Core Competencies for Rutgers New Jersey Medical School - RBHS

Access Medicine - CURRENT Medical Dx & Tx - Chapter 12. Blood Vessel & Lymphatic Disorders - Arterial Aneurysms - Aortic Dissection - Clinical Findings - Symptoms and Signs - Audio 12-1 - "Aortic regurgitation: The key features of aortic regurgitation are a blowing, early diastolic, decrescendo murmur, heard best over the upper left sternal border, with radiation to the cardiac apex. (Reproduced, with permission, from Cardionics, Inc., Houston, Texas.)."

123Sonography.com - Thomas Binder, MD, Medical University of Vienna - YouTube - Aortic Regurgitation Basics.

Access Medicine - Harrison's Principles of Internal Medicine Online - Chapter e29. Atlas of Noninvasive Cardiac Imaging - MRI/CT Images - Video e29-18 - Author(s): Rick A. Nishimura, Panithya Chareonthaitawee, and Matthew Martinez. "Cine MRI scan of a patient with a dilated ascending aorta (annulo-aortic ectasia). There is a central jet of aortic regurgitation entering the left ventricular outflow tract."

Access Medicine - CURRENT Medical Dx & Tx - Chapter 10. Heart Disease - Valvular Heart Disease - Aortic Regurgitation - Clinical Findings - Symptoms and Signs - Audio 10-20 - "Severe aortic regurgitation due to aortic valve endocarditis. Note the rough 3/6 mid-systolic murmur, then S2, a musical early diastolic murmur, and a mid-diastolic Austin-Flint murmur. (Reproduced, with permission, from T. Anthony Don Michael, MD: Mastering Auscultation [CD-ROM], McGraw-Hill, 2000.)."

The New England Journal of Medicine - Videos in Clinical Medicine - Arterial Puncture for Blood Gas Analysis. "Radial arterial puncture for arterial blood gas analysis is a common procedure performed in medicine. It is a fundamental skill that all medical trainees need to acquire. This video will review radial arterial puncture in the adult population." Arterial Puncture for Blood Gas Analysis Shelly P. Dev, M.D., Melinda D. Hillmer, M.D., BSc.Phm., and Mauricio Ferri, M.D. N Engl J Med 2011; 364:e7 February 3, 2011 DOI: 10.1056/NEJMvcm0803851

Access Medicine - Harrison's Principles of Internal Medicine - Author(s): Christian D. Becker, MD, PhD, FCCP, Mount Sinai Medical Center - Percutaneous Arterial Blood Gas Sampling.

Dalhousie University - Faculty of Medicine - YouTube - Introduction to Blood Cultures.

After accessing Bates' Visual Guide to Physical Examination Volumes 1-12 and following the directions found at the link above, select "Breasts and Axillae." A new menu will appear. Select "Examining Female Breasts" or "Examining Axillae." Watch the video that follows.

Access Medicine - Author(s): Richard LeBlond, MD, MACP - Examination of the Breasts and Nipple.

National Institutes of Health - National Eye Institute - NEI YouTube Videos: Cataracts - 1) NEI Animation: Cataract. 2) NEI: Cataract.

Access Medicine - Harrison's Principles of Internal Medicine - Author(s): Maria A. Yialamas, Anna Rutherford, and Lindsay King - Abdominal Paracentesis.

The New England Journal of Medicine - Videos in Clinical Medicine - Emergency Pericardiocentesis. "The use of emergency pericardiocentesis to aspirate fluid in patients with cardiac tamponade can be a lifesaving procedure that restores normal cardiac function and peripheral perfusion. This video demonstrates the procedure." Emergency Pericardiocentesis Michael T. Fitch, M.D., Ph.D., Bret A. Nicks, M.D., Manoj Pariyadath, M.D., Henderson D. McGinnis, M.D., and David E. Manthey, M.D. N Engl J Med 2012; 366:e 17March 22, 2012 DOI: 10.1056/NEJMvcm0907841

