Every topic, framed for the way you reason.
Each clinical topic gets its own page — a concise write-up and the cards built for it: teaching carousels, one-pagers or high-yield tables, to view or download.
Cardiology
Acute aortic syndromes: suspect, slow, repair
Dissection, intramural hematoma and penetrating ulcer: classification, ADD-RS plus D-dimer, imaging, anti-impulse targets and doses, type A vs type B repair, malperfusion and follo…
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Acute coronary syndrome
ECG in 10 min. hs-troponin 0/1-2 h. PCI on the clock. STEMI vs NSTE-ACS pathways, the high-sensitivity troponin algorithm, antiplatelet + anticoagulation choices, and reperfusion w…
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Atrial fibrillation at a glance
AFib on one page: CHA₂DS₂-VASc, HAS-BLED, DOAC dosing, rate vs rhythm, cardioversion windows, and the special situations that actually come up on call.
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Atrial fibrillation
Stabilize the unstable (synchronized cardioversion), rate-control the stable, and find the trigger. Then prevent stroke by risk (CHA2DS2-VASc, DOAC over warfarin), choose rate vs e…
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Decongest, then build
A sequence for the patient admitted with decompensated heart failure: profile, dose, escalate, build foundational therapy, and discharge — updated for the 2026 ESC guideline.
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Inpatient hypertension
Treat the patient, not the number. One question decides everything: new organ damage, or just a number? A 5-step bedside algorithm for asymptomatic inpatient BP, plus the IV dosing…
1 cardRead & downloadPick the right cardiac test
Non-invasive testing for suspected or known CAD: pretest likelihood, exercise ECG, stress echo, SPECT, PET, CMR, CCTA, FFR-CT and calcium score, patient factors, stress preparation…
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Read the neck veins
The JVP is one of the highest-yield signs in heart failure, and one of the most butchered. Nearly every miss is technique: bad positioning, or calling the carotid a vein.
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Start the aspirin?
Six patients with no prior heart attack or stroke. Since ASCEND, ARRIVE and ASPREE, aspirin for primary prevention is a narrow, individual decision, and bleeding risk decides most…
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The S3 is the finding
The heart-failure exam by likelihood ratio: the S3 rules in, crackles and edema barely move you, and only a normal BNP rules out.
1 cardRead & downloadUndifferentiated chest pain, minute by minute
Acute chest pain in the ED: 10-minute ECG, the six can't-miss causes, history likelihood ratios, hs-troponin 0/1 h and 0/2 h deltas, HEART and EDACS, disposition by risk, and when…
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When the electrodes are swapped
All six limb leads are calculated from three electrodes, so one wrong wire rewrites all six. Inverted P, QRS and T together in one lead is wiring, not infarct — check before you tr…
1 cardRead & downloadPulmonology
Acute COPD exacerbation
AECOPD definition and mimics, oxygen target 88–92%, bronchodilators and 5-day prednisone (REDUCE), GOLD 2026 severity and antibiotic criteria, NIV indications, and a discharge bund…
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ARDS: the injured lung is small, not stiff
The injured lung isn't stiff — it's small. A full breath lands in a lung the size of a child's, and that strain is what kills. Five cards: what counts as ARDS, the settings that pr…
1 cardRead & downloadRead a PFT like the 2022 standard
PFT interpretation per ERS/ATS 2022: z-scores and LLN, GLI Global, quality grades, obstruction versus GOLD 0.70, TLC for restriction, PRISm, the new bronchodilator rule, DLCO patte…
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The falsely normal SpO₂
The oximeter shines two wavelengths and assumes two pigments. Carbon monoxide reads as saturated; methemoglobin pins the display near 85%. Ask for co-oximetry — a routine gas calcu…
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What the ventilator actually controls
The ventilator is a machine you can read. Five cards on what the screen is telling you: what a mode controls, reading the waveforms, asynchrony, trapped air, and the high-pressure…
1 cardRead & downloadNephrology
Acid-base in five steps
Five steps go further than a glance at a blood gas: pH, primary disorder, compensation, the albumin-corrected anion gap, then the delta ratio to catch a hidden second or third diso…
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Acute kidney injury
KDIGO criteria and staging, pre-renal vs intrinsic vs post-renal categorization, urine microscopy clues (muddy brown, WBC casts, RBC casts), drugs to hold or dose-adjust, and AEIOU…
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AKI is a definition, not a diagnosis
Creatinine is a lagging indicator. Eight cards on what AKI is, what it costs, and when the circuit helps: the definition, the three questions, the pressure gradient, dialysis indic…
1 cardRead & downloadFix the electrolyte, find the cause
Hypokalemia, hypernatremia, calcium, magnesium and phosphate: urine and PTH-based workup, correction limits, ES 2023 hypercalcemia treatment, IV calcium, refeeding, and label doses…
Written guideReadHepatorenal syndrome
HRS-AKI by the ICA-ADQI 2024 criteria: baseline creatinine, workup and urine tests, the albumin challenge, terlipressin per the US label, norepinephrine, response and stopping rule…
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Hyperkalemia
One of the few emergencies where order matters as much as the drugs: protect the heart, shift potassium into cells, then remove it from the body.
