here are a few:
COMLEX Insight: Murmurs will likely appear on your exam in some way, shape, or form. Know how to recognize them based on physical exam findings and be comfortable with their distinguishing characteristics.
Bottom Line: The mitral regurgitation murmur is a harsh blowing holosystolic murmur radiating to the axilla.
Mitral Regurgitation: Harsh blowing, holosystolic murmur radiating from cardiac apex to the axilla, loud S1, presence of S3, widely split S2, midsystolic click.
Mitral Stenosis: Opening snap heard after S2 with diastolic rumble, loud S1.
Aortic Regurgitation: Wide pulse pressure with diastolic decrescendo murmur heard at right 2nd intercostal space, late diastolic rumble (Austin-Flint murmur), bounding pulses, wide pulse pressure.
Aortic Stenosis: Weak and prolonged pulse, crescendo-decrescendo systolic murmur with radiation to the neck/carotids, weak S2, murmur decreases with valsalva.
COMLEX Insight: It is very important to have a solid understanding of diagnostic imaging and when to order a study. You should be familiar with these and know the order in which they should be used. In general, go from least invasive to most invasive and from lowest cost to highest cost. This can vary, however, depending on the indication and clinical presentation.
COMLEX Insight: It's almost a given that you will have to interpret several ECGs on your COMLEX exam. Most of the time you will just have to make the correct diagnosis, and sometimes you will be faced with a subsequent question asking for treatment. Occasionally, you will have to put your brain to work and answer a question requiring you to understand the pathophysiology of the condition, as in the case above. We suggest you put the following arrhythmias on your list of "must knows" for the test: atrial fibrillation, atrial flutter, multifocal atrial tachycardia, heart blocks, ventricular fibrillation, torsades de pointes, WPW, ventricular tachycardia, PVCs, SVT, nodal tachycardia, sinus tachycardia, pericarditis, and digoxin toxicity.
COMLEX insight: Remember that abdominal ultrasound is the preferred screening test for both choledocholithiasis and cholecystitis, however ERCP is the best test to confirm choledocholithiasis, whereas, HIDA scanning is ideal for confirming cholecystitis. Also note that pancreatitis is a frequent complication of ERCP.
