Internal Medicine blog
Clinical teaching and practical ideas for your next study session.
Positive Anti-PLA2R With Nephrotic Syndrome: When Can Kidney Biopsy Wait?
A positive anti-PLA2R may establish membranous nephropathy without kidney tissue in selected adults. Learn how kidney function, urine sediment, secondary causes, and a new DVT change the biopsy decision.
Acute Hemolytic Transfusion Reaction Labs: Build a Layered SAQ Answer
For an acute hemolytic transfusion reaction SAQ, group tests by what they establish: red-cell destruction, immune incompatibility, and complications. A positive DAT is evidence to interpret—not the whole answer.
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.
A-Lines in Shock: What the Lung Ultrasound Pattern Can—and Cannot—Tell You
Anterior A-lines with lung sliding describe the sampled lung surface; they can fit tamponade physiology but do not rule out pulmonary edema elsewhere.
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.
After Severe Hyperkalemia in CKD: When to Restart an ACE Inhibitor
After emergency treatment, decide whether lisinopril should remain stopped or be restarted by weighing the drug’s indication, reversible triggers, potassium control, and a concrete monitoring plan.
Severe Aortic Stenosis Before Elective Surgery: What Should Move First?
A severe-aortic-stenosis echocardiogram does not, by itself, decide whether an elective operation proceeds. Learn to combine symptom attribution, valve-intervention candidacy, procedure risk, and urgency.
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.
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.
HHS Resuscitation: Why a Rising Sodium Is Not a Fluid Order
A rising sodium can be expected as glucose falls in HHS. Learn why serial osmolality, perfusion, fluid balance, and cardiac risk—not one lab value—should guide fluid changes.
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.