Heart sounds on Step 1

[21385]

can anyone comment on the difficulty of heart sounds on the recent Step 1s -- are they clear, can you answer them without listening? They don't appear on the NBMEs. In addition, what's a good resource for these?

Thanks!

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[operaman]

This is an evolving issue for the NBME. On mine, I had 2 media questions - both heart sounds - and you could not reliably answer the question based on the vignette alone. You could make an educated guess and probably guess right, but the sound should really help you confirm or refute your suspicion.

Both of mine were fairly difficult -- no straightforward cresc-decresc at the RUSB for me! One was incredibly difficult and took me a long time to figure out what was going on. The sound was actually a very subtle finding that I thought I was just imagining, so I answered based only on the vignette and probability given that info and got it right. The other I can't remember, but don't recall struggling much at all with it.

Don't forget, none of these will be "what sound is this," but rather they'll want you make the diagnosis Tricuspid regurg from the exam, connect that with IVDA, and then the question might ask about other steps in management (HIV test, etc) or other expected clinical findings or most likely organism (staph aureus) etc.

 

[FIREitUP]

i had 3 heart sounds. one i basically had to figure it out by the sound (insufficient info from vignette); i vaguely remember the other two. they were actually quite challenging

 

[Wordead]

The tests are moving away from super easy questions that can be answered without the pathology picture, the heart sound, etc. I had 4 heart sounds, 2 of which were just "what is this" and the 1 with a marginally useful history. I also had 2 12-lead EKGs to interpret (one which was totally normal and drove me batshti crazy).

So yeah, learn that stuff. It'll help on wards anyway.

 

[sashen]

i had 2 heart sounds questions in my test (on 06/03)...
one of them was super easy once you heard the media; it was a classic murmur - though the vignette had no specific clues; the other one - the vignette did have some classic symptoms but the heart sounds were very subtle and confusing. I really could not figure out in which area it was the loudest.

and yeah... i had a crazy 12 lead ekg question... and i'm not talking about the classic MI ekg

 

[hardee17]

i had 2 heart sounds questions in my test (on 06/03)...
one of them was super easy once you heard the media; it was a classic murmur - though the vignette had no specific clues; the other one - the vignette did have some classic symptoms but the heart sounds were very subtle and confusing. I really could not figure out in which area it was the loudest.

and yeah... i had a crazy 12 lead ekg question... and i'm not talking about the classic MI ekg

Axis deviation?

 

[sashen]

i tend to over think questions - so it might be all made up by my mind. it was not a straight up st elevation ekg though. more like a first degree block. i'm not sure i should discuss the question more - for obvious reasons. suffice to say, you need to know ekg basics for step 1

 

[Boysforlife]

what is the best way to distinguish between the different heart murmur sounds? Although I have the murmur pro app from the app store it is still difficult to distinguish the murmurs.

 

[anbuitachi]

they were hard as hell!!

 

[NeuroLAX]

Axis deviation?

Wouldn't that be kind of an easy question?