Medical Education
Clinical teaching and practical ideas for your next study session.
ST Depression in V1–V3: When to Record Posterior ECG Leads
Learn when ST depression in V1–V3 should prompt posterior leads, how to position V7–V9, and why reciprocal clues raise suspicion without proving posterior infarction.
Diabetic Foot Ulcer Off-Loading at Discharge: When to Cast—and When Not To
A discharge off-loading plan is more than a footwear order. Match the device to ulcer location, infection, ischemia, and safe mobility—and specify how it will be used.
STEMI With a Negative First Troponin: Reperfuse, Don’t Wait
A normal early troponin does not cancel an ECG-defined STEMI. Learn why the reperfusion decision follows the ECG, how biomarkers fit later, and when to reassess the tracing.
After Myxedema Coma: Converting IV Levothyroxine to Oral Therapy
Extubation alone does not establish oral readiness or the right maintenance dose. Learn how to assess absorption, convert IV dosing, account for cardiac risk, and monitor recovery without chasing TSH.
A High CAD Polygenic Risk Score: How It Should Change Statin Decisions
A high coronary artery disease polygenic risk score is a risk enhancer, not an individual event probability or automatic statin order. Learn to place it alongside PREVENT-ASCVD risk, family history, and coronary calcium when appropriate.
Cold Specimens and High Potassium: The Transport Clue
Cold transport before blood cells are separated can raise measured potassium. Learn why specimen temperature matters, what it cannot prove, and how to ask the laboratory for a reliable repeat.
Pre-excited Atrial Fibrillation: When Rate Control Is the Wrong Move
In pre-excited AF, stable blood pressure does not make routine AV-nodal rate control safe. Recognize the irregular wide-complex clue; stable patients may undergo monitored drug conversion or elective electrical cardioversion, while instability calls for immediate electrical cardioversion.
Pseudohyperkalemia: When the Sample, Not the Patient, Adds Potassium
A normal repeat does not identify the artifact. Trace how clotting, fragile blood cells, fist pumping, and specimen handling can raise measured potassium—and choose a confirmation that fits the suspected source.
King’s College Criteria in Acetaminophen ALF: A Trigger, Not a Transplant Order
A pH of 7.28 may meet the acetaminophen King’s College pH pathway only in established acute liver failure when the arterial sample, resuscitation, and timing fit the applicable protocol. Learn why the criteria guide urgent evaluation but do not decide transplantation.
Positive Malaria Smear: Use Parasitemia to Judge Severity
A positive malaria smear is the start of a severity decision, not the end of diagnosis. Learn how species, organ dysfunction, and parasitemia independently guide escalation, admission, and monitoring in a returned traveler.
Unstable Cardiac Tamponade: Why Fluids Are Only a Bridge to Drainage
In confirmed unstable tamponade, arrange immediate pericardial decompression. Cautious IV fluid may briefly support cardiac filling, but it cannot remove the pericardial constraint and must not delay drainage.
Zoledronic Acid at eGFR 28: Match the Renal Rule to the Indication
An eGFR of 28 is a reason to pause, not a universal zoledronic-acid cutoff. Match the preparation and indication to its renal rule, and don’t assume denosumab is automatically safe in advanced CKD.