Cardiovascular OSCE Stations

Cardiovascular OSCE Stations

You are seeing Mrs. Chan, an 81 year old female, in the ER for a one week history of progressive shortness of breath. Take a focused history of her complaint.

History

  • Onset and duration of shortness of breath
  • Progression of shortness of breath
  • Alleviating factors
  • Orthopnea
  • Asks about nighttime symptoms and paroxysmal nocturnal dyspnea
  • Association with cough
  • Chest pain
  • Palpitations
  • Leg swelling
  • Nocturia
  • Abdominal distension
  • Syncope, pre-syncope
  • Presence of fever, chills, and other systemic symptoms
  • Adherence to medications, diet
  • Personal history of CHF, CAD, MI, and CVA
  • Smoking history (quantity in pack-years)
  • Occupational history
  • Diabetes
  • Dyslipidemia
  • Hypertension
  • Current medications
  • Family history of heart disease
  • Effect on daily activities

Physical Examination

Inspection

  • Inspects patient, comments on respiratory status
  • States that weight should be measured for BMI/fluid overload status
  • Volume Status
  • Examines lower extremities for pitting edema
  • Examines JVP and comments on its estimated height
  • Measures pulse, comments on rate and rhythm
  • Evaluates patient’s orthostatic vitals
  • Examines the abdomen for ascites and a pulsatile liver, indicating right heart failure

Pre-cordium/Carotid

  • Palpates for the presence of thrills, heaves
  • Palpates PMI and comments on size, amplitude, duration, and location
  • Auscultates in all 4 areas of precordium with bell and diaphragm
  • Comments on presence of murmurs, extra heart sounds
  • Examines carotid arteries for bruits

Respiratory

  • Percusses posterior chest, comments on dullness
  • Auscultates all lung fields, commenting on presence of crackles, wheezes or other adventitious breath sounds

You are seeing Mr. Alexander, a 55 year old male, in the ER for a one week history of worsening and debilitating chest pain. Take a focused history of his complaint.

History

  • Onset and duration of chest pain
  • Location of pain
  • Severity of pain
  • Alleviating factors
  • Aggravating factors, especially activity
  • Frequency of chest pain
  • Radiation of pain
  • Association with shortness of breath
  • Diaphoresis
  • Palpitations
  • Nausea/vomiting
  • Symptoms of syncope
  • Personal history of coronary artery disease and myocardial infarction
  • TIA/Stroke
  • Diabetes
  • Dyslipidemia
  • Hypertension
  • Smoking history (quantity in pack-years)
  • Family history of heart disease
  • Effect on daily activities/occupation
  • Patient’s concern as to the cause of the pain

Physical Examination

Inspection/Palpation

  • Inspects precordium for scars, pulsations
  • Palpates for the presence of thrills, heaves
  • Palpates PMI and comments on size, amplitude, duration, and location

Carotid/JVP

  • Examines JVP and comments on its estimated height
  • Palpates the carotid arteries bilaterally
  • Auscultates the carotid arteries for bruits

Auscultation

  • Auscultates in all 4 areas of precordium with bell and diaphragm
  • Comments on presence of murmurs, extra heart sounds
  • Auscultates the lungs

Please assess the volume status of Mr. Kennedy, a 61 year old male, and comment on your findings.

Physical Examination

Vitals

  • Assesses heart rate by palpating the radial pulse
  • Measures blood pressure while supine
  • Assesses orthostatic changes by measuring blood pressure and heart rate with patient standing
  • Comments on vital signs findings of a patient who is hypovolemic

JVP

  • Observes JVP with correct patient position (30 degrees head-up-tilt); adjusts patient accordingly if JVP is not initially evident
  • Confirms JVP by changing angle of head of bed
  • Occludes JVP to confirm location
  • Comments on the multiple waveforms of the JVP
  • Comments on the JVP height

Peripheral Vasculature

  • Comments on capillary refill
  • Comments on skin turgor, mottling
  • Comments on mucus membranes
  • Examines for peripheral edema
  • Comments on peripheral temperature

You are seeing Mrs. Diaz, a 68 year old female, who is in your office because she says she has recurrent episodes of ‘fainting.’ Take a focused history of her complaint.

History

Syncope

  • Onset of syncope
  • Timing of syncope
  • Frequency
  • Duration of syncopal episodes
  • Activity surrounding syncope
  • Changes in position before syncope
  • Distinguishes if true syncope, i.e. full loss of consciousness

Pre-syncopal signs and symptoms

  • Distinguishes syncope from dizziness and vertigo
  • Chest pain before syncope
  • Shortness of breath
  • Palpitations
  • Focal neurologic deficits (vision, numbness, weakness)
  • Systemic neurologic deficits

Post-syncopal signs and symptoms

  • Post-ictal confusion
  • Incontinence
  • Weakness
  • Personal history of heart disease
  • Personal history of seizure
  • Cardiac risk factors
  • Family history of heart disease, seizure disorders