Saturday, October 15, 2011

CASE 7 EXAMINATION STATION Cardiovascular Examination 8mins

Please examine this patient's cardiovascular system and discuss your findings with the examiner.

Things to think about.....
?How would you use your 3mins pre reading to prepare for this case
?How would you present the case ie on the go or after you have done the examination

Also given an ECG to read so how do you read an ECG?


  1. I think I would present the case on the go.
    I would use the 3 min pre reading to run a fast forward examination in my mind.
    1. position pt at 45 degree in bed
    2. general inspection for dysponea, cyanosis, ECG monitoring,
    3. Hands for clubbing, cyanosis, splinter haemorrhage, radial pulse, bp measurement
    4. face for conjuntival pallor, jaundice and malar flush, cyanosis at lips
    5. neck for JVP, abdominojugular reflux and carotid pulse
    6. praecordium :
    ---inspection for scar, deformity, pacemaker
    ---palpation for apex beat, thrills, abnormal impulses
    ---auscultation with bell first then diaphragm, HS, murmurs, begins in mitral area, then tricuspid, then pulmonary and aortic area; position pt at lateral and sitting forward positions, palpate and auscultate again for thrills and murmurs; dynamic auscultation

    7. back while sitting forward: scar, deformity and sacral oedema, percussion for pleural effusion, auscultation for crepitus
    8. abdomen (lying flat) – enlarged liver, pulsatile, spleen, aorta pulsatile and bruit, shift dullness
    9. Legs: clubbing, cyanosis, trophic change, cold/warm, pitting oedema, cap. Refill, pulses calf tenderness


  2. How would you present the case on the go ie "how would you say it"

    (Write down what you would say in order for it to "flow" well).

    Dr Vin Tran

  3. I would say:
    Hi, I am Dr Tricia, I am going to examine your heart and blood vessles, is that ok?
    I have already washed my hand. Please let me know if I hurt you.
    First I put you 45 degree in bed. I am looking for dysponea, cyanosis, ECG monitoring and comment. Then your hands, looking for ......, as described above. I am not sure is that the best way?


  4. Tricia,

    You are doing quite well. (Just thought I let you know as we do not have any "non verbal" communication through this forum. I guess this is the downside of this system. Hopefully, we will do teleconferencing down the track.)

    As to how to approach a case like this, of course, there are many ways and no way is really more correct than another. However, I would like to highlight one way that "can work".

    I would start off by saying something like this...

    "Hi Sir or John (just make up a name and assume that you have met him before. This might save you time. Of course, you can ask for the name and do a formal introduction but Iam not sure whether you will get extra marks for this. Do what is comfortable for you here). My name is Dr Tran and I am asked to examine your cardiovascular system. Then say....

    On general appearance (this is important..always start with on general appearance), he looks relative well and stable. There is no obvious cyanosis on his lips or periphery. There is no evidence of peripheral stigmata for cardiovascular disease such as Osler's nodes, cyanosis or splinter haemorrhages. His pulse is 66 and regular etc etc etc.

    What do you think?

    Dr Vin Tran
    MBBS FRACGP University of Qld