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Internal Medicine Residency Handbook
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Introduction
Acknowledgements
Rationale
Disclaimers
Housestaff Handbook Web Version
Editors and Reviewers
Anesthesia & Pain Management
Acute Pain
Chronic Pain
Consulting Pain Services
Cardiology
Diagnostic Cardiac Tests
Approach to the ECG
Bedside Echocardiography
Right Heart Catheterization
Inpatient Hypertension
Autonomics and Orthostatic Hypotension
Chest Pain
Acute Coronary Syndromes
Pericarditis
Bradyarrhythmia
Tachyarrhythmias - Narrow
Tachyarrhythmias - Wide
Atrial Fibrillation & Flutter
Heart Failure
Cardiogenetic Shock
Cardiac Devices
Pulmonary Embolism
Syncope
Valvular Disease
Aortic Stenosis
Aortic Regurgitation
Mitral Regurgitation
Mitral Stenosis
Critical Care
Definition of Shock
Management of Shock
Sepsis
Acute Respiratory Distress Syndrome (ARDS)
Intubation and Extubation
Anesthesia Airway
Modes of Oxygen Delivery
Introduction to Vent Management
Refractory Hypoxemia
Refractory Hypercapnia
Tracheostomy
ABCDEF (A2F) Bundle
ICU Delirum
Brain Death
MICU/CCU Drips
Running Codes
Temperature Abnormalities
Dermatology
Terminology
Common Rashes
Inpatient Dermatology
Endocrinology
Adrenal Incidentalomas
Adrenal Insufficiency
Central Diabetes Insipidus
Diabetic Ketoacidosis (DKA)
Hyperthyroidism
Hypoglycemia
Hypothyroidism
Inpatient Diabetes Mellitus (DM)
Outpatient Diabetes
Osteoporosis
Outpatient Medical Weight Loss
Panhypopituitarism
Severe Hypertriglyceridemia
Steroid Conversion
Stress Dose Steroids
Thyroid Nodules
Thyroid Storm
Gastroenterology
Acute Abdominal Pain
Acute Diverticulitis
Acute Pancreatitis
Chronic Pancreatitis
Anorectal Disease
Biliary Disease
Clostridioides Difficile Infections
Constipation
Diarrhea
Dysphagia
Odynophagia
Gastroparesis
GERD
Eosinophilic Esophagitis
Peptic Ulcer Disease
GI Bleeding
Ileus
Inflammatory Bowel Disease
Intestinal Ischemia
Irritable Bowel Syndrome
Large Bowel Obstruction
Small Bowel Obstruction
Nausea & Vomiting
Ostomy Complications
Geriatrics
Functional Status
Dementia
Falls
Frailty and Malnutrition
Medication Management
Urinary Incontinence and Foleys
TOC/Disposition Urinary Incontinence and Foleys
Medicare
Immunizations / Screening
Home Safety
Driving Cessation
Hematology Oncology
Anemia
Neutropenia and Neutropenic Fever
Thrombocytopenia
Pancytopenia and Bicytopenia
Leukocytosis
Venous Thromboembolism
Anticoagulation
Hypercoagulable States
Bleeding Coagulopathies
Disseminated Intravascular Coagulation (DIC)
Transfusion Medicine
Sickle Cell Disease and Complications
Lymphoma
Clonal Hematopoiesis
Myelodysplastic Syndromes
Acute Leukemia
Plasma Cell Dyscrasias
Myeloproliferative Neoplasms
Bone Marrow Transplant
CAR-T cell Therapy and T cell Engagers
Oncologic Emergencies
Paraneoplastic Syndromes
Cancer of Unknown Primary
Therapy Toxicities
Indications for Inpt Radiation Oncology Consultation
Radiation Toxicity
Hepatology
Cirrhosis Overview
Liver Transplant (LT) Workup
Spontaneous Bacterial Peritonitis (SBP)
GE Varices and Hemorrhage
Ascites and Hepatic Hydrothorax
Hepatic Encephalopathy (HE)
AKI & Hepatorenal Syndrome (HRS)
Hyponatremia in Cirrhosis
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Hepatocellular Carcinoma (HCC)
Coagulopathy in Cirrhosis
Portal Vein Thrombosis (PVT)
Alcohol-associated Hepatitis
MASH and MASLD
Acute Liver Injury and Failure
Non-Invasive Testing
Hospital Medicine
Lines and Catheters
Telemetry
High Quality Handovers
High Quality Consults
Discharge Planning
Patient-Directed Discharges / AMA
Wounds
Caring for Custodial Patients
Enteral Nutrition
Guidelines for Pregnant Patients
Infectious Diseases
General Tips
Bacteremia: Interpreting GenMark ePlex® Results – VASP
Central Nervous System Infection
Diabetic Foot Infection
Endocarditis
Fever in a Return Traveler
Fungal Infections
Genitourinary Infection
GI Infections
HIV/AIDS and ART
AIDS Defining Clinical Conditions
Overview of Antiretroviral Therapy
Antimicrobial Prophylaxis per CD4 Counts
Immune Reconstitution Inflammatory Syndrome (IRIS)
