IC3 OSCE Cardiology Praecordium
“This is a cardiology station. You have 5 minutes to inspect, palpate and auscultate 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
chest today. That will involve looking at your
chest, examining for some pulsations and
listening to your heart. 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,
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
Closer Inspection
Scars
Performed from right hand side of the bed Describes site, length, orientation, colour
Inspects for ‘On closer inspection of the praecordium o Sternotomy (CABG/valve surgery)
o Scars there are no stigmata of cardiovascular o Thoracotomy (mitral valvotomy)
o Pacemaker/ICD box disease. ‘ o PPM/ICD & underlying mass
o Skeletal abnormalities Skeletal abnormalities
o Visible apex beat o Pectus Excavatum, Kyphoscoliosis
Visible apex beat
Palpation
• Apex beat- begins in axilla, moves • Apex beat- ‘The apex beat was
medially, counts down spaces impalpable/displaced to _location_’
Parasternal heave- uses heel of hand or Parasternal heave- ‘A parasternal heave
‘On palpation the apex beat was palpable in
fingers placed to left of sternum
the 5th intercostal space, mid-clavicular line. was present’
Thrills- uses flat of hand to palate over
There was no heave and no thrills. ‘ Thrills- ‘There was a palpable thrill felt
apex, left sternum & base of heart
over the Aortic/Pulm/Tricus/Mitral area’
Auscultation
• Auscultates all 4 valve positions with Murmur Descriptions
diaphragm- mitral (apex beat), tricuspid ‘On auscultation there was…’
(5thLICS), pulmonary (2ndLICS), aortic A (pan/ejection)systolic/
(2ndRICS) (early/mid)diastolic murmur
Auscultates with bell at apex Loudest at the Aortic/Pulmonary
Times to pulse /Tricuspid/Mitral area
Dynamic Manoeuvres Radiating to the axilla/carotids
• Mitral Stenosis- Listens over mitral area ‘On auscultation there is normal first and Louder on inspiration/expiration
using bell with patient in left lateral second heart sounds with no added sounds.’ Grade x/6
position
Aortic Regurgitation- Leans patient Valve replacement
forward in full expiration, listens at ‘On auscultation there was…’
lower left sternal border with diaphragm An audible (metallic) click
Mitral Regurgitation- Listens in axilla o Click before the carotid pulse =MVR
o Click after the carotid pulse= AVR
Carotids
“This is a cardiology station. You have 5 minutes to inspect, palpate and auscultate 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
chest today. That will involve looking at your
chest, examining for some pulsations and
listening to your heart. 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,
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
Closer Inspection
Scars
Performed from right hand side of the bed Describes site, length, orientation, colour
Inspects for ‘On closer inspection of the praecordium o Sternotomy (CABG/valve surgery)
o Scars there are no stigmata of cardiovascular o Thoracotomy (mitral valvotomy)
o Pacemaker/ICD box disease. ‘ o PPM/ICD & underlying mass
o Skeletal abnormalities Skeletal abnormalities
o Visible apex beat o Pectus Excavatum, Kyphoscoliosis
Visible apex beat
Palpation
• Apex beat- begins in axilla, moves • Apex beat- ‘The apex beat was
medially, counts down spaces impalpable/displaced to _location_’
Parasternal heave- uses heel of hand or Parasternal heave- ‘A parasternal heave
‘On palpation the apex beat was palpable in
fingers placed to left of sternum
the 5th intercostal space, mid-clavicular line. was present’
Thrills- uses flat of hand to palate over
There was no heave and no thrills. ‘ Thrills- ‘There was a palpable thrill felt
apex, left sternum & base of heart
over the Aortic/Pulm/Tricus/Mitral area’
Auscultation
• Auscultates all 4 valve positions with Murmur Descriptions
diaphragm- mitral (apex beat), tricuspid ‘On auscultation there was…’
(5thLICS), pulmonary (2ndLICS), aortic A (pan/ejection)systolic/
(2ndRICS) (early/mid)diastolic murmur
Auscultates with bell at apex Loudest at the Aortic/Pulmonary
Times to pulse /Tricuspid/Mitral area
Dynamic Manoeuvres Radiating to the axilla/carotids
• Mitral Stenosis- Listens over mitral area ‘On auscultation there is normal first and Louder on inspiration/expiration
using bell with patient in left lateral second heart sounds with no added sounds.’ Grade x/6
position
Aortic Regurgitation- Leans patient Valve replacement
forward in full expiration, listens at ‘On auscultation there was…’
lower left sternal border with diaphragm An audible (metallic) click
Mitral Regurgitation- Listens in axilla o Click before the carotid pulse =MVR
o Click after the carotid pulse= AVR
Carotids
