Preliminary Pages

ge1Intern Tips in Internal Medicine

ge2Disclaimer

The purpose of this resource is to provide a clinical decision pathway with a survey of treatment options, to accommodate the educational interests of trainees and practitioners in addressing the scope of options that might be considered in their clinical practice.

There is no assurance that the scope of clinical decision-making and treatment options outlined for any particular condition and/or individual clinical presentation is comprehensive.

The publisher and authors of this publication disclaim any liability, loss, injury or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this learning material.

ge3Intern Tips in Internal Medicine

Tips in Inpatient Rotations Internal Medicine, Family Medicine and ICU

Editors Lorenzo Aragon MD FAAFP Associate Professor Department of Family and Community Medicine Paul L Foster School of Medicine Texas Tech University Health Sciences Center El Paso El Paso, Texas, USA Sanja Kupesic Plavsic MD PhD Associate Dean for Faculty Development Director of Center for Advanced Teaching and Assessment in Clinical Simulation (ATACS) Professor, Department of Obstetrics and Gynecology Paul L Foster School of Medicine Texas Tech University Health Sciences Center El Paso El Paso, Texas, USA

ge4

Jaypee Brothers Medical Publishers (P) Ltd.

Headquarters

Jaypee Brothers Medical Publishers (P) Ltd.

4838/24, Ansari Road, Daryaganj

New Delhi 110 002, India

Phone: +91-11-43574357

Fax: +91-11-43574314

E-mail: jaypee@jaypeebrothers.com

Overseas Offices

J.P. Medical Ltd.

83, Victoria Street, London

SW1H 0HW (UK)

Phone: +44-20 3170 8910

Fax: +44(0) 20 3008 6180

E-mail: info@jpmedpub.com

Jaypee-Highlights Medical Publishers Inc.

City of Knowledge, Building 235, 2nd Floor

Clayton, Panama City, Panama

Phone: +1 507-301-0496

Fax: +1 507-301-0499

E-mail: cservice@jphmedical.com

Jaypee Brothers Medical Publishers (P) Ltd.

17/1-B, Babar Road, Block-B

Shaymali, Mohammadpur

Dhaka-1207, Bangladesh

Mobile: +08801912003485

E-mail: jaypeedhaka@gmail.com

Jaypee Brothers Medical Publishers (P) Ltd.

Bhotahity, Kathmandu, Nepal

Phone: +977-9741283608

E-mail: kathmandu@jaypeebrothers.com

Website: www.jaypeebrothers.com

Website: www.jaypeedigital.com

The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.

All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.

All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.

Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.

This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.

Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.

Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com

Intern Tips in Internal Medicine

First Edition: 2017

9789386056726

Printed at

ge5Dedicated to

My wife Lizette for her unconditional love and support, to my three beautiful daughters—Lizette Maria, Marcela Alejandra, and Melissa Eugenia; and my grandson Lukas David Wisnoski Aragon

—Lorenzo Aragon

My boys Branko, Ivor and Hobbes with love; Students, residents and trainees who will use this book to improve their clinical skills

—Sanja Kupesic Plavsicge6

ge7Contributors

Lorenzo Aragon MD FAAFP
Associate Professor
Department of Family and Community Medicine
Paul L Foster School of
Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

Gaston Berrios MD
Clinical Associate Professor
Department of Family and Community Medicine
Paul L Foster School of
Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

Pedro Blandon MD FASN
Assistant Professor
Department of Internal
Medicine
Division of Nephrology
Paul L Foster School of
Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

Juan Figueroa-Casas MD
Associate Professor
Department of Internal Medicine
Division of Pulmonary and
Critical Care Medicine
Paul L Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

Agathe Franck MD
Assistant Professor
Department of Family and Community Medicine
Paul L Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

Sanja Kupesic Plavsic MD PhD
Associate Dean for Faculty Development
Director of Center for Advanced Teaching and Assessment in Clinical Simulation (ATACS)
Professor, Department of
Obstetrics and Gynecology
Paul L Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

ge8

Amanda M Loya PharmD
Clinical Associate Professor of Pharmacy
UTEP/UT Austin Cooperative Pharmacy Program
Adjunct Clinical Assistant
Professor
Department of Family and Community Medicine
Paul L Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

Oscar Noriega MD FAAFP
Associate Professor
Department of Family and Community Medicine
Paul L Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

Diego P Peralta MD
Assistant Professor
Department of Internal Medicine
Division of Infectious Disease
Paul L Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

Gustavo J Rodriguez MD FANA
Associate Professor and
Vice Chairman
Department of Neurology
Clinical Associate Professor
Radiology Department
Paul L Foster School of
Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

Waseem Shami MD
Cardiovascular Medicine Fellow
Department of Internal Medicine
Paul L Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

Mary C Spalding MD FAAFP
Associate Professor and
Residency Program Director
Department of Family and Community Medicine
Paul L Foster School of
Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas, USA

ge9Preface

Intern Tips in Internal Medicine aims to provide physicians still in training, physicians-in-practice and medical students with a quick reference for commonly seen inpatient issues. Many currently available resources do not include specific medications, dosages and interventions that are needed at the point of care. Frequently, there is not enough time to read an article or look through a large reference, when there is a patient in need that requires an immediate response. This book serves as a reference and a simple starting point to assist in making initial decisions.

