clinical modules
TRANSCRIPT
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Clinical Modules - Required for Completion
The Internal Medicine curriculum is delivered through 19 on-line SIMPLE cases that
accompany the 20 curriculum modules ound !elo"# Each module "ill cover the
core topics$ assigned readings and cases and "ill assist students in developing
%no"ledge and competency in the clinical conditions most commonly encounteredin the care o the adult patient# Each o the ollo"ing topics has speci&c learning
o!'ectives and is accompanied !y an assigned reading in the te(t as "ell as an
online case# The end-of-rotation exam questions will be derived from the
objectives presented in the modules and accompanying the reading
assignments from Internal Medicine ssentials !except "MM speci#c
readings which are found in $oundations and %uchera&s'( Thus success on
the e(am "ill re)uire that students complete a minimum o 10 SIMPLE cases and all
reading assignments#
)( *cute Coronary +yndrome *+,
a# eading assignment. /hapter 1 /ardiovascular Medicine. pproach to /hest
Pain3 /hapter 4 /ardiovascular Medicine. cute /oronary Syndrome
!# 5n-line SIMPLE cases. /ase 1 69-year-old man "ith acute onset o chest
pain - Mr# Monson
c# 5!'ectives
i# /reate a di7erential diagnosis o acute chest pain and narro" the
di7erential !ased on speci&c physical e(am and history &ndings#
ii# 8e&ne and discuss the pathogenesis$ signs$ and symptoms o theacute coronary syndromes#
iii# List cardiovascular ris% actors
iv# Predict the primary and secondary prevention o ischemic heart
disease#
v# 8evelop an appropriate diagnostic and treatment planincluding
recommended liestyle modi&cationsor a patient presenting "ith
acute coronary syndrome
,( Ischemic heart disease *+,
a# eading assignment. /hapter 2 /ardiovascular Medicine. /hronic Sta!le
ngina
!# 5n-line SIMPLE cases. /ase 2 :0-year-old "oman "ith chest pain on
e(ertion ; Ms#
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c# 5!'ectives.
i# Identiy the symptoms and signs o chest pain characteristic o angina
pectoris#
ii# /ategori=e the patients> symptoms as angina pectoris$ atypical angina$
or non-cardiac chest pain#
iii# 5!tain$ document$ and present an appropriately complete medical
history that di7erentiates among the common etiologies o chest pain#
iv# 5!tain a history o a patient "ith chest pain that contains inormation
a!out those clinical characteristics that are typical o angina pectoris
and includes ris% actors o coronary heart disease#
v# Perorm a physical e(am that includes identiying the presence o
dyspnea and an(iety$ o!taining accurate vital signs$ and perorming
heart$ lung$ and vascular e(ams#
vi# 5rder appropriate la!oratory and diagnostic studies !ased on patient
demographics and the most li%ely etiologies o chest pain#
vii# ecommend primary and secondary prevention o ischemic heart
disease through the reduction o cardiovascular ris% actors e#g#
controlling hypertension and dyslipidemia$ aggressive dia!etes
management$ avoiding to!acco$ and aspirin prophyla(is#
viii# Prescri!e appropriate anti-anginal medications "hen indicated and
communicate potential adverse reactions#
( *rrhythmias . disorders of cardiac output *+,
a# eading assignment. /hapter 6 /ardiovascular Medicine. /onduction ?loc%s
and ?radyarrythmias3 /hapter @ /ardiovascular Medicine. Supraventricular
rrhythmias3 /hapter : /ardiovascular Medicine. Aentricular rrhythmias3
/hapter 60 Beneral Intern Medicine. pproach to Syncope
!# 5n-line SIMPLE cases. /ase 4 @6-year-old "oman "ith syncope - Mrs# Coda
c# 5!'ectives.
i# List the common causes o syncope#
ii# 8etermine the important aspects o the history and physical e(am in a
patient "ith syncope#
iii# 8iscuss the approach to the evaluation and treatment o a patient "ith
syncope#
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iv# Identiy atrial &!rillation on an electrocardiogram#
v# List the common causes o atrial &!rillation#
vi# 8iscuss the approach to the evaluation and treatment o a patient "ith
atrial &!rillation including stro%e ris% scoring#
vii# E(plain ho" atrial &!rillation and mitral stenosis may lead to syncope#
viii# List indications or permanent pacing#
i(# Identiy a !undle !ranch !loc% on electrocardiogram#
(# 8e&ne S node disease#
(i# 8iscuss management o a let !undle !ranch !loc%
(ii# 8e&ne Long DT syndrome and its ris% actors
(iii# Predict treatment regimens or ventricular tachycardia including
torsades de pointes
/( Congestive heart failure *+,
a# eading assignment. /hapter /ardiovascular Medicine. Feart Gailure3
/hapter H /ardiovascular Medicine. Aalvular Feart 8isease3 /hapter 90
Pulmonary Medicine. pproach to 8yspnea
!# 5n-line SIMPLE cases. /ase 6 :-year-old "oman "ith shortness o !reath
and leg s"elling - Ms# ivers
c# 5!'ectives.
