Internal Medicine blog
Clinical teaching and practical ideas for your next study session.
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.
INR 11.2 Without Bleeding: Safe Warfarin Reversal Without Overcorrection
An INR above 10 is a management threshold, not a cue for indiscriminate reversal. Learn how to confirm truly absent bleeding, consider low-dose oral vitamin K, monitor the response, and restart anticoagulation safely.
Sepsis-Associated Atrial Fibrillation: Is the Rhythm Causing Shock?
A fast irregular rhythm in sepsis may be the culprit, a consequence, or both. This case-based discussion teaches how to determine whether AF is driving instability, choose rate control versus synchronized cardioversion, and plan follow-up after recovery.
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.
When Wheeze Is Not Just COPD: Sorting HFpEF From Mixed Acute Dyspnea
An older smoker with wheezing, hypoxemia, orthopnea, and edema may have concurrent COPD exacerbation and acute heart failure. This case discussion shows how to identify the dominant physiology, interpret BNP and ABG findings, and treat both safely.
Wells Score for Pulmonary Embolism: The Point-Scoring Traps That Change D-Dimer vs CTPA
A Wells score is only useful when every point is earned. Learn how to assess DVT signs, immobility, and clinical judgment accurately, then choose D-dimer, CTPA, or V/Q imaging.
Modified Wells Score for Pulmonary Embolism: Score Precisely, Then Choose CTPA
A high Wells score should move the clinician toward definitive imaging—not reflexive D-dimer testing. Work through the score carefully, identify common traps, and choose the correct next test.
Suspected NSTE-ACS in CKD: A High-Stakes Diagnostic and Management Case
When diabetes, chronic kidney disease, dynamic ECG changes, and troponin elevation collide, the key is to recognize high-risk NSTE-ACS without under-treating or over-anticoagulating the patient.