Tag Archives: medical school honors

Must Have: Dubin’s Rapid Interpretation of EKG’s

Dubin's Rapid Interpretation of EKGsDubin’s Rapid Interpretation of EKG’s is a one-of-a-kind book that is often referenced in medical schools due to its fun and simple methods of teaching the evaluation of electrocardiograms. More importantly, it provides a high-yield, low-stress method of conveying these otherwise difficult concepts.

In each chapter, the fundamental concepts of EKG’s are delineated in a crisp and clear format. What makes up the bulk of the book is actually not free-text but illustrations that significantly help correlate concepts and electrocardiogram images. Individual diagnoses or findings on an EKG are accompanied by full explanations, including clearly delineated criteria and just enough information to teach pertinent core cardiology concepts (without overwhelming the reader). In fact, the information in Dubin’s EKGs is known for being dumbed down and presented in a “flashcard” style so that it is easy to understand and absorb on-the-go.  All concepts are reiterated and presented repeatedly to ensure maximum retention and an appropriate pace. Interestingly, despite the repetitiveness of the material and the seemingly “dumbed down façade, the book covers all the necessary information that students needs for medical school, and even quick review during residency.  Specific chapters include: Basic Principles, Recording of the EKG, Autonomic Nervous System, Rate, Rhythm, Axis, Hypertrophy, Infarction, and a catch-all Miscellaneous section.

While this title remains highly endorsed by the editors of this site, it is important to still note the drawbacks, for completeness.  Due to the ease of use, some students find Dubin’s EKG to not be challenging enough. While it remains a strong primer, some students (especially those with prior cardiology experience) believe that several pages of information can be condensed into a page or less.  It is important to realize that the aim of this title is to teach only the fundamentals of EKG knowledge. For depth and advanced nuances not needed for medical students, a larger, more condensed resources is warranted. As such, Dubin’s Rapid Interpretation of EKG’s should be used as a quick and superficial “top of the iceberg” but “solid foundations” reference guide to learning the basics of EKG’s.

ECG Complex - Learning the Basics

For medical school: exceedingly useful.
For residency: potentially helpful.
For cardiology fellowships: trainees ought to be well past the basics presented within this book.

Reading Dubin’s Rapid Interpretation of EKG’s cover to cover takes about 4 or 5 hours total, but it is more highly recommended that students periodically return to the book over time for increased retention of the repetitious material.  Overall, this earns a strong endorsement and is highly recommended for any new second year medical student learning cardiology.

 

Posted in Must Have, Pre-clinical Years | Tagged , , , , , |
5 Impressions on this resource so far. What's yours?

A High Yield Complement: BRS Physiology

Board Review Series (BRS) PhysiologyBoard Review Series (BRS) Physiology, now in its 5th edition, is the leading resource on physiology concepts crucial for the foundation of medicine as well as those highly tested on the United States Medical Licensing Examination (USMLE) Step 1. This book, written by the esteemed Linda S. Costanzo, Ph.D, provides very clear and concise explanations of essential physiological principles of each organ system as well as those of cellular physiology. This text contains many clinical examples and sample problems to help medical students test their understanding of these concepts and their application in clinical scenarios. Each chapter concludes with a review test, accompanied by explanations and references to sections from which the question arose. To further aid appreciation and long-term retention of these key principles, many full-color illustrations, flow diagrams, and tables as well as a summary page of “Key Physiology Equations for USMLE Step 1” are included. Additionally, each book features a scratch off code which provides access to supplementary online resources, such as a question bank and a comprehensive examination with an image bank, on The Point.

This book provides a clear outline with appropriate breadth and depth of high yield material that is most commonly tested on USMLE Step 1. It is recommended that this book be read in conjunction with corresponding physiology courses throughout med school or as part of review for the boards. Because this book presents the material in a very straightforward manner, it helps to simplify difficult concepts to better understand medical physiology.

Despite the many benefits of using this book as part of any study plan for the USMLE, there are a few drawbacks which should be noted. Many of the questions featured in the chapter Review Tests and Comprehensive Examination are not written in the style of the USMLE Step 1. Rather, most are short questions that are aimed to test the knowledge of key concepts and should not be relied upon to gain familiarity with the format of the USMLE Examinations. The review questions are also simpler than most found in question banks and the exam itself. Lastly, this book is designed to be a review book and as such should be used in conjunction with more comprehensive resources such as textbooks, classroom lectures and syllabi.