i# Interpret nec% vein &ndings or 'ugular venous distention
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vii# Interpret ?-type natriuretic peptide ?P results#
viii# ecommend pharmacologic management o heart ailure#
i(# 8e&ne grading o the intensity o cardiac murmurs#
(# 8escri!e the murmur$ etiology and treatment o aortic stenosis
(i# Predict the etiology$ diagnosis and therapy o mitral stenosis
0( 1iabetes mellitus *+,
a# eading assignment. /hapter 14 Endocrinology and Meta!olism. 8ia!etes
Mellitus3 /hapter 16 Endocrinology and Meta!olism. 8ia!etic Cetoacidosis
and Fyperglycemic
!# 5n-line SIMPLE cases. /ase 2H-year-old "oman "ith lightheadedness -
Ms# illiams
c# 5!'ectives.
1# 8iscuss the de&nition and di7erential diagnosis o hypotension$
including ho" to use orthostatic signs and symptoms#
2# Ktili=e the merican 8ia!etes ssociation 8 and the K#S#
Preventive Tas% Gorce KSPTG recommendations to screen or
dia!etes$ including recogni=ing ris% actors or dia!etes#
4# 8iscuss the pathogenesis o Type 1 and Type 2 dia!etes#
6# 8iagnose type 2 dia!etes mellitus using the our accepted criteria$ as
"ell as %no" the diagnostic criteria or impaired asting glucose and
impaired glucose tolerance#
@# /alculate anion gap$ osmolar gap$ and corrected sodium to distinguish
hyponatremia rom pseudohyponatremia#
:# 8e&ne hyperosmolar hyperglycemic state FFS$ including non%etotic
coma#
# ecogni=e precipitants and presenting symptoms and signs o FFS and
dia!etic %etoacidosis 8C$ as "ell as discuss the pathophysiology orthe a!normal la!oratory values o each#
H# 8escri!e the !asic management o dia!etic %etoacidosis and
non%etotic hyperglycemic states$ including the similarities and
di7erences in insulin therapy and uid and electrolyte replacement#
9# List the 8-recommended targets or glycemic control or adults#
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10#Knderstand the di7erences !et"een types o insulin and the
indications or their use#
11#/ounsel dia!etic patients appropriately on dietary measures and
e(ercise#
12#ecogni=e precipitants and presenting symptoms and signs o
hypoglycemia$ as "ell as !asic management#
2( 3I bleed 456
a# eading assignment. /hapter 1 Bastroenterology and Fepatology.
8yspepsia3 /hapter 1H Bastroenterology and Fepatology. Bastroesophageal
eu( 8isease3 /hapter 19 Bastroenterology and Fepatology. Peptic Klcer
8isease3 /hapter 2 Bastroenterology and Fepatology. pproach to
Bastrointestinal ?leeding3 /hapter 62 Beneral Internal Medicine. pproach
to Involuntary eight Loss3 /hapter @6 Fematology. Transusion Medicine3
/hapter H4 5ncology. /olorectal /ancer
!# 5n-line SIMPLE cases. /ase 10 6H-year-old "oman "ith diarrhea and
di==iness - Ms# ?la%e and /ase 21 H-year-old man "ith ever$ lethargy$ and
anore(ia ; Mr# amire=
c# 5!'ectives.
i# Perorm medication reconciliation upon admission and discharge#
ii# Identiy the common causes or and symptoms o upper and lo"er
gastrointestinal !lood loss$ including recogni=ing the distinguishingeatures o each#
iii# 8e&ne hematemesis$ melena$ and hematoche=ia#
iv# E(amine the role o contri!uting actors in gastrointestinal !leeding
such as Felico!acter pylori inection$ non-steroidal anti-inammatory
drugs$ alcohol$ coagulopathies$ and chronic liver disease#
v# 8emonstrate the indications or$ contraindications to$ and
complications o !lood transusion$ including descri!ing system errors
that produce transusion reactions#
vi# Identiy and manage transusion reactions#
vii# 8escri!e the di7erence !et"een adverse events and medical errors#
viii# 8evelop an appropriate evaluation and treatment plan or patients "ith
a gastrointestinal !leed that includes.
