Category Archive: Internal Medicine Rotation

Top Ten Books for Third Year Medical Students

This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3. 

1. First Aid for the Wards:

Beginning the third year of medical school is a daunting task. I shook like a little kid the first time I had to present on rounds. In retrospect, I wish I had read this book before I ever started third year. It provides great advice about prerounding, rounding, presenting patients, and working with your clinical team. It also gives rotation specific advice for each of the main third year clinical clerkships.

2. Pocket Medicine:

I consider pocket medicine a must-have for all students and residents. I used it during medical school and am still using it in residency. It highlights all the most common clinical illnesses and presentations. For each illness it describes the clinical presentation, signs and symptoms, diagnostic tools, and treatment plan.

3. Maxwell Quick Medical Reference:

A small book with a big role. Nearly every medical student I know carries this book in their white coat. It contains clinical pearls and references that are very high yield. Additionally, it contains sample notes (progress, transfer, procedure, admission, etc).  It is about the best $10 you can spend.

4. Case Files:

The Case Files Series Top Ten Books for Third Year Medical Students (Amazon link) is my favorite clerkship study series. Similar to the Pretest Series (#5) and the Blueprint Series (#6), Case Files publishes one book for each medical student clerkship. The book teaches principles through a series of 50-60 cases.  After each case is presented, the relevant clinical teaching points are discussed and followed with a series of questions. For my style of learning, this was the ultimate study tool during third year. I particularly recommend Case Files Neurology Top Ten Books for Third Year Medical Studentsand Case Files Family Medicine Top Ten Books for Third Year Medical Students.
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5. PreTest:

Another series of books for each medical student rotation, the PreTest Series Top Ten Books for Third Year Medical Students (Amazon Link) are simply question banks in print form. Their questions are very good and hit on relevant material. Although I prefer USMLEworld as a straight question bank tool, the Pretest books allow you to always have questions at your side for bus rides, downtime at the hospital, etc. Along with many medical students, I particularly recommend PreTest Pediatrics Top Ten Books for Third Year Medical Students, which was eerily similar to the shelf exam.

6. BluePrints:

The Blueprints Series (Amazon link) Top Ten Books for Third Year Medical Students is a third series with one book for each medical school clerkship. Unlike the case-based presentation of Case Files and the q-bank format of PreTest, the Blueprints series are more like textbooks. They aim to teach the most pertinent clinical facts without becoming too dense. Each book is about 300 pages and contains a wealth of information…if you can get through it. Blueprints Obstetrics and Gynecology Top Ten Books for Third Year Medical Students
is widely considered the most useful; I used it and did very well on the shelf.

7. Surgical Recall:

If you are interested in surgery or even interested in obtaining a good grade in your surgery rotation, you need to know what is going on in the OR. Surgical Recall provides step-by-step details of surgical procedures including surgical indications, pre-operative management, intra-operative management including a walk-through of the surgery, and post-op management. It will really help you shine in the OR.

8. First Aid for the USMLE Step 2 CK:

Yes, you will probably find a ‘First Aid’ book in each of my Top Ten book lists. This is because I have found them to be the best tool at solidifying the most important points of each phase of medical school. During third year the First Aid for Step 2 CK (Clinical Knowledge) was a great way to make sure I knew the most important facts. It is certainly not sufficient to study alone.

9. MKSAP for Students:

MKSAP is a resource produced by the American College of Physicians and used by nearly every internal medicine resident in the country. The book series is huge (15 volumes?) and not for student use. However, their question book for students is incredible. Next to USMLEworld there is no better question bank to prepare for shelf exams like internal medicine and family medicine.

10. Step-Up to Medicine:

You will also find this book at the top of my list for the the internal medicine rotation. However, it is so good that I thought I should mention it here too. The book comes highly recommended by nearly every student that has ever used it. It will give you a great base to study from and find out what you need to study more.

