Tag Archives: physical exam

Free copy of Bates’ Guide to Physical Examination and History Taking!

This contest is currently closed – the winner has been contacted.

Bates Guide to Physical Examination and History Taking

Continuing our trend of offering absolutely free books to fellow med students, we are happy to be giving away a free copy of Bates’ Guide to Physical Examination and History Taking.  We recently reviewed Bates Physical Exam on the site, and have gotten great feedback from it so far.

In our last giveaway, a student from the University of Pittsburgh took home a free copy of Pocket Medicine by giving great advice to incoming first year medical students. In a similar fashion, the winner of this contest will be able to provide the best feedback for the following challenge.

If you could improve MedStudentBooks.com to help med student readers from around the world, what would you add to the site? The winner not only gets a free copy of Bates, but may also have their idea implemented on the site.

Please check out the About section to get an idea of the original site goals, but keep in mind that the winner will be chosen based on the helpfulness of their ideas. We not only host reviews, but create new applications as well, so anything is fair game.  All contest ideas can be submitted by replying in the comment section of this post, and you may submit multiple ideas for this contest. While it doesn’t improve your chances of winning, be sure to also subscribe via RSS or click on any of the social network links at the bottom of this post or top of the page.

As this is valued at nearly $100, the winner will need to provide a valid US medical school e-mail address to confirm their status. E-mail addresses are never displayed publicly, and will not be used for any purpose outside of contests.  The contest will end on Friday, November 18th at 11:59pm, and the winner will be notified by the e-mail they provided shortly thereafter.

See our complete contest rules for further details.

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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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Sites to See: The Eyes Have It

University of Michigan Kellogg Eye Center: The Eyes Have It
As a complement to the latest post on ophthalmoscopes, we are happy to share an excellent online resource for medical students to learn about ocular findings and signs that may pop up on physical exam: The Eyes Have It, from the University of Michigan’s Kellogg Eye Center.

The Eyes Have It is a site that provides a split instructional and quiz portion to both review and solidify ophthalmology knowledge. The information is straight forward, and creates a great overview for med students in the primary care settings, and a starting point for ophthalmology clerkships.

Papilledema and Retinal Artery Occlusion

For the first-year medical students, after you purchase your ophthalmoscope for the first time, take a good hard look in as many eyes as you can.  When something looks weird, this is the site to go to as your first step.  For the third year medical students, here’s a pimp tip that will make you look like a rock star: involvement of herpes zoster on the nose is known as Hutchinson sign, and is a good clue that the eye is involves in the outbreak as well.  Bonus points are given to anyone who can comment on the pathology of the above two images from The Eyes Have It.

Iris Collage

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Compare Welch Allyn Series: How to Pick the Best Light Source

This is the third installment 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 light sources, which are the physical bulbs that illuminate the ear canal or retina through the otoscope and ophthalmoscope, respectively.

Choices here are limited throughout the industry to either halogen bulbs, which have been the long-standing default in the field, or the newer sexier light-emitting diode (LED) technology. If you’re interested in the bottom-line short version, scroll to the bottom.


Welch Allyn Halogen BulbFirst let’s hit the older (read: cheaper) option that is still the default for diagnostic kits today. Halogen bulbs have been the standard for otoscopes and ophthalmoscopes for a while now, and Welch Allyn has (in their usual fashion) claimed theirs is the best. Halogen lights in general produce a yellow or off-white softer light. This actually comes in handy when viewing a retina, as brighter lights will constrict the pupil, thus making it more difficult to actually see the retina.

The downside to halogen bulbs is that they are somewhat easy to break, and they degrade and burn out faster than LEDs. Historically, halogen bulbs have cost up to $60 to replace, making this a sub-optimal option that doctors just had to put up with. Today, the price has thankfully lowered. Overall, this is now the cheaper option simply because it is the older technology, even though it works reliably well.


Welch Allyn LED Bulbs for Diagnostic KitsDiagnostic kit LED lightsaber bullets bulbs on the other hand are the more expensive option, which is somewhat surprising simply because LED technology of this variety has been around for a lot longer than it has been used in otoscopes, and should theoretically be cheaper. Welch Allyn had previously scoffed at LED lights, but are now making the transition over since competitors have been offering this option. Due to these recent changes, you can still find contradictory representatives that claim LED lights are not needed, while portions of their website claim LED lights as superior. They have however taken some time to create shiny exaggerated graphics, which I will share below. Regardless, do not be surprised if this newer option is not yet offered by most retailers.