The material in this book is organized into seven chapters by organ system, each of which ends with a review test and explanations. The first chapter provides a general overview of Cell Physiology followed by chapters on: Neurophysiology, Cardiovascular Physiology, Respiratory Physiology, Renal and Acid-Base Physiology, Gastrointestinal Physiology, and Endocrine Physiology. This Board Review Series book culminates in a 99 question comprehensive examination which is followed by explanations and page references.

Overall, this book is highly recommended to medical students for learning the physiology of the major organ systems, and especially in conjunction with Tao Le’s First Aid for those who are preparing for the USMLE Step 1. This reasonably priced review text will provide any medical student with a clear understanding of the most frequently tested physiology concepts and to provide a solid foundation for a career in medicine.

 

Posted in Boards, Pre-clinical Years | Tagged , , , , , , , , , , |
1 Impression on this resource so far. What's yours?

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.

 

Posted in Core Clerkships, Elective Clerkships | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Used this resource? Leave your impressions.

Otoscope and Ophthalmoscope Set Alternatives: Med School Supply

Compare halogen and LED diagnostic kit bulbsWelch Allyn is the leading manufacturer of otoscopes and ophthalmoscopes, however the quality is also reflected in their higher prices. While many medical students want to purchase top name-brand equipment, and indeed this should be the case for such instruments as stethoscopes, this strategy is not always needed for diagnostic kits. Here’s the usual scenario: second year medical students from AMSA or some other group organize a “money-saving fundraiser” (let’s ignore that blatant oxymoron) and only highlight larger, more expensive, name-brand companies.   Often times there are even incentives to purchase the more expensive $500-$800 diagnostic sets to “save” on smaller instruments such as tuning forks or reflex hammers.

As mentioned in the Compare Welch Allyn series, it is incredibly important to talk to senior medical students at your school to ascertain the actual usage of instruments. This cannot be accurately assessed from manufacturer representatives, or even the second year medical students running the instrument sales.  If third and fourth year students carry their diagnostic sets with them at all times, a Welch Allyn set may be more beneficial.  If such diagnostic kits are used in a small handful of learning sessions that teach physical exam techniques during first and second years and are never utilized throughout the rest of medical school, we recommend the following.

Med School Supply Fiberoptic LED Otoscope Ophthalmoscope SetThe company Med School Supply (completely unrelated to this site despite the similar name) sells full-sized otoscope and ophthalmoscope sets for around $100.  Their standard model works just fine, although their LED otoscope set is actually more highly recommended due to the brighter, better lighting it produces.  You can clearly see the difference between their fiberoptic LED bulb and an older Welch Allyn halogen bulb in the top image of this article, and read more about the differences in the article How to Pick the Best Light Source.

Both kits work with standard otoscope tips, which means there is no reliance on this company for tips after purchasing one of their models.  Like the Standard Otoscope in the Welch Allyn description, Med School Supply otoscopes use a groove system to hold tips internally.  The ophthalmoscope uses the same halogen bulb for both kits, and is a solid basic model, without the bells and whistles as its WA counterpart. Unlike Welch Allyn, there is no built in rechargeable option for the handle.  These models take two C batteries, and that will last the entirety of medical school for the average user.

It is important to note that this company does not have the same quality control standards as Welch Allyn, so it is possible for them to sell and ship a set with a suboptimal component.  Nonetheless, they have a full lifetime warranty on all of their products, so any piece will be replaced free of charge with free return shipping at any point during your use of the instrument.  For the $400 difference between this and the Welch Allyn version, some find this compensated downside to be more than tolerable.

 

Posted in Medical Instruments | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , |
3 Impressions on this resource so far. What's yours?

Best Ob/Gyn Review: Blueprints Obstetrics and Gynecology

Best Ob/Gyn Book: Blueprints Obstetrics and Gynecology

Best Og/Byn Review: Blueprints

While this site had previously reported on the vast shortcomings of Blueprints Pediatrics, the writers of Blueprints Obstetrics and Gynecology, now in its fifth edition, have thankfully delivered one of the best ob/gyn review resources for medical students who are not going into obstetrics and gynecology. The book itself follows the same format and design as the others in the series, but don’t judge the book by its cover.

