Things to know for the OSCE Cardiovascular

Question 1

What are the cardiovascular causes of Clubbing

Answer 1

• Congenital cyanotic heart disease

- infective endocarditis

Question 2

What are Osler’s node

Answer 2

• red, tender nodules on fingers pulps or thenar eminence (immune complex deposition)
• seen in infective endocarditis as rare and late sing

Question 3

What are Janeway lesions

Answer 3

• non tender macular papular lesions seen on palms or finger pulps (embolic phenomenon) - infective endocarditis - rare

Question 4

What can cause radio-radial delay

Answer 4

• aortic correction
• aortic dissection
• subclavian artery stenosis

Question 5

What can cause a collapsing pulse

Answer 5

• Aortic regurgitation
• PDA
• pregnancy
• fever
• thyrotoxicosis

Question 6

What can cause pulses paradoxus

Answer 6

• cardiac tamponade (late)

- severe acute/COPD

Question 7

What is pulses paradoxus

Answer 7

• pulse wave volume decreases significantly during inspiration

Question 8

What are the signs of hypercholestrolaemia in eyes

Answer 8

• Corneal arcus - significant only if <50 years old

- xanthelasma

Question 9

What is mitral faces suggestive of

Answer 9

mitral stenosis

Question 10

what can cause central cyanosis

Answer 10

• hypoxaemia - e.g. right to left cardiac shunt

Question 11

What is Kussmaul’s sign

Answer 11

• JVP will rise with inspiration in pericardial constriction, right ventricular infarction or cardiac tamponade

Question 12

What can cause a raised JVP

Answer 12

• right sided heart failure - e.g. due to left sided heart failure or pulmonary hypertension
• tricuspid regurgitation
• constrictive pericarditis

Question 13

What is a thrill

Answer 13

a palpable vibration caused by turbulent blood flow through the heart valve (palpable murmur)

Question 14

What is a heave

Answer 14

• right ventricular hypertrophy

Question 15

What can cause displacement of the apex beat

Answer 15

• cardiomegaly (e.g. cardiomyopathy, CCF) mediastinal shift (e.g. Pleural effusion, tension pneumothorax)

Question 16

What can cause a forceful and sustained apex beat

Answer 16

• pressure-loaded

- e.g. left ventricular hypertrophy

Question 17

What is the cause of a forceful and non sustained apex beat

Answer 17

• volume loaded

- e.g. hyper metabolic states, aortic/mitral regurgitation

Question 18

What causes a double impulse apex beat

Answer 18

Hypertrophic cardiomyopathy

Question 19

Where are the valves

Answer 19

• aortic 2nd intercostal space right sternal edge
• pulmonary 2nd intercostal space in left sternal edge
• tricuspid 4th/5th intercostal space lower left sternal edge
• mitral 5th intercostal space midclavicular line

Question 20

How do you find the mitral stenosis

Answer 20

• mid diastolic rumble

- ask patient to roll onto their left side and ausculate the mitral area using the bell

Question 21

How do you find mitral regurgitation

Answer 21

• pan systolic murmur
• in the same position, ausculate in the mitral area again this time using the diaphragm
• ausculate into the axilla to identify radiation of this murmur

Question 22

How do you find aortic stenosis

Answer 22

• Ejection systolic

- with the patient back in normal seated position, auscultate int he carotid arteries using the diaphragm m

Question 23

How do you find aortic regurgitation

Answer 23

• early diastolic murmur

- sit the patient forwards and auscultate over the aortic areas with the diaphragm

Question 24

What investigations would you perform

Answer 24

• full set of abs
• peripheral vascular and respiratory exam
• ECG
• bloods
• CXR
• Echo