Need advice on murmurs

[johndoe3344]

Do you think that MOST murmur questions to be encountered on the real thing can be deduced from the question stem without listening to the murmur? I've noticed that I was able to deduce most of them in Rx but not in UW (I think I'm currently 0/4 for those).

If not, how long would you guys think it would take to learn to be able to hear the murmurs?My exam is in 3.5 weeks, and I'm not sure I want to commit many days to learn them as I'm absolutely horrible at them, and I cannot distinguish between murmurs for the life of me. They all sound the same to me.

If you guys feel that this is something can be learned relatively quickly, do you have any good websites for them?

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[shan564]

Do you think that MOST murmur questions to be encountered on the real thing can be deduced from the question stem without listening to the murmur? I've noticed that I was able to deduce most of them in Rx but not in UW (I think I'm currently 0/4 for those).

DIT says that you'll be able to figure them all out with fair certainty from the stem.

If not, how long would you guys think it would take to learn to be able to hear the murmurs?My exam is in 3.5 weeks, and I'm not sure I want to commit many days to learn them as I'm absolutely horrible at them, and I cannot distinguish between murmurs for the life of me. They all sound the same to me.

You can get audio clips of heart sounds fairly easily. If you spend a couple of hours listening to them, that should help you out. For Step 1, you only need to recognize a couple of things:

1. Which period is systole and which period is diastole (systole is the shorter period, diastole is the longer period)... I'm assuming that you'll be able to hear the two beats that separate the two periods.

2. What a murmur sounds like (hint: "woosh" or "poof").

3. What a click sounds like (although this one is less important).

With those two pieces of knowledge, you should be able to figure out whether a murmur is systolic or diastolic. That's the only piece of information that you'll need to extract from the heart sounds.

When you know whether the murmur is systolic or diastolic, you can figure out what it is based on its location. This point is all about reasoning your way through the anatomy/physiology of the heart and really doesn't have anything to do with your auscultation skills. First Aid 2012 has a nice little one-page high-yield summary in the cardiac physiology section.

 

[lemonade90]

There is a short chapter on murmurs in Lilly 5th edition. It helps you reason what they are so you need minimal memorization. You can read it if you have time.

 

[mdeast]

DIT says that you'll be able to figure them all out with fair certainty from the stem.


You can get audio clips of heart sounds fairly easily. If you spend a couple of hours listening to them, that should help you out. For Step 1, you only need to recognize a couple of things:

1. Which period is systole and which period is diastole (systole is the shorter period, diastole is the longer period)... I'm assuming that you'll be able to hear the two beats that separate the two periods.

2. What a murmur sounds like (hint: "woosh" or "poof").

3. What a click sounds like (although this one is less important).

With those two pieces of knowledge, you should be able to figure out whether a murmur is systolic or diastolic. That's the only piece of information that you'll need to extract from the heart sounds.

When you know whether the murmur is systolic or diastolic, you can figure out what it is based on its location. This point is all about reasoning your way through the anatomy/physiology of the heart and really doesn't have anything to do with your auscultation skills. First Aid 2012 has a nice little one-page high-yield summary in the cardiac physiology section.

I think it's pretty easy to be honest. They apparently have a virtual patient and you can move the stethoscope around on them on the exam. Sort of like the one in Kaplan's QBank- only you have control over it.

The murmur will be really distinct in one area of the chest. I.e. it's not going to be hard to figure out what valve is the one that is messed up. So memorize valve locations. Though, as a medical student I can't imagine you don't already know this.

From there all you really have to do is figure it out is the murmur is in diastole or systole. I.e. if it's over the aorta...it's either stenosis or regurg. Even if you don't really know what those sound like, you can figure it out from just knowing if it's in diastole or systole.

You might get into some more complicated things like Prolapse vs. Regurgitation, but usually the Step murmurs questions aren't meant to be that tricky. Also know your S3/S4's. If it's a child, you're almost immediately thinking PDA or VSD.

They also apparently provide a video of a real patient. So...for instance, if you notice bounding neck pulses you might think aortic regurgitation etc. As long as you know the typical presentations of each and what factors might excarcerbate them (i.e. Inspiration= right sided, Expiration=left sided, squatting, etc.). you should be golden.

 

[newdoc2013]

Do you think that MOST murmur questions to be encountered on the real thing can be deduced from the question stem without listening to the murmur? I've noticed that I was able to deduce most of them in Rx but not in UW (I think I'm currently 0/4 for those).

If not, how long would you guys think it would take to learn to be able to hear the murmurs?My exam is in 3.5 weeks, and I'm not sure I want to commit many days to learn them as I'm absolutely horrible at them, and I cannot distinguish between murmurs for the life of me. They all sound the same to me.

If you guys feel that this is something can be learned relatively quickly, do you have any good websites for them?

yes you can mostly figure them out from the stem - also the might show you on the chest where the stethoscope is auscultating and from that you can figure out which valve they're talking about eliminating a lot of the answer choices