The major strength of Blueprints Ob/Gyn is that it is specifically streamlined for NBME exams, which means it strips down all the unnecessary detail and presents the core topics that will aid you in rocking the shelf, as well as the ob/gyn questions on Step 2.  One of the tough areas of ob/gyn is learning all new normal anatomy and physiology while currently learning the pathophysiology.  The book does a good job of breaking this up into an easy to read flow, with chapters that have a manageable length.  This includes both big-picture overviews (e.g. things that go wrong in third trimester) as well as drill down topics (e.g. preeclampsia). Furthermore, the book also has its own question sets which further solidify the topics as you go. This book also doubles as a great guide on Family Medicine as well.

Specific chapters include Pregnancy and Prenatal Care, Early Pregnancy Complications, Prenatal Screening/Diagnosis/Treatment, Normal Labor and Delivery, Antepartum Hemorrhage, Complications of Labor and Delivery, Fetal Complications, Hypertension in Pregnancy, Diabetes in Pregnancy, Infectious Diseases, Other Medical Complications in Pregnancy, Postpartum Care, Benign Disorders of the Genital Tract, Endometriosis and Adenomyosis, Pelvic Relaxation, Urinary Incontinence, Puberty and Menopause, Amenorrhea, Hirsutism and Virilism, Contraception and Sterilization, Elective Pregnancy Termination, Infertility and Assisted Reproduction, various Cancers, and Breast Disease.

Keep in mind that this latest fifth edition has very few changes compared to the previous two versions.  If you can pick up the older copies for cheap or free, they will provide the same knowledge.

 

Posted in Boards, Core Clerkships | Tagged , , , , , , , , , , , , , , , , |
Used this resource? Leave your impressions.

Compare Welch Allyn Series: Building a Full Diagnostic Set

This is the sixth and final part of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic set (otoscope and ophthalmoscope).


By now, you should have reviewed the other five articles in the series, and noted your preferences:
Compare Welch Allyn Series: How to Pick the Best Battery and Handle
Compare Welch Allyn Series: How to Pick the Best Case
Compare Welch Allyn Series: How to Pick the Best Light Source
Compare Welch Allyn Series: How to Pick the Best Otoscope
Compare Welch Allyn Series: How to Pick the Best Ophthalmoscope


Trade-offs of Pricing and Usage

It is important to remember that many medical schools only require use of personal diagnostic sets while learning how to perform a physical exam during preclinical years. Many rotations will either not require use of these instruments, or provide them to medical students and staff if needed. You should contact senior medical students at your school to ascertain the usage of these instruments when considering the price. For minimal use, you may want to consider purchasing from another manufacturer entirely. It is also a common mistake for incoming med students to assume these instruments will be used after med school. Specialties that use these instruments have more expensive versions or wall mounted models, and many specialties won’t need them at all.


Selecting Your Model

Most retailers do not carry all diagnostic kit combinations of the above Welch Allyn components. Most local companies will carry about 4 of the 75 total diagnostic kits manufactured by Welch Allyn, and that is actually sufficient for the large majority of med students. It is not uncommon for retailers to highlight the more expensive components, such as the PanOptic ophthalmoscope, and to list all other options by their model number. This can be a rather confusing selection process, which can be remedied below.

The following application is designed to assist in putting it all together and selecting the Welch Allyn diagnostic kit that is best suited for your needs and desires based on the results of the above articles. You may input your selections and the application will output the specific model number for your use with retailers. It will also output a list of the closest matches to your selection, in case your first choice is not carried by your retailer.


Please click one of the following from each category:

Relative Price $
$$
$$$
Case
Handle
Otoscope
Ophthalmoscope

Recommended Diagnostic Kit Model Number:

 

Posted in Medical Instruments | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Used this resource? Leave your impressions.

Compare Welch Allyn Series: How to Pick the Best Ophthalmoscope

This is the fifth part of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic kit (otoscope and ophthalmoscope). The focus of this discussion is on Welch Allyn diagnostic kit ophthalmoscope heads.

This is the topic that will have the most options and provide the basis behind one of the larger price differences in your diagnostic kit. Ophthalmoscopes, as the name suggests, are instruments used to look at the eyes, specifically the retina. Some med students will get through all of medical school without learning how to actually perform an exam using their ophthalmoscope, let alone utilize many of the bells and whistles that come with it. As with otoscope heads, all of the below ophthalmoscopes are the 3.5 volt version, which refers to the standard power handles, and are in contrast to miniature “pocket sized” versions of these instruments. If you’re interested in the bottom-line short version, scroll to the bottom.


