We expect this application to take no more than one hour to complete.
Please note you can save your work and return to the form at any time.

 

Application for 

ReelDx Spring 2025 Internship

 

 

Cycle runs from Jan 13 - May 11, 2025

Expectations for ReelDx Interns:

• Must be in college or have already obtained a college degree
• Minimum 3-month commitment (or completion of intern cycle)
• Minimum commitment of 5 hours per week
• Tasks may include: 
  • Research
  • Virtual Clinical Exposure
  • Content Creation
  • Quality Control
  • Video Editing & Quiz-Making
  • Social Media Marketing & Advertising

Please complete the following tasks that you have selected.

Each task should take approximately ten minutes.

Quality Control (Part 1): Please use the guidelines provided here (please open in a new tab) to find at least 10 (hint - there are actually more than 20!) errors in the following case. You will list the errors and submit corrections on the following page.

*Note - you do not need to understand and fact check all of the medical lingo in order to complete this task; checking spelling and grammar of complex terms/sentences, along with the information provided in the attached guidelines, is sufficient.

Vitals and Demographics

Patient

• Gender: Female
• Age: 40
• Weight: Not Available
• Height: Not Available

 

 Vitals

• Temperature: 98.5
• Heart Rate: 85
• Respiratory Rate: 12
• Pulse Oximetry: 100% on room air
• Blood Pressure: 112/74

 

 Signs and Symptoms

• 2.5 days of painless vaginal bleeding in the first trimester of pregnancy.

 

 History

• Medical History: Four prior uneventful pregnancies, 5 children (one set of twins)
• Social History: None of note.
• Medications: None

 

Differential Diagnosis

• Misscarriage
• Threatened misscarriage
• Ectopic pregnancy

 

Patient Workup

• Labs, including CBC, CMP, PT/INR, and Beta-hCG level

 

Diagnosis

• Ectopic pregnancy

 

Actual Outcomes

• Treatment
  • Treated with Methtrexate
• Patient Disposition 
  • Discharge with OB/Gyn follow-up and serial Beta-hCG levels
• Supplemental Documents

 

Author's Note: "Ultrasound shows a pregnancy with yolk sac in the right fallopian tube outside of the uterus."

Standards of Care

Suggested Workup:

• Beta-hCG level
• Ultrasound

 

Suggested Treatment:

• Methotrexate is appropriate if the ectopic pregnancy is small (gestational sac

 

Suggested References:

• The American College of Obstetricians and Gynecologists, "Ectopic Pregnancy - Frequently Asked Questions"
• Noelle A. Rotondo, "When Is it Appropriate to Use Methotrexate for Ectopic Pregnancy in the Emergency Department?" Medscape (August 13, 2008).

 

Key Points & Editorial

Key Points

• Etopic pregnancy must be ruled out in any patient with early pregnancy and vaginal bleeding and/or abdominal pain. 
• Transvaginal ultrasound is the test of choice, and should be performed regardless of beta-hCG level. 
• In this case, an ectopic pregnancy was identified, with an empty uterus. 
• If TVUS does not detect a pregnancy inside or outside of the uterus, beta-hCG should be referred to. 
• A high beta-hCG (>1500mIU/ml, the “discriminatory zone”) with no evidence of intrauterine pregnancy suggests ectopic pregnancy until proven otherwise.
• If beta-hCG is low and there is no pregnancy seen it may represent either ectopic pregnancy or an early intrauterine pregnancy and serial hCGs should be followed. 
• Ectopic pregnancy may be treated medically if early (methotrexate), but may require surgical treatment if more advanced or ruptured.

 

Editor's Notes

• A classic triad of ectopic pregnancy is Abdominal pain, Amenorhea (+ pregnancy test), followed by Vaginal bleeding. However only about 50% of patients will have all 3 symptom.
• About 20% of patients diagnosed with ectopic pregnancies is already hemodynamically compromised usually from rupture.

Quiz Creation (Part 1): Using the information given, create 3 questions (one of each – vitals, testing, and diagnostics/hypothetical). Each question should be a multiple choice question with 4 answer choices. Highlight the correct answer choice and please provide explanations on the reasoning behind the correct and incorrect answer choices. Provide citations when necessary.

 

Instructions:

1- Vitals/Demographics: Create 1 question from the vitals given above. This should be like an immediate recall question in which the answer is straight out of the given information from the Vitals/Demographic Section.

2- Testing: Create 1 question in regards to testing and treatment for the above patient. This question should be regarding the possible treatments or tests that can be done as a work-up for this patient.

