OSCE Cardiovascular Assessment 1 — Questions and Answers
Question 1: During a cardiovascular OSCE station, where is the mitral valve best auscultated?
- 2nd intercostal space, right sternal edge
- 2nd intercostal space, left sternal edge
- 4th intercostal space, left sternal edge
- 5th intercostal space, midclavicular line (Correct answer)
Correct answer: 5th intercostal space, midclavicular line
The mitral valve is best heard at the cardiac apex, located at the 5th intercostal space in the midclavicular line, where the left ventricle is closest to the chest wall.
Question 2: A third heart sound (S3) auscultated in a 58-year-old patient is most likely indicative of which condition?
- Athletic training adaptation
- Heart failure with ventricular dilation (Correct answer)
- Hypertensive heart disease
- Aortic valve stenosis
Correct answer: Heart failure with ventricular dilation
In adults over 40, an S3 (ventricular gallop) is pathological and most commonly indicates heart failure, reflecting rapid ventricular filling in a dilated, poorly compliant ventricle.
Question 3: During JVP assessment, which waveform is characteristically absent in atrial fibrillation?
- x descent
- v wave
- a wave (Correct answer)
- y descent
Correct answer: a wave
The 'a' wave represents atrial contraction; in atrial fibrillation there is no organized atrial contraction, so the 'a' wave is absent from the JVP waveform.
Question 4: A collapsing (water-hammer) pulse on cardiovascular examination is most characteristic of which valvular pathology?
- Aortic stenosis
- Mitral stenosis
- Aortic regurgitation (Correct answer)
- Pulmonary hypertension
Correct answer: Aortic regurgitation
A collapsing pulse results from a wide pulse pressure caused by backflow of blood into the left ventricle during diastole in aortic regurgitation, producing a rapid rise and fall.
Question 5: Which location is correct for auscultating the aortic valve during a cardiovascular OSCE examination?
- 5th intercostal space, midclavicular line
- 2nd intercostal space, right sternal edge (Correct answer)
- 4th intercostal space, left sternal edge
- 2nd intercostal space, left sternal edge
Correct answer: 2nd intercostal space, right sternal edge
The aortic valve is best auscultated at the 2nd intercostal space, right sternal edge (right upper sternal border), where aortic sounds are transmitted.
Question 6: During peripheral examination for cardiovascular disease, splinter hemorrhages under the fingernails are most strongly associated with which condition?
- Deep vein thrombosis
- Infective endocarditis (Correct answer)
- Peripheral arterial disease
- Raynaud's phenomenon
Correct answer: Infective endocarditis
Splinter hemorrhages (longitudinal dark streaks under the nail) are peripheral stigmata of infective endocarditis, caused by microemboli lodging in subungual capillaries.
Question 7: You find a displaced apex beat at the 6th intercostal space, anterior axillary line. What does this most likely indicate?
- Hypovolemia
- Right ventricular hypertrophy
- Left ventricular enlargement (Correct answer)
- Pericardial effusion
Correct answer: Left ventricular enlargement
A laterally and inferiorly displaced apex beat indicates left ventricular enlargement, as the enlarged left ventricle pushes the apex further outward and downward.
OSCE Cardiovascular Assessment 1
During a cardiovascular OSCE station, where is the mitral valve best auscultated?