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Summary Chalk Talks in Internal Medicine Scripts for Clinical Teaching Somnath Mookherjee • Lauren A. B

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Chalk Talks in Internal Medicine Scripts

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This is a guide for teaching clinical medicine and not a manual for clinical practice. Readers should be vigilant for advances in medical science and changes in clinical practice that supersede the details of this book. W

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Chalk Talks in
Internal Medicine

Scripts for Clinical Teaching
Somnath Mookherjee
Lauren A. Beste
Jared W. Klein
Jennifer Wright
Editors

123

,Chalk Talks in Internal Medicine

,Somnath Mookherjee • Lauren A. Beste
Jared W. Klein • Jennifer Wright
Editors

Chalk Talks in Internal
Medicine
Scripts for Clinical Teaching

,Editors
Somnath Mookherjee Lauren A. Beste
University of Washington Medical Center VA Puget Sound Health Care System
Department of Medicine Department of Medicine
Division of General Internal Medicine Division of General Internal Medicine
University of Washington University of Washington
Seattle, WA Seattle, WA
USA USA

Jared W. Klein Jennifer Wright
Harborview Medical Center University of Washington Medical Center
Department of Medicine Department of Medicine
Division of General Internal Medicine Division of General Internal Medicine
University of Washington University of Washington
Seattle, WA Seattle, WA
USA USA

ISBN 978-3-030-34813-7 ISBN 978-3-030-34814-4 (eBook)
https://doi.org/10.1007/978-3-030-34814-4

© Springer Nature Switzerland AG 2020
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

,SM dedicates this book to his parents:
anything I have accomplished as a physician
and a scholar I owe to them.

LAB dedicates this book to all who spend
their lives in the service of learning,
teaching, and healing and to the families
who support us on that journey.

JWK dedicates this book to his family for
their boundless support.

JW dedicates this book to Patrick: for your
love and support.

,Preface

Chalk talks immerse high yield, and relevant teaching in the clinical setting – imme-
diately linking clinical experiences with the skills of physicianship. Chalk talks not
only enhance the learning of students and trainees but also enable fun, satisfying,
and meaningful teaching. We hope this book positively contributes to the experience
of teaching and learning medicine for all readers
This book is the result of a unique endeavor by the Division of General Internal
Medicine, University of Washington. We recruited ninety-six faculty members from
our Division to create teaching scripts for commonly encountered inpatient and
outpatient clinical scenarios. In addition to creating the teaching scripts, we encour-
aged co-authors to engage in peer mentorship around career development and satis-
faction. Thus, faculty not only used their expertise and experience to create these
teaching scripts, many developed partnerships supporting their career development.
This is a guide for teaching clinical medicine and not a manual for clinical prac-
tice. Readers should be vigilant for advances in medical science and changes in
clinical practice that supersede the details of this book. While we did our utmost to
avoid errors and omissions, the responsibility for verifying the accuracy of the con-
tent lies with the reader.
We hope that you will find Chalk Talks in Internal Medicine to be useful and
engaging. We wish you the best in your teaching career.

Seattle, WA, USA Somnath Mookherjee
July
8, 2019 Lauren A. Beste
Jared W. Klein
Jennifer Wright

vii

,Contents

1 Introduction�� 1
Somnath Mookherjee, Lauren A. Beste, Jared W. Klein,
and Jennifer Wright
2 How to Create a Teaching Script for a Chalk Talk �� 5
Diana Zhong and Somnath Mookherjee
3 How to Use a Teaching Script to Deliver a Chalk Talk�� 15
Diana Zhong and Somnath Mookherjee
4 Management of Acute Coronary Syndromes�� 19
Stephanie A. Field and Jared W. Klein
5 Management of Acute Decompensated Heart Failure�� 27
Pallavi R. Arora and Genji S. Terasaki
6 Interpretation of Pacemaker Settings�� 35
Divya Gollapudi and Thomas Rea
7 Secondary Hypertension �� 39
Yuree Lin and Anne Eacker
8 Approach to Hypertension�� 45
Stefanie A. Deeds and Kari M. Nelson
9 Stroke Prophylaxis in Atrial Fibrillation �� 53
Maya Narayanan and Paul R. Sutton
10 Workup for Chest Pain in the Clinic�� 59
Maryann K. Overland and Joseph Merrill
11 Management of Hyperosmotic Hyperglycemia�� 65
Shobha W. Stack and Karen A. McDonough
12 Management of Symptomatic Hypercalcemia�� 71
Yilin Zhang and John Sheffield

