Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. Specifically, the sounds reflect the turbulence created when the heart valves snap shut. In cardiac auscultation, an examiner may use a stethoscope to listen for these unique and distinct sounds that provide important auditory data regarding the condition of the heart. In healthy adults, there are two normal heart sounds often described as a lub and a dub (or dup), that occur in sequence with each heartbeat. These are the first heart sound (S1) and second heart sound (S2), produced by the closing of the atrioventricular valves and semilunar valves, respectively. In addition to these normal sounds, a variety of other sounds may be present including heart murmurs, adventitious sounds, and gallop rhythms S3 and S4. Heart murmurs are generated by turbulent flow of blood, which may occur inside or outside the heart. Murmurs may be physiological (benign) or pathological (abnormal). Abnormal murmurs can be caused by stenosis restricting the opening of a heart valve, resulting in turbulence as blood flows through it. Abnormal murmurs may also occur with valvular insufficiency (regurgitation), which allows backflow of blood when the incompetent valve closes with only partial effectiveness. Different murmurs are audible in different parts of the cardiac cycle, depending on the cause of the murmur.

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A subdural hematoma is a collection of blood outside the brain. Subdural hematomas are usually caused by severe head injuries. The bleeding and increased pressure on the brain from a subdural hematoma can be life-threatening.

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Dr. Shaun Kunisaki is an Associate Professor of Surgery at The Johns Hopkins University and Associate Chief of Strategy and Integration in the Division of General Pediatric Surgery at the Johns Hopkins Children's Center. His clinical practice spans the full breadth of pediatric general surgery, but he is recognized both regionally and nationally for this expertise in complex thoracic surgical problems in the fetus and young child. As Director of Pediatric Esophageal Surgery, he specializes in the management of long-gap esophageal atresia. In this role within the Johns Hopkins Children Center Fetal Program, he helps counsel parents with pregnancies complicated by fetal anomalies.

Learn more about Dr. Kunisaki at https://www.hopkinsmedicine.or....g/profiles/results/d

MRCPCH Clinical Revision - more videos at http://mrcpch.paediatrics.co.uk

Revise for your MRCPCH Clinical exam, with videos and high quality content created by the London Paediatrics Trainees Committee.

Video Credits: Dr Caroline Fertleman, Dr Hermione Race, Dr Camilla Sen, Dr Chloe Macaulay, Dr Emma McLaren, Chris Knapp

irregular, curved toenails. footwear that places a lot of pressure on the big toes, such as socks and stockings that are too tight or shoes that are too tight, narrow, or flat for your feet. toenail injury, including stubbing your toe, dropping something heavy on your foot, or kicking a ball repeatedly. poor posture.

Lower Limb Physical Examination

This video demonstrates the Retrograde Wire Intubation

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Spinal stenosis can put pressure on the spinal cord and the nerves within the spine. It commonly occurs in the neck and lower back. The condition is often caused by age-related wear and tear. Symptoms, if they occur, include pain, numbness, muscle weakness, and impaired bladder or bowel control. Treatment includes medication, physical therapy, and possibly surgery

Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a category of cancer treatment that uses chemical substances, especially one or more anti-cancer drugs (chemotherapeutic agents) that are given as part of a standardized chemotherapy regimen.

There are three main types of lung cancer. Knowing which type you have is important because it affects your treatment options and your outlook (prognosis). If you aren’t sure which type of lung cancer you have, ask your doctor so you can get the right information.

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Marfan syndrome is a genetic disorder that affects the body's connective tissue. Connective tissue holds all the body's cells, organs and tissue together. It also plays an important role in helping the body grow and develop properly. Connective tissue is made up of proteins.

Devi Shetty, founder of Narayana Health in India, reflects on the remarkable fact that, after 26 years of operation, the cost of heart surgery at Narayana Health has come down dramatically, and shares some of the strategies used to maintain high quality with low patient cost.

Learn more about the Creating Emerging Markets Project and explore its many compelling interviews: https://www.hbs.edu/creating-e....merging-markets/Page