Welch Allyn Compare Series: Standard Ophthalmoscope

Standard Ophthalmoscope

We’ll start as usual by reviewing the baseline model, seen right.  This has the basics that any med student would want, and will allow for visualization of the retina.  It feels and looks just like any other ophthalmoscope you would see in clinic, which means learning on this will prepare you for whatever you may find along medical school, with three additional filters you will most likely never use.

Aside from being able to change the light size or dim the light, this ophthalmoscope allows the user to change the light into a slit beam, for easier visualization of objects on the surface of the eye, as well as the depth of the anterior chamber. It also comes with a fixation aperture, which basically turns the light into cross hairs in case you want to double your ophthalmoscope as a sniper rifle scope. The actual reason for this configuration is for relative measurement and assessing blind spots.  This feature is rarely used even by ophthalmologists, usually in the setting of hospital consultation when there are limited instruments. The final added feature is the red-free filter, which is a funny way of saying “green light” used to contrast structures in the back of the eye from the otherwise red background on which they reside.  Again, chances are you won’t use any of these, and they won’t be taught in med school physical exam classes.

Welch Allyn Compare Series: Ophthalmoscope Apertures, including big, small, micro, fixation, slit, and red-reducing aperturesThe key component that will be used and comes standard on these types of ophthalmoscopes are the focusing lenses, which allow the user to adjust for the physical size of the eye and focus on a crisp image at the back of the eye.  This will come up in subsequent models.

Overall, this is the model of choice for the average med student looking to purchase a quality instrument without the markup associated with unneeded features.  However, many retailers do not offer Welch Allyn diagnostic sets with this lower-priced option, even though such sets are manufactured.


Welch Allyn Compare Series: Coaxial and AutoStep Coaxial Ophthalmoscopes

Coaxial Ophthalmoscope

The next step up is the coaxial ophthalmoscope, which is commonly one of the two models offered by retailers as an ophthalmoscope option in a Welch Allan diagnostic kit. Like the Standard Ophthalmoscope above, it has the same number of focusing lenses, and includes all of the above apertures, plus the cobalt filter.  This is a blue light used in conjunction with fluorescein stain placed in the eye, which produces neon green or orange concentrations of the dye within scratches or irregularities on the surface of the eye. The idea is that it highlights lesions on a clear medium that are otherwise difficult to visualize. This is helpful in field work during emergencies, but will not be a needed skill to use as a medical student, or a necessary tool in the middle of an actual emergency room that has full slit lamps with this feature.

Welch Allyn Compare Series: Opthalmoscope Cobalt Blue Filter

Welch Allyn claims, in their usual fashion, that this upscale model provides less glare, superior visibility, and a larger field of view compared to the standard ophthalmoscope. While bad or broken ophthalmoscopes are indeed a detriment to an ophthalmoscopic exam, I doubt anyone would be able to practically tell the difference between the coaxial and standard Welch Allyn ophthalmoscope.

For completeness, I will also mention that Welch Allyn manufactures the AutoStep Coaxial Ophthalmoscope, which is the exact same instrument, but with additional focusing lenses for super-fine tuning.  This model is not offered in any Welch Allyn diagnostic kit, and would need to be purchased separately.  However, as you can imagine, these additional focusing lenses are not a significant improvement and in no way recommended for medical students (or anyone else).


Welch Allyn Compare Series: PanOptic Ophthalmoscope

PanOptic Ophthalmoscope

The final Welch Allyn Ophthalmoscope to review is the PanOptic Ophthalmoscope, also known as the bazookascope. As you can see from the image, this is in a different league as the other varieties, as its price tag will also prove. Like the above opthalmoscopes, the PanOptic also fits on any standard Welch Allyn 3.5 V power handle.

Welch Allyn states the advantages of this scope include a five-times greater view of the back of the eye, and 26% increased magnification. As mentioned in the otoscope review, an oddly specific 26% increase in magnification is unnoticeable. The PanOptic Ophthalmoscope does however provide a significantly larger view of the retina, with significantly less skill required to use the instrument compared to the learning curve of the above models.  Simply holding this up to a patient’s eye will produce nice results.  Less time spent figuring out how to use the instrument means more time dedicated to figuring out what you’re looking at.  This is an underestimated double edged sword.

