Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

Makindo Medical Notes "One small step for man, one large step for Makindo"
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MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Cardiac Exam (OSCE)

📝 Always ask for the patient’s permission before beginning. OSCE examiners love to see professionalism.

🧼 Wash Hands, Introduction & Consent

🧼 Wash hands
👋 Introduce yourself and confirm patient identity
📝 Obtain consent and request a chaperone
💡 Remember: Even if you miss a sign, logical, structured presentation can earn marks!

👀 Inspection

General: Comfortable? Breathless? Anaemic? Plethoric? Thin? Obese?
Bedside clues: GTN spray 💊, IV lines, inotropes, insulin.
Scars: Midsternotomy (CABG/valve), pacemaker box.
Colour: Central vs peripheral cyanosis (cyanotic heart disease vs poor circulation).

😊 Face

Down’s (AV canal), Turner’s (CoA, bicuspid AV), Marfan’s (high-arched palate).
Malar flush (mitral stenosis), central cyanosis (lips, mucosa).
Eyes 👁: Xanthelasma, corneal arcus → hyperlipidaemia.
Mouth 👄: Rotten teeth 🦷 → endocarditis risk; stomatitis, glossitis, telangiectasia.
Thyrotoxicosis (AF, goitre, eye signs), Acromegaly (HTN, cardiomegaly).

✋ Hands

Temperature: Cold → poor output, Warm/dilated veins → CO₂ retention.
Clubbing (CHD, IE, cirrhosis, IBD).
Splinter haemorrhages (trauma vs IE).
Osler’s nodes (painful), Janeway lesions (painless) → endocarditis ❤️‍🔥.
Marfan’s: Arachnodactyly 🕷, high-arched palate.
Xanthomata (tendons, Achilles, elbows) → familial hypercholesterolaemia.

🫀 Pulse

Rate, rhythm, character, symmetry.
Compare right vs left radial; radial–femoral delay → coarctation.
Check for collapsing pulse (raise arm), slow-rising pulse (carotid).

📊 Pulse Characteristics

Pulse	Association
💪 Good volume	Normal
🔥 Bounding	Thyrotoxicosis, fever, Paget’s
💧 Collapsing	AR, PDA, AV fistula
🐢 Plateau	AS (slow-rising, narrow PP)
⚡ Jerky	HOCM
🔀 Bisferiens	Mixed AR + AS
↕️ Alternans	Severe LV dysfunction
⏳ Bigeminus	Extrasystoles
🌬 Pulsus paradoxus	Tamponade, asthma, constrictive pericarditis
❌ Absent	Dissection, embolism, Takayasu
⏱ Radial–femoral delay	Coarctation of aorta

📈 Rate & Rhythm

Normal: 60–90 bpm.
Brady <60: sinus brady, AV block, nodal rhythm.
Tachy >100: sinus tachy, SVT, AF, VT.
Rhythm:
- Regular: sinus rhythm, flutter 2:1.
- Regularly irregular: bigeminy, Mobitz II.
- Irregularly irregular: AF (commonest!).

💉 Blood Pressure

Pulse waveform: percussion wave + dicrotic notch (AV closure).
Korotkoff I = systolic, V = diastolic.
Hypertension >140/90; PP wide in AR, narrow in AS.
Inter-arm differences >20 mmHg → subclavian stenosis/dissection.
Brachial >> ankle → PVD or coarctation.

🫀 Praecordium

Apex beat: normally 5th ICS MCL. Note location, character.
Heaving → AS; Thrusting → AR; Tapping → MS.
Thrills → palpable murmurs.
Right ventricular heave → RVH.

🎧 Auscultation

Listen systematically: apex → tricuspid → pulmonary → aortic (sigmoid sweep).
Always time with the pulse.
Left lateral → MS; sit forward & exhale → AR.
Extra sounds: S3 (Kentucky) → HF; S4 (Tennessee) → stiff ventricle.
Prosthetic clicks: metallic vs tissue.

🎼 Murmurs

With pulse = systolic, not with pulse = diastolic.
Radiation: MR → axilla, AS → carotids, AR → LSE.
Grades I–VI (I = faint, VI = audible without stethoscope).
Golden Rules:
- Right-sided ↑ with inspiration.
- Left-sided ↑ with expiration.
- HCM & MVP louder with standing/Valsalva, softer with squatting.
- Diastolic murmurs are never innocent 🚨.

🔑 End of Exam

Check lung bases (pulmonary oedema), abdomen (hepatomegaly, ascites), legs (oedema, vein graft scars).
Offer peripheral pulse exam, fundoscopy (HTN), urine dip (renal disease).
Thank patient, wash hands, present findings clearly.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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