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2014 Stump the Professor

NASPAG "2014 Stump the Professor" Submission Form

Question Title

* 1. Demographic Information:

Name:

Academic Degree:

Medical School and/or Department:

Program Affiliation:

Mailing Address:

City:

Province/State:

Zip:

Country:

Telephone:

Email:

Question Title

* 2. Indicate if you are (select one):

Medical Student Year

Resident/PGY

Fellow/Year

Faculty/Private Practice

Question Title

* 3. Case Report format:
Age of patient, chief complaint, detailed history of the present illness, relevant past, family, social history, positive ROS, relevant physical findings, relevant lab results, differential diagnosis, and any procedures performed. Include the final diagnosis (which will be withheld from the panelists).

Your submission should be no more than 600 words. You are encouraged to include imaging studies and photographs to illustrate your presentation. If you have imaging studies and/or photographs you would like to submit to supplement your case report please email the digital file to naspagmtgs@talley.com with your name and contact information in the email.