As long as a PanOptic is used, better visualization will be acquired.  However the large majority of clinics and hospitals in this country do not have this expensive piece of equipment.  It is exceedingly common for a medical student who learned on a Welch Allyn PanOptic to subsequently have no technical ability to use a standard ophthalmoscope in a practical setting, placing them at a severe disadvantage without their own instrument.

One of the main reasons med students purchase a diagnostic kit is to learn the technique of using these instruments, more so than to use them throughout (or after) medical school. Most clinics will provide med students with wall mounted versions of the standard ophthalmoscope, making it unnecessary to haul around a personal set. Due to the shape, these are also bulkier items that weigh down white coats and do not sit well in soft cases. Given all of the above, as well as the price below, it is exceedingly common for med students to attempt to sell their PanOptic ophthalmoscopes, finding them unnecessary.  Nonetheless, some percentage of students will continue to purchase these instruments to ensure they have the best possible view of the back of the eye.  This is one that definitely has its trade-offs.


In summary, the direct comparison is as follows:

Approx.
Price *
Cobalt Filter Ease of Use Exposure
Standard Ophthalmoscope
$170 No Learning Curve 5 degrees
Coaxial Ophthalmoscope
$190 Standard Learning Curve 5 degrees
PanOptic Ophthalmoscope
$550 Optional Easy 25 degrees
* prices are for the ophthalmoscope heads only. handles are sold separately.

Prices are higher if you purchase components separately, so try to buy a value meal (a complete diagnostic kit sold as a single unit) unless you can find a really great deal. With that being said, the above three scopes were added to the price-check plugin as a reference.


Still can’t decide? Let us help! Check all that apply:

My med school requires infrequent usage of diagnostic kits.
Money is of no concern in the purchase of my instruments.
I have a habit of losing things easily.
I want to learn physical exam techniques using equipment that will best prepare me for practical clinical settings.
I want to learn physical exam findings using the absolute best equipment at my disposal.

Suggestion:

 

Posted in Medical Instruments | Tagged , , , , , , , , , , , , , , , , , , , , , , , |
6 Impressions on this resource so far. What's yours?

Compare Welch Allyn Series: How to Pick the Best Otoscope

This is the fourth part of a series of posts on comparing Welch Allyn products that will help incoming first year medical students learn about and select different medical instrument components to construct the right Welch Allyn diagnostic kit (otoscope and ophthalmoscope). The focus of this discussion is on Welch Allyn diagnostic kit otoscope heads.

Unlike prior posts in this series that assist medical students in deciding on which type of products to purchase, this one will focus more on the variability normally encountered by medical students when they first hit the clinic.  Most retailers offer only one option for otoscopes in their diagnostic kit even though Welch Allyn manufactures two varieties, so purchasing decisions are not really an issue.  However med students still need to know how to use all the historically popular versions and accessories, and what to avoid if buying an older model.  As with ophthalmoscope heads, all of the below otoscopes are the 3.5 volt version, which refers to the standard power handles, and are in contrast to miniature “pocket sized” versions of these instruments.


Welch Allyn Compare Series: Pneumatic Otoscope

Pneumatic Otoscope

First, let’s review the older pneumatic otoscopes, seen right. The thing to take away from the discussion of this type of scope is that you should not buy one.  The general concept is the same as all the other otoscopes, without the shiny distracting bells and whistles you’ll never use.  However the big difference between this and the next Welch Allyn otoscope type is the tip.  Notice how the base of the tip is rather wide?  It is essentially the diameter of the barrel of the scope itself.  There is no inherent problem with such tips, as they work perfectly well if you can actually find them, but the chances of coming across one in hospitals and clinics is rather low unless that clinic is specifically using this type of otoscope.  So, if you happen to come across one in clinic, you now know to shove the wide-base tip into the wide barrel of the otoscope.  However you are also aware that buying one of these most likely comes with providing your own lifetime supply of tips.


Welch Allyn Compare Series: Diagnostic Otoscope

Standard Otoscope

Next, let’s look at one of the latest Welch Allyn models to become obsolete for absolutely no reason: the standard diagnostic otoscope. This is the model you are most likely to come across in clinics and hospitals, because they are generally a solid and reliable means of assessing ears. You will also come across other otoscope makers that produce similar looking scopes (to be reviewed in future posts).  If you do want to save money by buying an older used diagnostic kit, this is the otoscope head to get.