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Hyponatremia
The full stepwise approach: confirm true hypotonicity (and the acute vs chronic distinction), read urine osmolality (ADH on/off) then urine sodium (30 mmol/L or less = low effectiv…
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The contrast nephropathy myth
Most AKI blamed on CT contrast was never caused by it. The confounding behind the myth, why PRESERVE and AMACING ended NAC and bicarbonate prophylaxis, and the narrow group where c…
1 cardRead & downloadNeurology
Acute ischemic stroke
LKW vs symptom-onset framing, imaging gates, 2026 BP targets, extended-window IVT, EVT for LVO with parallel IVT, and the posterior-circulation pitfalls that get missed. Tenectepla…
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Delirium
Recognize early. Treat the cause, not the behavior. Hypoactive delirium is the most common subtype and the most missed; antipsychotics manage behavior for safety — they do not trea…
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Status epilepticus: stop the seizure
Status epilepticus from minute zero: treat at 5 minutes, one full benzodiazepine dose, one full second-line load, the causes to treat in parallel, continuous EEG for the patient wh…
1 cardRead & downloadGastroenterology
Acute pancreatitis, start to finish
Acute pancreatitis per ACG 2024 and IAP 2025: Revised Atlanta diagnosis and grading, etiology and ERCP, BISAP and SIRS, WATERFALL moderate fluids, feeding, necrosis timing, and hyp…
Written guideReadDecompensated cirrhosis
Decompensated cirrhosis on the wards: staging, ascites and paracentesis, albumin dosing, SBP, encephalopathy, variceal prophylaxis, HCC surveillance, hyponatremia, drugs to avoid,…
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Feeding the critically ill
In the ICU, "feed early and full" is mostly wrong. Match feeding to the phase — start low, prefer the gut, and don't chase calories or high protein in week one.
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Hospital malnutrition
Up to half of inpatients are malnourished and most are never diagnosed. Screen within 24h, diagnose with GLIM, and feed to target — one of the few inpatient interventions with a su…
1 cardRead & downloadUpper and lower GI bleeding
Acute GI bleeding from triage to discharge: resuscitation and transfusion thresholds, endoscopy timing, Forrest stigmata, PPI, the variceal bundle, lower GI work-up, reversal agent…
Written guideReadInfectious Disease
Community-acquired pneumonia
The 2025 ATS update: lung ultrasound as a CXR alternative, the pathogen/test map, CURB-65 + PSI and IDSA severity criteria, empiric coverage by setting, shorter courses (<5 days),…
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Take the antibiotic allergy history
About 1 in 10 patients carry a penicillin-allergy label; more than 90% are not allergic on formal evaluation. The history is what separates them.
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The infectious diseases history
The entire ID differential comes down to two questions: what was the patient exposed to, and what are they susceptible to. Both pillars, plus the social history that ties them toge…
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The meningeal signs fail
Kernig, Brudzinski, and jolt accentuation have likelihood ratios near 1 in adults. The exam cannot rule out meningitis; do the LP.
1 cardRead & downloadHematology
DVT and PE, start to finish
DVT and PE workup and treatment: Wells and D-dimer, the 2026 AHA/ACC PE categories, choosing DOAC vs LMWH vs UFH, US-label doses with renal cutoffs, duration, distal DVT, subsegmen…
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Every bleed? Part 2: beyond the trauma bay
Six more TXA calls: GI bleeding, nosebleeds, hemoptysis, heavy periods, dental work on anticoagulants and inherited bleeding disorders — plus what it can cost.
