Medical Training

• End of Rotation Feedback Form

Strongly recommended books to have:
- Residents Guide to Ambulatory Care 7th+ edition
- Harrisons Manual of Medicine (small version / handbook)
- Blueprints : Pediatrics
- Blueprints : OBGYN
- Tintinellis EM Manual (small version)
- Pocket Medicine
- Comprehensive Handbook Obstetrics & Gynecology, Thomas Zheng (aka the red book)

- FM Board Review Audio series
- FM ITE Board Questions

Medical Student 4 week rotation:

[ ] Write 4 case reviews: (1 each week; study the case, critique the management, present the standard of care - diagnosis, work-up, management, enter the revised/proposed care plan to EMR).
[ ] Write up 1 Preventative Health Handout

Dress code: just look presentable. no ties, yes collared shirt / slacks / skirt.

ROS:
ROS: no f/c, good PO regular diet w/o diarrhea/constipation nor abdominal pain, no CP or palpitations, no SOB / cough / wheezing. ***

PE:
PE:
Const: Well-nourished, Well-developed, No acute distress
* ***
CV: +S1/S2, No murmurs, RRR
* ***
Resp: respiratory effort w/o labor
* . CTAB * ***
Psych: Awake, alert & oriented x3
* . Appropriate mood and affect * ***

Neuro: CNs II-XII grossly intact
* ***
Eyes: no conjunctival injection
* ***
ENMT: Atraumatic external nose and ears
* . Moist MM * ***
Neck: Symmetric, trachea midline
* ***
GI: No hepatosplenomegaly *. Nondistended / Nontender
* ***
MSK: Normocephalic /Atraumatic, Normal gait
* ***
Skin: Warm, Dry
* ***

AP Template
#. Dx/complaint:
- 1-liner: chief complaint since date, notable for blah blah.
- +/- pertinent history (previous work-up, tx, specialists)
- ddx: likely a,b,c ; less likely x,y,z
> reviewed the ddx, w/u, tx options w/ pt. noting that ---
> ? labs / imaging?
> ? tx
> f/u: when; what to consider at next appt?

-------------------
Diabetes:
- Diabetes control currently_***__; home blood sugars: _***_
- Complications: _***_ retinopathy, _***_ LE neuropathy; _***_ ulcers; _***_ CKD; _***_ microalbuminuria
- ASCVD hx : CAD hx _***__, CVA hx_***__
- Other rx: ACEi / ARB _***__; statin_***__; ASA 81 _***__
- Lifestyle: _***_ ADA diet, _***_ following nutritionist;
- Last Ophtho exam: ***
- Last DM foot exam: ***
- vaccinations: PNA vaccine _***__; flu vaccine _***_
- Current Regimen: *** reviewed in EMR.

- Low BG episodes: _***_
- Note: ***


----------------
Wellness Visit

- ASCVD RFs: *** hx CVA/CAD, *** DM, *** HTN, *** HLD, ASA candidate: ***; fhx CVD: ***
- CA Screening: mammogram: *** , pap smear: *** , CRC screening: *** ; fhx malignancies: ***
- Vaccinations: UTD ***
- Conditioning: regular exercise: ***, physical limitations to regular activity: ***
- Social: tobacco (***); etoh (***); drugs (***); home: ***, work: ***
- Dx/Rx reviewed. Code status: ***

- Repro/BCM: *** no abnormal bleeding/discharge/rash/ulcers; STI hx: ***; Sexual activity: ***; BCM method: ***; menses: ***

- Psych: *** denies depression; *** good energy; **** sleep; *** appetite; *** concentration

PHQ2:
Over the last 2 weeks, have you been bothered by... (None = 0, Several days = 1, >1/2 days = 2, Nearly daily = 3)
- ... Little interest or pleasure in doing things? _***_
- ... Feeling down, hopeless, or depressed? _***_




FM Clinic
UCSD Practical Guide to Clinical Medicine: physical exam guide
Radiology Online Training

U of Michigan Clinical Care guidelines; has common outpatient issues.
Iowa FM residency website; look at the disease specific resources at bottom.


Key Topics to Learn:
#. COPD chronic management & exacerbation management
#. DM2 chronic management.

#. HLD
> Lipid Metabolism and CV Risk
topic review 49 slides.
>
ACC/AHA 2018 Recs Summary (22 pg); updated 2019.


#. HTN management
> look at JNC8 review
>
2º causes : Online MedEd 18min

#. CAD management
#. CHF management
#. CVA management
#. Anxiety / Depression
#. PNA: CAP vs HCAP, management.
#. Skin infections
#. Osteoarthritis: knee, hip
#. Shoulder pain
#. Low back pain:
#. Gout
#. Weight management

#. Derm
14 Key Rashes to Know - 30 slides review.

