Helen Horvath @helenhorvath on GrepMed

Hemoptysis Differential Diagnosis Framework Cardiovascular: Pulmonary embolism, Heart failure, Vasculitis, Valvular disease, Arteriovenous malformation Pulmonary - Airway: Bronchitis, Bronchiectasis, Malignancy, Foreign body, Iatrogenic, Bronchovascular fistula Pulmonary - Parenchyma: Pneumonia, Lung abscess, Tuberculosis, Fungal infection, Paragonimiasis Other: Catamenial hemoptysis, Idiopathic pulmonary hemosiderosis Dr. André Mansoor @AndreMansoor - Frameworks for Internal Medicine https://amzn.to/2LmUODZ #Hemoptysis #Differential #Diagnosis #algorithm #pulmonary

Diagnosis Adrenal Insufficiency - Algorithm Step 1) Screening Test: 6-8AM Cortisol Level - Early morning cortisol levels < 5 have almost 100% specificity for AI (but low sensitivity). - Levels > 15 excludes AI in almost all patients, though some use a cutoff of > 18. - Intermediate levels (5 – 15), require Cosyntropin testing. Step 2) Confirmation Test: Cosyntropin Stimulation - Cosyntropin is an ACTH analogue. This test determines if the adrenal gland appropriately responds to a bolus of ACTH. - Check ACTH before administering cosyntropin (IV 250mcg). Then, check cortisol 30 min AND 60 min after administration. - Peak cortisol level should be > 18. If it is lower, you have diagnosed AI. Step 3) Differentiate primary vs secondary AI (by looking at the ACTH level checked in Step 2 above). - Low ACTH is consistent with secondary (i.e. problem with pituitary gland) - High ACTH is consistent with primary (i.e. problem with adrenal gland) #Adrenal #Insufficiency #Algorithm #Diagnosis #ACTH #Stimulation #Endocrinology

Problem Representation - Approach to the Infectious Disease Patient Who: Patient age and host/risk factors (such as immunosuppression, steroids, splenectomy, etc) When: Duration and tempo of illness What: Key signs and symptoms that define the clinical syndrome - Does this fit with an illness script (e.g. brain and lung lesions)? By Dr. Sara Dong @swinndong via Febrile febrilepodcast@gmail.com #InfectiousDiseases #History #HPI #Diagnosis #Problem #Representation

Problem Representation An evolving summary of a patient’s clinical presentation that strives to identify (1) Clinical syndrome (signs/symptoms), (2) Context (relevant history/demographics), and (3) Temporal pattern to maximize diagnostic signal. When to use? • One-liner at start of Assessment and Plan • Calling a consultant • Signing out a patient for cross coverage • Educating a team at a rapid response Full Inpatient Pocket Cards Collection: https://bit.ly/pocketcardset Dr. Anand Jagannath @AnandJag1 and Dr. Tyler Larsen @TylerLarsenMD #Problem #Representation #diagnosis #education #meded

Inpatient History & Physical (H&P) Presentation and Note Template • Chief Complaint/Concern • History of Present Illness • ER Course • Past Medical History • Past Surgical History • Medications • Allergies • Family History • Social History • Exam • Labs • Imaging • Other studies • Assessment and Plan - [Insert problem, chronicity, trajectory] - Chronic/Resolved Dr. Satya Patel @SatyaPatelMD Pocket Card Resources: https://bit.ly/pocketcardresources #Inpatient #History #Physical #HP #Note #Template

Morphology of Skin Lesions - Primary and Secondary - Description Algorithm • Primary Skin Lesion - Initial lesion not altered by trauma, manipulation (rubbing, scratching), complication (infection), or natural regression over time. • Secondary Skin Lesion - Lesion that develops from trauma, manipulation (rubbing, scratching), complication (infection) of initial lesion, or develops naturally over time #Morphology #SkinLesion #Primary #Secondary #Description #Algorithm #dermatology

Primary and Secondary Dermatology Skin Lesions #Diagnosis #Dermatology #Primary #Secondary #Skin #Lesions #Atlas #Nomenclature #Terminology

Shoulder Examination Step 1 Inspection Step 2 Palpation (ABCs) Step 3 Range of Motion and Strength (SITS) Step 4 Provocative Tests (BIAS) by Dr. Lizzy Hastie @LizzyHastie #Shoulder #Examination #PhysicalExam #diagnosis #checklist

Deprescribing algorithm for proton pump inhibitors To support clinicians in employing the recommendations outlined in the guideline, the team developed and piloted a two-page deprescribing algorithm. This algorithm helps clinicians decide when and how to reduce proton pump inhibitors safely and how to monitor effect. As life changes, medications that were once right for a person may no longer be the best choice for them. #Management #Geriatrics #PPI #ProtonPumpInhibitors #Deprescribing #Algorithm

Cholinesterase Inhibitor (ChEl) and Memantine Deprescribing Algorithm To support health care professionals in employing the recommendations outlined in the guideline, the team developed a two-page deprescribing algorithm. This algorithm helps health care professionals decide when and how to deprescribe cholinesterase inhibitors and/or memantine safely and how to monitor effects in their patients. #Management #Geriatrics #Dementia #Memantine #ChEI #Cholinesterase #Inhibitors #Deprescribing #Algorithm