Unlike the previous otoscope, this model and the following one both use standard otoscope tips, but through different means.  The covered end of the scope (under the black plastic tip) is conical metal, and has a groove cut into the top of it that helps lock in a bump of plastic on the inside of the tip.  The common mistake med students make is just shoving the tip on without lining up bump with groove, which means the tip doesn’t actually make a secure connection with the otoscope and readily falls off during the examination. While it is especially hilarious to observe medical students accidentally detach the tip and find it dangling out of the patient’s ear (sometimes without their knowledge), this is generally a newbie move to avoid. You should be able to give a slight tug on the tip to ensure it is secure.

Welch Allyn Compare Series: Insufflator BulbThe other difference to note between this and its predecessor is the input for the insufflator bulb, which is an accessory used to push air into the ear and gauge movement of the tympanic membrane.  You may never use an insufflator bulb throughout med school, and should not buy one. Pediatric offices that require their use will supply them. Nonetheless, Welch Allyn decided to change up the industry standard of having a tube attach onto an external plug (female port) to an extra piece of plastic that gets plugged into a hole in the side of the scope (male port). You can see the additional end piece in the image on the right. I’m sure they saw a minor rise in sales because of that change, but medical students should not purchase this accessory.


Welch Allyn Compare Series: Macroview Otoscope

Macroview Otoscope

Lastly, we come to the unnecessary but unavoidable up-sell, the Welch Allyn Macroview Otoscope. Despite decades of doctors being able to visualize the ear canal perfectly well with standard otoscopes, Welch Allyn claims “this instrument is a significant advance in hand-held otoscopy…”

Their key selling points are that this otoscope doubles the field of view and increases magnification by 30% compared to other models. The former may be helpful, but otherwise you can simply move the scope if you want to view the tympanic membrane periphery.  That’s how doctors have done it for decades.  The increased magnification simply isn’t noticeable.  Remember back when you last used a microscope?  The lowest setting was the 10X lens, followed by the 40X lens.  That’s 400% greater magnification.  This offers a 30% increase, which would be like moving up to a 13X lens on your microscope.  In the world of light otoscopy, it sounds like a big improvement, but this really isn’t doing much. This also comes with “the ability to adjust focus for variable ear canal length or farsighted eyes,” which is yet another issue doctors have never really had a big problem with historically.

Welch Allyn Compare Series: Standard Otoscope TipThe macroview otoscope also uses standard tips, but instead of holding onto them by a groove internal to the tip, they actually secure the tip externally.  Ridges found near the tip base actually twist under the end of the otoscope head.  This is actually a nice improvement, as it does a better job of securing the tips.  Of note, you most likely should not need to purchase otoscope tips yourself, as clinics provide them.  Be sure to always grab 10 or so extra for your case, just in case you run into a clinic which is not so courteous.

Another key difference in the Welch Allyn Macroview Otoscope is that its lens cannot be rotated or slid aside for direct access to the ear with a curette through the barrel of the otoscope. This is often used to remove ear wax under direct visualization.  However, most attendings will not want medical students to be performing manual cerumen disimpaction, as there have been rare case reports of bones in the ear accidentally being removed during this process.  Remember: never manually disimpact unless you can directly visualize some portion of the tympanic membrane!

Despite this article poking holes in the advertising of Welch Allyn, this is overall a great otoscope to have.  It is reliable, sturdy, and a great tool to visualize the ear canal, which are all excellent qualities as it is most likely your only diagnostic kit option. Unlike differing ophthalmoscope designs that require different learning and skill sets to actually use, there is no difference in the physical use of any of the above otoscopes.  That essentially means you can purchase and learn on the Welch Allyn Macroview Otoscope, and still know how to use any standard wall-mounted otoscope in an office or emergency department setting.


In summary, the direct comparison is as follows:

Approx.
Price *
Type
of Tip
Curette
Opening
Available
in New Kit
Pneumatic Otoscope
$150 Large Base yes special order only
Standard Otoscope
$110 Standard yes no
Macroview Otoscope
$225 Standard no yes
* prices are for the otoscope heads only. handles are sold separately.

Prices are higher if you purchase components separately, so try to buy a value meal (a complete diagnostic kit sold as a single unit) unless you can find a really great deal.  With that being said, the above three scopes were added to the price-check plugin as a reference.

 

Posted in Medical Instruments | Tagged , , , , , , , , , , , , , , , , , , , , , , , , |
2 Impressions on this resource so far. What's yours?