Pre clinc osce prep:

  • CVS: 




    Patient observation: 

    • Observe the patient's general appearance more closely for signs of cardiovascular disease 



    Patient positioning: 

    • The patient is evaluated supine and elevated 20-30 degrees 



    Inspection of the hand: 

    • The hands are checked for signs of CVS 

      • General pallor 

      • Presence of nicotine or tar stains 

      • Perfusion of the fingers 

      • Evidence of peripheral cyanosis 

      • The presence of digital clubbing 

      • Radial pulses are palpated and compared 



    Observation of the face and neck: 

    • Observe the patient's face and neck for any risk factors of CVS

    • Ask the patient to pull their eye down to check for pallor  

    • Check along the eyelids for cholesterol deposits 

    • Check the mouth for dental hygiene and anaemia  

    • Check for veins or pulsations in the neck region 



    Palpation and auscultation of the carotid arteries: 

    • Palpate the carotid arteries one at a time for any thrills 

    • Auscultate over the arteries for any breweries 

      • Ask the patient to take a deep breath in and hold 



    Inspection and palpation of the precordium: 

    • Inspect the precordium for any signs of surgeries or any visible pulsation or the apex beat along the 5th intercostal space along the mid clavicular line. 

    • Palpation of the precordium includes: 

      • Palpation of thrills along the valves, palpation of the apex beat and feeling for parasternal heaves. 

      • Aortic valve: 

        • Located at the second intercostal space of the sternal angle just right of the sternum 

      • Pulmonary valve: 

        • Located on the 2nd intercostal space or sternal angle just left of the sternum 

      • Tricuspid valve: 

        • Located on the 4th intercostal space just left of the sternum

      • Mitral valve: 

        • Located on the 5th intercostal space along the mid clavicular line 

      • Apex beat: 

        • Feel for the apex beat along the mid clavicular line 

        • Check laterally to check the beat is not displaced 

      • Parasternal heaves: 

        • With the heel of the hand push across the sternum 

    • Auscultation: 

      • Look for a murmur 

      • The same points as the palpation. 

      • Put the patient on the side for the mitral valve 

        • May increase the murmur 

      • Aortic valve: 

        • Patient is seating and they lean forward ask the patient to breathe out and hold 

    • Auscultation of the lung bases  



    Lower limb and major abdominopelvic arteries vascular examination: 

    • Examination of skin, temperature, perfusion and patency of pulses and edema 

    • Burgerses and lower limb neurological examinations  



    Inspection of lower limb skin:

    • Look in between the toes and legs from all sides for: 

      • Hair loss, peripheral cyanosis and ulcerations 

    • Back of the hand the lower leg temperature is felt along the limb and compared bilaterally 

      • Thighs, knees, calves, top of the foot and bottom of the foot 

    • Pitting oedema: 

      • Medial ankle, lower lateral to the tibia, medial upper tibial, lateral upper tibia 



    Examining perfusion and lower limb arterial pulses: 

    • Perfusion rate in the toes on both feet 

    • Palpate the lower limb arteries and compare bilaterally

      • Dorsalis pedis pulse 

    • Palpate the posterior tibial artery 

      • Behind the medial ankle 

    • Popliteal artery:

      • The patient’s leg is slightly flexed and we are feeling for inside the knee for a pulse compare bilaterally 

    • Femoral artery: 

      • It is located on the mid point of the ASIS and the pubic bone ask the patient to locate the pubic bone and find the mid point and feel for the pulse  



    Assessing the major blood vessels of the abdomen and pelvis: 

    • Abdominal aorta palpation: 

      • Palpated between the zygoid process and the umbilicus 

      • Feel for thrill, pulsation that are located laterally to the abdominal 

    • Auscultation: 

      • Listen for any breiws  

      • Ask the patient to breathe in and hold 

    • Iliac arteries: 



    Buerger’s test: 

    • For insufficiency in the lower limb 

    • Lift the patient’s leg up for 30 seconds and hold ask the patient to hang their feet off the couch and look for how the colour changes. 


    Vitals: 



    Consent: 

    • Hi, my name is Sam and I'm going to be doing the cardiovascular exam and I may need to contact you and require you to remove your clothing. Do you give me consent? 



    Measuring patient temperature: 

    • Contact temperature: 

      • Putting the thermometer against your armpits

    • Tympanic thermometer: 

      • Putting the thermometer in your ears 

    • Non-contact thermometer: 

      • Using the gun to point to the forehead 



     Assessing pulse and respiration: 

    • Assess the respiratory rate and pulse rate simultaneously 

    • The radial pulse is palpated with two fingers and place the other hand on the shoulder. 

    • Feel for it for 30 seconds 

    • Assess for rate, rhythm and volume 



    Measuring blood pressure: 

    • Align the brachial artery marker with the brachial artery place the cuff high enough to place the stethoscope on the brachial artery  

    • Find the systolic pressure by inflating the cuff until the brachial artery cannot be felt. 

    • Increase the cuff to 20-30 above the estimate 

    • Slowly decrease the pressure the first thump you hear is the systolic value and the pressure at which the beats fade is the diastolic pressure