Chronicles of an Inner City Hospital Resident Doctor #11

Howdy, StemSocial friends! I'm a 3rd year resident doctor in an inner city hospital. This is a blog to document some of the experiences I encounter as a training doctor, and some of the things that I learn in the process. After all, being a physician means that I'll be learning some fascinating topics for the rest of my career, and seeing how I can use those to help patients.


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The next multiple entries in this series will be notes that I take from my question bank; I am using these posts as a way to bolster my attention the questions and to consolidate the information I learn. They are my own summaries of key points within the questions that I am practicing, so do not take them as medical gospel – rather, as learning points from which to further build knowledge. If the topics appear scattered, it is because the questions are randomized. Once I complete my board examination I will resume these chronicles with a more story-like approach, as with my prior entries. Let's get started with today's key points:

  • Neck/facial + arm swelling --> Superior Vena Cava syndrome --> if history of smoking most likely small cell lung cancer (central location)
  • Asbestosis --> old building, plumbing, shipyards, welding
  • Anthrax (inhalational) --> work with farm animals/wool, flu-like symptoms then shortness of breath / respiratory failure, widened mediastinum; spore-producing rod; Ciprofloxacin/Levofloxacin or Doxycycline
  • Community-acquired pneumonia (adults) --> Strep pneumo, H influenzae, Moraxella (SHiM); inpatient treatment = levofloxacin/moxifloxacin or ceftriaxone + azithromycin; outpatient treatment = azithromycin/clarithromycin/doxycycline
  • Thyroidectomy --> parathyroid gland removal --> hypoparathyroidism --> hypocalcemia (PTH correlates positively with Ca, inversely with phosphorus) --> Trousseau's sign (carpopedal spasm w/ BP cuff) + Chvostek's sign (facial spasm when nerve is tapped) + QT prolongation
  • Hypercalcemia from malignancy or primary hyperparathyroidism --> kidney stones, bone pain, abdominal pain, altered mental status; IV hydration, Lasix, calcitonin, bisphosphonates
  • Hypokalemia (from GI loss / diarrhea or chronic kidney disease) --> flattened T waves, myalgias, muscle cramps, constipation, hyporeflexia; hyperkalemia (excess ingestion, chronic kidney disease) --> peaked T waves, cardiac arrhythmias (sinus bradycardia, sinus arrest, V tach, V fb, asystole), give calcium gluconate + insulin/D5
  • Unconjugated hyperbilirubinemias: Crigler-Najjar (Type 1 = severe, Type 2= less severe; due to UDPGT absence/reduction); Gilbert (reduced UDPGT, jaundice when stressed/ill)
  • Conjugated hyperbilirubinemias: Dun-Johnson (MRP2 protein missing, benign, black liver); Rotor (hepatic storage defect, benign, normal appearing liver)
  • Primary biliary cirrhosis --> jaundice, pruritis, antimitochondrial antibodies
  • Sturge-Weber --> port-wine stain on face, seizures, visual field loss (all due to vascular malformations), intellectual/developmental delays; GNAQ gene
  • Rendu-Osler-Weber --> AD, hereditary hemorrhagic telangiectasia (bleeding episodes, seizures, skin/mucosa telangiectasias)
  • Beckwith-Wiedemann (wide baby --> overgrowth disorder)
  • Osteopenia --> DEXA T-score -1 to -2.5, osteoporosis --> DEXA T-score <-2.5
  • Medial meniscus tear --> valgus (lateral to medial) stress, + McMurray test (extend knee + externally rotate --> click + pain)
  • Lateral meniscus tear --> varus (medial to lateral) stress, + McMurray test (extend knee + internally rotate --> click + pain)
  • Meniscus vs. ligament tear (anterior cruciate ligament or medical collateral ligament) --> with meniscus, locking sensation + can walk; with ligaments, no locking sensation, can't bear weight
  • ACL --> popping, joint effusion, + anterior drawer and Lachman tests
  • MCL --> popping, + valgus tress test, joint effusion
  • Cavernous hemangioma / hepatic hemangioma --> small blood collection within liver (hyperechoic, well-defined, <3 cm); if asymptomatic, no follow-up required; if >5 cm, then CT or MRI; if >10 cm or growing > 3mm per year, then surgery
  • Anal cancer --> bleeding, pain, weight loss, incomplete emptying (tenesmus), inguinal adenopathy; usually squamous cell carcinoma; risk factors = smoking, HPV, receptive anal intercourse

I hope you've enjoyed these little notes of topics I learned as a resident in an inner city hospital. I'll have many more stories and learning experiences coming in the future, so stay tuned.


  2. COMQUESTMED (my question bank for learning information)
  3. Me 😊

Disclaimer: this blog is for entertainment (and possibly educational) purposes only. This is not medical advice. If you have any questions or concerns about your own health, please contact a healthcare provider.

Here are the previous editions of this blog:
Chronicles of an Inner City Hospital Resident Doctor #10
Chronicles of an Inner City Hospital Resident Doctor #9
Chronicles of an Inner City Hospital Resident Doctor #8
Chronicles of an Inner City Hospital Resident Doctor #7
Chronicles of an Inner City Hospital Resident Doctor #6
Chronicles of an Inner City Hospital Resident Doctor #5
Chronicles of an Inner City Hospital Resident Doctor #4
Chronicles of an Inner City Hospital Resident Doctor #3
Chronicles of an Inner City Hospital Resident Doctor #2
Chronicles of an Inner City Hospital Resident Doctor #1

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At least you're not at intern, that first year really sucks. @taskmaster4450 has talked about creating a Wikipedia like database for Hive, something like this might be a good start for non physicians to be able to look up basic medical info.


In my institution, 2nd/3rd years are just about as difficult as 1st year. It's extremely flawed and notorious lol. No worries, hopefully it'll all be practical experience in one way or another.

Now, I did actually consider contributing to a database like this, however: 1) I don't think I'm knowledgeable enough yet, and 2) the types of content I'm posting here is more ideal for board review rather than for general consumption.

I'd be on board with contributing pieces to such a tool in the future though. There are already academic websites saturated with medical information and guidelines, however, so competition would be rough.


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