1# Esta!lishing ade)uate venous access
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2# dministering crystalloid uid resuscitation
4# 5rdering !lood and !lood product transusion
6# 8etermining "hen to o!tain consultation rom a
gastroenterologist or upper endoscopy#
i(# 8istinguish among the types o shoc% and their presentations#
(# 8iscuss the common causes or and symptoms o lo"er
gastrointestinal BI !lood loss#
(i# List elements o physical e(am in patient "ith suspected BI !leed#
(ii# ecommend la!oratory and diagnostic tests to evaluate BI !leeding#
(iii# Knderstand the physician>s role "hen a patient is no longer capa!le o
ma%ing medical decisions#
(iv# Ktili=e clinical history and appropriate diagnostic tests to diagnose
BE8
(v# 8iscuss treatment or BE8 and indications or EB8
(vi# /ite the strategy or diagnosis and treatment F# pylori
7( *bdominal pain *+,
a# eading assignment. /hapter 1: Bastroenterology and Fepatology.
pproach to !dominal Pain3 /hapter 2@ Bastroenterology and Fepatology.
pproach to 8iarrhea3 /hapter 2: Bastroenterology and Fepatology.
Inammatory ?o"el 8isease
!# 5n-line SIMPLE cases. /ase 12 @@-year-old male "ith lo"er a!dominal pain
- Mr# ilson
c# 5!'ectives.
i# List symptoms and signs indicative o an acuteJsurgical a!domen#
ii# ppro(imate a li%elihood ratio o the common causes o a!dominal
pain !ased on pain pattern$ the )uadrant the pain is located anda!dominal e(am &ndings#
iii# Benerate a prioriti=ed di7erential o the most important and li%ely
causes o a patient>s a!dominal pain and recogni=e speci&c history$
physical e(am$ and la!oratory &ndings that distinguish !et"een the
various conditions#
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iv# ecommend a !asic management plan or diverticulitis#
v# 8e&ne irrita!le !o"el syndrome#
vi# Ktili=e history and clinical presentation to create a di7erential or
inectious and non-inectious diarrhea
vii# Ktili=e common diagnostic tests or diarrhea to determine a diagnosis#
viii# 8i7erentiate ulcerative colitis rom /rohn>s disease#
8( 9iver disease *+,
a# eading assignment. /hapter 20 Bastroenterology and Fepatology.
pproach to Liver /hemistry Tests3 /hapter 21 Bastroenterology and
Fepatology. Fepatitis3 /hapter 22 Bastroenterology and Fepatology.
/irrhosis
!# 5n-line SIMPLE cases. /ase11 6@-year-old man "ith a!normal LGTs - Mr#
/hapman and /ase 4: 6@-year-old man "ith ascites ; Mr# ?erlusconi
c# 5!'ectives.
i# Knderstand pathophysiology o con'ugated and uncon'ugated
hyper!iliru!inemia#
ii# 8escri!e the common types o liver diseases and their ris% actors
including inherited and ac)uired#
iii# 5!tain an appropriate history to elicit ris% actors or viral hepatitis#
iv# Cno" "hen to order la!oratory tests or evaluation o liver disease and
"hen a liver !iopsy might !e indicated#
v# Cno" the signs$ symptoms$ and complications o portal hypertension#
vi# 8escri!e the presenting signs and symptoms o spontaneous !acterial
peritonitis S?P#
vii# /omplete an a!dominal e(am$ including evaluation or presence o
ascites#
viii# Knderstand the indications or paracentesis and ho" to analy=e the
ascitic uid using the serum to ascites al!umin gradient SB#
i(# 8escri!e the components o o!taining inormed consent#
(# ?ecome amiliar "ith the indications or hepatic transplantation
reerral in end stage liver disease#
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(i# Ktili=e history and patterns in liver unction tests to diagnose hepatitis#
(ii# Ktili=e hepatitis ? serologies to determine the stages o inection
(iii# Ktili=e clinical history to create a di7erential or liver diseases$ such as
hemochromatosis$ nonalcoholic atty liver disease$ alcoholic liver
disease$ autoimmune hepatitis$ hepatitis $ hepatitis ?$ etc#
(iv# List the goals o therapy or cirrhosis
:( ;ancreatic disease *+,
a# eading assignment. /hapter 1: Bastroenterology and Fepatology.
pproach !dominal Pain3 /hapter 20 Bastroenterology and Fepatology.
