2016 Archive

Stanford Medicine 25 Blog

  • What is amyopathic dermatomyositis?

    37 yr old male with a history of these lesions on his the back of his hands for the past two years. Notes no other medical issues. No weakness, fatigue, fevers or rashes anywhere else on his body. He works as a chiropractor and is concerned about his patients seeing his hands. Use of various over the counter treatments such as topical steroids and moisturizers did not improve the lesions.


  • What is skin coining (Gua sha)?

    37 yr old male with a history of these lesions on his the back of his hands for the past two years. Notes no other medical issues. No weakness, fatigue, fevers or rashes anywhere else on his body. He works as a chiropractor and is concerned about his patients seeing his hands. Use of various over the counter treatments such as topical steroids and moisturizers did not improve the lesions.


  • What is this Kussmaul’s sign?

    A 45 year old woman with a past medical history of Hodgkin’s lymphoma treated with mantle field radiation whose neck veins were incidentally noted on a thorough physical exam. The patient was in sinus rhythm on telemetry throughout the exam...


  • Abraham Verghese Asks: Why Are We Doing This Teaching?

    We teach bedside medicine. We emphasize the importance of the physical exam and how it can help care for your patient and also create an environment where the person you are caring for develops trust. We have taught this now for over 6 years (when the Stanford Medicine 25 was first created). But sometimes it’s important to ask why. In a recent blog post, “Will the Healing Touch Go Out the Door With the Stethoscope?”, we look at the how some think that ultrasound is replacing any need for a stethoscope...


  • Referred Pain Physical Exam

    A 78 year old man with no significant past medical history presents to his primary care physician with 4 days of right shoulder pain. The pain is located over the acromioclavicular joint. The pain is worse at night with lying down and associated with shortness of breath. He states that the pain is better during the day. He is an avid ping pong player and does not have pain or shortness of breath with playing ping pong...


  • Will the Healing Touch Go Out the Door With the Stethoscope?

    We teach bedside medicine. We emphasize the importance of the physical exam and how it can help care for your patient and also create an environment where the person you are caring for develops trust. We have taught this now for over 6 years (when the Stanford Medicine 25 was first created). But sometimes it’s important to ask why. In a recent blog post, “Will the Healing Touch Go Out the Door With the Stethoscope?”, we look at the how some think that ultrasound is replacing any need for a stethoscope...


  • Spasticity versus Rigidity (Stanford 25 Skills Symposium, 2015)

    Can you differentiate between spasticity versus rigidity? This is our first video release from our 2015 Stanford 25 Skills Symposium. This video is a part of a larger group of videos that were created during the symposium. In this short excerpt, Dr. Steve McGee talks about the approach to differentiating spasticity versus rigidity at the bedside.


  • What is a roth spot?

    A 42 year old female presents to Stanford hospital with fevers, chills and mild confusion. You perform a fundoscopic examination and see this (image below). What is the diagnosis? Answer: Roth spot What is a Roth Spot? A Roth spot, seen most commonly in acute bacterial endocarditis is a red spot (caused by hemorrhage)...


  • Stanford 25 Skills Symposium 2016 Announced!

    The Program for Bedside Medicine at Stanford is proud to announce registration is open for the Stanford 25 Skills Symposium 2016! Date: August 27th and 28th 2016 (Saturday & Sunday) Location: Stanford University School of Medicine Visit this link for registration. You can also learn more about last year’s symposium and our upcoming event here. The Symposium is designed for early...


  • Every Patient Has a Story Worth Hearing

    Earlier this year, Canadian newspaper The Globe and Mail commemorated the anniversary of the death of neurologist Oliver Sacks by taking a look at his legacy. The piece, by author Norman Doidge, aptly reminds us that “the world’s most famous neurologist believed that every patient had a story worth hearing.” And indeed, his work proves...


  • What is the Howell-Jolly body?

    This is a picture of a red blood cell with a Howell-Jolly body (red arrows). They are left over nuclear remnants that are usually removed when blood cells are in the spleen. Howell-Jolly bodies occur where there is no spleen or an non-functioning spleen, referred to as asplenia. They are usually one of these at most in a red cell, round, dark purple to red in color and often located peripherally on the red blood cell...


  • What will bedside manner look like for new data-driven physicians?

    Earlier this year, Managed Care magazine published a cover story on young doctors. Praising them for their ability to collaborate, their openness to measurement and consciousness related to cost-effective care, the article advanced the idea that these “newly minted” physicians are just what health care needs. However, it had one main question: “How well will...


  • What is Plummer-Vinson syndrome?

    A middle aged woman presents with difficulty swallowing. She has a history of menometrorrhagia for 10 years, secondary to uterine fibroids. She endorses fatigue and shortness of breath. What’s the cause of her dysphagia and why? Answer: Esophageal webs in the setting of iron deficiency anemia. This is seen in Plummer-Vinson syndrome. This syndrome usually has: dysphagia...


  • What is the Sister Mary Joseph nodule?

    A 78 year woman presents with weight loss, lethargy and abdominal pain. Clinical examination showed abdominal distention and a firm, non-tender, irregular 1 cm nodule within the umbilicus...


  • What is rhinophyma?

    This 42 year old male give a history of a chronic “skin rash” of his face. He notes he’s had it for many years and never sought treatment. While it comes and goes on its own, it seems to get worse with alcohol consumption...


  • What is the ugly duckling sign?

    The ugly duckling sign refers to one mole among many that sticks out and looks different (“the ugly duck”) and should raise suspicion for melanoma...


  • Diagnose this skin lesion with newest Stanford 25 video and topic.

    Presenting the first of our dermatology series. Every skin exam starts with a description. Can you accurately describe the below lesion and make the diagnosis? If you need help, visit our newest Stanford 25 page: “The Dermatology Exam: Learning the Language”...


  • What is the exam of calciphylaxis?

    A 49 year-old obese man with non-alcoholic steatohepatitis and cirrhosis, complicated by hepatorenal syndrome not on dialysis, was admitted for expedited liver transplant workup. On admission, he was found to have the lower extremity skin lesions shown below. He noted that these slowly-enlarging lesions had developed over the past 2 months and were extremely tender, requiring opiates to control the pain...


  • Medical Errors and Adverse Events from a Missed or Inadequate Physical Exam

    In the last 20 years the knowledge base for a physician has grown exponentially. Meanwhile technological advances, combined with a growing healthcare system and greater demands on the physician have left the need to find more ways to overcome these challenges. The physical exam, once regarded in the medical profession and the litmus test to...


  • Stanford Medicine 25 Launches New Website

    The Stanford Medicine 25 is proud to announce the launch of our new website with the new year! Since the start of our website, we’ve had millions of visitors and look forward to improving and adding more content! The new site is now mobile-friendly and share’s more about what we do, including our Stanford 25...


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