For Zoom Morning Report, Internal Medicine

1. © U N I V E R S I T Y O F U T A H H E A L T H ,
MORNING CASE CONF APR 9
BRIAN LOCKE, MD. CHIEF MEDICAL RESIDENT, INTERNAL MEDICINE

2. © U N I V E R S I T Y O F U T A H H E A L T H ,
INTRODUCTION: TERMS
@ U t a h I M C M R S
Problem Representation:
Pertinent
demographics/risk factors
Middle aged man
Length/tempo Acute
Key signs/symptoms Pleuritic chest pain, shortness
of breath
Problem Representation:
One-sentence summary highlighting
the defining features of the case to
help generate a differential. Evolves
with new information.
• Who is the patient?
• What is the timecourse of illness?
• What is the clinical syndrome?

3. © U N I V E R S I T Y O F U T A H H E A L T H ,
INTRODUCTION: TERMS
@ U t a h I M C M R S
Problem Representation:
Pertinent
demographics/risk factors
Middle aged man with a
recent total knee replacement
Length/tempo Acute
Key signs/symptoms Pleuritic chest pain, shortness
of breath, scant hemoptysis
Signal Detection Theory:
With each aliquot of information, our
task is to separate data helpful for
solving the problem (signal) from
data with limited bearing on the
solution (noise).
We’ll update and prune our
problem representation and
prioritized differential with each
aliquot. Use abstract semantic qualifiers: acute > 3 days

4. © U N I V E R S I T Y O F U T A H H E A L T H ,
HPI THE FOREGROUND
CC: 23M with weight gain and swelling
• -40lb weight gain in two months, progressive
throughout the two months
• -swelling in legs, abdomen, hands
• -Abdominal pain: epigastric, worse w/ meals,
associated w watery, loose stools
• -No loose stools when not eating.
• -Dyspnea on exertion
Differential Diagnosis
1. Renal -Nephrotic
2. Liver – cirrhosis
3. CHF
Schema
Problem Representation:
Pertinent
demographics &
risk factors
Length & tempo
Key signs &
symptoms =>
Syndrome
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5. © U N I V E R S I T Y O F U T A H H E A L T H ,
HISTORY THE BACKGROUND
• Medical:
• Surgical:
• Medications:
• Social:
• Family:
Schema
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6. © U N I V E R S I T Y O F U T A H H E A L T H ,
OBJECTIVE VITALS AND EXAM
• VS:
• GEN:
• HEENT:
• CV:
• Pulm:
• Abd
• Ext
• Neuro:
• Psych:
• Skin:
Schema
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7. © U N I V E R S I T Y O F U T A H H E A L T H ,
OBJECTIVE BASIC LABS
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Cl
WBC
Hgb
Plt
INR
PTTPT
Na
K CO2
Cr
Glu
CaBUN
TP
Alb
Bili
AST
ALT
AP
Other Labs:

8. © U N I V E R S I T Y O F U T A H H E A L T H ,
OBJECTIVE IMAGING
Schema
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• CXR

9. © U N I V E R S I T Y O F U T A H H E A L T H ,
OBJECTIVE INVESTIGATIONS
Schema
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• CXR

10. © U N I V E R S I T Y O F U T A H H E A L T H ,
OBJECTIVE INVESTIGATIONS
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11. © U N I V E R S I T Y O F U T A H H E A L T H ,
OBJECTIVE INVESTIGATIONS
Schema
• A1c 5.1 etc. etc. Beyond basic labs
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12. © U N I V E R S I T Y O F U T A H H E A L T H ,
OBJECTIVE TO THE DIAGNOSIS
Schema
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• Key test to confirm

13. © U N I V E R S I T Y O F U T A H H E A L T H ,
SUMMARY: KEY POINTS
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DIAGNOSIS: Miliary TB
Illness Script ***
Key lab point:
Think about problem representations!
• Who is the patient?
• What is the temporal pattern of
illness?
• What is the clinical syndrome?

14. © U N I V E R S I T Y O F U T A H H E A L T H ,
BONUS MANAGEMENT
• Discharged on:
– Prednisone
– Lisinopril
– Apixaban
– Furosemide
– Bactrim
– 25mcg LT4, atorva.
• Why?
@ U t a h I M C M R S

15. © U N I V E R S I T Y O F U T A H H E A L T H ,
SUMMARY: APPROACH TO LEARNING
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Preclinical: Anki (space-repetition software)
Procedures: practice skills (knots, etc)..
Medicine….?
More Cases!
• Clerkship + Residency
• HumanDx
• Clinical Problem Solvers
• NEJM Case Series
• NEJM Interactive Cases