OSCE CV Exam Palpation of Apex Beat

[Medstart108]

---

Members don't see this ad.

My school has objective structured clinical exams that require you to perform clinical examinations on mock patients and you get evaluated.

One of the instructions for the CV Exam is the palpation of the apex beat. I can feel it on myself, however on friends I cannot (they have tried themselves and cannot) and on the mock patients I cannot either. I think it probably has something to do with how fat you are. So what should you do if you can't feel it but you are pretty sure you are at the right place (mid clavicular line, 5th intercostal space)

On the same vein, what if you cannot feel a radial pulse? I was asked to do an exam on a patient and I couldn't find a radial pulse. I am sure I was feeling the right place, I had never been able to not find the radial pulse before. After a bit of awkward looking, I tried both wrists I lied and said I felt it and I made up a BPM but it was poorly made up (I said 60 which is too perfect)... I heard rumours later on that the patient had A-fib which we were supposed to comment on. Still, A-fib should be irregularly irregular not non-existent. I'm still in pre-clinical so I don't think not being able to find a pulse was supposed to happen..

Either way, how am I supposed to handle it. Do you lose marks if you tell the truth even if you have the right placement?

 

[operaman]

I forget the % but a substantial number of people don't have a palpable PMI. I've felt it on a few patients but I have to be honest that I don't often perform that maneuver, which is too bad because a displaced PMI is actually one of the most powerful physical exam findings.

I would always report whatever you actually find though; never make stuff up. Don't be the student who comments on a left radial pulse only to find out that patient had that vessel harvested during a previous operation! Just keep practicing and you'll get better at it.

 

[NickNaylor]

For OSCEs I fake it all the way. I do the exam and report normal exam findings. OSCEs are typically more about process than correctly identifying abnormalities. The time limitations also limit your ability to keep trying to find something of you have trouble.

 

[DermViser]

For OSCEs I fake it all the way. I do the exam and report normal exam findings. OSCEs are typically more about process than correctly identifying abnormalities. The time limitations also limit your ability to keep trying to find something of you have trouble.

THIS.

OSCEs are acting and all Kabuki theater. You're not actually supposed to diagnose anything. You just go thru the movements.

 

[Kaustikos]

For OSCEs I fake it all the way. I do the exam and report normal exam findings. OSCEs are typically more about process than correctly identifying abnormalities. The time limitations also limit your ability to keep trying to find something of you have trouble.

Seriously. My neuro exam for DTR's was all hollywood. You really think I can do any reflexes of the arms bilaterally in a proper fashion? Noooope.

 

[Serous Demilune]

Dextrocardia FTW

 

[IJL]

Gets a little interesting when your standardized patient has D cups...

 

[eefen]

As mentioned, the preclinical OSCEs can be a bit silly at times.

That said. If you really want to find the PMI, try having the pt turn onto their left side and exhale, then try again.

For the radial pulse...just find the clump of flexor tendons 1-2 in. proximal to the wrist, go just lateral of those, and dig in/under with two fingers. Usually works.

 

[Kaustikos]

Gets a little interesting when your standardized patient has D cups...

Or when she goes to an eye appointment the morning before and presents with anisocoria.... and then mentions it much later.

 

[NickNaylor]

Or when she goes to an eye appointment the morning before and presents with anisocoria.... and then mentions it much later.

LOL