pproach to Liver /hemical Tests3 /hapter 24 Bastroenterology and
Fepatology. 8iseases o the Ball ?ladder and ?ile 8ucts3 /hapter 26
Bastroenterology and Fepatology. cute Pancreatitis
!# 5n-line SIMPLE cases. /ase 9 @@-year-old "oman "ith upper a!dominal
pain and vomiting ; Mrs# Turner
c# 5!'ectives.
i# 8escri!e the pathophysiology o the principle types o a!dominal pain.
parietal$ visceral$ vascular$ and reerred#
ii# 8etermine "hen to consult a surgeon regarding a!dominal pain#
iii# E(plain the indications and utility o hepato!iliary imaging studies
including M/P and E/P#
iv# Ktili=e liver unction tests and clinical history to create a di7erential or
cholestatic liver disease#
v# 8iscuss common etiologies o pancreatitis in the KS#
vi# Predict general treatment plan or pancreatitis#
vii# Ktili=e clinical history such as painless 'aundice and ris% actors to
diagnose pancreatic cancer#
)
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c# 5!'ectives.
i# ?e amiliar "ith the /BE and K8IT screening tools or alcohol a!use#
ii# Ta%e a su!stance a!use history and provide counseling in a non-
'udgmental manner#
iii# ecogni=e the clinical presentations o su!stance a!use and
recommend treatment#
iv# pply diagnostic criteria or alcohol a!use$ dependence$ and addiction#
v# ecommend !asic prevention and treatment or alcohol "ithdra"al#
))( *cute renal failure *+,
a# eading assignment. /hapter :: ephrology. pproach to Cidney 8isease3
/hapter 0 ephrology. cute Cidney In'ury
!# 5n-line SIMPLE cases. /ase 44 69-year-old "oman "ith conusion - Mrs#
?a(ter
c# 5!'ectives.
i# /ompare the pathophysiology o ma'or etiologies o acute renal ailure
including decreased renal perusion pre-renal$ intrinsic renal disease$
and acute renal o!struction post renal#
ii# Ktili=e the ractional e(cretion o sodium and apply it to distinguish
!et"een pre-renal and intrinsic renal disease#
iii# Ktili=e common diagnostic tests$ including K$ ?MP to determine li%ely
etiology o acute renal ailure#
iv# 8evelop appropriate initial management plan or acute renal ailure
including volume management$ dietary recommendations$ drug
dosage alterations$ electrolyte monitoring$ and indications or dialysis#
v# Identiy ris% actors or contrast-induced nephropathy and recommend
steps to prevent this complication#
vi# Interpret a urinalysis$ including microscopic e(amination or casts$ red!lood cells$ "hite !lood cells$ and crystals#
vii# 8i7erentiate nephrotic syndrome and nephritic syndrome#
viii# /reate a di7erential diagnosis or acute %idney in'ury !ased on clinical
history and !asic diagnostic studies#
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),( Chronic =idney disease *+,
a# eading assignment. /hapter 41 Beneral Internal Medicine. Fypertension3
/hapter :: ephrology. pproach to Cidney 8isease3 /hapter :H
ephrology. /alcium and Phosphorus Meta!olism3 /hapter 1 ephrology.
/hronic Cidney 8isease
!# 5n-line SIMPLE cases. /ase 24 @6-year-old Fispanic "oman "ith atigue ;
Ms# Torres
c# 5!'ectives.