The New England Journal of Medicine - Videos in Clinical Medicine - Paracentesis - "Abdominal paracentesis is performed as a diagnostic procedure to establish the etiology of new-onset ascites or to rule out spontaneous bacterial peritonitis in patients with preexisting ascites. Large-volume paracentesis is performed in hemodynamically stable patients with tense or refractory ascites to alleviate discomfort or respiratory compromise." - Paracentesis Todd W. Thomsen, M.D., Robert W. Shaffer, M.D., Benjamin White, M.D., and Gary S. Setnik, M.D. N Engl J Med 2006; 355:e21 November 9, 2006 DOI: 10.1056/NEJMvcm062234

The New England Journal of Medicine - Videos in Clinical Medicine - Thoracentesis. "Thoracentesis is used diagnostically to establish the cause of a pleural effusion. It can also be performed to drain large effusions that lead to respiratory compromise." Thoracentesis Todd W. Thomsen, M.D., Jennifer DeLaPena, M.D., and Gary S. Setnik, M.D. N Engl J Med 2006; 355:e16 October 12, 2006 DOI: 10.1056/NEJMvcm053812

Access Medicine - Harrison's Principles of Internal Medicine - Author(s): Charles A. Morris, Andrea Wolf - Thoracentesis.

"These tutorials teach medical students and residents basic and more advanced Radiologic imaging including CT, US, MRI and Nuclear Medicine. Anatomy, the current menu of Radiologic tests utilized, a detailed approach to evaluating images, and the typical Radiologic presentation of common abnormalities are emphasized. The tutorials are voiced over and the answers to questions are formally tracked so that the user can assess his or her own progress. To view related teaching materials, please see eradiology.harvard.bidmc.edu." By: Gillian Lieberman, MD.

University of Virginia Health Sciences Center - Department of Radiology - Introduction to Chest Radiology. "This web site is intended as a self-tutorial for residents and medical students to learn to interpret chest radiographs with confidence. Technique, normal anatomy and common pathology are presented. Quizzes are provided for practice and self-assessment." By: Spencer B. Gay, M.D., Juan Olazagasti, M.D., Jack W. Higginbotham, M.D., Atul Gupta M.D., Alex Wurm M.D., Jonathan Nguyen M.D. Department of Radiology - University of Virginia Health Sciences Center.

Olympia Eye Clinic - Olyeye.com - Rodger Bodoia, MD, PhD - YouTube - Understanding Nonproliferative Diabetic Retinopathy.

Olympia Eye Clinic - Olyeye.com - Rodger Bodoia, MD, PhD - YouTube - Understanding Proliferated Diabetic Retinopathy.

University of Wisconsin - Department of Medicine and Public Health - Department of Family Medicine - Electrocardiogram (ECG) Course 1. Play video found on this webpage. By: Melissa Stiles MD, Dean Keller, MD. Dr. Dean Keller and Dr. Melissa Stiles discuss the basics of electrocardiogram (ECG) interpretation.

University of Wisconsin - Department of Medicine and Public Health - Department of Family Medicine - Electrocardiogram (ECG) Course 2. Play video found on this webpage. By: Melissa Stiles MD, Dean Keller, MD. Dr. Dean Keller and Dr. Melissa Stiles continue to discuss the basics of electrocardiogram (ECG) interpretation.

Please see the directions on how to view this resource found at the following link: http://libraries.rbhs.rutgers.edu/newarklib/PDF/BatesVideowithIE.pdf. After accessing Bates' Visual Guide to Physical Examination Volumes 1-12 and following the directions found at the link above, select "Male Genitalia, Hernias, Rectum, and Prostate." A new menu will appear. Select "Examining the Male Anus, Rectum, and Prostate Gland." Watch the video that follows. When you are finished watching this video, exit the window in which the video was playing. Click on the screen where is says "Click to Access Menu." Select from the drop-down menu in the upper-right corner of the screen "Female Genitalia, Anus, and Rectum." A new menu will appear. Select "Examining the Anus and Rectum." Watch the video that follows.

