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Checking Cardio
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Valvular heart disease
Common valvular heart disease for OSCE Single valve disease
Mitral stenosis (MS)Mitral regurgitation (MR)Aortic stenosis (AS)Aortic regurgitation (AR)Tricuspid regurgitation (TR)
Common valvular heart disease for OSCE
DiseasePositionLocationStethoscopeMurmur RadiationMSApexBellLoud S1, OS, DRMNoMRApexDiaphragmPSMLt. axillaASAVA (2nd Rt ICS)DiaphragmClick, SEMCarotid a.ARErbs pointDiaphragmDBMNoTRTVA (LLSB)DiaphragmPSMNo
Scenario
:
(60 ) (25 )3. 1 (15 )
Skill
CompleteSequence Doctor-Patient relationship
Cardiovascular examination
() -
Peripheral Central (vascular) (Cardiac)
, neck vein engorgement, carotid artery radial pulse water hammer thrill ventricular heaving apex beatCardiovascular examination (1)
heart apex (MR) apex bell (MS) (AR) radiation carotid artery (AS)Cardiovascular examination (2)
Pitfall (skill)The most dangerous (1) 25 50
Pitfall (skill)The most dangerous (2) OSCE : skill evaluation > knowledge evaluation
Pitfall (skill), neck vein engorgement,
: Neck vein : -
:
3 important things to do
Not only to see or to say
Correct : sternocleidomastoid muscleIncorrect 2
carotid artery
Correct : 2
Incorrect
Radial pulse
water hammer
Pulse palpationWater hammer
thrill valvular area heaving LV RV heaving
Heaving palpationLV heavingRV heaving
Thrill palpation
Apex beat
Most of all : OK
Auscultation valvular areaSome : forget
Dont forget heart apex (MR)
apex bell (MS)
(AR)
radiation carotid artery (AS)
Doctor-Patient relationshipCommunication : OK But precordium !!! May be its not OK
The last recommendation
(finding & diagnosis)v.s.