One of the OSCE stations

Instruction outside the station: Please examine the patient’s heart

 

Me: (Introduction, Some difficulty with exposure as the lady was shy to take off her bra. Then Inspection, Palpation and Auscultation, then turned to examiner)

 

Examiner: Are you finished?

 

Me: Yes, I think so.

 

Examiner: Are you sure? No other examination to do?

 

Me: Yes, I am sure.

 

Examiner: Ok. Present your finding.

 

Me: On inspection, the lady looks comfortably at rest with some malar flush on the face. On inspection of the precordium, there is a median sternotomy scar. On palpation, there is no parasternal heave or thrills. On auscultation, I can hear an ejection systolic mummur loudest in the aortic area radiating to the carotids, There is no basal crepitation or peripheral oedema.

 

Examiner: Anything else?

 

Me: I think I heard a prosthetic valve click as well.

 

Examiner: Which valve?

 

Me: I’m not sure.

 

Examiner: What do you mean you are not sure? Did you listen with your stethoscope?

 

Me: Yes…

 

Examiner: Well? Do you know how to listen with your stethoscope?

 

Me: (A little taken back by his rudeness!) Yes, I do know. I think the click was loudest in the mitral area. 

 

Examiner: Only the mitral area?

 

Me: Well, I think so. But I think there is definitely two separate clicks on each of the first and second heart sounds, especially at the aortic area.

 

Examiner: So you heard clicks on the mitral and aortic area?

 

Me: Yes.

 

Are you saying that this patient has a combined aortic and mitral prosthetic valves?

 

Me: Yes.

 

Examiner: Good. Thank you. You may leave.

 

 

After being mocked on my auscultating skills, I was sure that I have failed this station. Turned out to have been award 6/7 for this station! The examiner had just put the diagnosis into my mouth. Luckiest escape ever. Just had to keep saying yes. :)

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