The Stanford Medicine 25

This site is a map to a territory that must be explored in person.
We created this website to complement live, hands-on Stanford Medicine 25 sessions — the site isn't meant to be a substitute for personal experience. This site is a place to remind ourselves of what we learned or are about to learn in a hands-on session.

Ankle Brachial Index

Measuring an ankle brachial index is a simple skill that can be done at the bedside and give you helpful information about a patient's peripheral circulation. This technique is reviewed here.

Ascites & Venous Patterns

The simple act of observing venous patterns and the direction of venous flow on the abdomen can help us to differentiate inferior vena cava obstruction from portal hypertension. The techniques for detecting ascites are reviewed here.

Blood Pressure & Pulsus Paradoxus

An accurate and reproducible blood pressure reading is a basic clinical skill. We review that skill and discuss how to test for pulsus paradoxus.

Bedside Ultrasound

With improvement in technology, the bedside ultrasound is becoming frequent in use. Here we discuss the principles and basics of bedside ultrasound.

Cardiac Second Sounds

The second sounds and their variations can tell us volumes about everything from pulmonary or systolic hypertension to bundle-branch block.

Cerebellar Exam

A number of signs and symptoms correlate with cerebellar disease and the clinician needs to be able to elicit them from head to foot.

Deep Tendon Reflexes

Subtle changes in your technique can elicit an otherwise absent deep tendon reflex. Having a proper reflex hammer helps. Here we review those subtle techniques to improve on this import exam skill.

Dermatology Exam: Acne vs Rosacea

These two forms of acne are very common. It's important to know how to differentiate between these two as it may affect treatment and outcomes.

Dermatology Exam: Learning the Language

Before you can diagnose a skin lesion, you need to know how to describe one. This page will cover the fundamentals that you will need to know.

Dermatology Exam: Nevi (mole) Exam

Examining the moles for abnormal ones involves looking for many signs. Learn more about those signs and the normal skins lesions you may commonly find.

Examination of the Liver

The liver, unlike the spleen is easily located when enlarged and its surface can be readily felt.

Examination of the Spleen

An enlarged spleen can be easily missed. It is a prime example of how technique matters and even with the best technique, the spleen is not easily felt.

Fundoscopic Exam

When it comes to an ophthalmoscopic exam there's more to it than meets the eye! Here we take a look at the various ophthalmoscopes available to internists and review their proper use.

Gait Abnormalities

Abnormal gaits are commonly seen in the hospital and elsewhere. Many of them should be recognizable on sight and it would be a shame to subject a person to a CAT or MRI for lack of recognition. We review a number of abnormal gaits and their disease associations.

Internal Capsule Stroke

A stroke within the internal capsule leads to a unique number of physical exam findings. We review these changes and compare them with strokes in other locations. 

Involuntary Movements

There are many types of involuntary movements and the diagnosis rests on observation and knowledge of the types of involuntary movements and their causes.

Knee Exam

The knee is one of the most common causes of joint pain. A good knee exam helps us to rule out serious conditions such as a septic or inflammatory joint space and can also help make an accurate anatomical diagnosis of ligament or meniscus injury.

Liver Disease, Head to Foot

Many if not most of the signs of liver disease are paradoxically to be found outside the abdomen. The clinician needs to be able to elicit and recognize these signs and here we review them from head to foot. 

Lymph Node Exam

Do you know what a “shotty” lymph node is? Do you keep your nails neatly trimmed? Learn this and other tips from our experts and watch them perform a meticulous lymph node exam.

Neck Veins & Wave Forms

Identifying an elevated jugular venous pulse will almost always affect your management of a patient. An understanding of waveforms can help you recognize everything from canon "a" waves of complete heart block to "ventricularization" of the "v" wave in tricuspid regurgitation.

Precordial Movements

Palpation is a critical part of the cardiac exam. The size and the character of the PMI (PMI) can speak volumes and predict the presence of an S3 or 4.

Pulmonary Exam: Percussion & Inspection

The pulmonary exam is more than simple auscultation--in fact percussion and inspection often tell you much more than auscultation. Knowing the normal boundaries of percussion and the surface anatomy is critical.

Pupillary Responses

The pupillary response requires a complex integration of nerve fibers. An abnormal pupillary response can be a harbinger for disease or simply a benign process. We review the physiology behind this reflex and discuss situations where it will be abnormal.

Rectal Exam

A rectal exam is important to help rule out prostate issues, diagnosing causes of perirectal pain and looking for distal rectal masses. As the saying goes, "If you don't put your finger in, you will put your foot in!"

Shoulder Exam

Careful examination of the shoulder can provide valuable information and help the physician determine when image studies may or may not be helpful.

The Hand in Diagnosis

The hands are a window to the body, and changes in the hands are linked to a plethora of illnesses. Recognizing these phenotypic expressions of disease is a basic clinical skill.

The Tongue in Diagnosis

Changes in the tongue occur in many situations. Systemic disease such as amyloidosis or lymphoma will affect its size and color. Localized infections may suggest underlying immune disorders. Nutritional deficiencies will cause abnormalities.

Thyroid Exam

A good thyroid exam depends above all on knowledge of anatomy and proper technique.