Access Medicine - DeGowin's Diagnostic Examination - Chapter 9. The Abdomen, Perineum, Anus, and Rectosigmoid - Physical Examination of the Abdomen - Examination of the Anus and Rectum - Author(s): Richard LeBlond.

The New England Journal of Medicine - Videos in Clinical Medicine - Female Urethral Catheterization - "Female urethral catheterization, the insertion of a catheter through the urethra into the urinary bladder to permit drainage of urine, is a fundamental skill for the practicing health care professional. This video discusses the indications for catheterization, the equipment available, the current methods of catheter insertion and maintenance, potential complications, and how to troubleshoot common problems." - Female Urethral Catheterization Rafael Ortega, M.D., Linda Ng, M.D., Pavan Sekhar, B.S., and Michael Song, M.A. N Engl J Med 2008; 358:e15 April 3, 2008 DOI: 10.1056/NEJMvcm0706671

Access Medicine - Harrison's Principles of Internal Medicine - Insertion of Female Urethral Catheter - Author(s): Jeffrey A. Stock, MD, and Ardavan Akhavan, MD.

Access Medicine - Harrison's Principles of Internal Medicine - Insertion of Male Urethral Catheter - Author(s): Jeffrey A. Stock, MD and Ardavan Akhavan, MD.

The New England Journal of Medicine - Videos in Clinical Medicine - Male Urethral Catheterization - "Urethral catheterization may be performed as either a therapeutic or a diagnostic procedure. Therapeutically, catheters may be placed to decompress the bladder in patients with acute or chronic urinary retention. In addition, catheters may be placed to facilitate bladder irrigation in patients with gross hematuria. Diagnostically, urinary catheters may be placed to obtain an uncontaminated urine sample for microbiologic testing, to measure urinary output in critically ill patients or during surgical procedures, or to measure post-void residuals. The only absolute contraindication to urethral catheterization is known or suspected urethral injury, usually in the setting of a pelvic fracture." - Male Urethral Catheterization Todd W. Thomsen, M.D., and Gary S. Setnik, M.D. N Engl J Med 2006; 354:e22 May 25, 2006 DOI: 10.1056/NEJMvcm054648

YouTube - Hypertensive Retinopathy.

Access Medicine - Harrison's Online - IV Insertion - Author(s): Sean Sadikot, MD, Pulmonary Fellow, Department of Medicine, Mount Sinai Medical Center.

The New England Journal of Medicine - Videos in Clinical Medicine - Peripheral Intravenous Cannulation - "The ability to obtain peripheral intravenous access is an essential skill for all physicians. Although considered one of the simplest invasive procedures, mastering this potentially lifesaving intervention requires refined skills and experience. Cannulating a vein, particularly a small one, can be challenging. The purpose of this video is to demonstrate how to access peripheral veins using an intravenous catheter." - Peripheral Intravenous Cannulation Rafael Ortega, M.D., Pavan Sekhar, M.D., Michael Song, M.D., Christopher J. Hansen, B.A., and Lauren Peterson N Engl J Med 2008; 359:e26 November 20, 2008 DOI: 10.1056/NEJMvcm0706789

The New England Journal of Medicine - Videos in Clinical Medicine - Ultrasound-Guided Peripheral IV Placement - "Placement of peripheral intravenous (IV) catheters is a fundamental skill that all health care professionals should possess. Unfortunately, it can be difficult to obtain IV access in some patients, including obese patients, children, and patients who have undergone placement of many IVs or who have a history of difficult IV access. Ultrasound guidance enables visualization of veins that are not apparent on physical examination." - Ultrasound-Guided Peripheral IV Placement Scott Joing, M.D., Seth Strote, M.D., Liberty Caroon, R.D.M.S., Christopher Wall, M.D., Jamie Hess, M.D., Chad Roline, M.D., Laura Oh, M.D., Ben Dolan, B.A., Robb Poutre, Kathleen Carney, R.N., David Plummer, M.D., and Robert Reardon, M.D. N Engl J Med 2012; 366:e38 June 21, 2012 DOI: 10.1056/NEJMvcm1005951

Access Medicine - Harrison's Principles of Internal Medicine - Endotracheal Intubation - Author(s): Charles A. Morris and Emily Nelson Maher.

