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Valvular Heart Disease and Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Kali Polytarchou, Constantina Aggeli
Severe MS manifests as dyspnea, orthopnea, paroxysmal postural dyspnea, cough and hemoptysis, palpitations, and fatigue. Hoarseness as a result of laryngeal nerve pressure by the enlarged LA can ensue. Typically, symptoms worsen under high-output conditions. MS can also manifest as angina, thromboembolism, respiratory infections, or infective endocarditis. On auscultation, there is loud S1, wide-split S2, and an opening snap. Unless the patient is in AF, a mid-to-late diastolic rumble with presystolic accentuation is best heard at the apex. As severity increases, the murmur becomes longer. ECG may reveal “mitrale” P waves, signs of RV hypertrophy, and AF. Chest radiograph may reveal straightening of left cardiac border, double density sign of right cardiac, upper zone venous enlargement, or pulmonary edema.39
Cardiovascular system
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Redmond P Tully, Robert Turner
High-pitched pansystolic murmur loudest at the apex, radiating to the axilla, louder on expiration. S1 is classically soft, but may be preserved in mixed rheumatic disease or MVP. Widely split S2 in severe MR, +/– audible S3 and S4.
What faculty write versus what students see? Perspectives on multiple-choice questions using Bloom’s taxonomy
Published in Medical Teacher, 2021
Seetha U. Monrad, Nikki L. Bibler Zaidi, Karri L. Grob, Joshua B. Kurtz, Andrew W. Tai, Michael Hortsch, Larry D. Gruppen, Sally A. Santen
We hypothesize that the discrepancy between student and faculty categorizations arises for two reasons: (1) the use of different clinical reasoning strategies based on different underlying knowledge by the two groups, as described above, and (2) the impact of pedagogy (instruction). Kern and Thomas’s framework for curriculum development emphasizes the interrelatedness of all elements in the instruction - learning - assessment cycle (Kern 2009). Assessments must be matched not only to learning objectives but also to instructional strategies. For example, how to assess a learning objective such as “Differentiate between a physiologic split S2 and a pathophysiologic S3” will depend on whether the students learn this distinction through review of text descriptions or via auscultation of different heart sounds. How faculty design curriculum and associated assessments may differ from how students experience them, depending on students’ approaches to learning and faculty/learner choice of educational strategies. For example, some items might be drawn directly from a point made explicitly in lecture, with the lecturer occasionally stating that students “should know this for the exam”; these items would therefore be categorized as lower-order, even if the question was designed to be higher-order.