i# List the most common causes o chronic %idney disease /C8#
ii# Ktili=e clinical history and diagnostic tests to diagnose etiologies o
chronic %idney disease#
iii# 8escri!e pathophysiology and clinical signs o uremia#
iv# Tell a!out the pathophysiology o hyper%alemia$ hypocalcemia$ and
hyperphosphatemia in the setting o /C8#
v# Educate patients a!out the signi&cance o proteinuria in /C8#
vi# ppropriately recommend the use o angiotensin converting en=yme
/E-inhi!itors and angiotensin receptor !loc%ers ?s in the
management o /C8#
vii# 5utline treatment "ith phosphate !inders and calcium replacement#
viii# Summari=e the staging o /C8 !ased on glomerular <ration rate
BG#
i(# 8e&ne hypertension$ hypertensive emergency$ and hypertensive
urgency#
(# List indications or antihypertensive drug classes#
(i# 8e&ne the stages o chronic %idney disease#
(ii# List the indications or dialysis#
)( *cid->ase 1isorders *+,
a# eading assignment. /hapter :9 ephrology. cid-?ase 8isorders
!# 5n-line SIMPLE cases. /ase 2: @H-year-old man "ith altered mental status -
Mr#
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i# /alculate anion gap$ osmolar gap$ and correct sodium to distinguish
hyponatremia rom pseudohyponatremia#
ii# 8iscuss the pathophysiology o simple and mi(ed acid- !ase disorders#
iii# /alculate the anion gap and e(plain its relevance to determining the
cause o a meta!olic acidosis#
iv# List the di7erential o anion-gap meta!olic acidosis#
v# /alculate the anion gap and generate a di7erential diagnosis or
meta!olic acidosis
)/( ;neumonia *+,
a# eading assignment. /hapter 4@ Beneral Internal Medicine. pproach to
/ough3 /hapter :@ Inectious 8isease Medicine. Fealth /are-ssociated
Inections3 /hapter @ Inectious 8isease Medicine. /ommunity-c)uiredPneumonia3 /hapter 90. Pulmonary Medicine. pproach to 8yspnea
!# 5n-line SIMPLE cases. /ase 22 1-year-old male "ith cough and atigue ;
Mr# Bros=e%
c# Suggested on-line resources. Inectious 8isease Society o merican
/ommunity-c)uired Pneumonia and Fospital-c)uired Pneumonia guideline
1# http.JJ"""#idsociety#orgJ5rganNSystemJOLo"erJKpper espiratory
d# 5!'ectives.
1# 8iscuss the common causes o acute dyspnea$ their pathophysiology$
symptoms$ and signs#
2# List the common pneumonia pathogens viral$ !acterial$ myco!acterial$
and ungal in immunocompetent and immunocompromised hosts#
4# 8escri!e radiographic &ndings associated "ith speci&c pathogens#
6# Identiy !ronchial !reath sounds$ rales crac%les$ rhonchi$ and
"hee=es$ signs o pulmonary consolidation$ and pleural e7usion on
physical e(am#
@# ecogni=e the most common complications o pneumonia#
:# ecommend "hen to order diagnostic la!oratory testsincluding
complete !lood counts$ sputum gram stain and culture$ !lood cultures$
and arterial !lood gasesho" to interpret those tests$ and ho" to
recommend treatment !ased on these interpretations#
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# Select an appropriate empiric anti!iotic regimen or community-
ac)uired$ nosocomial$ immunocompromised-host$ and aspiration
pneumonia$ ta%ing into account pertinent patient eatures#
H# 8iscuss the /enters or Medicare and Medicaid Services /MS and
s )uality measures or smo%ing cessation advice andvaccination against pneumonia and inuen=a in patients "ith
pneumonia and other pulmonary disorders#
9# /reate a di7erential diagnosis or chronic cough#
10#8e&ne hospital-ac)uired and ventilator-associated pneumonia#
11#Predict empiric anti!iotic treatment or FP and AP#
12#8iscuss ris% actor modi&cation or the prevention o FP and AP#
14#/reate a di7erential diagnosis or acute and chronic dyspnea#
)0( Chronic lung disease *+,
a# eading assignment. /hapter H1 5ncology. Lung /ancer3 /hapter H9
Pulmonary Medicine. Interpretation o Pulmonary Gunction Tests3 /hapter 90
Pulmonary Medicine. pproach to 8yspnea3 /hapter 92 Pulmonary
Medicine. sthma3 /hapter 94 Pulmonary Medicine. /hronic 5!structive
Pulmonary 8isease3 /hapter 9@ Pulmonary Medicine. 8i7use Parenchymal
Lung 8iseases
!# 5n-line SIMPLE cases. /ase 2H 0-year-old man "ith shortness o !reath
and leg s"elling - Mr# Fonig
c# 5!'ectives.
