Penn State Internal Medicine Student Report

Enhancing the med student experience on the Internal Medicine services at Penn State Hershey Medical Center. Delivering daily pearls for students! #IMpearls

[Penn State Internal Medicine Student Report @PSUIMReport]

@NickDuca57 @BMcGillenMD @davidshoremd

[Penn State Internal Medicine Student Report @PSUIMReport]

1/12 #IMPearls 55 yo F w/ a PMH of rheumatoid arthritis visits the doctor with 8 months of progressive SOB on exertion and dry cough. She has a 25-year smoking history. Bibasilar inspiratory crackles on exam. PFTs show a reduced TLC and DLCO. High-res CT shown.

[Penn State Internal Medicine Student Report @PSUIMReport]

12/12 ILD should be on your differential when evaluating patients with chronic dyspnea! If you rotate on #pulmonarymedicine you will absolutely see ILD in clinic! Educators, please add your clinical pearls! #MedEd @duca @mcgillen @davidshore

[Penn State Internal Medicine Student Report @PSUIMReport]

11/
Want to learn more? Here is a great podcast by @thecurbsiders on cirrhosis:
https://t.co/d1qDJBmLrK
Educators feel free to add your #IMpearls
#MedEd #MedTwitter
@NickDuca57 @BMcGillenMD @klkrok @KofiClarkeMD

[Penn State Internal Medicine Student Report @PSUIMReport]

1/ #IMpearls #MedTwitter
A 64yoM with a PMH of significant alcohol use presents with his partner due to progressively worsening confusion, a distended and tender abdomen, fever, and jaundice. His partner says he has stopped taking his medications.
Here is a CXR from the ED:

[Penn State Internal Medicine Student Report @PSUIMReport]

10/
◽️ Change in mental status - This could indicate hepatic encephalopathy which can be supported by elevated ammonia on labs.
✨ Recent TIPS procedure can lead to reduced hepatic elimination of ammonia and actually worsen encephalopathy ✨
This is a classic board question!