Medical Education
Clinical teaching and practical ideas for your next study session.
Fibrinogen in Postpartum Hemorrhage: When <2 g/L Changes the Plan
In postpartum hemorrhage, fibrinogen below 2 g/L supports targeted replacement. MTP packs vary, so distinguish protocol-directed empiric support from routine dosing for everyone—and manage the bleeding source in parallel.
Hepatitis B After Sexual Assault: When Is HBIG Needed?
An uncertain vaccine history does not automatically mean HBIG. Use the survivor’s documented vaccine status and the assailant’s HBsAg status as separate decision points to choose vaccination, HBIG, or both.
When a 14-Year-Old Refuses a Pelvic Exam: Assent and Parental Permission
When a 14-year-old declines a pelvic exam, parental permission is only one part of the decision. Learn how to weigh assent, legal authority, clinical necessity, and urgency—without treating a routine intimate exam as an automatic override.
Pregnancy and RLQ Pain: When a Nonvisualized Appendix Is Nondiagnostic
Why a nonvisualized appendix on ultrasound is not a negative test—and how MRI, reassessment, and selective CT guide the next step in pregnancy.
Lidocaine for Office I&D: Why the Dose Ceiling Isn’t a Guarantee
For a normal, healthy 60-kg adult receiving plain 1% lidocaine, calculate the maximum recommended dose as 270 mg, or 27 mL. Learn why that ceiling is not a safety guarantee—and how cumulative exposure, injection technique, monitoring, and early toxicity signs matter.
Severe Vomiting in Pregnancy: When to Exclude a Molar Pregnancy
Learn when severe early-pregnancy vomiting should prompt evaluation for molar pregnancy, what ultrasound can and cannot show, and why hCG alone is not diagnostic.
PMOS (Formerly PCOS): Why Test Glucose, Not Fasting Insulin?
Insulin can amplify ovarian androgen production and raise free testosterone, but a fasting insulin level is not a useful routine decision tool. Learn which glycemic assessment guides care—and why.
When a Partner Can See the Portal: Safer IPV Documentation in OB/GYN
When a patient discloses partner violence, the documentation decision is not just what to write—it is who may see the note, diagnosis, after-visit summary, messages, and linked records. Learn how to map access, preserve useful clinical facts, and use only verified privacy safeguards.
C. perfringens in Septic Abortion: Gas, Hemolysis, and Source Control
Clostridium perfringens is the classic gas-gangrene organism, but uterine gas is not synonymous with myonecrosis—and the organism alone does not mandate hysterectomy. Learn how toxin-related hemolysis changes urgency and how to distinguish uterine source control from removal of the uterus.
The Uterus as a Living Ligature: Placental-Bed Hemostasis After Birth
Learn how myometrial contraction and retraction compress vessels at the placental bed, why atony can cause bleeding despite normal coagulation tests, and how uterine tone should shape immediate assessment.
Postpartum Infant-Harm Thoughts: Distinguishing OCD From Psychosis
An unwanted thought about harming the baby is not, by itself, evidence of intent. Learn which questions help distinguish an obsessional thought from a psychotic belief—and when the response must be urgent.
FGR at 32 Weeks: How Reversed Dopplers Shape Delivery Counseling
At 32 weeks, umbilical artery reversed flow reaches a delivery window; ductus venosus reversal adds evidence of fetal strain. Learn to recommend delivery while explaining prematurity and why pooled fetal-death figures are not individualized risk estimates.