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Febrile neutropenia: antibiotics within 60 minutes
A single fever plus an ANC under 500 is the whole trigger. The first-60-minute workup, antipseudomonal monotherapy, when vancomycin is actually indicated, and the common sources wh…
1 cardRead & downloadEndocrinology
DKA & HHS
Updated ADA 2024 DKA criteria (β-OHB ≥3.0 is the new gate), HHS criteria, K-before-insulin fluid protocol, transition to SC insulin, euglycemic DKA triggers, and resolution by gap…
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Hypoglycemia
Treat fast. Recheck. Find the cause. Definitions, the bedside fork (airway → access), pharm vs non-pharm etiologies, recurrent hypoglycemia workup, and discharge planning.
2 cardsRead & downloadOsteoporosis
Diagnosis, FRAX thresholds, risk tiers, drug-by-scenario selection, holidays, adverse effects, and board pearls — ABIM high-yield.
Read & print →Critical care
Adult cardiac arrest, 2025 AHA
Adult arrest and peri-arrest care per the 2025 AHA guidelines: shockable and nonshockable sequences, doses and energies, airway, bradycardia, tachycardia, post-ROSC targets, specia…
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Airway, breathing, circulation
The undifferentiated deteriorating adult. The order isn't tradition, it's physiology: an obstructed airway kills faster than a low pressure. Assess in order, treat as you find, res…
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Alcohol withdrawal: benzos or phenobarbital
The withdrawal timeline, the three scores (PAWSS, CIWA-Ar, RASS), two first-line pathways (benzodiazepines or phenobarbital), withdrawal seizures, thiamine before glucose, and deli…
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Fluid responsive is not fluid depleted
Four cards on one decision. Responsiveness is a position on a curve, not a diagnosis. The bolus works by widening a venous gradient, most of it leaves the capillary within hours, a…
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Give the TXA? Part 1: major bleeding
Six bedside calls on tranexamic acid in trauma, postpartum hemorrhage, brain bleeds and surgery. It protects clot that has already formed, so timing decides most of the benefit.
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Hang the albumin?
Albumin is one of the most commonly given blood products, and one of the most commonly given outside the evidence. Six calls, then 5% versus 25%, sepsis, cirrhosis, long-term use,…
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Normal saline isn't normal
0.9% saline was set by an 1890s hemolysis experiment, not matched to plasma. Its chloride load, what SMART, BaSICS, and PLUS actually showed, and when saline still beats balanced.
1 cardRead & downloadRun a pediatric code by weight
Pediatric cardiac arrest (2025 AHA/AAP): CPR quality by age, shockable and nonshockable sequences, weight-based energies and doses with caps, bradycardia and tachycardia with a pul…
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Sepsis & septic shock
Sepsis-3 screening pitfalls, individualized fluid resuscitation (the 30 mL/kg mandate is gone), vasopressor ladder, source control as the intervention, and the 1-hour antibiotic ga…
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Start the steroid?
Six bedside calls on sepsis, septic shock and severe pneumonia. Two decades of trials have alternated between a survival benefit and no difference; the finding that repeats is fast…
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The cuff is guessing
Oscillometry measures one pressure and calculates the other two. Wrong size, wrong arm, wrong height, wrong number — and nothing on the screen will tell you that.
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The damped arterial line
A blood pressure is a waveform before it is a number. Flush the line, count the oscillations after the flush, and you know which number to believe.
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The end-tidal CO₂ gap
End tidal is the CO₂ of the last gas to leave, normally 35–45 mmHg. How far it sits below the arterial value is itself a measurement — and the waveform shape has to be read before…
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The number is as good as the trace
SpO₂ is computed from the pulsatile part of the signal. If the plethysmograph is noise, flat, or out of step with the ECG, the saturation is not a measurement.
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The skin is not the core
Peripheral thermometers miss about a third of real fevers. A forehead reading that says no fever means very little — when the decision turns on it, measure core.
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Type B lactic acidosis
Elevated lactate without tissue hypoperfusion — increased production, decreased clearance, or both. It should prompt a differential, not automatic escalation of fluids or pressors.
1 cardRead & downloadVentilate the newborn first
Newborn resuscitation (2025 AHA/AAP): cord by gestational age, warmth, ventilation and corrective steps, starting oxygen, SpO₂ by minute, compressions, epinephrine and volume doses…
Written guideReadIntern Survival Guide
Call a consult well
The two minutes of prep that make the call short, the 5 Cs of Consultation, SBAR for the phone call, one specific question instead of "can you come see this?", curbside vs formal,…
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Does this finding matter?
