For the most part, the book is successful in achieving its goal. For example, there are useful discussions of straightforward clinical presentations of acute otitis media, sinusitis, dizziness, and similar ear nose and throat conditions that are treated in primary care settings. And, as promised, the authors provide some information on how to manage more complex cases. For example, recurrent otitis media in children is often treated with myringotomy tubes, and the authors take care to articulate the indications: “three to four bouts of acute otitis media in six months or four to five bouts in a single year” (page 23).

The discussions are very straightforward, which makes this book very good for average medical students. Remember, ear nose and throat diseases are very well represented in clinical practice and on the Boards, but they are often underemphasized in medical school curricula. Primary Care Otolaryngology (2019) will help students bridge this gap.

Next edition of the book should probably focus a bit more on differential diagnosis. For example, the identified causes of dizziness (Chapter 6) include benign paroxysmal positional vertigo, vestibular neuronitis, and Ménière’s disease, but stroke is unfortunately mention in just two words and only very tangentially (“vascular abnormality”). Considering its clinical importance, stroke should probably be discussed more fully and specifically as a potential cause of severe dizziness. In addition, pharyngitis isn’t mentioned in the book at all. And while I understand that most otolaryngologists don’t see many patients with a chief complaint of sore throat, the Pediatric Otolaryngology chapter (Chapter 17) feels incomplete without it, especially because other pediatric diseases of the neck (peritonsillar abscess, epiglottitis, croup, etc.) are discussed in adequate detail.

Overall, Primary Care Otolaryngology (2019) remains an excellent starting point for medical students who are looking to broaden their understanding of ear nose and throat diseases. I therefore recommend Primary Care Otolaryngology (2019) very highly to medical students, particularly those who are rotating in otolaryngology or are preparing for the USMLE (all Steps!). The book is available online for free. My review of a previous edition of the book can be found here.

The post Primary Care Otolaryngology (2019) appeared first in The Medical Media Review.

Generally, the discussions are very straightforward and suitable for most better than average medical students. However, rheumatology is a speciality of subtlety and nuance, and the book does a very good job in situations where such treatment is required. Take for example the discussion of scleroderma, the prototypical disease of skin hardening and fibrosis. There are three important mimics to keep in mind, and the author does a great job explaining how to distinguish them from each other clinically:

• Eosinophilic fasciitis: younger patient with skin thickening on distal forearms; associated with exercise and peripheral eosinophilia; no finger involvement.
• Morphea: localized, patchy hardening of the skin without hand involvement (sclerodactaly or Raynaud’s phenomenon)
• Nephrogenic systemic fibrosis: history of exposure to gadolinium contrast

As you can see, this type of presentation is very useful, both clinically and for preparation for standardized examinations such as the United States Medical Licensing Examination (USMLE).

It’s really, really, hard to find much fault with this book. The author is quite obviously a master in his field and a master educator too. And unlike some of the other books in the “Ridiculously Simple” series, Rheumatology Made Ridiculously Simple (2020) is a serious book written by a serious author who is quite obviously an expert in his specialty. I therefore think future editions of this book deserve a less irreverent cover (see above). Also, I suspect that the chapter on pharmacotherapy (Chapter 2) should be placed after the chapter on laboratory testing (Chapter 17). This would be more consistent with the way diseases are approached in medicine more generally: patient history, then physical examination, then workup, then treatment.

It’s very hard for me to find any additional ways to improve this book. I therefore recommend Rheumatology Made Ridiculously Simple (2020) to medical students and residents and to non-rheumatologist attendings who are interested in brushing up on the specialty.

The post Rheumatology Made Ridiculously Simple (2020) appeared first in The Medical Media Review.

All surgeries take place in the three dimensions of space, and in a particular sequence, that is, in the fourth dimension of time. So you can’t really understand surgery by reading a book. This is why Surgical Anatomy for Mastery of Open Operations (2018) comes with excellent cadaveric surgery videos—free sample here—which help make the text come to life in the mind of the reader.

While I like the content of the book, I’m not too excited about its structure. You see, even though it’s only about 250 pages long, it reads too much like a textbook. For example, the operative part of emergency cricothyroidotomy is described this way:

Use a Kelly, mosquito, or right-angle clamp to spread tissues in the midline. Use the introducer needle to penetrate the cricothyroid membrane and immediately angle the needle in an inferior direction in alignment with the airway (Fig. 1.10). A guide wire is inserted. Hooked dilators are placed in size succession smallest to largest. Be sure to begin dilator insertion over the wire perpendicular to the skin. Rotate the dilator clockwise and counterclockwise to “screw” it into the airway.

