2013 Archive

Stanford Medicine 25 Blog

  • Using Google Glass to Examine the Hand with Dr. Verghese

    Watch this video to get a first-person perspective of the Examination of the Hand with Abraham Verghese.


  • Patient has this new skin finding, what should you worry about?

    This patient has livedo reticularis. This can be a sign of severe bacteremia and possible sepsis. This patient was later diagnosed with bacterial pneumonia, bacterial meningitis and later grew streptococcal pneumonia in his blood. He was treated in the ICU and recovered fully a week later.


  • Stanford 25: Approach to Tremor

    In this video, we aim to provide you an overview of the approach your patient with tremor.


  • Congratulations to our ACP Winners!

    This past weekend our Stanford residents took first place in the medical jeopardy contest and clinical vignette poster contest! We finished second in the research & quality improvement poster contest!…


  • 11 Facts About Sir William Osler

    Osler was one of four professors whose names are associated with the founding of the Johns Hopkins.


  • Happy Halloween! So this is the scariest picture we’ve got! What is it?

    It’s just a solitary keratoacanthoma (KA). A keratoacanthoma represents a proliferation of the squamous layer of the skin. Some doctors believe this to represent a spectrum of squamous carcinoma of the skin.


  • An interesting illustration of the physical exam

    An article was recently published in the Annals of Internal Medicine using a cartoon to illustrate a doctor’s haunting history of misdiagnosis in a patient with respiratory distress. The article highlights the cause of this misdiagnosis from missing the physical exam finding.


  • If you put your stethoscope over this, what will you hear?

    A thyroid bruit is described as a continuous sound that is heard over the thyroid mass. (If you only hear something during systolic, think about a carotid bruit or radiating cardiac murmur.) A thyroid bruit is seen in Grave’s disease from a proliferation of the blood supply when the thyroid enlarges.


  • The History of Pulsus Paradoxus

    A thyroid bruit is described as a continuous sound that is heard over the thyroid mass. (If you only hear something during systolic, think about a carotid bruit or radiating cardiac murmur.) A thyroid bruit is seen in Grave’s disease from a proliferation of the blood supply when the thyroid enlarges.


  • A patient presents with foot pain and these chronic findings?

    This is a patient with chronic tophaceous gout likely presenting with an acute gout attack of the foot. The enlarged and often inflamed fingers (dactylitis) can be mistaken for psoriatic arthritis and ankylosing spondylitis.


  • Your patient gets this rash, what’s the diagnosis?

    DRESS is an immune response seen most commonly with certain drugs including anticonvulsants (lamotrigine, carbamazepine and phenytoin) and allopurinol. The diagnosis is usually made with a rash (such as in the picture) combined with eosinophilia and end-organ dysfunction (renal failure, transaminitis or lung involvement). Many other organs can be less commonly affected.


  • Stanford ENT Free Oral Screening November 2nd

    Oral cancer affects 40,000 new people each year and kills one life every hour in the United States. Many cases are preventable and can be linked to tobacco use, alcohol, HPV, and lack of oral hygiene. Early detection of oral cavity lesions through a quick, painless, and noninvasive screening is the most effective way to counter this harsh reality.


  • This patient presents with chest pain. What’s the diagnosis?

    A majority of adults with Marfan’s syndrome have aortic dilation and if untreated can lead to aortic dissection.


  • Website Reaches Half a Million Visitors!

    The Stanford Medicine 25 website recently passed 500,000 total visits and 375,000 unique visits since our initial launch in February, 2012. We just wanted to thank everyone for all the support!…


  • A patient asks you… what is this?

    The Stanford Medicine 25 website recently passed 500,000 total visits and 375,000 unique visits since our initial launch in February, 2012. We just wanted to thank everyone for all the support!…


  • Can you diagnose the cause of the patient’s lymphedema?

