Pre clinc osce prep:

Patient Observation

Observe the patient's general appearance for signs of cardiovascular disease.

Patient Positioning

Evaluate the patient in a supine position elevated 20-30 degrees.

Inspection of the Hand

Check hands for signs of cardiovascular disease, including pallor, nicotine stains, perfusion, cyanosis, clubbing, and radial pulse comparison.

Observation of the Face and Neck

Assess for risk factors of cardiovascular disease, including pallor, cholesterol deposits, dental hygiene, and neck vein pulsations.

Palpation and Auscultation of Carotid Arteries

Palpate and auscultate carotid arteries for thrills and bruits, instructing the patient to hold their breath.

Inspection and Palpation of the Precordium

Inspect for surgeries, pulsations, and palpate for thrills, apex beat, and heaves.

Aortic Valve Location

Located at the second intercostal space just right of the sternum.

Pulmonary Valve Location

Located at the second intercostal space just left of the sternum.

Tricuspid Valve Location

Located at the fourth intercostal space just left of the sternum.

Mitral Valve Location

Located at the fifth intercostal space along the mid-clavicular line.

Apex Beat

Feel for the apex beat along the mid-clavicular line and check for displacement.

Parasternal Heaves

Assess by pushing across the sternum with the heel of the hand.

Auscultation for Murmurs

Listen for murmurs at the same points as palpation, positioning the patient appropriately.

Lower Limb Examination

Assess skin, temperature, perfusion, pulses, and edema in the lower limbs.

Inspection of Lower Limb Skin

Look for hair loss, cyanosis, and ulcerations between toes and legs.

Pitting Edema

Check for edema in specific areas around the ankle and tibia.

Examining Perfusion and Arterial Pulses

Assess perfusion in toes and palpate lower limb arteries bilaterally.

Popliteal Artery

Palpate inside the knee with the leg slightly flexed.

Femoral Artery

Locate at the midpoint between the ASIS and pubic bone.

Abdominal Aorta Palpation

Palpate between the zygoid process and umbilicus for thrills and pulsations.

Buerger’s Test

Assess lower limb insufficiency by observing color changes after leg elevation.

Consent

Obtain patient consent for the cardiovascular exam and clothing removal.

Measuring Patient Temperature

Use contact, tympanic, or non-contact thermometers for temperature assessment.

Assessing Pulse and Respiration

Simultaneously assess respiratory and pulse rates, noting rate, rhythm, and volume.

Measuring Blood Pressure

Align the cuff with the brachial artery, inflate, and measure systolic and diastolic pressures.