OSCE year 1 abdo and cvr - notes for CVS and Abdominal osce PDF

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notes for CVS and Abdominal osce...

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OSCE CV Walk in and introduce self to patient, give examiner paper while doing introduction. “Hello good day I am ………………., i am going to do a ………………. Is that ok?” “The exam includes me touching your legs, inspecting your hands and face and listening to your heart.” “Can I have your name and age…………………………” “Are you in any pain today?.........” Position patient at 45 degrees and expose chest appropriately. “Ideal exposure of patient is neck to waistline” While inspecting the patient check for pedal edema. “on inspection patient is in no cardiopulmonary distress, there are no chest wall deformities, no surgical scars or bruising, no active precordium, no aids at bedside” “No pitting edema” Move to hands, ask patients to view hands. “Hands are warm and moist, no palmer erythema, no Janeway lesions, no splinter hemorrhages, no osler nodes, capillary refill is less than 2 seconds, no peripheral cyanosis, no xanthomata” Clubbing: “there is no loss of nail angle (watch nail bed at eye level), no fluctuance of nail bed, check shamroths window.” Pulse: Assess radial pulse (check pulse for 15s and multiply by 4 or just say 72 beats per minute) comment on rhythm, volume and character DO RADIO-RADIAL DELAY AT THE SAME TIME WHILE CHECKING RADIAL PULSE. “pulse was found to be 72 beats per minute, rhythm is regularly regular, volume and character are normal” Check radio-femoral delay. Ask patient to look to the left and tell them you are going to be touching the groin. “No radio femoral delay”

Check collapsing pulse: “do you have any pain in your shoulder?, I am going to lift your hand don’t move it please.” (LEAVE HAND UP FOR A FEW SECONDS DON’T PUT DOWN RIGHT AWAY) “collapsing pulse is absent” Check brachial pulse “brachial pulse is same as radial” “ideally in would check the patients’ Blood pressure, or ask for patients’ blood pressure” Face: Check eyes: “Mucous membranes are pink and moist, no corneal arcus, no xanthelasma, sclera is white, no jaundice” Mouth: ask them to open mouth and also lift tongue to roof of mouth. “no central cyanosis, dentition is adequate, and no oral ulcers” Neck: Check for tracheal deviation “trachea is central” assess carotid pulse “carotid pulse is same as radial pulse” Assess JVP: “do you have any pain in your abdomen? I am going to press down now, There is no Hepatojugular Reflux” (Palpate the liver one time) Chest: “On closer inspection of chest, findings are similar to that of the foot of the bed” Place both hands on chest and feel for apex beat “apex beat is situated within the fifth intercostal space on the left side along the midclavicular line” Check for thrills and parasternal heaves ‘’no thrills and parasternal heaves felt/seen” Auscultate: ASCULTATE ALL REGIONS THEN MAKE COMMENTS ON FINDINGS “I am going to be listening to your heart now” Auscultate the mitral valve using the diaphragm, Identify S1 & S2 heart sounds by palpating the radial or carotid pulse. Switch to the bell, stay on the same spot and ask the patient to turn to their left and ask the patient to breath OUT and deeply hold. Ask patient to return to normal position and listen to mitral, tricuspid, pulmonary and aortic heart sounds using the diaphragm (2-5s each)

Ask the patient to sit up, place diaphragm on aortic valve, ask patient to breath OUT and hold breath. Then place diaphragm over pulmonary valve and ask patient to breath IN deeply and hold. Auscultate Carotid bruits ask patient to hold breath. Auscultate back for basal crepitations, ask patient to breath in and out every time. “on auscultation normal S1 & S2 heart sounds were heard, no abnormal or additional were heard, no carotid bruits were heard and no basal crepitations were heard” Check for sacral edema (somewhere in the lower back) “No sacral edema” Ask patient to lay back down, cover them back and thank them.

This is ….(patient’s name and age)….., he came in with no pain, no pulmonary distress, S1 & S2 heart sounds were normal, findings are constituent with that of a normal cardiovascular exam. To complete the exam I would perform an ECG, echocardiogram and chest x-ray on the patient.

ABDO Walk in and introduce self to patient, give examiner paper while doing introduction. “Hello good day I am ………………., i am going to do a ………………. Is that ok?” “The exam includes me touching your legs, inspecting your hands and face and abdominal are or distress.” “Can I have your name and age…………………………” “Are you in any pain today?.........” Position patient at 45 degrees and expose chest appropriately. “Ideal exposure of patient is neck to waistline” While inspecting the patient check for pedal edema. “on inspection patient is in no cardiopulmonary distress, no surgical scars or bruising, patient appears to be of normal habitus, gynecomastia, caput medusa, spider naive, no visible masses, distension of abdomen, normal hair distribution, the umbilicus is protruding/non protuding, no aids at bedside” “No pitting edema” Move to hands, ask patients to view hands. “hands are warm and moist, no palmer erythema, no leukonychia (nails), no xanthomata, no peripheral cyanosis” Clubbing: “there is no loss of nail angle (watch nail bed at eye level), no fluctuance of nail bed, check shamroths window.” Check for flapping tremors. Face: Check eyes: “Mucous membranes are pink and moist, no corneal arcus, no xanthelasma, sclera is white, no jaundice” Mouth: ask them to open mouth and also lift tongue to roof of mouth. “no central cyanosis, dentition is adequate, and no oral ulcers, no glossitis” Ask patient to hunch shoulder and assess Virchow’s node. “Virchow’s node is not palpable” Abdomen: “on closer inspection findings are constituent with that of the foot of the bed”

“Are you in any pain?” Lightly palpate the 9 quadrants of abdomen, then do deep palpations. On palpation there are no abdominal masses, no rebound tenderness, no guarding. Palpate the liver palpate the spleen, ask patient to turn towards you and place right hand on my left shoulder. “Livers edge is not palpable therefore hepatomegaly, spleen is not palpable therefore no splenomegaly” Percuss liver “liver is ……..cm” Percuss the spleen “spleen is resonant” Ballot kidneys (find kidneys where patients elbows fall) “kidneys are not ballotable” Check for shifting dullness and fluid thrills. “there is no shifting dullness ore fluid thrills, therefor no acities” Auscultate: Bowel sounds, renal arterial bruits, aortic bruits, hepatic hums, splenic rub “Bowel sounds are normal, no renal arterial bruits, aortic bruits, hepatic hums, splenic rub heard” Ideally, I would assess hernial orifices. (or just check for the umbilical hernia) Cover back patient and thank them. This is ….(patient’s name and age)….., he came in with no pain, on examination there were no signs of peripheral liver disease, liver and spleen were not palpable, kidneys were not ballotable. Findings were consistent with that of a normal abdominal exam. To complete this exam I would assess the patients hernial orifices, external genitalia, performing a DRE and urinalysis or stool culture if necessary.

NOTE: SPEND LESS TIME AT PERIPHERIES AND MORE TIME ON THE MAIN AREAS CHEST(CVR), ABDOMEN (ABDO)...