i# ccurately interpret arterial !lood gas#
ii# E(plain pulmonary unction test PGT results and use them to
recommend appropriate therapy#
iii# List ma'or pathologic states causing dyspnea#
iv# elate the utility o supplemental o(ygen and the potential dangers o
overly aggressive o(ygen supplementation#
v# 8escri!e the indications or$ !ene&ts o$ and side e7ects o therapies
or chronic o!structive pulmonary disease /5P8 including. !eta-
agonists$ anticholinergics$ methyl(anthines$ and inhaled and systemic
corticosteroids#
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vi# ecommend appropriate la!oratory evaluation or suspected /5P8
e(acer!ation#
vii# 8escri!e the !ene&ts o immuni=ing adults "ith /5P8 against
inuen=a and pneumococcal inection#
viii# Identiy paraneoplastic syndromes associated "ith lung cancer#
i(# ecogni=e !asic treatment protocols or lung cancer !ased on stage#
(# 8i7erentiate o!structive and restrictive lung disease using pulmonary
unction tests#
(i# Ktili=e history and clinical e(amination to diagnose di7use
parenchymal lung diseases#
(ii# Ktili=e diagnostic tests imaging and la!oratory in a "or%-up o acute
and chronic dyspnea#
(iii# 8iagnose asthma and initiate treatment !ased on asthma severity#
(iv# /lassiy /5P8 !y stages and predict treatment !ased on severity#
(v# /reate a di7erential diagnosis or di7use parenchymal lung diseases#
)2( *ltered mental status *+,
a# eading assignment. /hapter 60 Beneral Internal Medicine. pproach to
Syncope3 /hapter : ephrology. Gluid and Electrolyte 8isorders3 /hapter
: eurology. ltered Mental Status$ 8ementia$ and 8elirium
!# 5n-line SIMPLE cases. /ase 4 @6-year-old "oman "ith syncope - Mrs#
Coda$ /ase 2@ @-year-old "oman "ith altered mental status - Mrs# Cohn$
and /ase 2: @H-year-old man "ith altered mental status - Mr#
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vi# Identiy the ris% actors or developing altered mental status$ including.
1# 8ementia
2# dvanced age
4# Su!stance a!use
6# /omor!id physical pro!lems such as sleep deprivation$
immo!ility$ dehydration$ pain$ and sensory impairment
@# I/K admission
vii# Thoroughly revie" prescription medications$ over-the-counter drugs$
and supplements$ and in)uire a!out su!stance a!use "hen evaluating
delirium#
viii# ecogni=e the symptoms and signs o the most common and most
serious causes o altered mental status$ including meta!olic causes$
such as hyponatremia#
i(# Perorm a thorough diagnostic evaluation o altered mental status#
(# Manage the most common causes o altered mental status#
(i# 8escri!e the pathophysiology$ presenting signs and symptoms$
la!oratory interpretation$ and the management o hyponatremia$
including the ris% o too rapid or too delayed therapy o hyponatremia#
(ii# rite appropriate uid and replacement orders or patients "ithcommon electrolyte and meta!olic distur!ances#
(iii# Identiy the presenting signs and symptoms o into(ication and
overdose o common su!stances o a!use#
(iv# ecogni=e the presenting signs and symptoms and list the di7erential
diagnosis o hypernatremia#
(v# Knderstand ho" homelessness can inuence patient>s access to illicit
su!stances and interere "ith a!ility to ena!le e7ective treatment#
(vi# 8escri!e the pathophysiology o ethylene glycol to(icity#
(vii# Evaluate or calcium o(alate crystalluria and relate the presence to
ethylene glycol to(icity and other disorders#
(viii# List the di7erential o hypernatremia#
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(i(# Manage ethylene glycol to(icity$ including the use o the antidote
omepi=ole#
((# 8escri!e ho" to correct hypernatremia#
)7( +epsis *+,
a# eading assignment. /hapter :0 Inectious 8isease Medicine. Krinary Tract
Inections3 /hapter :6 Inectious 8isease Medicine. Sepsis Syndrome3
/hapter 4 eurology. Feadache3 /hapter 6 eurology. pproach to
Meningitis and Encephalitis
!# 5n-line SIMPLE cases. /ase 21 H-year-old man "ith ever$ lethargy$ and
anore(ia ; Mr# amire= and /ase 26 @2-year-old emale "ith headache$
vomiting$ and ever - Mrs# /ole
c# 5!'ectives.
i# Interpret a urinalysis#
ii# ecommend appropriate empiric therapy or urosepsis !ased on an
understanding o urinary tract inection pathogenesis and resistance
patterns#
iii# 8iscuss types o patient isolation precautions and their indications#
iv# 8escri!e indications or and contraindications and complications o
lum!ar puncture#
v# 8emonstrate %no"ledge o cere!rospinal uid analysis and itsinterpretation#
vi# 8e&ne systemic inammatory response syndrome$ sepsis$ severe
sepsis$ and septic shoc%#
vii# Predict treatment principles o sepsis including early recognition$
appropriate la!oratory$ aggressive uid resuscitation$ early !road-
spectrum anti!iotic administration and vasopressor administration
viii# Predict treatment o urinary tract inections !ased on clinical history
and ris% actors#
i(# ecogni=e red agQ headache signs#
(# 8i7erentiate headaches !ased on clinical history and physical e(am
&ndings#
(i# 8i7erentiate !acterial rom viral meningitis !ased o7 typical
cere!rospinal uid &ndings#
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(ii# Predict empiric anti!iotic treatment or meningitis !ased on age and
clinical ris% actors#
)8( ?ospital acquired infections *+,
a# eading assignment. /hapter :@ Inectious 8isease Medicine. Fealth /are-
ssociated Inections
!# 5n-line SIMPLE cases. /ase 26 @2-year-old emale "ith headache$
vomiting$ and ever ; Mrs# /ole
c# Suggested on-line resources. Inectious 8isease Society o merica I8S
guideline on Prevention o Fealthcare-ssociated Inections in cute /are
Fospitals and /lostridium diRcile
i# http.JJ"""#idsociety#orgJ5rganNSystemJOBastrointestinal BI
d# 5!'ectives.
