INTERNAL MEDICINE - CARDIOLOGY + PULMONOLOGY
YEAR 3 | PAGE 61A - STABILITY -> SYNDROME -> TEST SEQUENCE -> INITIAL MANAGEMENT -> DISPOSITION
A. CARDIOPULMONARY REVIEW MAP
| Presentation | Reasoning spine | Questions should force |
|---|---|---|
| Chest pain / ACS Heart failure / edema | Stability -> ischemic vs nonischemic danger -> ECG/biomarkers -> reperfusion/risk pathway -> secondary prevention. Congestion vs perfusion -> precipitant -> oxygenation/hemodynamics -> diuresis/afterload strategy -> chronic therapy. | What must happen now vs what confirms later; contraindications; disposition. Acute decompensation vs chronic optimization; renal/electrolyte monitoring. |
| Arrhythmia / syncope Dyspnea / hypoxemia | Stable vs unstable rhythm -> narrow/wide, regular/irregular -> reversible triggers -> therapy/anticoagulation risk. Cardiac vs airway/parenchymal vs vascular -> severity -> gas exchange/ventilation -> imaging/testing -> therapy. | When instability changes treatment; medication effects; admission vs outpatient workup. Pneumonia, COPD/asthma, PE, edema and respiratory failure discrimination. |
| Pulmonary infection / COPD | Host risk + syndrome -> severity -> imaging/microbiology when useful -> empiric therapy -> oxygen/ventilatory support. | Who can go home, who needs admission, and what complication changes the plan. |
A. CARDIOPULMONARY REVIEW MAP — 1. Instability changes the order of operations DEEP EXPLANATION A standardized vignette may contain enough information for a diagnosis, but shock, severe hypoxemia, dangerous arrhythmia, active ischemia or altered mental status can make stabilization the immediate answer.
Diagnostic precision and definitive therapy still matter, but their order changes when physiology is failing.
A. CARDIOPULMONARY REVIEW MAP — WHY STUDENTS MISS IT Students often identify the disease correctly and then choose the best confirmatory test even though the patient first needs stabilization or escalation. EASIEST CLUE Before interpreting the differential, ask what can deteriorate in the next minutes? If the answer is circulation, oxygenation, rhythm or mental status, sequence emergency actions first. 2. Chest-pain questions test sequence and risk, not a single magic test DEEP EXPLANATION Chest pain is a pathway: identify immediate threats, obtain time-sensitive evidence, integrate serial data when appropriate, then move to reperfusion, further testing, prevention or discharge according to risk. A normal or
nondiagnostic early result rarely erases the pretest probability by itself.
WHY STUDENTS MISS IT Learners memorize one association - "chest pain = troponin" or "ACS = cath" - without asking what has already been established and what decision remains. EASIEST CLUE Translate the stem into unstable? ischemic evidence? current risk? what decision is unresolved? Then choose the next step, not the eventual endpoint. 3. Dyspnea is a physiology problem before it is a disease list DEEP EXPLANATION Dyspnea questions become easier when you separate oxygenation, ventilation, circulation and work of breathing. The same symptom can arise from pulmonary edema, pneumonia, COPD/asthma, PE or metabolic
disease, but severity markers and gas-exchange clues determine urgency and disposition.
B. SUBSTANTIVE REPAIR RESOURCES — Ninja Nerd - Pneumonia | Overview
- long-form pulmonary infection review
B. SUBSTANTIVE REPAIR RESOURCES — OnlineMedEd Clinical
- clerkship-level diagnostic/management sequencing
AMBOSS Medicine Shelf
- targeted IM questions + reference 2026/27 clerkship-review expanded edition - align with school objectives, local protocols and current NBME/NBOME guidance