The Happy Hospitalist - Latest Comments in Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

WakkaWakka — Wed, 15 Apr 2015 10:24:10 -0000

As a 2nd year medicine-pediatrics resident, I occasionally come back and look at this post when talking to people that don't know about what a "globulin gap" is (it's true! It's not really talked about in med school much). I am always impressed by how useful these have been for me. Thanks, Happy!

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

happyhospitalist — Thu, 01 May 2014 23:15:33 -0000

Thanks!

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

Just Another Med Student — Thu, 01 May 2014 19:47:33 -0000

Randomly came here from interweb but I am very glad I stopped by. As a barely finished post-STEP1 3rd year med student, I will definitely do my best to remember these throughout the year and will share them with others. Thank you!

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

Nurse Ron — Sun, 14 Oct 2012 10:35:30 -0000

Thanks for this. At this point in time the hospitalist is waiting for a consult from the hematologist/onco MD on my mother. He educated me on rule #2 last night.

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

roger — Fri, 06 Aug 2010 22:40:24 -0000

lost intern:
any occult infection. Guy came in with back pain, elevated gap? Sent blood cultures and he had thoracic osteomyelitis. Could be endocarditis, anything. I have seen senior residents send SPEPs on patients with gangrene... no need. The globulins are there as a response to the infection

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

Mike — Sat, 08 May 2010 15:11:53 -0000

I believe amyloidosis can be included in the ddx as well....

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

lost intern — Wed, 03 Jun 2009 21:23:49 -0000

Rule #2 is to look for the globulin gap, but I'm having a hard time finding a good differential for an elevated gap. I know the typicals (hiv, hcv, multiple myeloma), but what else?

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

Sun, 29 Jun 2008 13:26:00 -0000

i just finished my internal medicine residency, and i'd have to say i agree 100%. great post.

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

Frank Drackman — Fri, 27 Jun 2008 07:14:00 -0000

Drackmans Postulates of Medicine

#1 If it hurts, X-ray it.

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

Anonymous — Mon, 23 Jun 2008 07:01:00 -0000

3 more I learned in my IM residency last millenium:

21. If you're not sure if the pt needs an LP, then the pt needs an LP.

22. If you're not sure if you need a consult, the pt needs the consult.

23. At least once a day one very smart person will tell you to do something stupid. Part of your job is to not listen to them.

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

Doctor David — Mon, 23 Jun 2008 00:48:00 -0000

Was coming to leave exactly the same comment as CK. #20 is your most important. The good docs know their limitations. The dangerous ones do not.

Awesome post!

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

ck — Sun, 22 Jun 2008 22:37:00 -0000

#20: Know your limitations. If you don't know your limitations, you shouldn't be doing this.

Probably the most important. This should be tattooed on some people's foreheads haha.

Re: Increased Globulin Gap And Ninteen Other Golden Rules For Fleas

Ken Jr. — Sun, 22 Jun 2008 21:49:00 -0000

I hope you don't mind but I copied your rules and shared them with a couple med school buddies. Don't know if any of us plan to be internists yet but always plan for the unexpected I say