Test Stations

Surgery / General Surgery: Aortic Stenosis


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 in cardiovascular clinic, you have been asked by your consultant to perform a full cardiovascular examination and present to them

Patient: 45 year old presenting to out patient clinic

Task:
- Examine this patients cardiovascular system
- Talk through your examination whilst examining, stating any key positives and negatives
- After 6 minutes you will be asked a series of questions by the examiner

Candidate has been asked to examine the cardiovascular system. The candidate does not have to take a history. If they attempt to do so then please remind them this is an examination station only. However they are expected to gain consent for the examination.

CategoryQuestion
Done
Excellent
ConsentCandidate appropriately introduced themselves with:
Full name
Role
Clarifies who they are examining
Gains consent for examination


Examination introductionExamination introduction
Washes hands
Appropriate exposes patient
Positions patient correctly at 45 degrees


InspectionInspection from end of bed
Observes patient from end of bed
Comments on general appearance (well / unwell)
Comments if oxygen, fluids or monitoring is in place
Comments if walking aids are present


Peripheral examinationPeripheral examination, comments examining for
Capillary refill time
Temperature normal
Finger clubbing
Koilonychia
Splinter hemorrhages
Tendon xanthomata


PulsesExamines for pulses
Radial pulse – rate, rhythm, volume, character
Candidate told - low ring, small volume pulse
Collapsing pulse – no marking point if candidate does not ask if any shoulder / doesn’t explain procedure
Radio-radial delay
Carotid pulse
JVP


FaceFace examined for:
Malar flush
Corneal arcus
Conjunctival pallor
Central cyanosis


InspectionCloser inspection for
Presence of pacemaker
Presence of midline sternotomy
Presence of vein harvesting scar on legs


PalpationPalpation for:
Apex beat – 5th intercostal space, midclavicular line
Heaves
Thrills


AuscultationAuscultation
Auscultates whilst palpating carotid pulse
Aortic region (2nd right intercostal space)
Pulmonary region (2ne left intercostal space)
Tricuspid region (Left lower sternal edge i.e 4/5th intercostal space)
Apex region (Left 5th intercostal space mid-clavicular line)
Examines all 4 regions with both bell and diaphragm


Auscultation extendedAuscultation heart sounds extended
Carotid pulse auscultation, held at end expiration
Patient rolled onto left hand side, listening over apex, at expiration
Patient sitting forwards, leaning forwards, at expiration
Radiation of murmur to carotid


Auscultation extra-precordium
Auscultation of lung bases
Checks for sacral oedema
Checks for calf tenderness and pitting oedema


FinishingFinishing remarks
Invites patient to dress again
Re-washes hands
Offers to view observation chart (including BP, HR, O2 sat and T)


Question
“Please listen to the following sound clip of auscultation of the heart and comment on this”

Heart sounds one and two present
Systolic murmur
Ejection systolic in nature


QuestionGiven the sound clip, what condition is this patient most likely have?
Aortic stenosis


QuestionWhat are the causes of aortic stenosis?
Calcific valve disease
Congenital bicuspid valve
Rheumatic heart disease


Advanced QuestionWhen is valve replacement indicated in aortic stenosis?
Symptomatic patients with serve AS (gradient >50)
Asymptomatic patient with left ventricular with ejection fraction less than
Asymptomatic patient with abnormal BP in response to exercise
Asymptomatic patient with a valve area less than 0.6 cm



Score


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