The New England Journal of Medicine - Videos in Clinical Medicine - Fiberoptic Intubation - "Fiberoptic intubation plays an important part in the management of a difficult airway and is recommended by many societies of anesthesia. It is primarily important for the management of the anticipated difficult airway, but can also be used to secure the airway in an unexpected situation. There are different techniques for both situations -- the nasal and oral approach in the awake and anesthetized status, respectively. The choice of the equipment and medication is primarily dependent on personal preference." - Fiberoptic Intubation Thomas Heidegger, M.D. N Engl J Med 2011; 364:e42 May 19, 2011 DOI: 10.1056/NEJMvcm0906443

The New England Journal of Medicine - Videos in Clinical Medicine - Nasogastric Intubation - "Common indications for nasogastric intubation include decompression of the GI tract in patients with bowel obstruction and gastric emptying in intubated patients to prevent aspiration. NG tubes may be placed as an adjunct for the delivery of oral agents, such as activated charcoal or oral radiographic contrast medium. NG tubes are often placed in patients with suspected upper GI hemorrhage. However, the sensitivity and negative predictive value of nasogastric aspirates for detecting active bleeding is suboptimal, and the absence of bloody return cannot be relied upon to rule out hemorrhage." - Nasogastric Intubation Todd W. Thomsen, M.D., Robert W. Shaffer, M.D., and Gary S. Setnik, M.D. N Engl J Med 2006; 354:e16 April 27, 2006 DOI: 10.1056/NEJMvcm050183

The New England Journal of Medicine - Videos in Clinical Medicine - Orotracheal Intubation - "Emergency orotracheal intubation is indicated in any situation in which definitive control of the airway is needed. Specific indications include cardiac or respiratory arrest, failure to protect the airway from aspiration, inadequate oxygenation or ventilation, and impending or existing airway obstruction. Orotracheal intubation is also commonly performed as part of the care of the critically ill patient with multisystem disease or injuries, and to facilitate control of the airway during surgical procedures requiring general anesthesia." - Orotracheal Intubation Christopher Kabrhel, M.D., Todd W. Thomsen, M.D., Gary S. Setnik, M.D., and Ron M. Walls, M.D. N Engl J Med 2007; 356:e15 April 26, 2007 DOI: 10.1056/NEJMvcm063574

The New England Journal of Medicine - Videos in Clinical Medicine - Lumbar Puncture. "This video will demonstrate safe and successful methods of performing lumbar puncture. Lumbar puncture is indicated for both diagnostic and therapeutic purposes. Also, the administration of spinal and epidural anesthesia involves the use essentially of the same technique. Analysis of cerebrospinal fluid may be helpful in the diagnosis of infectious processes such as meningitis, inflammatory diseases such as multiple sclerosis, cancers such as leukemia, and metabolic processes. Therapeutically, lumbar puncture allows for the intrathecal administration of chemotherapeutic agents and antibiotics." Lumbar Puncture Miles S. Ellenby, M.D., Ken Tegtmeyer, M.D., Susanna Lai, M.P.H., and Dana A.V. Braner, M.D. N Engl J Med 2006; 355:e12 September 28, 2006 DOI: 10.1056/NEJMvcm054952

Access Medicine - Harrison's Online - Chapter 265. Atlas of Noninvasive Cardiac Imaging - Echocardiographic Images - Video e29-6a - Author(s): Rick A. Nishimura, Panithya Chareonthaitawee, and Matthew Martinez - "Real-time two-dimensional echocardiographic images from the parasternal long-axis view of a patient with mitral valve prolapse. During systole, both anterior and posterior leaflet of the mitral valve prolapse into the left atrium. A. Gray-scale images demonstrate a leaflet morphology and motion. Abnormalities of the valve apparatus such as annular dilatation, prolapse, flail leaflets, vegetation, and rheumatic involvement can be diagnosed by two-dimensional echocardiography. The left ventricular response to volume overload can be assessed by two-dimensional echocardiography."