The book contains the information to cover common inpatient cases seen on internal medicine, family medicine, intensive care unit (ICU) as well as inpatient surgery rounds. Admission orders, progress notes and discharge summary examples are included to help the physicians/physicians in training focus on the points needed in each note.

The book is organized by organ system and addresses wide differential diagnosis concerns and specific diagnostic work-ups for common patients' presentation. It attempts to point the clinicians in the proper initial direction to assist in disposition, initial management and initial patient work-up.

Lorenzo Aragon

Sanja Kupesic Plavsicge10

ge11Acknowledgments

We would like to thank all of our students and residents who challenged and pushed us ever forward. Special thanks to Dr Lisa Montgomery, who proposed and initiated this project.

We would also like to thank the dedicated staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who were willing to dedicate their time and energy to this project. The team has always provided excellent technical support.ge12ge13ge14ge15ge16ge17ge18

ge19Abbreviations ABC:

Airway Breathing Circulation

ACE:

Angiotensin Converting Enzyme

ACE-i:

Angiotensin-converting Enzyme Inhibitor

ACLS:

Advanced Cardiac Life Support

ACS:

Acute Coronary Syndrome

ARB:

Angiotensin Receptor Blocker

ASA:

Aspirin

AV:

Atrioventricular

BNP:

Brain Natriuretic Peptide

BIPAP:

Biphasic Positive Airway Pressure

BP:

Blood Pressure

BID:

Twice a day

BUN:

Blood Urea Nitrogen

Ca:

Calcium

CBC:

Complete Blood Count

CCU:

Cardiac Care Unit

CHF:

Congestive Heart Failure

CIWA-Ar:

Clinical Institute Withdrawal Assessment for Alcohol, Revised

COPD:

Chronic Obstructive Pulmonary Disease

CPAP:

Continuous Positive Airway Pressure

Cr:

Creatinine

CT:

Computerized Tomography

CTA:

Computerized Tomography Angiogram

CVA:

Cerebrovascular Accident

CVP:

Central Venous Pressure

CXRay:

Chest X-ray

DDX:

Differential Diagnosis

DKA:

Diabetic Ketoacidosis

DLD:

Dyslipidemia

DM:

Diabetes Mellitus

DM2:

Type 2 Diabetes Mellitus Disease

Echo:

Echocardiogram

ED:

Emergency Department

EKG/ECG:

Electrocardiogram

ESR:

Erythrocyte Sedimentation Rate

ETOH:

Alcohol

GB:

Gallbladder

GERD:

Gastroesophageal Reflux Disease

GI:

Gastrointestinal

H⁺:

Hydrogen Ion

HF:

Heart Failure

hr:

Hour

hrs:

Hours

H & P:

History and Physical

HPI:

History of Present Illness

ge20HR:

Heart Rate

HTN:

Hypertension

ICU:

Intensive Care Unit

ICP:

Intracranial Pressure

INR:

International Normalized Ratio

IV:

Intravenous

IVF:

Intravenous Fluid

IVP:

Intravenous Push

I/O:

Intake and Output

Potassium

kg:

Kilogram

KUB:

Kidneys, Ureters, Bladder

LAD:

Left Anterior Descending

LBBB:

Left Bundle Branch Block

LV:

Left Ventricle

LVEF:

Left Ventricle Ejection Fraction

Mg:

Magnesium

MAP:

Mean Arterial Pressure

max:

Maximum

med:

Medication

meds:

Medications

mg:

Milligram

mL:

Milliliter

mm:

Millimeter

MI:

Myocardial Infarction

min:

Minute

Na:

Sodium

NaCI:

Sodium Chloride

NGT:

Nasogastric Tube

Nitro:

Nitroglycerin

NSTEMI:

Non-ST-elevation Myocardial Infarction

NTG:

Nitroglycerin

O₂:

Oxygen

PE:

Physical Examination

PE:

Pulmonary Embolus

PICC:

Peripherally Inserted Central Catheter

PNA:

Pneumonia

PND:

Paroxysmal Nocturnal Dyspnea

PO:

By Mouth

PPI:

Proton Pump Inhibitor

prn:

As Needed

pt:

Patient

PTX:

Pneumothorax

pulm:

Pulmonary

Every

r/o:

Rule out

rtPA:

Recombinant Tissue Plasminogen Activator

RV:

Right Ventricle

SC:

Subcutaneous

SOB:

Shortness of Breath

SBP:

Systolic Blood Pressure

S/S:

Signs and Symptoms

STEMI:

ST-elevation Myocardial Infarction

SVT:

Supraventricular Tachycardia

TIA:

Transient Ischemic Attack

TEE:

Transesophageal Echocardiogram

TPN:

Total Parenteral Nutrition

Vfib:

Ventricular Fibrillation

VT, Vtach:

Ventricular Tachycardia

VS:

Vital Signs

WPW:

Wolff-Parkinson-White Syndrome

Chapter Notes