Internal Medicine blog
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.
Pancreatitis With Gallstones and TG 1,250: Is Plasma Exchange Needed?
When gallstones and triglycerides near 1,250 mg/dL coexist, the triglyceride result supports a possible contributor—not an automatic insulin drip or plasma-exchange order. Separate cause from treatment, and assess for biliary obstruction.
MASCC Risk Index MCQs: Why Two 5-Point Answers Can Tie
A MASCC question can have two five-point features. Learn to separate the score’s numerical ceiling from the feature the stem actually supports—and spot when mild chills leave illness burden unclear.
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.
Esophageal Cancer Work-up on Warfarin: Biopsy vs EUS-FNA
For progressive dysphagia in a patient with a mechanical mitral valve, distinguish diagnostic biopsy from EUS-guided sampling before deciding whether to interrupt warfarin.
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.
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.
TLS Hypocalcemia: Why Phosphate Is the Missing Link
Trace how phosphate released during tumor lysis lowers calcium and can injure the kidneys. A focused retrieval drill helps you explain the mechanism without overreading one lab panel.
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.
TMP-SMX in ANCA Glomerulonephritis: PJP Prophylaxis, Not Relapse Prevention
In ANCA-associated glomerulonephritis, TMP-SMX is used to prevent Pneumocystis during induction—not as routine vasculitis-maintenance therapy. Learn to separate the indications and monitor potassium and kidney function in active AKI.
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.
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.