i# List ris% actors or and precautions against the ac)uisition o
nosocomial inection#
ii# Ktili=e system-!ased practices to prevent health care-associated
inections such as catheter-related !loodstream inections$ urinary
tract inections and ventilator-associated pneumonia
iii# 8iagnose Clostridium difcile inection and predict treatment !ased on
severity o the illness#
):( @enous thromboembolism *+,
a# eading assignment. /hapter 9 /ardiovascular Medicine. Aascular 8isease3
/hapter 14 Endocrinology and Meta!olism. 8ia!etes Mellitus3 /hapter @4
Fematology. Throm!ophilia
!# 5n-line SIMPLE cases. /ase 40 @@-year-old "ith leg pain - Ms# ?ond
c# 5!'ectives.
i# 8escri!e indications or and methods o deep vein throm!osis
prophyla(is#
ii# List ris% actors or the development o a deep vein throm!osis 8AT#
iii# ecogni=e the signs and symptoms o 8AT and pulmonary em!olism
PE#
iv# Benerate a prioriti=ed di7erential diagnosis o 8ATJPE !ased on speci&c
physical &ndings using pre-test pro!a!ility tools#
http://www.med-u.org/http://www.idsociety.org/Organ_System/%23Gastrointestinal%20(GI)%20http://www.med-u.org/http://www.med-u.org/http://www.idsociety.org/Organ_System/%23Gastrointestinal%20(GI)%20http://www.med-u.org/
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v# Knderstand the indications or and utility o various diagnostic tests
and descri!e their interpretation#
vi# 8evelop an appropriate management plan or 8ATJPE$ including
appropriate use and monitoring o heparin and "ararin
vii# 8iagnose congenital and ac)uired throm!ophilia disorders utili=ing
clinical history and diagnostic testing
,
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hile the end-o-rotation e(am is derived rom the didactic curriculum$ reading
assignments and o!'ectives descri!ed in the /urriculum section$ the end-o-rotation
evaluation completed !y your internal medicine preceptor is !ased on clinical
competencies$ demonstrated proessionalism and demonstrated %no"ledge o the
discipline and the a!ility to apply that %no"ledge to the care o the patient# These
core competencies reect student perormance in : %ey areas. communication$pro!lem solving$ clinical s%ills$ medical %no"ledge$ osteopathic medicine and
proessional and ethical considerations# our end-of-rotation evaluation from
your preceptor will be based directly on your performance in these 2 core
competencies as described below(
1# Communication - the student should demonstrate the ollo"ing
clinical communication s%ills.
a# E7ective listening to patient$ amily$ aculty$ peers$ and other
mem!ers o the healthcare team
!# 8emonstrates respect$ compassion and respect in patient
communications and interactions
c# 8emonstrate the a!ility to conduct !oth a ocused and
comprehensive patient intervie"$ o!tain historical and current
inormation that is pertinent to the care o the patient and
demonstrate accuracy and e7ectiveness in their investigation o
medical complaints$ medical$ social and psychosocial history
speci&c to the rotation#
d# /onsiders "hole patient. social$ spiritual cultural concerns
e# ERciently gathers$ interoperates and prioriti=es essential rom
non-essential inormation
# S%ill in educating and motivating patient compliance and
understanding o condition$ treatment instructions$ consents
medications
g# 8emonstrated a!ility to present patient cases and medical
inormation in an accurate$ concise$ "ell organi=ed manner in
!oth "rittenQ documents and oral ormats#
2# ;roblem +olving ; the student should demonstrate the ollo"ing
pro!lem solving s%ills.