Honorable Mention:
  1. I can not create a list of study tools for third year medical students without mentioning USMLEworld.  After using many Q-banks, many question books, and other resources, I have concluded that USMLEworld provides questions most consistently similar to the real shelf exams and boards as well as provided the clearest explanations.
  2. The Pestana Notes are an absolutely necessary resource for students on the Surgery rotation.
  3. Success on the Wards: 250 Rules for Clerkship Success Top Ten Books for Third Year Medical Studentsis a highly rated book for third year students
  4. 250 Biggest Mistakes 3rd Year Medical Students Make and How to Avoid Them Top Ten Books for Third Year Medical Students is written as the same authors as “Success on the Wards” and also comes highly recommended.
  5. The Ultimate Guide to Choosing a Medical Specialty: Top Ten Books for Third Year Medical Students Really, this books should be in the Top Ten.  I left it off because it is not specifically for third year medical students. However, it is one of the best resources available for deciding what is important to you in a specialty, and comparing variables across all medical specialties. I highly recommend it.
  • Updated April 27, 2012

Is the Patient’s Device Safe for MRI?

MRI Safety Is the Patients Device Safe for MRI?MRIsatety.com is a great resource for medical students, residents, and all medical personnel.  We all know that when a patient has a pacemaker from 2004 that they can not get a thoracic MRI. However, what if the patient had a recent shoulder replacement? What if the patient has a port for chemotherapy? What if the patient had recent spinal surgery? No matter what the circumstance, you can search this website for the patient’s device and find out if it is safe for an MRI.

The main website is…
http://www.mrisafety.com

Or, the searchable list of implantable devices can be found directly at…
http://www.mrisafety.com/list_search.asp

The list of all searchable products includes:

  • Pumps
  • Aneurysm clips
  • Bone and Nerve stimulators
  • Cardiac Pacemakers and AICDs (defibrillators)
  • Breast and other soft tissue implants
  • Coils, Filters, Stents, Grafts
  • Dental Implants and Devices
  • Catheters
  • Clips
  • Foreign Bodies
  • Ocular Implants, lens
  • Sutures
  • Etc.

 

EKG Basics PowerPoint

ekg EKG Basics PowerPointI recently started a rotation in cardiology. It has been nearly 2 years since I have worked on a heart service and I was looking for a quick refresher on EKGs. Luckily, I found a great powerpoint review on the Standford website. There are only 20 or so slides and they cover major topics such as: review of heart conduction system, EKG lead placement, determining the heart rate, and determining the QRS axis.  They review both the ‘quadrant’ approach to axis determination and the ‘equiphasic’ approach. If you are going to be starting a rotation in cardiology or if you just want to refresh yourself on EKG basics, I suggest you take a look.

You can click the link below to download the PowerPoint directly from this website or you can go to the Stanford website listed below.

EKG Basics – Long

http://medresidents.stanford.edu/TeachingMaterials/EKG%20Basics/EKG%20Basics%20-%20Long.ppt#34

Procedure Notes: Central Venous Catheter (CVC) Placement

Central Venous Catheter (CVC, Central Line) Placement

Date: <____>
Time: <____>
Indication: Hemodynamic monitoring/Intravenous access
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient was placed in a dependent position appropriate for central line placement based on the vein to be cannulated. The patient’s <right/left> < neck/shoulder/groin> was prepped and draped in sterile fashion. 1% Lidocaine was used to anesthetize the surrounding skin area. A triple lumen <9-French> Cordis catheter was introduced into the the <subclavian/internal jugular/common femoral vein> using the Seldinger technique <and under ultrasound guidance>. The catheter was threaded smoothly over the guide wire and appropriate blood return was obtained. Each lumen of the catheter was evacuated of air and flushed with sterile saline. The catheter was then sutured in place to the skin and a sterile dressing applied. Perfusion to the extremity distal to the point of catheter insertion was checked and found to be adequate. <Attending/Resident> was present for the entire procedure.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Lumbar Puncture

Lumbar Puncture

Date: <____>
Time: <____>
Indication: Altered Mental Status
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient was placed in the <LEFT/RIGHT> lateral decubitus position in a semi-fetal position with help from the nursing staff. The area was cleansed and draped in usual sterile fashion. 1% lidocaine was used anesthetize the surrounding skin area. A <20-gauge 3.5-inch> spinal needle was placed in the <L3-L4/L4-L5> interspace. Clear cerebral spinal fluid was obtained and the opening pressure was noted to be <?cm>. Four tubes were filled with 4 mL of CSF. These were sent for the usual tests, including 1 tube to be held for further analysis if needed. <Attending/Resident> was present for the entire procedure