3- Hypothetical: Create 1 hypothetical question regarding this case. This should ask about how circumstances (diagnosis, workup, treatment, etc.) would change if an aspect of the patient or their presentation were different. Try to be as detailed as possible and think outside of the box! (Hint: think of this as a “What if?” question, a “Why?”, or a “How might things change?” type question).

 

Example Questions:

- Question 1 (Vitals): 

What neurological symptom was seen in the patient other than facial drooping?

A. Diarrhea
B. Headache  - The patient's symptoms included headaches, facial drooping, left arm weakness, dizziness, confusion, constant crying, etc. 
C. Fever
D. Shortness of Breath

- Question 2 (Testing):

What is the earliest sign of a Cerebral vascular accident (CVA) on the CT scan of the head?

A. Hematoma present in the CT scan.
B. Calcification present in the CT scan.
C. Cannot be seen in a CT scan.
D. A loss of grey-white interface on the CT scan  - If a CT scan shows no/very little differentiation between grey and white areas it is the earliest sign of a CVA.

- Question 3 (Diagnostic/Hypothetical):

What is the difference between ischemic cerebral vascular accident and hemorrhagic stroke?

A. Hemorrhagic stroke occurs in the brain while ischemic cerebral vascular accident occurs due to sudden compromise of the immune system. 
B. An ischemic CVA (sometimes called a mini stroke) occurs only temporarily while hemorrhagic stroke occurs very gradually. 
C. Hemorrhagic stroke is when there is a rupture in blood vessels which causes blood to pool in the brain. Ischemic CVA is when blood is blocked from entering the brain - Hemorrhagic stroke does occur when blood vessels burst and pressure is put on the cranium. Ischemic CVA does occur when blood cannot enter the brain.
D. Hemorrhagic stroke occurs only in the early morning, while ischemic CVA occurs mainly in the night.

Quiz Creation (Part 2): Case Information

 *Note - if you also chose to do the Quality Control task, please note that the following case is not an accurate representation of the correct formatting and will therefore not aid you in your response to that task.

Vitals and Demographic Information:

• 22-year-old female
• Temperature: 95.7 F / 35.4 C
• Heart Rate: 62
• Respiratory Rate: 18
• Pulse Oximetry: 94%
• Blood Pressure: 124/83 mmHg

 

Signs and Symptoms:

• Shoulder pain after boating accident

History:

• No pertinent medical or social history

Differential Diagnosis:

• Shoulder strain
• Shoulder/Arm/Clavicle fracture
• Shoulder separation
• Shoulder dislocation
• Rotator cuff tear

 

Patient Workup:

• Ultrasound

Diagnosis:

• Shoulder dislocation

Treatment:

• Interscalene nerve block
• Shoulder reduction

Patient Disposition:

• Discharge home with sling

Suggested Workup:

• Diagnosis of shoulder dislocation can be done using a physical exam, ultrasound, x-ray, or a combination of the three.

Suggested Treatment:

• Shoulder reduction

Key Points:

• This is a fairly classic presentation of a shoulder dislocation. The mechanism – having the arm undergo abduction while raised in extension may result in dislocation. The physical examination was also characteristic, with an area that is sort of “scooped out” just below the acromion.
• Ultrasound confirmed the diagnosis by showing a substantial distance between the humeral head and acromion. While an x-ray is often performed pre-reduction to confirm the diagnosis and exclude fracture, we were confident of the diagnosis and did not perform a pre-reduction x-ray. The post-reduction x-ray showed no fracture.
• Anesthesia in this case was performed with an ultrasound guided interscalene brachial plexus block using 10cc of 1% lidocaine. This achieved nearly complete analgesia and muscle relaxation without other medications or sedation.
• The reduction technique was traction and external rotation. Unfortunately the video did not capture the actual moment of reduction but this was accomplished fairly easily with traction.
• Post-reduction examination (and x-ray) show restoration of the normal anatomy. She was discharged with a sling and orthopedic follow-up.

Patient Information (Part 1): Given an incomplete set of information from a patient case, complete the remaining drawers with medically accurate information. Please follow the guidelines laid out here.

 

Instructions: 

1. Make sure to follow the guidelines and formatting regarding the drawer you are working on to properly fulfill the requirements.
2. Use proper resources like Medscape, StatPearls, UpToDate, Mayo Clinic, Centers for Disease Control, and Cleveland Clinic to help build the drawers.
3. If using ChatGPT, refer to the guidelines below on how to use it while filling in drawers
   1. Note: Try and use sources first to build the drawers and then, if needed, ChatGPT to help fill the drawers with relevant information.