Access Medicine - Harrison's Online - Chapter 265. Atlas of Noninvasive Cardiac Imaging - Echocardiographic Images - Video e29-6B - Author(s): Rick A. Nishimura, Panithya Chareonthaitawee, and Matthew Martinez - "Real-time two-dimensional echocardiographic images from the parasternal long-axis view of a patient with mitral valve prolapse. During systole, both anterior and posterior leaflet of the mitral valve prolapse into the left atrium. B. Color flow imaging demonstrating late systolic blue-colored jet of mitral regurgitation. Abnormalities of the valve apparatus such as annular dilatation, prolapse, flail leaflets, vegetation, and rheumatic involvement can be diagnosed by two-dimensional echocardiography. The left ventricular response to volume overload can be assessed by two-dimensional echocardiography."

Access Medicine - CURRENT Medical Dx & Tx - Chapter 10. Heart Disease - Signs of Heart Disease - Heart Sounds & Murmurs - Audio 10–8 - (Reproduced, with permission, from T. Anthony Don Michael, MD: Mastering Auscultation [CD-ROM], 2000.) - "Mitral valve prolapse with S1, non-ejection click, late systolic murmur, and S2."

Duke University School of Medicine - Department of Anesthesiology - YouTube - Mitral Valve Prolapse and Mitral Regurgitation - "Mitral valve prolapse and consequent mitral valve regurgitation is seen during TEE examination in a patient undergoing mitral valve repair. The P2 scallop of the posterior mitral leaflet is seen as prolapsed with a flail chord. Color Doppler shows a mitral regurgitant jet."

Access Medicine - Harrison's Online - Chapter e29. Atlas of Noninvasive Cardiac Imaging - Echocardiographic Images - Video e29-5a - Author(s): Rick A. Nishimura, Panithya Chareonthaitawee, and Matthew Martinez - "Real-time two-dimensional echocardiographic images of a patient with mitral stenosis. There is diastolic doming and restricted leaflet opening secondary to fusion of the commissures. A. Parasternal long-axis view."

Access Medicine - Harrison's Online - Chapter e29. Atlas of Noninvasive Cardiac Imaging - Echocardiographic Images - Video e29-5b - Author(s): Rick A. Nishimura, Panithya Chareonthaitawee, and Matthew Martinez - "Real-time two-dimensional echocardiographic images of a patient with mitral stenosis. There is diastolic doming and restricted leaflet opening secondary to fusion of the commissures. B. Parasternal short-axis view."

Access Medicine - CURRENT Medical Dx & Tx - Chapter 10. Heart Disease - Valvular Heart Disease - Mitral Stenosis - Treatment & Prognosis - Video 10-10 - Courtesy of T Amidon and T Chou - "Percutaneous transvenous mitral commissurotomy (PTMC) with Inoue balloon catheter. The balloon inflates distally and then proximally to allow proper positioning across the mitral valve. The mean pressure gradient across the mitral valve is proportionate to the area between the pressure curves and is markedly reduced after PTMC."

123Sonography.com - Thomas Binder, MD, Medical University of Vienna - YouTube - Mitral Stenosis Basics.

Access Medicine - CURRENT Medical Dx & Tx - Chapter 10. Heart Disease - Valvular Heart Disease - Mitral Stenosis - Clinical Findings - Symptoms and Signs - Audio 10–15 - Reproduced, with permission, from T. Anthony Don Michael, MD: Mastering Auscultation [CD-ROM], McGraw-Hill, 2000.) - "Moderate mitral stenosis with a typical presystolic murmur, loud S1, and S2 followed by a late opening snap and soft, barely audible mid-diastolic murmur."

Access Medicine - CURRENT Medical Dx & Tx - Chapter 10. Heart Disease - Valvular Heart Disease - Mitral Stenosis - Clinical Findings - Diagnostic Studies - Video 10-8 - Courtesy of B Macrum and E Foster - "Rheumatic mitral stenosis with mitral regurgitation."