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Thoracentesis

Thoracentesis

Date: <____>
Time: <____>
Indication: Large pleural effusion
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient’s <right/left> side was prepped and draped in a sterile manner after the appropriate infiltration level was confirmed by ultrasound. 1% lidocaine was used anesthetize the surrounding skin. A finder needle was then used to locate fluid and clear yellow fluid was obtained. A 10-blade scalpel used to make the incision. The thoracentesis catheter was then threaded without difficulty. The patient had <?mL> of clear yellow fluid removed. <Attending/Resident> was present for the entire procedure. A post-procedure chest x-ray was ordered and the fluid will be sent for several studies.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Swan-Ganz Catheter

Swan-Ganz Catheter Placement

Date: <____>
Time: <____>
Indication: Hemodynamic monitoring/Intravenous access
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient was placed in a dependent position appropriate for central line placement based on the vein already cannulated with a 9F Cordis catheter. The patient’s <right/left>  <shoulder/neck/groin> was prepped and draped in sterile fashion. A triple lumen continuous cardiac output Swan-Ganz catheter was brought onto the field and each line flushed with sterile saline and the SVO2 sensor calibrated. The catheter was introduced into the Cordis catheter to a distance of 15-17 cm. The balloon was then inflated and the catheter was advanced through the right ventricle and into the pulmonary artery until a wedge position pressure tracing was obtained. The balloon was then deflated and verification of return of a pulmonary artery pressure tracing made. During the floating procedure to position the catheter the position of the catheter tip was determined by continuous pressure monitoring via the distal port. The catheter was locked to the Cordis with the tip inserted to a distance of <?cm> and a sterile dressing applied. <Attending/Resident> was present for the entire procedure.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Endotracheal Intubation

Endotracheal Intubation

Date: <____>
Time: <____>
Indication: Respiratory Distress
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient was placed in a flat position. Sedation was obtained using <Versed 3mg>, and additionally with <Etomidate 20mg>. The patient was easily ventilated using an ambu bag. The <GLIDESCOPE TECHNOLOGY/ MAC 3 BLADE> was used and inserted into the oropharynx at which time there was a Grade 1 view of the vocal cords. A 7.5-french endotracheal tube was inserted and visualized going through the vocal cords. The stylette was removed. Colorimetric change was visualized on the CO2 meter. Breath sounds were heard in both lung fields equally. The endotracheal tube was placed at 23 cm, measured at the teeth. <Attending/Resident> was present for the entire procedure.

A chest x-ray was ordered to assess for pneumothorax and verify endotrachealtube placement.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Thoracostomy (Chest Tube)

THORACOSTOMY (CHEST TUBE) PLACEMENT

Date: <____>
Time: <____>
Indication: Pneumothorax/Hemothorax
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The patient was positioned appropriately for chest tube placement. The patient’s <right/left> chest was prepped and draped in sterile fashion. 1% Lidocaine was used to anesthetize the surrounding skin area. A <2 cm> skin incision was made in the mid-axillary line at the inframammarycrease. Utilizing blunt dissection a subcutaneous tunnel was created cephalad just adjacent to the superior rib. The pleural space was entered bluntly and gush of  <air/blood> was observed. A finger was inserted into the pleural space to check for anatomy and guide tube insertion. A <36F/40F> thoracostomy tube was inserted using a Kelly clamp and positioned appropriately. The chest tube was sutured securely to the skin and a sterile dressing applied. A pleurevac was attached to the chest tube and a chest x-ray obtained. <Attending/Resident> was present for the entire procedure.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital:

Procedure Notes: Arterial Line

ARTERIAL LINE (A-Line) PLACEMENT

Date: <____>
Time: <____>
Indication: Hemodynamic monitoring
Resident: <____>
Attending: <____>

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. Allen’s test was performed to ensure adequate perfusion. The patient’s <right/left> wrist was prepped and draped in sterile fashion. 1% Lidocaine was used to anesthetize the area. A <18G/20G> Arrow arterial line was introduced into the <radial/femoral> artery. The catheter was threaded over the guide wire and the needle was removed with appropriate pulsatile blood return. The catheter was then sutured in place to the skin and a sterile dressing applied. Perfusion to the extremity distal to the point of catheter insertion was checked and found to be adequate. <Attending/Resident> was present for the entire procedure.

Estimated Blood Loss: <____>
The patient tolerated the procedure well and there were no complications.

Other procedure note examples:

Also, thank you to my two favorite websites for helping me write notes in the hospital: