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I have adopted the use of italics to denote internal monologue.

A reviewer suggested that I italicize a word of spoken dialog to denote emphasis:

"What… what in the Sam Hill is that?"

I know this is ultimately a question of style. Is it common to use italics for both purposes in a given work?

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yes, it's fine. It's obvious which is which in context.

Separately, if you want to emphasize something in internal monologue which is already italics, the usual convention is that the word is in roman/book (that is, the opposite of italic). I have seen bold italic used, but rarely.

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