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.
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.
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.
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.
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.
Hand Examination
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.
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.
Cardiac Second Sounds
The second sounds and their variations can tell us volumes about everything from pulmonary or systolic hypertension to bundle-branch block.
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.
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.
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.
Examination of the Liver
The liver, unlike the spleen is easily located when enlarged and its surface can be readily felt.
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.
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.
Tongue Examination
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.
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.
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.
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.
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.
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.
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.
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.
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.
Bedside Ultrasound
With improvement in technology, the bedside ultrasound is becoming frequent in use. Here we discuss the principles and basics of bedside ultrasound.
Pelvic Exam
The pelvic exam is a vital part of every woman's preventative care and is also important towards making a number of diagnoses when presenting with abdominal or pelvic complaints. Here we cover each aspect of the pelvic exam and demonstrate both in text and in our video how this done.
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!"
- Aortic Regurgitation Exam
- Ankle Brachial Index
- Ankle and Foot Exam
- Ascites & Venous Patterns
- Bedside Ultrasound
- Breast Exam
- Cardiac Second Sounds
- Carpal Tunnel Exam
- Cerebellar Exam
- Deep Tendon Reflexes
- Dermatology Exam: Acne vs. Rosacea
- Dermatology Exam: Learning the Language
- Dermatology Exam: Nevi (Mole) Exam
- Fundoscopic Exam (Ophthalmoscopy)
- Gait Abnormalities
- Hand Exam
- Hip Region Exam
- Internal Capsule Stroke
- Involuntary Movements and Tremor Diagnosis: Types, Causes, and Examples
- Knee Exam
- Liver Exam
- Low Back Exam
- Lymph Node Exam
- Neck Vein Exam
- Newborn Jaundice Assessment
- Pelvic Exam
- Precordial Movements in the Cardiac Exam
- Pulmonary Exam: Percussion & Inspection
- Pupillary Responses
- Pulsus Paradoxus and Blood Pressure Measurement Techniques
- Rectal Exam
- Spleen Exam
- Tarsal Tunnel Exam
- Thyroid Exam
- Tongue Exam
- Liver Disease, Head to Foot
- Visit the 25
- Shoulder Exam Tutorial
- Parkinson's Disease Exam
- Diastolic Murmurs Exam
- Dermatology Exam: Nevi (Mole) Exam
- Mastering Newborn Exams
- Modified Sarnat Exam for Neonatal Encephalopathy
- Neonatal Neurologic Exam
- Rapid Assessment of a Newborn
- The Stanford 25 Exams
- Lung Ultrasound: A Comprehensive Guide
- Common Mistakes in Point of Care Cardiac Ultrasound (Echocardiography, POCUS)
- Understanding Scleroderma