Patient Information (Part 2): Case Information

  *Note - if you also chose to do the Quality Control task, please note that the following case is not an accurate representation of the correct formatting and will therefore not aid you in your response to that task.

 

Vitals and Demographic Information:

• 40-year-old male
• Temperature: 98.0 F/ 36.7 C
• Blood Pressure: 123/75 mmHg
• Heart Rate: 95
• Respiratory Rate: 22
• Pulse Oximetry: 93%

 

Signs and Symptoms:

Patient presented to emergency department 5 days ago after trauma to left chest from a falling tree branch 2 months ago during Hurricane Isaias in Connecticut with persistent ongoing left-sided chest pain, difficulty breathing, and increased productive cough. The patient also reported worsening fatigue, occasional night time chills, and being bedridden for 1 month. Patient rated chest pain as 7 out of 10 on pain scale, with pain worsening with movement, and Ibuprofen for pain relief. Upon admission to ER, patient reported pneumonia and month-long intermittent fevers, and denied symptoms of nausea and vomiting. 

 

History:

• Medical History:  Opioid use disorder (Sober for 2 years), PTSD, anxiety, depression (previously on Lexapro), left shoulder surgery during high school
• Social History:  Automobile industry, divorced with 2 children, non-daily smoker 
• Medications: N/A

 

Differential Diagnosis:

• Hemothorax causing anemia

Patient Workup:

• History

 

Diagnosis:

• Left-sided loculated infected hemopneumothorax
• Anemia from blood loss

 

Treatment:

• Left chest tube placement followed by video-assisted thoracoscopic surgery (VATS).
• Frequent instillation of TPA through chest tube to help break loculations.

 

Disposition:

20 days in-patient admission to thoracic surgery service with full recovery

 

Standards of Care:

Suggested Workup

• Comprehensive lab work
• Immediate bed side thoracic and cardiac Ultrasound followed by CXR and CT chest
• Blood cultures and thoracic fluid cultures

Suggested Treatment

• Immediate chest tube insertion by thoracic specialists but in the setting of loculated collection, VATS and antibiotics were indicated

Suggested References

UpToDate - Initial evaluation and management of blunt thoracic trauma in adults
UpToDate - Imaging of pleural effusions in adults
StatPearls, 2023 - Hemothorax
MedScape - Hemothorax

 

Key Points & Editorial:

Key Points

• This patient had a traumatic injury to the chest nearly two months prior but did not seek medical care until they started experiencing pain and symptoms of infection and hemorrhagic anemia that had started to significantly impact his activities of daily life.
• The late presentation complicated his management requiring OR procedures due to loculation formation and infectious hemopneumothorax.
• Patient also grew gram positive cocci in chains in the thoracic fluid culture requiring prolonged antibiotic therapy.
• He made a full recovery and was discharged home.
• He was motivated to keep his narcotic use to the minimum and worked closely with addiction medicine while in-patient.

Editor's Notes

• This patient had a complex and unusual history leading to this presentation and diagnosis.
• I wonder how his narcotic addiction/abuse may have contributed to this delayed presentation of hemopneumothorax, which is quite impressive from an imaging standpoint.

Prompt Building (Part 1): Create a role-playing AI that will act as a patient, while you [the user] will act as a physician in order to take the “patient's” history.

 

 Instructions:

• Given the patient information on the next page, create a text prompt to instruct AI to act as the patient during an interview. 
• The patient should accurately decribe their chief complaint and history when asked. Please restrict the AI patient to only utilize the information that we have provided.
• Feel free to use chat.openai.com to test your prompt, since that’s how we’ll be assessing it!
• This is a creative task and there are many ways to achieve the goal. But for some guidance, here is a source to help you with prompt creation! https://huit.harvard.edu/news/ai-prompts

Prompt Building (Part 2): Case Information

Transcript:

“PROVIDER: All right, good morning. How are you doing?

PATIENT: OK.

PROVIDER: I'm Dr. Moore. We're here at the Guilford Shoreline Medical Center. Thanks for taking the time to do the video.

PATIENT: No problem.

PROVIDER: Can you tell me what brought you in here today?

PATIENT: I have extreme pain in my side, and I can't stop vomiting. I'm nauseous.

PROVIDER: It's pretty early in the morning. It's almost 6:00 AM now, here. What time did this start, or how long ago?

PATIENT: I'd say it started probably around 4:00.

PROVIDER: OK. Did it wake you up from sleep?

PATIENT: It did.

PROVIDER: OK, so all of a sudden, you just had this pain. And where is it?

PATIENT: It's in my side, right around here-ish.

PROVIDER: Does it go anywhere, to your belly or your back?

