Just Talley & O'Connor things: Part 2
Choice quotes from Talley and O'Connor's Clinical Examination, 8th edition.
Leo Buerger (1879–1943), New York physician, born in Vienna, who described thromboangiitis obliterans. He was obsessed with expensive cars. (p. 113)
John Homans (1877–1954), a professor of surgery at Harvard University, Boston. He described his sign in 1941, originally in cases of thrombophlebitis. He later became disenchanted with the sign and is reputed to have asked why if a sign were to be named after him it couldn’t be a useful one. (p. 115)
Rudolph Virchow (1821–1902), a brilliant German pathologist, regarded as the founder of modern pathology, professor of pathological anatomy in Berlin. He provided the first description of leukaemia. He died aged 81 after fracturing his femur jumping from a moving tram. (p. 115)
The following supplementary tests are occasionally helpful (and surgeons like to quiz students on them in examinations) (p. 116)
This [mitral stenosis] murmur is famously difficult to identify. Fewer than 10% of medical students identified the murmur on a standardised audiotape. (p. 128)
This [water hammer] Victorian children’s toy consisted of a sealed tube half-filled with fluid, with the other half being a vacuum. Inversion of the tube caused the fluid to fall rapidly without air resistance and strike the other end with a noise like a hammer blow. It is not easy to imagine a child today being entertained by this for very long. (p. 133)
Austin Flint (1812–86), a New York physician and professor of medicine at the New Orleans Medical School, described this [Austin Flint] murmur in 1862. Author of The principles and practice of medicine, he was very much opposed to the naming of signs after people. (p. 133)
Note: These [eponymous] signs [of aortic regurgitation] are amusing, but not often helpful. (p. 134)
Modern leaflet valves are much less noisy than ball-in-cage valves, which can be heard from the other side of a crowded room. When patients complain of the noise, reassure them that they should worry only if the noise stops. (p. 137)
It is not necessary to memorise the entire list of eponymous signs of aortic regurgitation (in fact, you can forget them all). (p. 143)
Most medical students faced with giving their interpretation of a chest X-ray either opt for a ‘spot diagnosis’ (usually wrong) or raise their eyes to heaven, hoping for divine inspiration. (p. 147)
Although [portable echocardiography] will result in the temptation not to bother listening to the heart, any test used without an adequate history and examination is likely to be misleading.
Students and junior doctors need to understand when an echocardiogram is likely to be a helpful test (List 8.1) and not order one simply as a delaying tactic to help avoid making a decision about the patient’s diagnosis. (p. 151)
[COPD] has undergone many changes in nomenclature, and it is pleasing to think that experts have something to keep them occupied. (p. 175)
[Tactile fremitus] is a palpable vibration felt by the examiner’s hands on a patient’s chest wall when the patient is speaking (or singingi).
i Probably not to be encouraged during an OSCE exam. (p. 182)
Medical students soon learn to keep the right middle fingernail short. (p. 184)
Many people when asked to take big breaths, breathe in, and then, for some reason, stop. Although it is tempting to amuse oneself by waiting patiently for the patient to realise that expiration is also a part of breathing, this tends to waste time. (p. 186)