IC3 OSCE Cardiology General
“This is a cardiology station. You have 5 minutes to perform a cardiology examination excluding the praecordium. I
will then ask you to present your findings and answer a question”.
Examination Expected/Normal Comments Potential/Abnormal Comments
Introduction
Hand hygiene
• Cleans hands with alcohol gel
Introduction, explanation and consent Hi my name is X. I’m a third year medical
• Introduces self with name and level, student at RCSI. What’s your name? Nice to
explains what he/she will be doing and meet you. I’ve been asked to examine your
obtains consent for same
cardiovascular system today. That will involve
examining your hands, face, neck, and your
legs. Would that be ok?
Position and exposure
• Patient positioned at a 45 degree angle Mr/Mrs A is appropriately positioned and
and undressed to the waist exposed for this examination.
Enquires about pain Are you in any pain?
• Prior to examining
General Inspection
Equipment
Performed from the end of the bed ‘On general inspection Mr/Mrs A appears o O2 delivery, IV access, ECG monitor,
o Inspects for well; there are no peripheral stigmata of catheter bag, mobility aids
o Equipment cardiovascular disease and no equipment Patient
o Patient around the bed.’ o Appears unwell, tachypnoea, cachexia,
chest asymmetry, midline sternotomy
scar, pacemaker, ICD
Hands
•Clubbing- ‘There is grade X clubbing.’
o Inspects for o Grade 1: Fluctuation & softening of nail bed
o Clubbing o Grade 2: Loss of the <165° angle between the
o Stigmata of infective endocarditis ‘On closer inspection of the hands there were nailbed and fold
o Palmer crease pallor no stigmata of cardiovascular disease. ‘ o Grade 3: Increased convexity nail fold
o Xanthomata o Grade 4: Thickening of distal finger
o Peripheral cyanosis •Stigmata of infective endocarditis
o Tar staining
o Osler nodes, Janeway lesions, splinter
haemorrhages
Other
o Palmar crease pallor, tendon xanthomata,
peripheral cyanosis or tar staining present
Pulse & Blood pressure
Pulse
Palpates with 2 fingers & comments on ‘On palpation of the pulse it is…
rate, rhythm & character. Tachy/bradycardic at a rate of X
Delays Regular irregular or irregularly irregular
• Palpates for radio-radio delay ‘On palpation of the pulse, its rate was
rhythm
• Offers to do radio-femoral delay. ‘X’bpm, and was of a regular rhythm, with a
Collapsing pulse normal character. There was no collapsing
pulse and no evidence of radio-radio delay or ‘There is…
• Palpates pulse with two fingers,
radio-femoral delay.’ Radio-radio delay
grasping muscular part of forearm and
o Aortic dissection
then raising the patient’s arm vertically
Radio-femoral delay
upwards (asks about shoulder pain
o Coarctation of the aorta
before lifting), feels for tapping impulse
Collapsing pulse
at the wrist on raising
Blood pressure o Aortic Regurgitation
• Offers to perform blood pressure
Head
Face Face
• Skin changes Malar flush (Mitral Stenosis)
Eyes
Eyes • Conjunctival pallor (Anaemia)
‘On closer inspection of the face, there are • Corneal arcus or xanthelasma ( ↑Chol)
• Examines by pulling down/up eyelids
no stigmata of cardiovascular disease.’ • Scleral icterus (haemolytic anaemia
looking at conjunctiva/sclera
“This is a cardiology station. You have 5 minutes to perform a cardiology examination excluding the praecordium. I
will then ask you to present your findings and answer a question”.
Examination Expected/Normal Comments Potential/Abnormal Comments
Introduction
Hand hygiene
• Cleans hands with alcohol gel
Introduction, explanation and consent Hi my name is X. I’m a third year medical
• Introduces self with name and level, student at RCSI. What’s your name? Nice to
explains what he/she will be doing and meet you. I’ve been asked to examine your
obtains consent for same
cardiovascular system today. That will involve
examining your hands, face, neck, and your
legs. Would that be ok?
Position and exposure
• Patient positioned at a 45 degree angle Mr/Mrs A is appropriately positioned and
and undressed to the waist exposed for this examination.
Enquires about pain Are you in any pain?
• Prior to examining
General Inspection
Equipment
Performed from the end of the bed ‘On general inspection Mr/Mrs A appears o O2 delivery, IV access, ECG monitor,
o Inspects for well; there are no peripheral stigmata of catheter bag, mobility aids
o Equipment cardiovascular disease and no equipment Patient
o Patient around the bed.’ o Appears unwell, tachypnoea, cachexia,
chest asymmetry, midline sternotomy
scar, pacemaker, ICD
Hands
•Clubbing- ‘There is grade X clubbing.’
o Inspects for o Grade 1: Fluctuation & softening of nail bed
o Clubbing o Grade 2: Loss of the <165° angle between the
o Stigmata of infective endocarditis ‘On closer inspection of the hands there were nailbed and fold
o Palmer crease pallor no stigmata of cardiovascular disease. ‘ o Grade 3: Increased convexity nail fold
o Xanthomata o Grade 4: Thickening of distal finger
o Peripheral cyanosis •Stigmata of infective endocarditis
o Tar staining
o Osler nodes, Janeway lesions, splinter
haemorrhages
Other
o Palmar crease pallor, tendon xanthomata,
peripheral cyanosis or tar staining present
Pulse & Blood pressure
Pulse
Palpates with 2 fingers & comments on ‘On palpation of the pulse it is…
rate, rhythm & character. Tachy/bradycardic at a rate of X
Delays Regular irregular or irregularly irregular
• Palpates for radio-radio delay ‘On palpation of the pulse, its rate was
rhythm
• Offers to do radio-femoral delay. ‘X’bpm, and was of a regular rhythm, with a
Collapsing pulse normal character. There was no collapsing
pulse and no evidence of radio-radio delay or ‘There is…
• Palpates pulse with two fingers,
radio-femoral delay.’ Radio-radio delay
grasping muscular part of forearm and
o Aortic dissection
then raising the patient’s arm vertically
Radio-femoral delay
upwards (asks about shoulder pain
o Coarctation of the aorta
before lifting), feels for tapping impulse
Collapsing pulse
at the wrist on raising
Blood pressure o Aortic Regurgitation
• Offers to perform blood pressure
Head
Face Face
• Skin changes Malar flush (Mitral Stenosis)
Eyes
Eyes • Conjunctival pallor (Anaemia)
‘On closer inspection of the face, there are • Corneal arcus or xanthelasma ( ↑Chol)
• Examines by pulling down/up eyelids
no stigmata of cardiovascular disease.’ • Scleral icterus (haemolytic anaemia
looking at conjunctiva/sclera