PATIENT: It doesn't move, really, no. It's just-- it comes in waves.

PROVIDER: In waves. And with the nausea, and you've been-- you were vomiting?

PATIENT: Yeah, vomiting quite a bit, actually.

PROVIDER: OK, all right. Any fever or anything else?

PATIENT: I don't think so. I got real sweaty when I was vomiting.

PROVIDER: Yeah, OK. And do you have any other past medical history, things you've had?

PATIENT: I've had a kidney stone before.

PROVIDER: OK. Are you allergic to any medications?

PATIENT: I am not.

PROVIDER: OK. We've got you a little bit of medication with some fluids here. What would you put your pain on a scale from 1 to 10 right now?

PATIENT: Right now, probably about a seven or eight.

PROVIDER: So still hurting a bit?

PATIENT: It still hurts quite a bit, yes.

PROVIDER: OK, but you were a little more uncomfortable when you came in?

PATIENT: Oh, yeah. I was-- I was in agony when I came in.

PROVIDER: OK, so a little bit better?

PATIENT: Yeah. Definitely better.

PROVIDER: All right. It's still coming in waves, and then the vomiting. OK, that's great. Thanks for taking the time to talk to us.

PATIENT: No problem.”

 

Case Information:

 

Patient

• Gender: Male
• Age: 44
• Height: N/A
• Weight: N/A

 

Vitals

• Temperature: 98.3 F / 36.8 C
• Heart Rate: 82
• Respiratory Rate: 15
• Pulse Oximetry: 99% RA
• Blood Pressure: 135/76 mmHg

 

Signs and Symptoms

Acute onset of right flank pain that comes in waves; rated pain 7-8; vomiting; nausea

 

History

• Medical:  History of kidney stones 
• Social: N/A
• Medications: No allergies to medications. 

Lab Results (Part 1): Download and fill out this blank CBC template using the patient information on the following slide. Your lab values should be consistent with the patient's diagnosis, history, signs and symptoms, etc. using credible medical resources. You should also include a brief explanation for the abnormal results.

 

Lab Results (Part 2): Case Information

 

Patient

Gender: Male
Age: 28
Height: 69 in/175 cm
Weight: 160 lb/73 kg

 

Vitals

Temperature: 101.1 F/38.4 C
Heart Rate: 111
Respiratory Rate: 18
Pulse Oximetry: 81% RA
Blood Pressure: 127/76 mmHg

 

Signs and Symptoms

Sickle cell pain, chest pain, cough, shortness of breath, fever

 

History

Medical History: Sickle cell disease, asthma
Social History: Non-smoker
Medications: albuterol, Symbicort, hydroxyurea, morphine

 

Diagnoses

Acute chest syndrome
Sickle cell crisis

Conference Research (Part 1): One of the most valuable ways for ReelDx to grow is by acquiring speaking positions at conferences. Interns on the Research team research relevant events and put their persuasive writing skills to use by carefully crafting proposals for these speaking opportunities. 

This task can be split into two parts; you will submit a document on the following page containing one paragraph for each part:

1. Research the conference NLN Nurse Education Summit from 2024 and compile a brief paragraph overviewing the conference.

Please include the following information in your paragraph, citing your sources:

• Purpose: what information does the conference aim to share each year?
• Main audience: who is this conference meant for? Who can attend? Who might benefit the most from attending?
• Benefits: why would someone want to attend this conference? What might one gain from being a speaker at this conference? 
• Formatting: how is information shared? Are there meetings, lectures, PowerPoint presentations, or forums? 
• Content: provide at least 3 titles of abstracts or presentations that have been presented at the conference in prior years

2. Come up with a fictitious company or speaker who would be ideally suited for a speaking position at this conference, and write a paragraph explaining why they are a good fit.

Teaching Points (Part 1): Please create a list of 3-5 Teaching Points for case 873, which can be found using the instructions below. Teaching points should cover important or unique considerations for the diagnosis, patient's presentation, labs/imaging, etc. Use the "Key Points and Editorial" section of cases 953 and 1001 as examples of what types of information to include in your submission.

 

Login Instructions: 

Follow this link to access the collection with cases for this task. When prompted, use the below login information.

interns@reeldx.com

Interns2024@! 

Further Information:

 

Thank you for taking the time to fill out this application!

 

On the following page, you will find a list of intern expectations that you must agree to before submitting. Please take the time to honestly reflect on these expectations to ensure that you would be able to commit to the internship if selected.

 

We will review your application shortly, and decisions will be sent via email on Monday, December 30th, 2024. If you have any questions, don't hesitate to reach out to us at interns@reeldx.com