a# Identiy important )uestions$ identiy and sort data in organi=ed
ashion organi=ing and prioriti=ing positives negatives
!# 8iscern ma'or rom minor patient pro!lems
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c# Gormulate an appropriate di7erential diagnosis "hile identiying
the most common and pro!a!le diagnoses
d# Identiy indications or$ interoperate and apply &ndings rom the
most appropriate diagnostic or clinical tests or the patient and
the condition
e# Identiy correct treatment and management plans considering
contraindications interactions !ased on scienti&cally valid$
outcome proven inormation rom research o literature
# Incorporate patient>s and amily perspectives and values into
the diagnostic and therapeutic decision ma%ing#
g# ?e %no"ledgea!le o socioeconomic considerations in design o
diagnostic and treatment plans or the patient#
4# Clinical +=ills - the student should demonstrate the ollo"ing s%ills.
a# 8emonstrate the a!ility to utili=e inductive and deductive
reasoning to pro!lem solve patient complaints and conditions#
!# 8emonstrate the a!ility to apply the clinical %no"ledge and
s%ills they "ere instructed on during PP/ and 5MM education
throughout the 5MS-I and 5MS-II years#
c# ssesses vital signs triage patient according to degree o
illness
d# 8emonstrate good o!servational$ auscultory$ palpatory and
visual s%ills to gather clinical inormation and the a!ility to apply
the &ndings to the treatment o the patient#
e# Perorm a thorough physical e(am pertinent to the patient and
the systems involved "ith the patient>s condition or complaints#
# 8emonstrate the a!ility to incorporate the clinical &ndings "ith
osteopathic treatment o a!normalities discovered in structure
or unction#
6# "steopathic Manipulative Medicine - the student shoulddemonstrate the ollo"ing s%ills in regards to osteopathic manipulative
medicine
a# pply osteopathic principles to all patient encounters and
osteopathic manipulative medicine successully "hen
appropriate
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!# Perorm and document a thorough musculos%eletal e(am
c# Ktili=e palpatory s%ills to accurately discern physical changes
that occur "ith various clinical disorders
d# pply osteopathic manipulative treatments successully
@# Medical %nowledge ; the student should demonstrate the ollo"ing
in regards to medical %no"ledge
a# Identiy correlate the anatomical$ physiological$ pathological$
psychological and socio-economic conditions that are related to
patients condition and the disease processes
!# 8emonstrate characteristics o a motivated$ lie-long learner
including demonstrating intellectual curiosity$ academic and
clinical interest and enthusiasm a!out patient care and the
a!ility to revie" and research the literature
c# Thoroughness and /ompetency in researching evidence !ased
literature and the a!ility to apply scienti&cally valid$ outcome
!ased inormation or the treatment o patient populations as
"ell as the individual patient#
d# /orrelate symptoms and signs "ith most common diseases "ith
underlying pathophysiological conditions#
e# 8emonstrated a!ility to di7erent normal rom a!normal
physiology$ !ehavior$ structure and unction in the patient#
# !ility to perorm a comprehensive and accurate history and
physical e(amination and correlate the history$ clinical signs$
symptoms and &ndings "ith the clinical condition$ its
management and underlying pathology#
g# !ility to utili=e$ evaluate and apply diagnostic processes or
common adult medical conditions#
:# ;rofessional and thical >ehaviors - the student should
demonstrate the ollo"ing proessional and ethical !ehaviors and s%ills.
a# Is dutiul$ punctual$ relia!le$ and responsi!le regarding
o!ligations o the rotation and patient care needs#
!# Prepares or each day !y perorming assigned and re)uired
reading$ sel-study$ documentation$ revie" and completing
individual responsi!ilities#
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c# /onsistently completes all patient care$ call and documentation
responsi!ilities to ensure that they contri!ute to high )uality
patient care and outcomes#
d# ccepts and appropriately responds to eed!ac%$ evaluation$
praise as "ell as criticism "ithout resistance or o!stinacy#
e# 8isplays proessionalism in relationships "ith patients$ sta7$
peers
# 8isplays integrity and honesty in assessment o their medical
competency and documentation
g# c%no"ledges errors$ see%s to correct errors appropriately
h# Identi&es the importance to care or diverse$ disadvantaged$
underserved populations in a culturally competent$ non-
'udgmental and altruistic manner#
i# 8emonstrated a!ility to "or% proessionally$ colla!oratively and
cooperatively in a team environment#
'# 8emonstrates a"areness o and respect or patient>s rights$
including need or inormed consent$ patient involvement in
medical care and treatment decisions and end o lie issues#
%# 8emonstrate respect or and complies "ith the rules and
o!ligations that are esta!lished !y the educational$ regulatory$
legislative and proessional organi=ations that regulate$supervise and govern the proession o osteopathic medicine