Joint Infection and Osteomyelitis
Odontogenic Infections
Pulmonary Infections
Inpatient COVID-19 Management
MTB and NTM Infections
Sexually Transmitted Infections
Skin and Soft Tissue Infection
Nephrology
Acute Kidney Injury (AKI)
Contrast Induced AKI
Approach to Chronic Kidney Disease
Renal Replacement Therapy
Peritoneal Dialysis Peritonitis
Intravenous Fluids
Acid-Base
Electrolytes
Approach to Urinalysis
Hematuria
Kidney Transplant Medicine
Neurology
Common Neurologic Problems
Altered Mental Status
Amyotrophic Lateral Sclerosis
Brain Masses
Inpatient Headache
Outpatient Headache
Multiple Sclerosis
Neuromyelitis Optica and Spectrum Disorder
Neuropathy
Parkinson’s Disease
Seizure without Status Epilepticus
Vertigo
Neurologic Emergencies
Guillain-Barre Syndrome (GBS)
Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome
Status Epilepticus
Stroke
Ophthalmology
Common Abbreviations in Ophthalmology
Taking a Good Ocular History
Approach to Blurry Vision
Approach to Double Vision
Approach to Flashes, Floaters, Spots
Approach to a Red Eye
Anisocoria
Conjunctivitis
Cataracts
Corneal Abrasion, Exposure Keratopathy, Ulceration
Dry Eye
Fungemia and Intraocular Involvement
Glaucoma
Optic Neuritis
Orbital vs Preseptal Cellulitis
Papilledema
Retinal Detachment and Posterior Vitreous Detachment
Uveitis
Wilson’s Disease
Outpatient Medicine
Allergy
Anxiety/Depression
Asthma
Dermatology
Fatigue
Gender Affirming Care
Hypertension
Immunizations
Lipids
Obesity/Nutrition
Preventive Medicine/Screening
Palliative Care
Code Status Discussion
Videos for Difficult Conversations
Prognosis
Goals of Care Discussions
Palliative Care and Consulting Palliative Care
Caring for Imminently Dying Patients
Hospice
The Death Pronouncement
Death Process in EPIC
Death Process at the VA
Advance Directives
Acute and Chronic Pain
Opioids: General Principles and Conversion
Physical Medicine Rehabilitation
Reasons for Consultation or Referral to PM&R
Rehabilitation Options
Rehab Terms and Definitions
Spinal Cord Injury
Spasticity
Traumatic Brain Injury (TBI)
Acute Back Pain
Knee Pain
Neck Pain
Shoulder Pain
Procedures
Procedures Overview
Anticoagulation and Bleeding Risk
Anesthesia and Sedation
Arterial Line
Central Line
Lumbar Puncture
Dobhoff Tube
Paracentesis
Thoracentesis
US-Guided PIV
Post-Procedural Care
Psychiatry
Agitation Management
Alcohol Use Disorder
Catatonia
Delirium
Inpatient Insomnia
Medical Decision-Making Capacity
Medical and Psychiatric Holds
Medications for Opioid Use Disorder
Motivational Interviewing
Navigating “Difficult” Pt Interactions
Opioid Use Disorder
Personality Disorders
Tobacco Use Disorder
Pulmonary
Acute Asthma Exacerbation
Airway Clearance Therapy
Basics of Blood Gases
COPD Exacerbation
Chest Tubes
Cystic Fibrosis (CF) Exacerbation
Hemoptysis
Home Oxygen Therapies
Hypoxia and Hypoxemia
Inhaler Therapy
Lung Masses
Lung Nodule
Pleural Effusions
Pulmonary Function Tests
Pulmonary Hypertension
Radiology
Common Radiology Exams by Suspected Diagnosis
Basic Abdominal X-ray Interpretation
Basic Abdomen and Pelvis CT Interpretation
Gastrointestinal Fluoroscopy
Basic Chest X-ray Interpretation
Basic Non-Contrast Head CT Interpretation
Consults for Radiology Procedures
Anticoagulation for IR Procedures
Contrast Allergies or Extravasation
Rheumatology
Overview of Rheumatic Disease
Approach to Joint Pain
Arthrocentesis
Biologics Overview
Rheumatology Lab Testing
Spondyloarthritis
Psoriatic Arthritis
Rheumatoid Arthritis
Crystalline Arthropathies
Pseudogout
Systemic Lupus Erythematous (SLE)
Systemic sclerosis
Inflammatory Myopathies
IgG4-related disease (IgG4-RD)
Vasculitis
Polymyalgia Rheumatica
Adult-Onset Still's
Sarcoidosis
Fibromyalgia
Toxicology
Management of Specific Overdoses
Drug-Induced QTc Prolongation
Brown Recluse Bites (Loxoscelism)
Toxidrome Overview
Appendices
Uploading Records to EPIC
VA Phone and Pager Directory
VUMC Phone and Pager Directory
VUMC Rotations
VA Rotations
How to Discharge a Pt at VUMC
How to Discharge a Pt at VA
VUMC and VA Door Codes and Ultrasound Locations
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