internal medicine
Clinical teaching and practical ideas for your next study session.
Cirrhotic Variceal Bleeding: Should INR and Platelets Be Corrected?
With suspected variceal bleeding, an INR of 1.8 and platelets of 45,000/µL can trigger reflex transfusions. Learn why those results alone should not delay endoscopic hemostasis.
Corrected Calcium on Boards: Calculate It Without Calling It Ionized Calcium
For a calcium SAQ, calculate the requested albumin adjustment—but be precise about what the estimate can and cannot prove.
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.
Ceftriaxone PK/PD: How to Read Time Above MIC in Board Questions
In a conventional beta-lactam PK/PD MCQ, identify the feature that matters: free-drug time above MIC, not peak height. A six-minute sketch drill helps separate the index from the exposure target.
Pulmonary Embolism With sPESI 0: What Still Has to Be True Before ED Discharge?
A zero sPESI score estimates low short-term clinical risk; it is not a discharge order. This case shows how teams pair the score with current physiology, treatment barriers, medication access, and follow-up before choosing home care.
qSOFA in Sepsis MCQs: A Risk Flag, Not a Diagnosis
A qSOFA of 3 flags a high-risk patient, not a completed Sepsis-3 diagnosis. Learn how to use the score, compare acute SOFA with baseline, and avoid converting hypotension into septic shock.
Apixaban Before Type A Aortic Dissection Repair: Protect the Bypass Plan
A recent apixaban dose complicates emergency Type A dissection repair. Learn how to assess residual drug, weigh reversal, and avoid compromising heparinization for cardiopulmonary bypass.
Just Culture MCQs: System Fix, Coaching, or Discipline
A missed catheter removal is not automatically nursing error or reckless behavior. Learn which facts matter, how to classify the behavior, and how to choose the right Just Culture response.
Adverse Drug Reactions on the Boards: Classify Before You Restrict the Drug
The key board move is not memorizing Type A versus Type B. Use timing, dose dependence, organ involvement, and severity to choose whether to adjust, stop, document, or refer.
A Negative IGRA Before Biologic Therapy: When to Reopen the TB Workup
A negative IGRA before biologic or other immunosuppressive therapy lowers the probability of TB infection, but its reassurance depends on exposure timing, immune competence, and the clinical evaluation for TB disease. Learn when to repeat testing, consider a second test, or investigate further.