OSCE Cardiovascular Assessment 3

Question 1

A patient has bilateral pitting edema to the knees. Which combination of findings most strongly supports a cardiac rather than hepatic or renal cause?

Accepted Answer

Bilateral edema, raised JVP, bibasal lung crackles

Answer

Cardiac failure causes bilateral pitting edema, raised JVP (elevated central venous pressure), and pulmonary congestion producing bibasal crackles, distinguishing it from other causes.

Question 2

On palpating the radial pulse, you note it is slow-rising and of low volume. This pulsus parvus et tardus is most consistent with which valvular lesion?

Accepted Answer

Aortic stenosis

Answer

Aortic stenosis produces a slow-rising, low-volume pulse (pulsus parvus et tardus) because obstruction to left ventricular outflow reduces the speed and volume of blood entering the aorta.

Question 3

Quincke's sign — visible capillary pulsation at the nail bed when gentle pressure is applied — is most specifically associated with which condition?

Accepted Answer

Aortic regurgitation

Answer

Quincke's sign results from the widened pulse pressure in aortic regurgitation, producing exaggerated capillary pulsation visible even in peripheral capillaries.

Question 4

The hepatojugular reflux test is performed by applying sustained pressure to the right upper quadrant. A positive result is defined as:

Accepted Answer

A sustained rise in JVP of ≥3 cm for ≥10 seconds

Answer

A positive hepatojugular reflux (sustained JVP rise ≥3 cm lasting ≥10 seconds) indicates the right heart cannot accommodate increased venous return, suggesting right or biventricular heart failure.

Question 5

An ejection click heard in early systole at the aortic area is produced by which mechanism?

Accepted Answer

Turbulent flow through a stenotic but mobile aortic valve

Answer

An aortic ejection click occurs when a stenotic but still pliable aortic valve opens abruptly in early systole, producing a high-pitched click shortly after S1.

OSCE Practice Test

OSCE Practice Test

OSCE Cardiovascular Assessment 3