clinical modules

8/16/2019 Clinical Modules

1/21

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#


2/21

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#

http://www.med-u.org/http://www.med-u.org/


3/21

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


4/21

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#



5/21

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

http://www.med-u.org/http://www.med-u.org/http://www.med-u.org/http://www.med-u.org/


6/21

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#



7/21

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#



8/21

(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#

)


9/21

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#



10/21

),( 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 &ltration 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#


11/21

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#

http://www.med-u.org/http://www.idsociety.org/Organ_System/%23Lower/Upper%20Respiratory%20%20http://www.med-u.org/http://www.idsociety.org/Organ_System/%23Lower/Upper%20Respiratory%20%20


12/21

# 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#



13/21

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#


14/21

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#


15/21

(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#



16/21

(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/


17/21

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

,


18/21

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


19/21

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


20/21

!# 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#


21/21

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

clinical modules

Documents