    Neurofibromatosis Type-1 (NF-1) can have a number of clinical exam findings. A hallmark of NF-1 are the tumors that can be anywhere (most commonly cutaneous). However, if deeper, they can lead to lymphatic obstruction as seen in our patient.


  • Can you guess the cause of the patient’s bleed?

    This is a patient with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) and both bleeds have been caused by telangiectasia throughout her upper airways and GI tract. In some cases GI bleeds can be caused by arterial-vascular malformations (AVM’s).


  • Do you know how to measure pulsus paradoxus?

    Pulsus paradoxus is an exaggeration of the normal drop in blood pressure that occurs during inspiration. It’s seen in disease states such as cardiac tamponade and less commonly constrictive pericarditis.


  • Remember this finding???

    Half and Half Nails are hallmarked by separate and almost even halfs with one half more pale than the other. This finding is usually seen in all (or almost all) nails when found. It is associated with chronic renal insufficiency.


  • Learn how doctor’s should perform a bedside swallow evaluation!

    We created this video to teach healthcare professionals how to perform an initial bedside swallow evaluation.


  • Welcome New Stanford Interns!!!!

    The Stanford Medicine 25 would like to welcome our new internal medicine interns! They have just been included to our list of subscribers, along with our seasoned residents and other subscribers throughout the world!…


  • Teaching the teachers… Our methods.

    As we begin a new year at Stanford, we’re taking time to reassess our methods of teaching the physical exam. Yesterday we had a session with some wonderful faculty from the VA in Palo Alto who are committed to teaching the physical exam.


  • Do you know Marcus Gunn?

    As we begin a new year at Stanford, we’re taking time to reassess our methods of teaching the physical exam. Yesterday we had a session with some wonderful faculty from the VA in Palo Alto who are committed to teaching the physical exam.


  • Abdominal Wall Pain

    Ever take care of a patient with abdominal wall pain? Sure you have (or will)! Don’t miss diagnosing pain coming from the abdominal wall with this simple and quick exam maneuver!…


  • Terry's Nails - Nail Exam

    This finding is seen in people with low albumin such as in patients with liver failure and severe malnutrition. This finding is called Terry’s nails.


  • This-Week’s-Stanford-25-Session

    This finding is seen in people with low albumin such as in patients with liver failure and severe malnutrition. This finding is called Terry’s nails.


  • Examination of the Trachea

    Watch our video by Visiting Professor, Dr. Andrew Elder, as he shows us how to conduct the examination of the trachea!…


  • Split Fixed Second Heart Sound & Loud P2

    Here is video showing an actual patient from Stanford Hospital describing the fixed split second heart sound and a loud pulmonic valve (P2).


  • The History of the Reflex Hammer

    Did you know the first hammers weren’t used for reflexes? They were initially used for percussion. The first hammer used for percussion was created by a Scottish physician Sir David Barry in the early 1800’s.


  • Dr. Andrew Elder Visiting Stanford

    We are delighted to have Dr. Andrew Elder visiting us from Edinburgh, Scotland for almost three months. He is a Consultant Physician in Acute Medicine for Older People at the Western General Hospital in Edinburgh, Scotland, UK and an Honorary Senior Lecturer at the University of Edinburgh Medical School.


  • Abraham-Verghese’s-TED-Talk:-Over-one-million-views!

    Dr. Verghese was invited to speak at the TED Global in Edinburgh, Scotland in 2011. He spoke about the importance of the physical exam and how we physicians are in danger of losing the connection with our patients as we focus more on technology and the electronic medical record.


  • Stanford Medicine 25 Clinical Pearl Award

    This year, the medical student interest group created a “Clinical Pearl Award” that challenged medical students to create a clinical pearl through an essay, a step-by-step photo guide or a video demonstration.


  • Measuring Central Venous Pressure with the Arm

    In this video, we show how to use a patient’s arm veins to estimate the central venous pressure.


  • Know your tremor?

    It’s important to understand what diseases are associated with a given type (test) of tremor.


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