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Confidence in diagnoses
Feel prepared Ace the OSCE
Content
Focused History Cardiac Examination for finals Key diagnoses Aortic Stenosis Mitral Regurgitation Previous cardiac surgery Atrial Fibrillation Practical Run-through
The History
Wash your hands Introduce yourself Check your patients ID
Presenting Complaint HPC/ Associated symptoms PMH Drugs and Allergies Family History Social History Systems Review Summarise
Presenting Complaint
Chest pain SOB Palpitations Syncope/pre-syncope/ funny do
Warfarin
Differentials
Chest Pain Angina/IHD MI GORD SOB Heart Failure Valvular disease P.E. Palpitations AF/SVT Thyroid Caffeine/Alcohol Syncope Valvular Arrhythmia Postural Hypotension
P.E.
MSK
COPD/Asthma
Metabolic
Neurological
Summarise
This is a ___year old ___ who has presented with ____
Cardiac Examination
General Inspection Peripheral examination JVP Chest
Inspection, palpation, auscultation
Summarise Investigations
General Inspection
Around the patient: GTN Oxygen Telemetry Cigarettes Drip
The patient: appears comfortable, sat upright Expose and position
Peripheral
Hands
Endocarditis Clubbing Tar stains Cap refill Anaemia
Pulse
Rate Rhythm Character
Radio-radio delay Collapsing pulse Slow rising
Peripheral
Eyes Xanthalasma Pale conjunctiva Face Malar flush Central cyanosis Hydration Dentition Neck Carotid volume JVP
JVP
Six characteristics: Positional (45 degrees) Double pulsation Non-palpable Occlude-able Variable with respiration Hepato-jugular reflux
Chest
Inspection Scars Visible heave
Chest
Palpation Apex Beat Heaves Thrills Vibrations palpated secondary to a murmur Turbulence blood flow
Auscultation
Site Timing
Character
Radiation
Maneuvers
Site
Four key areas
Aortic Pulmonary Tricuspid Mitral
Timing
Radiation
Character
Aortic Stenosis
http://www.easyauscultation.com/cases-listingdetails.aspx?caseID=123
Mitral Regurgitation
http://www.easyauscultation.com/cases-listingdetails.aspx?caseID=91
Aortic Regurgitation
http://www.easyauscultation.com/cases-listingdetails.aspx?caseID=94
Mitral Stenosis
http://www.easyauscultation.com/cases-listingdetails.aspx?caseID=125
Maneuvers
Mitral Stenosis
Roll over to left side Listen with bell
Aortic Regurgitation
Lean forward Expiration
End Pieces
Auscultate lung bases Sacral and Peripheral oedema Hepato-jugular reflux Thank the patient Cover them up!
Summarise
This is a 65 yr old lady with___
Investigations
Bedside Tests Laboratory Ix Imaging Special Tests
Routine Obs
ECG
Haematology
Biochemistry Microbiology
CXR
Cardiac MRI
Common Stations
Cardiac examination Aortic Stenosis Mitral Regurgitation Atrial Fibrillation Heart Failure
Aortic Stenosis
Key findings
Slow rising pulse Narrow pulse pressure JVP- raised if element of heart failure LVH: heaving apex beat, precordial thrill Ejection systolic murmur, loudest aortic area Radiation to carotids
Mitral Regurgitation
Key Findings:
Atrial Fibrillation Blood pressure often unchanged JVP- if element of heart failure Laterally displaced apex beat Heaves Pansystolic murmur in mitral area Radiation to axilla Signs of Infective endocarditis
OSCE STATION
You are an FY1 in MAU, a 74 year old lady has presented with SOB and lightheadedness, please carry out a cardiovascular examination and present your findings
ECG
What do you think of this ECG?
Summary
Focused History Likely diagnoses Examination for finals Likely findings How to summarise
What to expect
Questions