Internal Medicine Residency Education

Internal medicine residency education has evolved from providing exposures to meet objectives and measuring competencies. The internal medicine curriculum is designed to educate internal medicine residents to deliver compassionate, evidence-based medicine curriculum, high-quality, cost-effective care to adults and adolescents. Adult learning principles are encouraged and utilized including self-directed learning and tutorials.

It is Professor EBM goal to offer outstanding training for medical students, residents, fellows and practicing physicians. We provide an outstanding balance between hands-on clinical experience, didactic learning and exceptional quality of life.

Through a flexible curriculum structure, Internal Medicine residents are afforded the opportunity to focus their training in specific areas that are of most need in the medical community such as Hospitality Medicine.

Brief Introduction of Status Epilepticus (SE)

Status Epilepticus (SE) refers to a life-threatening condition in which the brain is in a state of persistent seizure. Definitions vary, but traditionally it is defined as one continuous unremitting seizure lasting longer than 30 minutes, or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes (or shorter with medical intervention).

Subtle Status Epilepticus consists of electrical seizure activity that endures when the associated movements are fragmentary or even absent. This is confusing and is sometimes called a type of nonconvulsive Status Epilepticus.

Traditionally, Status Epilepticus was defined as 30 minutes of continuous seizure activity or a series of seizures without return to full consciousness between the seizures. Many believe that a shorter period of seizure activity causes neuronal injury and that seizure self-termination is unlikely after 5 minutes; some suggest times as brief as 5 minutes to define Status Epilepticus.

For detailed information on Status Epilepticus, read internal medicine teaching by Professor EBM.

An Introduction to Pleural effusion – Health Care

Pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during inhalation.

Pleural effusion is defined as an abnormal accumulation of fluid in the pleural space. Excess fluid results from the disruption of the equilibrium that exists across pleural membranes.

Both parietal and visceral membranes are smooth, glistening, and semitransparent. Despite these similarities, the two membranes have unique differences in anatomic architecture, innervation, pain fibers, blood supply, lymphatic drainage, and function. For example, the visceral pleurae contain no pain fibers and have a dual blood supply (bronchial and pulmonary).

Normally, very small amounts of pleural fluid are present in the pleural spaces, and fluid is not detectable by routine methods. When certain disorders occur, excessive pleural fluid may accumulate and cause pulmonary signs and symptoms. Simply put, pleural effusions occur when the rate of fluid formation exceeds that of fluid absorption. Once a symptomatic, unexplained pleural effusion occurs, a diagnosis needs to be established.

Internal Medicine Teaching by Professor EBM is a complete medical solution.

Diastolic Heart Failure

The diagnosis of diastolic dysfunction is now fairly common, especially among older women, most of whom are shocked to hear they have a heart problem at all. While some of these patients will go on to develop actual diastolic heart failure, many will not - especially if they get appropriate medical care, and also take care of themselves.

The diagnosis of diastolic heart failure, unfortunately, is often missed by unwary physicians. Because once the patient presenting with diastolic heart failure has been stabilized, unless the doctor looks specifically for evidence of diastolic dysfunction on the echocardiogram, the heart can appear entirely "normal."

Diastolic heart failure, a major cause of morbidity and mortality, is defined as symptoms of heart failure in a patient with preserved left ventricular function. It is characterized by a stiff left ventricle with decreased compliance and impaired relaxation, which leads to increased end diastolic pressure.

Patients who have had an episode of diastolic heart failure have a somewhat better prognosis than patients with traditional, systolic heart failure - but a far worse prognosis than patients without heart failure or diastolic dysfunction. Given this relatively poor prognosis, patients should be aggressively evaluated and treated even after their acute episodes of heart failure have been resolved.

Diagnosis and Acute Management of Gout

Gout is a disease resulting from the deposition of urate crystals caused by the overproduction or under excretion of uric acid. The disease is often, but not always, associated with elevated serum uric acid levels. Clinical manifestations include acute and chronic arthritis, tophi, interstitial renal disease and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joints, tissues or body fluids.

The diagnosis of gout is generally made on a clinical basis, although tests are required to confirm the disease. This is done by drawing fluid from the joint with a needle and examining it under a polarized light microscope. Although the test is invasive, the results are definitive, and a positive result facilitates proper treatment and quick relief. Usually, physicians can diagnose gout based on the physical examination and medical history (the patient's description of symptoms and other information). Doctors can also administer a test that measures the level of uric acid in the blood.

Cause of Gout
Gender and age are related to the risk of developing gout; it is more common in men than in women and more common in adults than in children.
Drinking too much alcohol can lead to hyperuricemia because it interferes with the removal of uric acid from the body.
An enzyme defect that interferes with the way the body breaks down purines causes gout in a small number of people, many of whom have a family history of gout.

Introduction to Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances.

Diabetic ketoacidosis (DKA) is a state of inadequate insulin levels resulting in high blood sugar and accumulation of organic acids and ketones in the blood. It is also common in DKA to have severe dehydration and significant alterations of the body’s blood chemistry. Diabetic ketoacidosis (DKA) is a state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism. The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes.

Diabetic ketoacidosis symptoms often develop quickly, sometimes within 24 hours. You may notice:

* Excessive thirst
* Frequent urination
* Nausea and vomiting
* Abdominal pain
* Loss of appetite
* Weakness or fatigue
* Shortness of breath
* Fruity-scented breath
* Confusion

How can it be detected?
* High blood sugar level
* High ketone level in your urine

Other possible triggers of diabetic ketoacidosis may include:

* Stress
* Physical or emotional trauma
* High fever
* Surgery
* Heart attack
* Stroke
* Alcohol or drug abuse

Diagnosis Of Ascites

Ascites is the presence of excess fluid in the peritoneal cavity. Ascites is more often associated with liver disease and other long-lasting (chronic) conditions. Ascites is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity). Ascites occur in long-standing disorders including cirrhosis, alcoholic hepatitis without cirrhosis, chronic hepatitis, and obstruction of the hepatic vein. Several blood tests are commonly performed for ascites, including full blood count, electrolytes and renal function, liver enzymes, and glucose. If the cause is not apparent, serology for viruses known to cause hepatitis and ferritin may contribute to the analysis.

Ascites is the pathologic accumulation of fluid in the peritoneal cavity and is a common manifestation of liver failure, being one of the cardinal signs of portal hypertension. The diagnostic evaluation of ascites involves an assessment of its cause by determining the serum-ascites albumin gradient and the exclusion of complications e.g., spontaneous bacterial peritonitis. Although sodium restriction and diuretics remains the cornerstone of ascites management, many patients require additional therapy when they become refractory to such medical treatment. These include repeated large volume paracentesis and transjugular intrahepatic portosystemic shunts.

Small amounts of ascitic fluid cause no symptoms. Moderate amounts cause increased abdominal girth and weight gain. Massive amounts may cause nonspecific diffuse abdominal pressure, but actual pain is uncommon. If ascites results in elevation of the diaphragm, dyspnea may occur. Symptoms of SBP may include new abdominal discomfort and fever.
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