How to read a likelihood ratio at the bedside: LR >10 rules in, <0.1 rules out, and most exam maneuvers sit near 1 and change nothing.
1 cardRead & downloadDon't run on empty
Burnout's three dimensions, how common it is in residents, what the trials say works, fatigue countermeasures, warning signs, 988 and the Physician Support Line, and where licensur…
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Inpatient insulin dosing
Basal, nutritional, correction — build it, don't chase it. Weight-based total daily dose, a worked 80 kg example, correction dosing by insulin sensitivity, converting home regimens…
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Multimodal pain control
Inpatient pain control for the new intern: multimodal opioid-sparing first, a CDC-anchored equianalgesic conversion table, a worked IV-hydromorphone-to-oral-oxycodone conversion, a…
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NPO after midnight
"NPO after midnight" is ritual, not evidence. Clear liquids are fine until 2 hours before surgery; past that, more fasting doesn't lower aspiration risk.
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Present like you belong
How to open and organize a presentation: the one-liner formula for admits, progress notes, and sign-outs; the order to present a new patient on rounds; OLDCARTS for a tight HPI; th…
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Reading a chest x-ray
A simple, repeatable system so you read every film the same way: confirm identity, check quality (RIPE), then airway-to-soft-tissue in the same order — plus the common misses behin…
1 cardRead & downloadRun the day before it runs you
A prerounding script and time budget, task triage and batching, I-PASS handoffs and the evidence behind them, pages that get answered, the always-call-your-senior list, and the 202…
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VTE prophylaxis
Risk-assess every admission (Padua, IMPROVE-BLEED, Caprini), pick the agent, adjust for renal function and body size, and switch to mechanical when you can't anticoagulate. Plus or…
1 cardRead & downloadWrite notes people read
Problem-based notes that lead with the plan, copy-forward traps, orders that can't be misread (Do Not Use list, PRN indications, hold parameters), two-source med rec, discharge sum…
Written guideReadCareer & Finance
Fund the right accounts first
403(b), 401(k), 457(b) and 401(a) explained, the 2026 IRS limits, the new Roth catch-up rule, Roth vs pre-tax in residency, backdoor Roth and the pro-rata trap, HSAs, and why the m…
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Insure your income first
Your biggest asset is your future paychecks. Group vs individual disability insurance, the riders that matter, term vs whole life, and the mistakes clinicians make.
1 cardRead & downloadMake residency payments count
Federal student loans after the 2025 reconciliation law: RAP vs IBR, the end of SAVE, PSLF rules and litigation, the plan to pick in residency, when refinancing makes sense, and ho…
Written guideReadMoonlight without getting burned
Moonlighting in residency: ACGME and program rules, J-1 and H-1B limits, W-2 vs 1099, self-employment tax, quarterly estimates and safe harbors, QBI, solo 401(k) vs SEP-IRA, malpra…
Written guideReadNegotiate before you sign
Your first attending contract: pay models and wRVU fine print, termination and notice, where non-competes stand in 2026, malpractice and tail, bonuses and clawbacks, loan repayment…
Written guideReadRising Senior
Apply like you mean it
IM fellowship applications: the ERAS July cycle and NRMP Medicine and Pediatric Specialties Match dates, letters, the personal statement, signals, virtual interviews, post-intervie…
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Day one as senior
The intern-to-senior role change: from executing the plan to owning it, the team, and the safety net. A day-one playbook and the rookie-senior pitfalls.
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How much rope?
How to calibrate autonomy: the entrustment judgment via the RIME ladder, matched to the task and re-checked over time.
1 cardRead & downloadOwn the admit pager
Taking the ED call with a structured handoff, choosing the right level of care, the ACGME IM admission caps as written for 2026–27, triaging a busy night, and scripts for pushing b…
Written guideReadRun the code from the foot
Leading a code or rapid response: stepping back, assigning roles, closed-loop talk, calling for help, pauses and stopping, family presence (Jabre 2013), and the TALK debrief — alig…
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Running the list
Run the list by acuity, not room. What a good list holds, the run-the-list playbook, and where lists break down.
1 cardRead & downloadSay the hard thing well
Feedback models that work (ask-tell-ask, R2C2), when to involve the program director, SPIKES and NURSE for bad news, REMAP and the Serious Illness Conversation Guide for goals of c…
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Teaching in five minutes
The one-minute preceptor and feedback that lands: teach one point well, in the seconds you have on rounds.
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