CramPuppy.Com

CramPuppy - Free Revision Notes » University » Medicine » Osce » Cardiovascular Examination for Medical Student OSCE

Cardiovascular Examination for Medical Student OSCE

Share View PDF | Print View | Views: 0 |

Cardiovascular system

1. General inspection

   1. Well / ill

   2. Breathing

   3. Weight

   4. Cyanosis, pale

   5. Malar flush: mitral stenosis, low cardiac output

   6. Cool / clammy

   7. GTN spray

   8. Oxygen

   9. Monitors – heart, O₂ sats

   10. Dysmorphic – Down’s; Marfan’s syndrome; etc.

2. Hands

   1. Clubbing

      1. Cyanotic congenital heart disease

      2. Endocarditis

      3. Atrial myxoma

   2. Nails

      1. Koilonychia: spoon-shaped: iron deficiency, syphilis, ischaemic heart disease

      2. Nail-fold infarcts: vasculitis

      3. Nail-bed pulsation: aortic regurgitation (Quineke’s sign)

   3. Capillary refill (<2s normal; abnormal in hypotension, peripheral vascular disease)

   4. Splinter haemorrhages: if febrile, suggests infective endocarditis

   5. Osler’s nodes: tender nodules on finger pulps: infective endocarditis

   6. Janeway lesions: red macules on palms: infective endocarditis

   7. Tendon xanthomata: hyperlipidaemia

   8. Pulse: rate, rhythm

      1. Slow-rising: aortic stenosis

      2. Collapsing: aortic regurgitation, Arteriovenous fistula (lift up arm)

      3. Pulsus paradoxus: inspiration gives >10mmHg fall in pulse pressure: cardiac tamponade, pericardial constriction, (asthma)

      4. Both wrist pulses at once:

   9. Blood pressure: HTN / hypotension

3. Face

   1. Head nodding sign

   2. Eyes:

      1. Corneal arcus: hyperlipidaemia

      2. Xanthalesma: yellowish cholesterol plaques around eyelids and periorbital area: hyperlipidaemia

      3. Roth’s spots: retinal infarcts in fundus: infective endocarditis

      4. Anaemia – check conjunctiva

   3. Mouth:

      1. Angle stomatitis: iron-deficiency anaemia

   4. Neck:

      1. JVP: >4cm above sternal notch, at 45? = raised: right-sided or congestive cardiac failure. N.B. hepatojugular reflex

      2. Carotid pulse

      3. Carotid bruits: atherosclerosis, or ?aortic stenosis

4. Precordium

   1. Scars

   2. Dextrocardia

   3. Apex beat: 5^th intercostal space, mid-clavicular line

      1. Displaced laterally?

      2. Heaving? Mitral/aortic regurgitation, ventriculo-septal defect

      3. Strong? Aortic stenosis, hypertension

      4. Tapping? Mitral stenosis

      5. Diffuse? LV failure

   4. Left parasternal heave: pulmonary stenosis, cor pulmonale¹ , atrial septal defect

   5. Thrills: transmitted murmurs

   6. Auscultation: while palpating carotid

      1. Apex – bell

      2. Sounds I + II + 0

      3. Mitral area: apex

      4. Tricuspid area: 5^th interspace, left parasternal

      5. Pulmonary area: 2^nd interspace, left parasternal

      6. Aortic area: 2^nd interspace, right parasternal

      7. Left axilla: sounds of mitral incompetence – lean to left, breathe out

      8. Left lateral position: apex: listen for diastolic rumble of mitral stenosis

      9. Leaning forwards, breathe out: lower left sternal edge: blowing diastolic sound: aortic regurgitation. (‘Accentuated by expiration’)

RICE = (Right Inspire, Left Expire)

 

1. Lung

   1. Bases: crepitations due to effusions – cardiac failure

2. Oedema

   1. Pitting?

   2. Ankles to sacral area: what extent?

3. Abdomen

   1. Hepatomegaly + ascites: right heart failure.

   2. Hepatomegaly, pulsatile: tricuspid regurgitation

   3. Splenomegaly: infective endocarditis

   4. Auscultation: renal and iliac arteries

4. Further tests

   1. Check the chart

   2. Postural BP – dysautonomia, hypovolaemia (phaeochromocytoma), medication ( tricyclics, MAO-Is, α -1 blockers – HTN and benign prostatic hyperplasia)

   3. CXR

   4. ECG

   5. Bloods: FBC, CRP, WBC,

Common threads:

1. Infective endocarditis

   1. Clubbing (and endocarditis generally)

   2. Splinter haemorrhages

   3. Osler’s nodes

   4. Janeway lesions

   5. Roth’s spots

2. Iron-deficiency anaemia

   1. Pallor (general, conjunctival)

   2. Koilonychia

   3. Hyperdynamic circulation

   4. Angle stomatitis

3. Chest pain DD

   1. Cardiac pain

      1. Angina:

         1. Stable angina

         2. Unstable angina

         3. Prinzmetal’s angina

 

1.  
   1.  

      1. STEMI

         1. Treatment: MONA then

            1. T: thrombolysis / angioplasty

            2. B: ?-blockers

            3. A: ACE-inhibitor

      2. Non-STEMI

   2. Aortic dissection

   3. Pleuritic pain

      1. Pleural

      2. Pericardial

   4. Musculoskeletal chest pain

   5. Gastro-oesophageal pain

      1. Oesophageal reflux

      2. Oesophageal spasm: often provoked by reflux. Retrosternal tightness / heaviness, which may be severe: confusing with cardiac pain, but may be relieved by antacids e.g. milk, or cold drinks

      3. Peptic ulcer

   6. Gall bladder disease: attacks are classically intermittent, may be severe, and are not related to exercise. Eating particularly fatty foods can precipitate. Diagnosed on ultrasonography, and by excluding anginal syndromes.

      1. Classic biliary colic felt in epigastrium. Biliary disease may also be felt in the chest and confused with angina.

      2. Cholecystitis felt in right upper quadrant

About the Author

by: Admin
Total views: 0
Word Count: 1744
Date: Fri, 22 Jan 2010 Time: 3:47 PM
0 comments

---

Rating: Not yet rated
Login to vote

Comments

No comments posted.

Add Comment

You do not have permission to comment. If you log in, you may be able to comment.

Search

Normal Search:

Advanced Search

Tag Cloud

Community

Welcome Guest

PageNav

Categories

Users Online

16