Monthly Archives: October 2011

Careful Consideration: Pocket Neurology

Pocket Neurology LippincottPocket Neurology (also known as “The Yellow Book”) can be readily found in the white coats of many Neurology residents. Unlike its Medicine counterpart (The Green Book), Pocket Neurology does not seem to hold the same popularity among medical students. There are a few reasons for this. First, it hasn’t been around as long, and thus it hasn’t had time to built up the full extent of its reputation. Few attendings will readily reference it during rounds, and residents simply won’t expect students to own or have access to a copy. Second, Neurology is usually a clerkship of shorter duration compared to Internal Medicine in most medical schools, and therefore comprehensive pocket guides are less bang for the same buck.

What Pocket Neurology covers, it covers very well.  However the target audience for this title is not the same as for Pocket Medicine as a result of the focus in our medical education. We are taught the core principles of Internal Medicine from an early point on entering medical school, including history taking, physical examination, general findings, and many organ system courses focused on Internal Medicine subspecialties. It is because of this focus that new third year medical students can open a copy of Pocket Medicine and understand the more advanced topics without the need for referencing the basics.

This is not the case on a Neurology rotation, where most students are just starting to learn the specialty’s language, techniques, and the significance of common findings. For example, students may be frustrated if trying to use the book to assess the common presentations of migraine prodrome, despite a concise and comprehensive overview of headache differential diagnosis and workup. Getting past the basics quickly to fully utilize this book is highly recommended, as it will certainly be a strong resource to those who can wield it well.

As with all of the titles in the Pocket Notebook series, downsides include lack of space for annotation, and small print font, but these come with the territory of creating pocket reference guides.  Another consideration for this title specifically is an index section that is somewhat lacking.  Topics not contained within tidy concepts involve a good amount of searching in the appropriate chapter.  As a result, many residents will place labeled flags or earmarks on pages to quickly access commonly referenced topics.

Specific sections include neurologic emergencies, lesion localizing in clinical neurology, neuroimaging, vascular neurology, neurocritical care, acute intracranial hypertension, interventional neurology, seizures and other spells, electroencephalography (EEG), delirium, dementia, movement disorders, behavioral neurology, poisons and vitamin deficiencies, meningitis / encephalitis / brain abscesses, infectious diseases, headache, central nervous system vasculitis, pain, dizziness and deafness, demyeliminating diseases of the central nervous system, spine and spinal cord diseases, motor neuron diseases, peripheral neuropathy, radiculopathy and plexopathy, neuromuscular junction disorders, myopathy, electromyography (EMG), neuro-rheumatology, neuro-oncology, sleep medicine, pregnancy neurology, neuro-ophthalmology, consult issues, and selected pediatric disorders.

Overall, this is a title worth purchasing for all Neurology residents and medical students interested in the field. Medical students who wish to excel in their Neurology clerkship or enter a field that uses neurology such as Internal Medicine, Trauma, or Ophthalmology should consider purchasing Pocket Neurology with the above considerations, based on their personal preferences. This is probably not heavily needed for students who have no interest in neurology.

 

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Must Buy: Bates’ Guide to Physical Examination and History Taking

Bates Guide to Physical Examination and History TakingThe heart of all medical education is centered around a solid foundation in history and physical exam skills. These are not only learned and critiqued early during the preclinical years, but comprise the basis on which medical students are assessed and evaluated during clinical rotations as they are conveyed through presentations. Due to the strong and constant need for excellent history and physical examination skills in producing superior grades, it is highly recommended that all medical students master these abilities early.

Bates’ Guide to Physical Examination and History Taking, now in its 10th edition, represents the best reference resource for this goal. The book itself is rather extensive as a primer for all things history and physical, which makes it perfect for incoming medical students. The text is detailed and straight-forward, with great complementary pictures, illustrations, and tables. It is important to note that the focus extends behind the basic logistics and mechanics of taking a history and performing a physical.  Special attention is placed on normal physiology, as well as the significance of abnormal exam findings. Combined with proper instrument technique and care, this book allows for a deep understanding and mastery of the basic physical exam.

Other benefits of this book include the CD and website access on The Point, which host patient examination and assessment videos, fully searchable text, and cardiopulmonary exam sounds. To a lesser degree, the book is also helpful at providing basic differential diagnosis development. While many medical schools specifically assign chapters in this book as required reading during preclinical years, it remains a fantastic reference source throughout clinical rotations as well, with continued potential for residency.

There are a few drawbacks to this book.  First and foremost is the price.  At around $100, this “must buy” book is often times considered a “must borrow” from the library. Purchasing the black 9th version of this book will offer nearly all the same content for a slightly lower price, but has issues with page discordance when professors assign specific pages from the latest version. Second, Bates’ strength in providing full explanations to completely inexperienced medical students can sometimes become undesirable later in medical school when trying to obtain a quick concise answer for an understood concept.  Along those same lines, the weight of this 992 page book can make constant transport somewhat arduous. It should also be noted that this book does not delve into the depths of specialty exams, but rather focuses strongly on the general history and physical exams needed for core clerkships. For example, the basic eye exam is included, but does not cover the depth that an ophthalmologist might assess. The book does however provide a full and thorough neurologic, pediatric, and gynecologic exam.

The first unit is a general overview, and contains specific book chapters on: Physical Exam and History Taking Overview; Clinical Reasoning, Assessment, and Recording; and Interviewing and the Health History. Unit 2 covers regional examination, with chapters on: General Survey, Vital Signs, and Pain; Behavior and Mental Status; The Skin, Hair, and Nails; Head and Neck; Thorax and Lungs; Cardiovascular System; Breasts and Axillae; Abdomen; Peripheral Vascular System; Male Genitalia and Hernias; Female Genitalia; Anus, Rectum, and Prostate; Musculoskeletal System; and Nervous System. The final unit is dedicated to “special populations,” and includes chapters on: Children – Infancy through Adolescence; The Pregnant Woman; and the Older Adults.

Overall, this is a highly recommended book for incoming medical students to master vital skills. Be sure to use the below links to get a starting price comparison between retailers before making a purchase, as the price can be steep.

 

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