Not quite sure how to interpret this one…

LED bulbs produce whiter and brighter light, allowing for clearer visualization of ears and noses. Check out the direct comparison of the two light sources in the top image. The LED is like a light-bazooka in comparison. Med students can just use their LED otoscope and actually forgo carrying a separate penlight to check pupils or look in someone’s throat, as they run on similar LED bulbs (that only cost the expected $2). LEDs use a fraction of the power compared to halogens (which means your handle battery lasts longer), are near-impossible to burn out, and don’t degrade in light quality during extended use. In almost every way, LED bulbs produce harder, better, faster, and stronger light.

The first real downside at this point is the cost, but that is expected to dramatically drop as soon as generic options are created that fit Welch Allyn diagnostic kits. Refuting the claim that the LED can be “too bright” is as easy as dimming the bulb on the power switch. As an aside, I find it amusing that Welch Allyn believes that dimming a halogen bulb, as seen in their demo on the right, somehow produces black-light (I said they were exaggerated). My personal solution, and the setup that I use in my instruments, is keeping the ophthalmoscope halogenated, and using an LED only with the otoscope. I get the best of both worlds. Keep in mind that you may need to open your instruments to insert the LED bulb yourself if your retailer does not provide this service for you. If you have the smarts to get into med school, this shouldn’t be too difficult to figure out. I’m sure there’s a “how many med students does it take to screw in a light bulb” joke somewhere in there.

Selecting an LED bulb may seem like a no-brainer. However, choosing this optional component in your diagnostic kit should come down to the question as whether this sexy super-light is actually needed. For the large majority of medical students, the answer is no, and the prices offered by Welch Allyn should serve as a deterrent, if the option is offered by retailers at this point.


In summary, the direct comparison is as follows:

Approx. Price Lifetime *
Color and Intensity
Halogen Bulb
$25 ~7 months Soft yellow
LED Bulb
$90 ~25 years Bright white
* refers to the total time when the bulb is actually on and in use

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

My retailer doesn’t even offer LED, and I’m not really a do-it-yourself kinda person.
Money is of no concern in the purchase of my instruments.
I have a habit of dropping my cell phone frequently.
I want to learn on the same components as everyone else, including the people teaching me.
I want to learn physical exam techniques using the absolute best equipment at my disposal.
I’m never going to use this diagnostic kit after med school, and will probably not use it that much in med school either.

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Compare Welch Allyn Series: How to Pick the Best Case

This is the second 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 cases, which is one of the easier choices to make as it doesn’t directly affect the use of your medical instruments.

The choices are straight forward: soft or hard casing. While many people instantly jump at the hard case, there are actually benefits and drawbacks to each.


Welch Allyn Hard CaseFirst, let’s look at the hard case, seen right, which are usually the default option offered upon purchasing a Welch Allyn diagnostic set.  Hard cases are designed to provide a shell of hard plastic around your instruments, with some padding between the case itself and the instruments inside. As such, dropping your Welch Allyn kit in a hard case is more likely to prevent the actual instruments themselves from directly feeling the shock of the floor. The other great benefit is that the inside of the case is basically a molding of the instrument components, meaning each part has its own place, and everything stays organized.

The biggest downside is that the hard case is somewhat bulky.  While it will fit into an empty white coat pocket, it will be somewhat of a tight fit to get the fabric around the corners.  It goes without saying that most med students don’t put too many other things in the white coat pocket that will carry their diagnostic kit, as it makes things difficult or impossible to fit everything. The downside of the organization benefit is that the molded inner casing essentially requires the user to organize everything before being able to close the case at all.  Some people find this annoying, especially if they are in a rush or have only one hand free.  It also means you can’t really re-use the case for new or other instruments. Lastly, the side-zipper requires the user to remove the entire kit from their pocket and set it down on a table to open. It’s rather difficult to access instruments directly from a pocket, or one-handed.


Welch Allyn Soft CaseNow let’s turn towards the soft case.  Depending on the retailer, you may need to specially request a soft case if you so desire it, but keep in mind that Welch Allyn instruments will most likely fit into any standard soft case, even if it is not made by Welch Allyn. The biggest benefit of soft casing is that it is a bit more convenient to use.  Instruments sit longitudinally inside the case, covered by a flexible padding layer, with an opening on top. The width of soft casing is thinner than the hard casing and without the hard corners, which means it easily slips into white coat pockets, even with other things in them. This flexibility and ability to squish into its surroundings also means it can even be slipped into pants pockets.  This is incredibly useful on a Pediatrics clerkship where white coats are optional.  The other big benefit is that the top opening allows for instruments to just be slipped in and out of the case while it’s still in your pocket.  No table for setup or organization time is needed.  Just grab and drop back in when done.  Lastly, it is important to mention that the open space inside the case means additional instruments can be placed within it.  When I bring a diagnostic kit with a soft case, my tuning fork and reflex hammer are stored within it in one convenient package as well. Thinking ahead, new or upgraded instruments do not require a new soft case, as they can be re-used.

