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MurmurQuiz

MurmurQuiz is designed to help students of cardiac auscultation learn by listening to actual cases. You will be able to listen to heart sounds then answer 4 basic questions about each case: 1) is the case likely normal, normal with innocent murmur, or abnormal, 2) if abnormal, what findings are abnormal, 3) what specific description of the findings is most likely, and 4) what specific diagnosis is most likely. You will be scored on each of these questions and will thus be able to follow your progress as you improve in each area.

We believe competent auscultation involves accurate listening, understanding of the key findings, and correct association of those key findings with a likely diagnosis. This quiz is designed to help you with each of these aspect of auscultation. The general quiz does not include any patient history, as we want the learner to focus on listening without other cues. However, auscultation is practiced in reality as part of a complete evaluation which includes taking a good history and performing a complete examination, all of which goes into forming a diagnosis. We provide a search feature to allow the user to find cases that include history along with the sounds. Teachers of auscultation can request an additional level of access to the site to be able to create learning sets of the cases and custom quizzes that can also include history elements to use with their trainees (please contact us for further details).

Background

MurmurQuiz uses cases from the Cardiac Auscultatory Recording Database (CARD), found in our website. In July 1997, we began recording and storing digitized heart sounds and clinical data on patients having an echocardiogram done in the Pediatric Cardiology Echocardiography Laboratory at the Johns Hopkins Outpatient Center. To date we have collected over 5000 individual recordings from over 1000 cardiology clinic visits by more than 900 different patients. The primary data files have been post processed into over 100,000 related sound files of 20 seconds duration each, in three different formats. An additional ~14,000 related image files depicting phonocardiograms, spectrograms, and 12-lead electrocardiograms from this patient population has also been collected in the database. Patients range in age from 1 day old to 80 years. Approximately 25% of the patients have no detectable heart disease by echocardiogram, with roughly 25% of these "normals" having at least one "innocent" heart murmur. Among the other patients with an abnormal echocardiogram, a wide range of diagnoses is represented, including these common congenital lesions: tetralogy of Fallot, atrial septal defects, common atrio-ventricular canal, mitral regurgitation, ventricular septal defects, coarctation of the aorta, bicuspid aortic valve, aortic stenosis, aortic regurgitation, mitral stenosis, mitral valve prolapse, pulmonary stenosis, idiopathic hypertrophic subaortic stenosis, patent ductus arteriosus.

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