Surgical Anatomy for Mastery of Open Operations (2018), pages 8-9

There are several issues here. First, surgeons plan procedures in steps. (“Checklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realized.” ~ The Checklist Manifesto). So it would be helpful if future editions of this book laid things out with numbered items (see example below) rather than by clustering the information into dense paragraphs. This way, trainees can rehearse things in their mind more easily before operations. Second, did you notice all the passive language in the text (e.g., “a guide wire is inserted” and “hooked dilators are placed,” etc.)? This passive phrasing weakens the text and is un-conducive to effective learning and memorization. In future editions I’d much rather see active language in a numbered list format. For example, something like this might be much more effective:

1. Use a Kelly, mosquito, or right-angle clamp to spread tissues in the midline.
2. Use the introducer needle to penetrate the cricothyroid membrane and immediately angle the needle in an inferior direction in alignment with the airway (Fig. 1.10).
3. Insert a guide wire.
4. Place hooked dilators in size succession, from smallest to largest.

These types of changes would require almost line by line editing and revision of the text. However, all the content is already there, so I don’t think the task would would be too difficult for a medical editor of average ability.

So while I believe that there’s still work that needs to be done to bring this text to top-notch level, Surgical Anatomy for Mastery of Open Operations (2018) is, as is, among the best in its genre, and I therefore recommend it very highly to surgery residents and to medical students who have a keen interest in general surgery.

The post Surgical Anatomy for Mastery of Open Operations (2018) appeared first in The Medical Media Review.

The book, written by a cardiologist with a lot of experience teaching cardiology to medical students and residents at an academic center, is quite different from most entry level electrocardiography books. While like most ECG books it covers basic and intermediate level interpretation skills, the focus is on clinical management, both short and long term. (In this sense, Basic and Bedside Electrocardiography (2009), is quite different from the otherwise equally excellent A Visual Guide to ECG Interpretation (2017), a book that is more focused on acute management). So, example, there is a rather extensive discussion about the different kinds of atrial fibrillation: nonvolvular, valvular, paraxyxsmal, permanent, etc.

And while the book provides a rather deep dive into the subject matter, the discussions remain interesting, lucid and approachable throughout. And the author doesn’t just throw EKGs at you. Rather, the captions explain what is going on, and there are additional illustrations throughout the book to help you understand the pathophysiology of corresponding lesions and arrhythmias. The illustration and sample electrocardiograms are enlightening, and the text is clear and to-the-point. I’d considered the book almost perfect, if not for the fact that it is more than a decade old and very much in need of an update.

Basic and Bedside Electrocardiography (2009) isn’t for someone who likes to dabble in EKGs or wants to be “good enough” at reading and interpreting them. It is more of a clinical cardiology book that leans very heavily, perhaps almost exclusively, on electrocardiography as a diagnostic modality.

I therefore recommend Basic and Bedside Electrocardiography (2009) very highly to primary care residents and to highly motivated third and fourth year medical students who have a strong interest in cardiology or emergency medicine.

The post Basic and Bedside Electrocardiography (2009) appeared first in The Medical Media Review.

To better understand what this book can do for you, consider, Essential Biostatistics: A Nonmathematical Approach (2015), which I reviewed elsewhere. That book is also a qualitative description of important concepts biostatistics concepts, but it’s biostatistics for the ideal world. On the other hand, A Clinician’s Guide to Statistics and Epidemiology in Mental Health (2009) picks up where Essential Biostatistics leaves off: it shows you how clinical epidemiology and biostatistics should be used in the real world.

The real world, you see, imposes a lot of limitations and traps that you might not have learned too much about in preclinical medicine. For example, there is the corrosive influence of conflicts of interest, publication bias, and the general pressure within academia to publish a lot of studies with “positive” results.

The book helps you navigate these challenges and shows you how to arrive at accurate conclusions despite all the problems with contemporary clinical research. As the author notes:

I believe that the answer to the harmful influence of the pharmaceutical industry in medical research is to become less ignorant about medical research. If we as clinicians knew more, we would not be so open to being manipulated.