The downsides are just the opposites.  Welch Allyn claims “both cases provide sufficient protection,” but the truth is that the soft case will transmit impact with the floor more than the hard casing. It also means instruments are laying loose inside the soft case and can bump and rub against each other.  This generally doesn’t actually represent any threat to the instruments as Welch Allyn claims all of their instruments are incredibly durable, but it should be pointed out.  As things are loose, grabbing otoscope tips that migrated to the bottom can be troublesome, but this is a moot point if you don’t need to bring your own tips because the clinic supplies them.


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

I have a habit of dropping my cell phone frequently.
Ease of use is the most important aspect.
When I’m done using the vacuum, I never wind up the wire properly.
I want to keep my instruments as well protected and preserved as possible.
My school bag is a gigantic mess, but I know where everything is.
Presentation is everything.

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Compare Welch Allyn Series: How to Pick the Best Battery and Handle

This is the first 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 handles and power sources, which house the battery and provide power for the otoscope or ophthalmoscope head. If you’re interested in the bottom-line short version, scroll to the bottom.

Welch Allyn Universal Desk Charger Not Needed for Med StudentsThe easiest way to start is to say what you do NOT need, and that is the Welch Allyn Universal Desk Charger (seen right).  These clunky things run upwards of $200 and represent the superfluous up-sell. The concept is good in theory, in that you can just drop your instruments into one of the holes to get it charged. As a med student on the wards, such a tactic is sub-optimal at best and a good way to get your gear stolen at worst. The actual handles have their own methods of charging which do not require this costly and unnecessary extension cord.

Now let’s turn to the real decision: Welch Allyn NiCad or Lithium Lightsaber power handle.  Each one has its pros and cons, but understanding your use of your Welch Allyn diagnostic kit as a med student is what should really determine your buying trend. Most med schools only require you to purchase and use personal diagnostic kits during the teaching of physical exam techniques in the preclinical years, with very rare use in specific clinics during third and fourth year of medical school. You should ascertain usage patterns at your med school to make sure you don’t jump at the high end model when it will only be used a handful of times for the entirety of your medical school training.


Welch Allyn Nickel Cadmium Battery Powered HandleThe Welch Allyn Nickel-Cadmium (NiCad) handle (shown left) is the baseline model that will serve as a cheaper but reliable power source.  The NiCad battery inside can be recharged by plugging the handle directly into any wall socket.  One of the biggest benefits of this power source over the Lithium below is that it can be converted to normal C-battery use. I have seen several med students forget to charge their handle, subsequently lose power in the middle of clinic, and then look really foolish for the rest of the day. With this model, having a couple of batteries in your bag means you can pop them in and keep going strong when the charge dies.  This is especially ideal for developing countries with unpredictable electrical sources, should you decide to go abroad.

 

There are a couple of downsides to the NiCad battery. First, it is heavier than the Lithium handles.  For most people, this is not significant and not an issue whatsoever. The only other consideration is that there are rumors (often times furthered by Welch Allyn representatives) that NiCad batteries in general may experience “charge memory” or “memory effect.” This refers to a historic observation that NiCad batteries will remember the point at which you charge them as “empty,” thus not utilizing the full capacity.  Most modern observations of this effect require over 1000 charges and partial-discharges for this to actually take effect. Suffice it to say, I have never heard of any medical student or resident complain about their NiCad handle losing charge time, and this may possibly by a result of the overall infrequency of use. Many medical students can get through all of medical school on just one set of 2 C batteries in their diagnostic kit.


Welch Allyn Lithium Ion Rechargeable HandleNext we have the “superior” (read: more expensive) option, the Lithium Ion battery powered Welch Allyn diagnostic kit handle.  This is one of their up-sells, advertised as “twice the battery life with just half the weight.”  It mostly speaks for itself, but there are a few considerations. Like the NiCad handle, it can be plugged into any electrical outlet via the hidden electrical AC plug within the handle.  However this handle cannot be converted to use C batteries.  In other words, when you run out of juice in this thing, you’re done until you can charge it in the wall again.  Again, keep in mind that a full charge will get you pretty far, so weigh things based on your schools requirements.  Another possibly-insignificant difference with this handle is that the green push-and-twist power button is on the side of the handle itself instead of on the top edge. There’s really no difference in ease of use.


In summary, the direct comparison is as follows:

Approx. Price Battery Life Compare Weight Recharge Options
Nickel Cadmium $150 ~60 minutes less light Wall Outlet or C Batteries
Lithium Ion $300 ~120 minutes lighter Wall Outlet only

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 have a habit of forgetting to charge my cell phone.
I want to learn physical exam techniques using the absolute best equipment at my disposal.
I want to look like a jedi.

Suggestion:

 

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