ix

,x Contents

13 Management of Type 2 Diabetes�� 79
Anna L. Golob and Sara L. Jackson
14 Management of Incidental Thyroid Nodules�� 85
Eve Lake and Bradley D. Anawalt
15 Management of Osteoporosis�� 91
Neha S. Deshpande and Kay M. Johnson
16 Management of Gastrointestinal Bleeding�� 97
Daniel Cabrera and Andrew White
17 Management of Clostridium difficile Infection�� 105
Allison Himmel and Jill Watanabe
18 Evaluation of Dysphagia�� 111
Sabeena Setia and Heidi Powell
19 Approach to Abnormal Liver Blood Tests �� 117
Sylvia Mollerstrom and Lauren A. Beste
20 Workup of Diarrhea�� 125
Maralyssa Bann and Deborah Greenberg
21 Approach to the Care of the Solid Organ Transplant Recipient �� 131
Joana Lima Ferreira and Christopher Wong
22 Screening for Lung Cancer �� 137
Ronald Huang and Barak Gaster
23 Approach to Hemolytic Anemia�� 143
Brandon Fainstad and Leslie Enzian
24 Management of Monoclonal Gammopathy
of Uncertain Significance�� 151
Mahri Haider and Mehraneh Khalighi
25 Approach to Unintentional Weight Loss�� 159
Alexander Pratt and Caroline Rhoads
26 Approach to Sepsis�� 165
Daniel Santovasi and Paul Cornia
27 Approach to Fever in the Hospitalized Patient�� 171
Meghaan Hawes and Alexandra Moretti Morrison
28 Approach to Genital Lesions�� 179
Toby Sinton and Joyce Wipf
29 Approach to Pulmonary Embolism�� 185
Mellena Giday and Traci Takahashi
30 Management of Pneumonia�� 191
Lindee M. Strizich and John H. Choe

,Contents xi

31 Approach to Dyspnea�� 197
Jeffrey Redinger and Tyler Albert
32 Interpretation of Pulmonary Function Tests �� 203
Scott Hagan and Tyler Albert
33 Management of Chronic Obstructive Pulmonary Disease�� 209
Neil Argyle and William Weppner
34 Approach to Sleep-Disordered Breathing�� 217
Ken He and Grady Paden
35 Approach to Acute Kidney Injury�� 225
Andrea S. Christopher and Melissa M. Hagman
36 Approach to Hyponatremia�� 231
Kelly Nakamura and Doug Paauw
37 Workup of Chronic Kidney Disease �� 237
Naomi Shike and Somnath Mookherjee
38 Approach to Microscopic Hematuria�� 241
Somnath Mookherjee, Lauren A. Beste, Jared W. Klein,
and Jennifer Wright
39 Prevention and Management of Gout�� 247
James Darnton and Christopher Knight
40 Approach to Monoarticular Arthritis�� 253
Gabrielle Berger and Thomas Payne
41 Management of Fibromyalgia�� 261
Anna Hagan and Jennifer Wright
42 Approach to Acute Altered Mental Status �� 269
Tiffany Chen and Susan Merel
43 Approach to Vertigo �� 275
Michael Northrop and Kim O’Connor
44 Approach to Intimate Partner Violence �� 281
Lindsay Gibbon and Nancy Sugg
45 Approach to Contraceptive Counseling �� 289
Ginger Evans and Stephanie Wheeler
46 Approach to Secondary Amenorrhea�� 295
Adelaide McClintock and Catherine P. Kaminetzky
47 Approach to Abnormal Uterine Bleeding�� 301
Jocelyn James and Alexandra Molnar
48 Approach to Transgender Health �� 309
Tyra Fainstad and Kamala B. Jain

, xii Contents

49 Inpatient Treatment of Opioid Withdrawal�� 317
David S. Levitt and Alexandra Moretti Morrison
50 Approach to Determination of Decision-Making Capacity�� 325
Jessica Woan and Kara Mitchell
51 Management of Pharmacotherapy for Depression �� 333
Nicole Chow Ahrenholz and Amy Baernstein
52 Approach to Pharmacotherapy for Alcohol Withdrawal �� 339
Albert Ackil and Genevieve L. Pagalilauan
Index�� 347

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