A Clinician’s Guide to Statistics and Epidemiology in Mental Health (2009), page 121

To help you know more about how clinical trials actually get done, the book discusses problems such as ghost authorship, lack of “author” control over the primary data, unpublished negative studies and disease mongering (the unnecessary invention and expansion of diagnostic criteria).

All in all, A Clinician’s Guide to Statistics and Epidemiology in Mental Health (2009) is an outstanding introductory book to applied clinical epidemiology. Unfortunately, I don’t think the book has gotten the exposure it deserves because of its rather limiting and convoluted title. (How about Real World Clinical Epidemiology for the next edition?). Nonetheless, it is an exceptionally good book and, in my view, one of the best medical books of all time. I recommend it very highly to later-year medical students, to residents, and to attendings who have a limited background in the subject.

The post A Clinician’s Guide to Statistics and Epidemiology in Mental Health (2009) appeared first in The Medical Media Review.

Presentations are mostly case-based. For example, the book (page 135) provides a case of a young female with obesity who presents with complaints of progressively worsening headache and vision changes. Physical examination is positive for papilledema, but the MRI of her brain is normal. Takeaway points, which are presented in the form of multiple choice questions and answers, are that (a) the presentation is suspicious for idiopathic intracranial hypertension (“pseudotumor cerebri”), (b) the best next diagnostic test is lumbar puncture with measurement of opening pressure, and (c) treatment is with acetazolamide.

There are several dozen rather classic cases that are presented in this way: you get the case presentation, including relevant images, and then are given the most likely questions you might be asked about the case, along with sufficiently detailed explanations. Fluff, controversy and ambiguity are avoided, which is exactly what medical students need.

(The book hits the mark nearly 100%. The only thing I’d consider changing in future editions is the way images are presented. Right now, images are shown along with their interpretations. So, for example, in the case of idiopathic intracranial hypertension mentioned above, the brain MRI is shown and the caption says “no acute intracranial pathology.” I think it would be better if images were presented as-is, and then the learner was asked, in the form of a multiple choice question, to interpret the image. This would provide an important additional Socratic learning opportunity with respect to the interpretation of radiographic findings).

But the book is excellent as is. What’s more it’s available at no extra charge through Amazon if you subscribe to KindleUnlimited. I recommend it very highly to all medical students, particular those on neurology rotation.

The post Raven Neurology Review: For the Medical Student Clerkship (2018) appeared first in The Medical Media Review.

Aids to Radiological Differential Diagnosis (2020) is an extremely helpful handbook for interpreting imaging studies. For each radiographic finding, the book provides a differential diagnosis based on frequency, from most to least frequent. Take magacolon, for example, which is defined a colonic dilation greater than six centimeter. Radiologically this can be devided into two categories, toxic (with mural abnormalities) and non-toxic (without mural abnormalities.

The provided differential for toxic megacolon is:

1. inflammatory bowel disease: ulcerative colitis, Crohn’s disease.
2. Infection: especially pseudomembranous colitis.
3. Ischemia (page 164).

On the other hand, differential diagnosis for non-toxic megacolon includes distal obstruction, paralytic ileum, chronic pseudo-obstruction, fecal impaction, Hirschsprung’s disease and hypoganglionosis, laxative abuse and amyloidosis.

This is exactly the kind of book you need to reach for when you see a radiographic finding, or read about one in a radiology report, and you want to explore alternative interpretations for those findings.

Perhaps even better, an entire section of the book, Part 2, is devoted to explaining key radiological findings, listed on the basis of the underlying diagnoses. This way, if you, as a clinician, already know—or think you know—the diagnosis you can look at this section to help you decide if the radiologic findings are compatible with the already-known diagnosis. For example, according to the authors (pages 617-8), hilar lymphadenopathy in patients with sarcoidosis should be bilateral and symmetric. Unilateral hilar adenopathy is uncommon and the same is true with regard to pleural involvement.

It would be very nice if future editions of this book showed simple schematics or drawings of the key radiographic findings. For example, I suppose that most radiologist know what “bone within a bone” appearance looks like, but it would be helpful for early learners to see a drawing of it while they are learning the relevant differential diagnosis (page 452). That way, they can read the book with needing to use a different resource to figure out what the pertinent findings actually are.

All in all, recommend Aids to Radiological Differential Diagnosis (2020) to anyone who reads and interprets imaging studies, especially general practitioners and radiologists. It is a terrific book to read and keep as a reference.

The post Aids to Radiological Differential Diagnosis (2020) appeared first in The Medical Media Review.