#. Antibiotics
>
Antibiotics Ladder - MedCram, 18min. Great overview and structuring of the most common abx and what they cover.

#. Wellness Exams
#. Pre-op clearance
#. Sports physicals

#. Doing an efficient complete PE
#. Presenting a patient
#. Medicine & Finance

Medicine Service
• PNA
• Chest pain
• DM2 inpatient management
• HTN
• ACS / CAD
• Stroke

MCH

• Pre-Eclampsia / Eclampsia
• Routine Prenatal Care
• Post-partum anemia / depression
• PPH
• Neonatal Sepsis
• Neonatal Bilirubin
• 
Newborn Care

Renal

Pulm


Cardiovascular

- HTN :



Endocrine



=======
Intro Day

[ ] ITE Q-bank PDF
[ ] Share Note Template. review how to write note. 4 purposes of writing a note.
[ ] Share review audio
[ ] Print Learning Calendar
[ ] Wordpress / Blog Format for learning
[ ] Evidence-Based Medicine / Statements
[ ] Learning tools; NOT Up-to-date
[ ] Share the ProxyT2.wordpress.com and med.impalads.org sites.
[ ] Standard PE for my notes.
[ ] Recommended Books / BUY them.

Between
[ ] Choosing residencies & specialties.
[ ] Finance
[ ] Transition Student to Physician
[ ] Storytelling
[ ] Logic & Emotion in Pt Decision-making.
[ ] Guiding the conversation
[ ] Key phrases for presentations.

Exit Day
[ ] DC review audio
[ ] Scan learning calendar
[ ] LOR rules



Monday: 
• Liver & Biliary duct
> how to read & interpret LFTs / bilirubin / GGT / alk phos
> how to find cirrhosis - physical exam, labs, imaging? once you dx cirrhosis, then what do you do?
> cholelithiasis vs cholecystitis vs choledocholithiasis
• Pancreas
> acute pancreatitis work-up, tx, management
> chronic pancreatitis 
• GERD & PUD : 
> how to differentiate between GERD vs PUD?
> work-up options, tx options

Tues: 
• chest pain / CAD
> define typical vs atypical vs non-cardiac CP
> common non-cardiac causes of CP
> angina (stable vs unstable) vs NSTEMI vs STEMI
> standard management of CAD patient after having had MI / acute coronary syndrome
• Heart failure
> what does typical HF patient hx look like? various etiologies?
> what does HF acute exacerbation look like (hx, PE)? how do you tx?
> CHF staging; NYHA 1-4, systolic vs diastolic, L vs R
> role of echo in CHF? BNP?
• Afib
> how to read afib / flutter on ecg
> management of afib : rate / rhythm control, anti-coagulation
> anti-coagulation; INR goals, warfarin, heparin, lovenox, NOACs (xarelto, eliquis)
> know CHADSVASC, HASBLED

Wed: 
• Pneumonia
> CURB65 criteria
> CAP vs HCAP vs HAP vs aspiration PNA
> antibiotic regimens for each above, what they cover
• COPD
> review COPD GOLD guidelines; find a brief review of it, don't read whole thing. 
> how to dx? confirmatory testing? how to tell COPD vs asthma?
> rx options: anti-cholinergics, respiratory steroids, BB (long-acting vs short-acting)
> what does COPD exacerbation look like? how do you treat it? 
• Asthma:
> same as above questions for COPD
> how to stage asthma? "rule of 2's"
> asthma vs RAD? Whats the youngest age you can dx asthma? 

Thurs:
• HLD
> ASCVD risk calculator; how to use
> rx options; statins, fibrates, niacin
> LDL goals? HDL? learn ATP4 guidelines
• HTN: 
> JNC 8 vs JNC 7 guidelines
> common rx options; thiazides, ACEi/ARB, BB, CCB. 2nd line: hydralazine, clonidine
> how to differentiate and manage HTN urgency vs emergency
• Migraine
> POUND criteria / quetions for dx migraine
> tx options: triptans for "abortive", prophylaxis options (propranolol, topiramate, etc.)
> differentiate vs cluster headache vs tension. migraine w/o aura vs w/ aura. 
• Antibiotics: 
> look for a youtube video called "antibiotic ladder"

Friday:
• Depression / Anxiety
> PHQ9, GAD 7 screening tools
> what is "official" DSM dx for depression, anxiety
> how to tx: SSRI/SNRI/other for daily use, prn rx for anxiety / panic attacks
• Common skin issue: 
> eczema, psoriasis, contact dermatitis
> tick bites, dog / cat bites, scabies vs lice vs bed bugs etc
> urticaria
> tinea corporis vs unguiam vs ... all the "tineas"; learn what they look like on different parts of the body