Internal Medicine blog
Clinical teaching and practical ideas for your next study session.
Abdominal Pain in DKA: When to Look Beyond Ketoacidosis
Abdominal pain may accompany DKA or signal its trigger. Learn when fever, focal findings, or persistent pain warrant evaluation beyond metabolic treatment.
Pneumonia With Septic Shock and Paradoxical Breathing: When to Intubate
Learn why severe work of breathing can change the intubation decision before an ABG confirms ventilatory failure—and why a respiratory-rate cutoff alone is not the answer.
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.
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.
POCUS in Undifferentiated Shock: What You Can Act On Before Formal Echo
For shock MCQs, separate what a focused bedside scan can support now from what still needs a comprehensive echocardiogram. Image quality and clinical context determine how far to go.
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.
Delirium, Pneumonia, and a Positive Urinalysis: When to Treat the Urine
A positive urinalysis does not automatically make delirium a UTI. Learn how to reassess urine findings when pneumonia already explains the systemic illness.
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.
Acetaminophen Level 65 µg/mL: Why Timing Changes the NAC Answer
A level of 65 µg/mL can fall below or above the acetaminophen treatment line depending on when it was drawn. Use that contrast to connect NAPQI biology with board-ready NAC reasoning.
Normal Bilirubin, Acute Cholecystitis: Choose the Next Test
A normal bilirubin does not make persistent right upper quadrant pain benign. Learn how cystic-duct anatomy, ultrasound, HIDA, CT, MRCP, and ERCP answer different diagnostic questions.
Severe Aortic Stenosis With Iron-Deficiency Anemia: Don’t Call It Heyde Syndrome Too Early
A low ferritin in severe aortic stenosis is a diagnostic clue, not a completed diagnosis. Learn how to separate stabilization, occult GI bleeding evaluation, and timely valve intervention.