The finger-to-nose exam is typically used to detect a cerebellar lesion. In subtle cases though, this can be be difficult to detect.
How can you improve your sensitivity of this exam?
Did you know that a cup of coffee can cost over $9… when planning a CME conference?
In an interesting survey-based publication by Dr. Tabas (one of my colleagues) that just came out in Archives of Internal Medicine, we learn more about the ins and outs of CME activities. The authors set out to determine the audience members’ opinions about:
The ideal clinical decision tool has a sensitivity and specificity of 100%.
You need a high sensitivity to be sure that your negative result indeed predicts a true negative. That means if your clinical decision tool suggests that you don’t need to get a head CT, then your head CT would have been normal.
On the flip side, this realistically means there is a low-moderate specificity. That means a clinical decision tool with at least 1 positive criterion does not always mean that there will be an abnormal finding on head CT.
There are 3 major clinical decision rules that I’ve heard tossed around in the literature:
There is no perfect tool.
Take a look at these decision rules and their inclusion criteria.
Which do you use? I use a combination of all 3 and my clinical gestalt.
Go to ALiEM (PV) Cards for more resources.
Thanks to Dr. David Duong and Dr. Najm Haqu (UCSF) for letting me cross-post their amazing instructional video on the “EM Eye Exam”. These videos were made for the purpose of teaching senior medical students on their UCSF-SFGH EM clerkship. I thought it’d be great to share these tutorials, since the eye exam is typically a daunting task for many medical students (and residents).
Have you ever been to an ultrasound workshop where each small group of attendees huddles around the small ultrasound display? Personally I think the 3 people closest to the display really see the images well. This tends to exclude the other participants.
Last week, I hosted (my first!) ultrasound workshop for the UCSF Alumni CME Conference where I showed peri-retired UCSF alumni from various specialties about the future of bedside ultrasonography. I equated it to the 21st century stethoscope. Thanks to my star team of ultrasonographers: Dr. Asaravala, Flores, Miss, Lenaghan, and Wilson.
You always hear about it when working up syncope and sudden cardiac arrest in young patients, but it’s so easy to forget what it looks like on ECG. We so rarely see it… or DO we?!
This Paucis Verbis card on Brugada Syndrome is to help emblazon these ECG tracings in our mind, so that we don’t miss the subtle findings which place a patient at risk for sudden cardiac death. Pay special attention to Type 1, which is most specific for Brugada Syndrome.
* Update 8/2/18: Only Type 1 and Type 2 are recognized for Brugada syndrome. The type 3 pattern is likely a normal variant.
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Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
Mandible, or TMJ, dislocations occur when the patient excessively opens the mouth, such as in a yawn. They are typically bilateral and are difficult to relocate because of masseter and medial pterygoid muscle spasm. You can relocate the condyles back into the TMJ space with gentle but firm intraoral pressure inferiorly and posteriorly. Often it requires some sedation to help relax the muscles of mastication.