palpate for heaves

Question 14

What is involved in 10) Auscultation

Answer 14

Auscultate for heart sound in four valvular areas;
(includes) Auscultation of apex in left lateral position on expiration with bell;
Left sternal edge sitting forward on expiration, with diaphragm.
AND palpate the neck pulse whilst auscultating in order to identify the timing of any abnormality

Question 15

What is involved in 11) Auscultation of carotid arteries

Answer 15

Auscultate for bruits over carotid arteries during breath hold

Question 16

What is involved in 12) Auscultate Back

Answer 16

Auscultate for basal crepitations and/ or pleural effusions

Question 17

What is involved in 13) Inspect for pitting oedema

Answer 17

Apply pressure over the anterior tibial border for 10 seconds.