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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
Blood Pressure
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 Heart 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
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
Corticosteroids
Common Rashes
Inpatient Dermatology
Common Drug Rash Comparisons
Endocrinology
Adrenal Incidentalomas
Adrenal Insufficiency
Central Diabetes Insipidus
Diabetic Ketoacidosis (DKA)
Hyperthyroidism
Hypoglycemia
Hypothyroidism
Inpatient Diabetes
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
Dementia
Falls
Failure to Thrive
Medication Management
Urinary Incontinence and Foleys
Disposition
Screening in Older Adults
Hematology Oncology
Anemia
Neutropenia and Neutropenic Fever
Thrombocytopenia
Pancytopenia and Bicytopenia
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)
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
High Quality Handovers
Wounds
Caring for Custodial Patients
Enteral Nutrition
Guidelines for Pregnant Patients
When to Hold Anticoagulation
When to Make Patients NPO
Admissions at VA and VUMC
Ordering Telemetry
Transitions of Care: Discharge Planning
Patient-Directed Discharges / AMA
Infectious Diseases
General Tips
Central Nervous System Infection
Diabetic Foot Infection
Endocarditis
Fever in a Return Traveler
Fungal Infections
Genitourinary Infection
Gastrointestinal Infections
HIV/AIDS and ART
AIDS Defining Clinical Conditions
Antimicrobial Prophylaxis per CD4 Counts
Overview of Antiretroviral Therapy
Immune Reconstitution Inflammatory Syndrome (IRIS)
Joint Infection and Osteomyelitis
Odontogenic Infections
Pulmonary Infections
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
Acid-Base
Electrolytes
Approach to Urinalysis
Hematuria
Nephrolithiasis
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
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
Fatigue
Gender Affirming Care
Hypertension
Immunizations
Lipids
Obesity/Nutrition
Preventive Medicine/Screening
Travel Medicine
Palliative Care
Code Status Discussion
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
Resident Resources after Patient Death
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)
Musculoskeletal (MSK) Injuries
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
Delirium
Inpatient Insomnia
Medical Decision-Making Capacity
Medical and Psychiatric Holds
Personality Disorders
Catatonia
Alcohol Use Disorder
Opioid Use Disorder
Medications for Opioid Use Disorder
Tobacco Use Disorder
Motivational Interviewing
Pulmonary
Basics of Blood Gases
Hypoxia and Hypoxemia
Pulmonary Function Tests
Acute Asthma Exacerbation
COPD Exacerbation
Cystic Fibrosis (CF) Exacerbation
Hemoptysis
Interstitial Lung Disease
Lung Nodule
Pleural Effusions
Pulmonary Hypertension
Airway Clearance Therapy
Chest Tubes
High Altitude Disorders
Radiology
Common Radiology Exams by Suspected Diagnosis
Basic Abdomen and Pelvis CT Interpretation
Basic Chest X-ray Interpretation
Basic Chest CT Interpretation
Rheumatology
Approach to Rheumatic Disease
Autoantibody Testing and Inflammatory Markers
Medications in Rheumatology
Arthrocentesis/Synovial Fluid
Approach to Joint Pain
Rheumatoid Arthritis
Crystalline Arthropathies
Spondyloarthropathies
Systemic Lupus Erythematous (SLE)
Systemic Sclerosis
Antiphospholipid Syndrome
Idiopathic Inflammatory Myopathies
Sjögren’s Syndrome
IgG4-related disease
Vasculitides
Polymyalgia Rheumatica
Adult-Onset Still's
Sarcoidosis
Fibromyalgia
Toxicology
Management of Specific Overdoses
Drug-Induced QTc Prolongation
Envenomation
Toxidrome Overview
Appendices
Uploading Records to EPIC
VUMC Rotations
VA Rotations
How to Discharge a Pt at VUMC
How to Discharge a Pt at VA
VUMC Phone and Pager Directory
VA Phone and Pager Directory
VUMC and VA Door Codes and Ultrasound Locations
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