OSCE Cardiovascular Assessment 2 — Questions and Answers
Question 1: Pulsus paradoxus is defined as a fall in systolic BP greater than 10 mmHg during inspiration. Which condition most commonly causes this finding?
- Hypertensive crisis
- Cardiac tamponade (Correct answer)
- Aortic regurgitation
- Complete heart block
Correct answer: Cardiac tamponade
Cardiac tamponade causes pulsus paradoxus because pericardial fluid restricts ventricular filling, exaggerating the normal inspiratory drop in left ventricular stroke volume.
Question 2: During cardiovascular examination you note Kussmaul's sign — the JVP rises paradoxically on inspiration. This is most pathognomonic of which condition?
- Cardiac tamponade
- Right heart failure alone
- Constrictive pericarditis (Correct answer)
- Pulmonary embolism
Correct answer: Constrictive pericarditis
Kussmaul's sign is pathognomonic for constrictive pericarditis, where a rigid, fibrotic pericardium prevents right heart expansion on inspiration, causing JVP to rise rather than fall.
Question 3: A pansystolic murmur heard best at the cardiac apex that radiates to the left axilla is most consistent with which diagnosis?
- Aortic stenosis
- Tricuspid regurgitation
- Mitral regurgitation (Correct answer)
- Ventricular septal defect
Correct answer: Mitral regurgitation
Mitral regurgitation produces a pansystolic murmur loudest at the apex that classically radiates to the axilla, reflecting the direction of the regurgitant jet from the mitral valve.
Question 4: With the patient at 45 degrees, you measure JVP pulsation 5 cm above the sternal angle. How do you interpret this finding?
- Normal JVP
- Mildly elevated JVP (Correct answer)
- Severely elevated JVP
- JVP cannot be assessed at 45 degrees
Correct answer: Mildly elevated JVP
Normal JVP is ≤3–4 cm above the sternal angle at 45°; a measurement of 5 cm represents a mildly elevated JVP, suggesting impaired right heart filling or increased central venous pressure.
Question 5: During the peripheral cardiovascular inspection, you observe yellow plaques at the medial canthi of both eyes. These are called xanthelasma and are associated with which risk factor?
- Diabetes mellitus
- Hyperlipidemia (Correct answer)
- Hypertension
- Hypothyroidism
Correct answer: Hyperlipidemia
Xanthelasma are cholesterol deposits in the periorbital skin, most strongly associated with hyperlipidemia and elevated cardiovascular risk.
Question 6: You auscultate a mid-systolic click followed by a late systolic murmur at the apex. Which condition does this pattern most strongly suggest?
- Hypertrophic obstructive cardiomyopathy
- Aortic stenosis
- Mitral valve prolapse (Correct answer)
- Atrial septal defect
Correct answer: Mitral valve prolapse
The classic auscultatory hallmark of mitral valve prolapse is a mid-systolic click (leaflet billowing) followed by a late systolic murmur from resulting mitral regurgitation.
Question 7: Which maneuver increases the intensity of the murmur in hypertrophic obstructive cardiomyopathy (HOCM)?
- Squatting
- Standing (Correct answer)
- Sustained hand grip
- Passive leg elevation
Correct answer: Standing
Standing reduces preload by decreasing venous return, which decreases left ventricular volume and worsens the dynamic outflow obstruction in HOCM, increasing murmur intensity.
OSCE Cardiovascular Assessment 2
Pulsus paradoxus is defined as a fall in systolic BP greater than 10 mmHg during inspiration.
Which condition most commonly causes this finding?