Makindo Medical Notes

Related Subjects: |Cardiac Examination |Cardiology History Taking |Respiratory Examination |Gastroenterology Examination |Cardiac Anatomy and Physiology |Coronary Artery Anatomy and Physiology |Cardiac Electrophysiology |Cardiac Embryology

📝 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

📈 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.