Internal Medicine

I started week five of twelve for Internal Medicine. The hours are from 7 to 5 most days. I should be personally responsible for 1 to 3 patients, and we round on all patients in the morning with the senior resident or attending. On a regular day, patients are seen from 7 AM to 8:30 AM, and progress notes are written. From 8:30 to 10:30 AM is morning rounds. 10:30 to 12:00 PM is teaching rounds. After a one hour lunch break, the rest of the day till 5 PM involves placing orders and other tasks for patients. Call is every four days, and we stay until 10 PM. A typical day in Internal Medicine provides time for reading textbooks.

Podscope

Podscope
Search through audio broadcasts with text.

H and P for PDA

Here's a typed up H and P for a PDA. You can put in on a Palm PDA as a memo or a Dataviz Documents to Go file. Fill in the details during the patient encounter, and then synch it with a desktop for printing. Feel free to make adjustments and post them as comments on this site.

H and P
Patient Name:
Hospital Unit:
Time of Admission:
Informant:
Birthdate:
Age:
Sex:

CC:
Reason for Admission:

History of Present Illness:






Past Medical History:

Past Surgical History:

Injuries/Disabilities:
Medications:




Herbal Meds:
Immunizations:
Allergies:
Drugs:
Food:
Family History:
Social History:

Review of Systems:
General: ( ) weight loss ( ) fever ( ) night sweats ( ) weakness/fatigue ( ) appetite
Endocrine: ( ) heat intolerance ( ) decreased energy ( ) thyroid/reanl dz ( ) polydipsia ( ) polyuria
Lympatics: ( ) lymphadenopathy
Skin: ( ) itching ( ) pale ( ) palmar creases
Hematology: ( ) anemia ( ) bruising ( ) bleeding
Head: ( ) seizures ( ) trauma ( ) loss of conscioussness ( ) headache ( ) vertigo ( ) dizziness
Eyes: ( ) visual changes ( ) blurred vision ( ) loss of vision ( ) discharge
Ears: ( ) discharge ( ) ear pain ( ) tinnitus ( ) ototoxic drug history ( ) hearing loss
Nose: ( ) discharge ( ) rhinorrhea ( ) epistaxis
Mouth and Throat: ( ) lip cracking ( ) gum soreness ( ) gum hypertrophy ( ) dryness ( ) thirst ( ) excessive salivation ( ) throat pain ( ) hoarseness
Cardiorespiratory: ( ) SOB ( ) valvular disease ( ) orthopnea ( ) dyspnea on exertion ( ) nocturia ( ) edema ( ) paroxysmal nocturnal dyspnea ( ) cough ( ) cyanosis ( ) hemoptysis
Gastrointestinal ( ) dysphagia ( ) abdominal pain ( ) vomiting ( ) hematemesis ( ) melena ( ) hematochezia ( ) change in appetite ( ) diarrhea ( ) constipation ( ) jaundice
Genitourinary: ( ) change in bladder function ( ) change in amount ( ) dysuria ( ) hematuria ( ) discharge
Neuropsychiatric: ( ) weakness ( ) motor/sensory deficit ( ) depression ( ) anxiety
Pain:


Physical Exam
General Appearance:
Vital Signs:
Temperature: Oxygen Saturation: Blood Pressure:
Respiratory Rate: Pulse Rate:
Skin/Nails:
Head:
Eyes:
Ears:
Nose:
Throat/Mouth:
Neck:
Lymph:
Pulmonary:
CV:
Abdomen:
Breasts:
Rectal:
Genitals:
Peripheral pulses:
Musculoskeletal:
Neurologic:
Mental Status
CN I
CN II
CN III,IV, VI
CN V, VII
CN VII
CN VIII
CN IX, X
CN XI
CN XII
Cerebellar
DTRs

Labs:




Assessment:

Problem List:

Differential Diagnosis:

Diagnostic Plan:

Therapeutic Plan:

Flash Drives Make Any Computer 'Personal'

Flash Drives Make Any Computer 'Personal': Financial News - Yahoo! Finance
Flash drives with built in software such as Migo allow users to carry their personal settings and files to any computer. Apparently, plugging in the USB flash drive will allow access to personal documents, e-mail, and internet favorites. It's a great idea for people who work in places with several computers and move among them, such as a hospital.

CMDT Review by MS3

Although CMDT appears as a tome of medicine at 1888 pages, its proven to be a good home reference book. Diseases are covered in a few pages, while still maintaining good attention to detail in presentation and management. This book is all text with a few tables and no pictures. More pages are dedicated to common diseases with varying presentations like pneumonia. It's main advantage over other books is it's updated every year.

Washington Manual Handbook Review by an MS3

The Washington Manual of Medical Therapeutics is a good handbook reference for the internal medicine rotation. It's descriptions of diseases can be succinct, but the book covers other aspects such as imaging and treatment well. The main drawback to the book is its size. The spiral bound can add a couple of pounds of weight to a white coat; a paper bound copy seems to be more compact. Overall, The Washington Manual is a good reference to have when free time is available during the day.

Removing an Ink Stain from a Silk Tie

Today was a busy day in the hospital, and I was running around when I accidently left some pen marks on my tie. Luckily I found this site, and it suggested using alcohol to wipe away the stain. So I had some alcohol swabs from the hospital, and I was able to take away the marks.

Tom Evans' ECG Cribsheets - PDA Version

http://medicine.ucsf.edu/housestaff/ecg/pda.html

This is a great guide to reading ECGs, and this can also be downloaded to a Palm PDA device. Download the zip file for Pocket PCs, and then install Pluckr for your Palm PDA and Sunrise Desktop for your computer. After extracting the zip file, send the index.html file to Sunrise, and then synch your Palm PDA.

More than 100 Links for Medical Students

http://www.medicalstudent.com/

This page links to several free online resources. I especially like the anatomy links.

Indications for Oxygen Therapy to Treat COPD

COPD is a disease of airflow obstruction. It can be caused by chronic bronchitis and emphysema. Most of the people with COPD have an extensive cigarette smoking history. Patients are eligible for oxygen therapy at home if their room air resting ABG shows an SaO2 less than 88% or a PaO2 less than 55 mm Hg. With a PaO2 of 56-59 mm Hg or a SaO2 less than 89%, people who have polycythemia, heart failure or pulmonary hypertension can receive oxygen therapy. Oxygen therapy as a treatment for COPD has been shown to reduce mortality and morbidity.

Source:
The Washington Manual of Medical Therapeutics, 31st edition.