Yarmouk University

OSCI Simulation

Student’s name …………………………………………………………….

Physical Examination/pericardial examination

Questions Mark Student’s mark

Hand washing 1
Introduce yourself 1
Gain consent 1
Room settings 1
(privacy, temp and light)
Exposure 1
(above the waist)
Position 1
(45-degree)
Vital signs 1/2
Inspection
From the right side of the patient:
Chest wall deformities 1
(pectus excavatum, pectus carinatum…)
Surgical scars 1
(midline sternotomy scar, left submammary scar, infraclavicular
scar…)
Scars in the axillary area 1
Neck inspection 1
(jugular veins, carotid arteries)
Visible pulsation 1
Dilated veins 1/2
Skin rash 1/2
Gynecomastia 1/2
Palpation
warm his hand 1/2
Ask for any tender area on the chest 1
General palpation of the chest with maintaining eye-to-eye 1
contact
palpate the apex beat 2
(assess the character and position)
Heave 1
Apply the heel of the right hand firmly to the left parasternal
area and ask the patient to hold their breath in expiration
Thrill 1
Palpate for trills using the pulps of your fingers at the apex and
both sides of the sternum
 Auscultation
Warming the device 1/2
Auscultation the heart valves using diaphragm whilst palpating 1
the radial pulse:
Mitral valve (5th left ICS, midclavicular line) 1
Tricuspid valve (4th ICS at lower left sternal edge) 1
Pulmonary valve (2nd ICS at the left sternal edge) 1
Aortic valve (2nd ICS at the right sternal edge) 1
Repeat the auscultation using the bell 1
Radiation of the murmurs:
Listen to the carotid arteries (radiation of aortic stenosis 1
murmur)
Listen to the left axilla (radiation of mitral regurgitation) 1
Auscultation for murmurs maneuvers:
Roll patient to the left side then listen to the apex by the bell 1
(mitral stenosis)
Ask the patient to sit up and lean forward, breath out fully and 1
hold their breath then listen by diaphragm to aortic area and
left sternal edge (aortic regurgitation)

Cover and thank the patient 1

Hand washing 1

Questions:

Q; What you should do if you can’t locate (feel) the apex beat?

*ask the patient to roll on to their left side then try to feel it again

Q; What dose pulsation (heave) over left parasternal area indicate?

*right ventricular hypertrophy or dilatation

Q; Mention 2 cases in which the apex beat may be impalpable?

*in overweight or muscular people

*patient with asthma or emphysema (lungs are hyperinflated)