CURRENT Medical Dx & Tx - Chapter 10. Heart Disease - Valvular Heart Disease - Mitral Stenosis - Clinical Findings - Diagnostic Studies - Video 10-9 - Courtesy of B Macrum and E Foster - Rheumatic mitral stenosis.

The New England Journal of Medicine - Videos in Clinical Medicine - Diagnosing Otitis Media - Otoscopy and Cerumen Removal - "Pneumatic otoscopy and cerumen removal will be discussed in this video. Mastery of otoscopic examination techniques is necessary for the accurate diagnosis of otitis media. Otitis media is a general term for middle-ear inflammation and may be classified clinically as either acute otitis media or otitis media with effusion. In general, acute otitis media is diagnosed when the tympanic membrane is bulging, and otitis media with effusion is diagnosed when the tympanic membrane is neutral or retracted." - Diagnosing Otitis Media - Otoscopy and Cerumen Removal Nader Shaikh, M.D., M.P.H., Alejandro Hoberman, M.D., Phillip H. Kaleida, M.D., Dianna L. Ploof, Ed.D., and Jack L. Paradise, M.D. N Engl J Med 2010; 362:e62 May 20, 2010 DOI: 10.1056/NEJMvcm0904397

The New England Journal of Medicine - Videos in Clinical Medicine - Tympanocentesis in Children with Acute Otitis Media - "Tympanocentesis is defined as needle aspiration of fluid from the middle ear. In children with acute otitis media, drainage of pus from the middle ear results in a rapid and marked improvement in symptoms and enables the clinician to prescribe tailored antimicrobial therapy. This video will demonstrate the technique of tympanocentesis." - Tympanocentesis in Children with Acute Otitis Media Nader Shaikh, M.D., M.P.H., Alejandro Hoberman, M.D., Diana H. Kearney, R.N., C.C.R.C., and Robert Yellon, M.D. N Engl J Med 2011; 364:e4 January 13, 2011 DOI: 10.1056/NEJMvcm0706756

After accessing Bates' Visual Guide to Physical Examination Volumes 1-12 and following the directions found at the link above, select "Thorax and Lungs." A new menu will appear. Select "Normal and Adventitious Breath Sounds." Watch the video that follows.

Access Medicine - CURRENT Medical Dx & Tx - Chapter 9. Pulmonary Disorders - Pleural Diseases - Pleural Effusion - Clinical Findings - Symptoms and Signs - Audio 9–13 - Reproduced, with permission, from Raymond L.H. Murphy, Jr., MD: A Simplified Introduction to Lung Sounds [audio tape], 1977 - "Lung sound: pleural friction rub. Note that it is heard in both inspiration and expiration and that it has both continuous and discontinuous portions."

YouTube - Whispered Pectoriloquy Examination.

YouTube - Whispered Pectoriloquy Sounds.

After accessing Bates' Visual Guide to Physical Examination Volumes 1-12 and following the directions found at the link above, select "Cardiovascular System." A new menu will appear. Select "Heart Sounds, Auscultation of Heart Sounds, Attributes of Grading Murmurs, or Auscultation of Murmurs." Watch the video that follows.

Access Medicine - CURRENT Medical Dx & Tx - Chapter 10. Heart Disease - Coronary Heart Disease (Atherosclerotic CAD, Ischemic Heart Disease) - Acute Myocardial Infarction with ST Segment Elevation - Clinical Findings - Signs - Heart - Audio 10–23 - Reproduced, with permission, from T. Anthony Don Michael, MD: Mastering Auscultation [CD-ROM], 2000 - "Viral pericarditis with effusion and pericardial friction rub. Note the three component rub, two in diastole, and one in systole."

YouTube - S3 and S4 Heart Murmur Sounds.

Centers for Disease Control and Prevention - YouTube - PPD Training Part 1.

Centers for Disease Control and Prevention - YouTube - PPD Training Part 2.

Centers for Disease Control and Prevention - YouTube - PPD Training Part 3.

Access Medicine - Harrison's Online - Phlebotomy - Author(s): Jeremy Matloff, MD.