Stanford Medicine Resources:

Stanford Medicine 25 An Initiative to Revive the Culture of Bedside Medicine

The 25

Welcome to the Stanford Medicine 25 website. Remember, this site is NOT the Stanford Medicine 25; it is only a map to a territory, one that must be explored in person! The Stanford Medicine 25 consists of hands-on sessions in small groups. You can't substitute for that, and we don't try to. However, this site provides a place to go to remind ourselves of what we have learned, or are about to learn in a hands-on session.

#1 Thyroid Exam

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

#2 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. Learn more »

#3 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. Learn more »

#4 Examination of the Liver

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

#5 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. Learn more »

#6 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. Learn more »

#7 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. Learn more »

#8 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. Learn more »

#9 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. Learn more »

#10 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. Learn more »

#11 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. Learn more »

#12 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. Learn more »

#13 Pulmonary Exam

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. Learn more »

#14 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. Learn more »

#15 Cardiac Second Sounds

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

#16 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. Learn more »

#17 BP & 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. Learn more »

#18 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. Learn more »

#19 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. Learn more »

#20 Bedside Ultrasound

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

#21 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!" Learn more »

#22 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. Learn more »

#23 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. Learn more »

#24 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. Learn more »

#25 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. Learn more »