Advanced Learning Objectives

The advanced learning objectives are designed to be covered in an advanced, clinical physical diagnosis course, generally by 3rd and/or 4th year medical school students in conjuction with on-going clinical training.
Basic learning objectives should be mastered before moving onto advanced learning objectives.

1. Demonstrate the following aspects of the physical exam:
1. Auscultation in the left lateral decubitus position for S3 and S4, and in the sitting upright with forward lean for aortic insufficiency.
2. Describe typical history and physical related to:
1. hypertension (asymptotic, diastolic BP >90 mmHg, systolic BP >150 mmHg)
2. angina pectoris (chest pain)
3. acute myocardial infarction (chest pain)
4. congestive heart failure (dyspnea and edema)
5. heart block (irregular heart beat)
3. Describe the precordial location and timing of murmurs and other heard sounds due to:
1. aortic insufficiency (regurgitation)
2. atrial fibrillation
3. atrial septal defect
4. bigeminy
5. coarctation of the aorta
6. ebstein's abnormality
7. ejection click
8. mitral stenosis
9. patent ductus arteriosus
10. pericardial friction rub
11. pulmonic insufficiency (regurgitation)
12. pulmonary stenosis
13. quadruple gallop (at rates of ~40, ~55, and ~100 beats per minute)
14. s3
15. s4
16. split S1
17. split S2
18. split S1 with split S2
19. summation gallop
20. systolic murmur (early)
21. systolic murmur (late)
22. systolic murmur (pansystolic)
23. tricuspid insufficiency (regurgitation)
24. tricuspid stenosis
25. ventricular septal defect
26. venus hum
4. Know the physiological processes and clinical correlation of an S3 and S4.

(18 December 2008)
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