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The method behind the modules

Frameworks first: how internal medicine thinks, the physiology the investigations rest on, and the working skills of rounds, notes, handover, and discharge.

16 topics
160 minutes of reading
29 presentations

Foundations

The internal medicine approach8 minOne synthesis, many inputs

Clinical reasoning10 minProblem representation

Problem representation6 minThe one-sentence case

Building a differential7 minMechanism first, then probability, then danger

Physiology

Acid-base physiology9 minOne ratio, two organs

Electrolyte physiology9 minSodium is water

Hemodynamics8 minPressure = flow × resistance

Respiratory physiology8 minVentilation and oxygenation are different failures

Reading the data

How to read an ECG18 minThe paper before the patient

How to read an ABG12 minOxygenation first, acid-base second

How to read PFTs11 minThree numbers, one ratio

How to read the morning labs13 minRead the panel like a chart, not a list

Ward skills

Presenting on rounds10 minSay what matters, in order

Clinical documentation12 minNotes are thinking made portable

Discharge planning10 minDischarge is a process, not an event

Handover9 minSignal over completeness

Approach to presentations

DyspneaFirst threat: Hypoxia needing oxygen now (SpO2, work of breathing, mentation)

Chest painFirst threat: ACS: the ECG within 10 minutes of arrival

Acute kidney injuryFirst threat: Hyperkalemia with ECG changes

Confusion / altered mental statusFirst threat: Hypoglycemia: glucose at the bedside, immediately

GI bleedingFirst threat: Hemodynamic instability: two large-bore IVs before any diagnostics

Fever in the hospitalFirst threat: Septic shock physiology

SyncopeFirst threat: Arrhythmic syncope: no warning, during exertion, or while supine

PalpitationsFirst threat: Sustained VT or rapid pre-excited AF

JaundiceFirst threat: Ascending cholangitis: fever, rigors, RUQ pain with jaundice

Peripheral edemaFirst threat: Unilateral swelling is DVT until reasoned otherwise

Acute joint painFirst threat: Septic arthritis: the hot joint that destroys cartilage in days

Unintentional weight lossFirst threat: Occult malignancy, especially GI, pancreatic, and lymphoma

AnaphylaxisFirst threat: Airway edema: voice change, tongue swelling, stridor

Falls in the older patientFirst threat: Head injury on anticoagulation: scan generously

Polyuria & polydipsiaFirst threat: New diabetes tipping into DKA or hyperosmolar state

Shock & hypotensionFirst threat: All of it: shock is the threat; the question is which engine failure

HeadacheFirst threat: Thunderclap onset (peak within a minute): subarachnoid hemorrhage until excluded

First seizureFirst threat: Ongoing or recurring seizure at 5 minutes: status epilepticus, benzodiazepine now

Focal weaknessFirst threat: Sudden focal deficit is a stroke code: time of onset (or last seen well) decides therapy eligibility

Acute abdominal painFirst threat: Peritonitis (rigid, silent abdomen) or free air: surgical review now, not after imaging

HemoptysisFirst threat: Massive hemoptysis (over ~100 mL or any airway compromise): the threat is asphyxiation, not exsanguination

Back pain with red flagsFirst threat: Cauda equina: saddle anesthesia, retention with overflow, bilateral leg symptoms: MRI within hours, not days

Acute diarrheaFirst threat: Shock and profound dehydration, most dangerous at the extremes of age

DysuriaFirst threat: Fever, flank pain, or rigors on top of dysuria: pyelonephritis, and with shock, urosepsis

Bruising and bleedingFirst threat: Bleeding into a closed space: head, airway and neck, retroperitoneum: image and correct in parallel

HypoglycemiaFirst threat: Neuroglycopenia (confusion, seizure, coma) is brain injury in progress: glucose now, by any working route

AnemiaFirst threat: Active bleeding with hemodynamic change: the falling hemoglobin with a rising heart rate

ThrombocytopeniaFirst threat: Thrombotic thrombocytopenic purpura: fragments on the film with thrombocytopenia is plasma exchange tonight

Rash on the wardFirst threat: A non-blanching rash with fever: meningococcal sepsis until proven otherwise