Penile Problems MDM Page Contents MDM Templates Procedure Notes Clinical Education References Last reviewed: March 2026 MDM Templates Paraphimosis — Reduction Patient presents with paraphimosis with foreskin retracted and unable to reduce. Exam shows edematous glans without evidence of ischemia or necrosis. Manual reduction performed successfully with granular sugar osmotic technique and steady circumferential pressure. … More Penile Problems MDM

Bradycardia MDM Last reviewed: March 2026Contents MDM Templates Stable Bradycardia Symptomatic Bradycardia Pacemaker Malfunction Toxicologic Bradycardia Clinical Education Classification & Etiologies ECG Recognition: AV Blocks ECG Recognition: Junctional & Escape Rhythms ACLS Bradycardia Algorithm Treatment Ladder Transcutaneous Pacing Pearls Transvenous Pacing Pearls Toxicologic Bradycardia & Antidotes References MDM Templates Stable Bradycardia Patient found to have … More Bradycardia MDM

ED Workup: CBC, BMP, LFT, Ca-Mag-Phos, Troponin, ECG. Presentation not consistent with digoxin toxicity, clonidine toxicity, infectious bradycardia, increased ICP, inferior MI involving RCA, ED interventions: Activated Charcoal, atropine, IVF, Calcium gluconate 3g (30-60mL of 10% soln), Glucagon 5 mg IV bolus over one minute. Consults: Poison ControlDisposition: Admit to ICU PEARLS General Beta Blocker … More Beta-Blocker and Ca-Channel Blocker Toxicities MDM

Benign, External:Patient’s history and exam most consistent with hemorrhoid as an etiology for their pain. Exam not consistent with thrombosed hemorrhoid. Patient’s symptoms and exam not typical for other emergent causes of rectal pain such as, but not limited to, anorectal abscess, rectal foreign body, anal fissure, anal fistula, proctitis, rectal prolapse. Rx: Bowel regimen, … More Hemorrhoid MDM

Cyanide Toxicity Etiology Chemical Lab Exposure or exposure to fires that involve plastics, wools, and synthetic materials → uncoupling of the electron transport chain → anaerobic metabolism → lactic acidosis Presentation: confusion, tachypnea, hypotension, bradycardia Hallmarks: Lactic acidosis +  hypotension + initial hypoxia improved by supplemental oxygen even though overall clinical picture doesn’t improve Since … More CO + CN + MetHb Toxicity

Painless Vision Loss MDMLast reviewed: March 2026 Contents MDM Templates Posterior Vitreous Detachment / Floaters Retinal Detachment Concern Central Retinal Artery Occlusion (CRAO) Central Retinal Vein Occlusion (CRVO) Amaurosis Fugax Clinical Education Approach to Painless Vision Loss PVD vs Retinal Detachment Ocular POCUS CRAO Pearls CRVO Pearls GCA Screening Disposition References MDM Templates Posterior Vitreous … More Painless Vision Loss MDM

pt presents with concern for recent ASA overdose.Airway maintained. Unlikely intracranial bleed, ischemic CVA, opioid intoxication, sepsis, hypothyroidism. Workup: POC glucose, CBC, BMP, LFTs, PT/INR, 4 hour APAP level, salicylate levelECG: Normal Sinus Rhythm. No overt ischemic findings and no prolongation of QTc or QRS intervals. Findings:  Salicylate level <100mg/mL on 2 consecutive checks over >1 … More Salicylate Toxicity MDM

Hyper/Hyponatremia MDM Last reviewed: March 2026 Contents Hyponatremia Overview & Volume Status Hyponatremia — Mild/Asymptomatic Hyponatremia — Severe/Symptomatic SIADH Pearls Hypertonic Saline Protocol DDAVP Clamp Strategy Osmotic Demyelination Syndrome Hypernatremia Pearls Medication Causes References MDM Templates Hyponatremia — Mild/Asymptomatic Patient found to have sodium *** mEq/L. Alert and oriented with no neurologic deficits, no seizure … More Hyper/Hyponatremia

HIV Headache MDMLast reviewed: March 2026 Contents MDM Templates Headache — No Fever, No AMS, Preserved Immunity Headache — Fever and/or AMS and/or Low CD4 Clinical Education CNS Differential by CD4 Cryptococcal Meningitis Toxoplasmosis CSF Pearls in HIV References MDM Templates Headache — No Fever, No AMS, Preserved Immunity Patient with HIV (on HAART, CD4 … More HIV Headache MDM