Advanced Clinical Diagnosis
A 45-year-old woman presents with new-onset dizziness, gait instability, and urinary incontinence. MRI shows hyperintense lesions in the periventricular white matter. What is the most likely diagnosis?
What is Multiple Sclerosis (MS)?
This class of drugs is a first-line option for chronic management of severe asthma, specifically targeting eosinophilic inflammation.
What are monoclonal antibodies (e.g., Mepolizumab or Omalizumab)?
A patient with diabetes and poorly controlled hypertension presents with bilateral ankle edema and an S3 gallop. What is the most appropriate next step in management?
What is evaluating for heart failure with preserved ejection fraction (HFpEF)?
This metabolic disorder, characterized by an insulin deficiency or resistance, can lead to diabetic ketoacidosis or hyperosmolar hyperglycemic state if poorly controlled.
What is Type 1 Diabetes Mellitus?
This screening tool is used to assess frailty in older adults, predicting adverse outcomes such as falls, hospitalization, and mortality.
What is the Fried Frailty Criteria?
This syndrome is associated with progressive dyspnea, bibasilar crackles, and clubbing, often seen in patients with a history of interstitial lung disease and autoimmune disorders.
What is Idiopathic Pulmonary Fibrosis (IPF)?
A patient with cirrhosis presents with ascites and is started on spironolactone. What is the maximum dose of spironolactone typically used in the management of ascites?
What is 400 mg/day?
A 50-year-old patient with chronic migraine who is not responding to triptans is considered for this type of preventive therapy.
What is onabotulinumtoxinA (Botox)?
A 64-year-old male with a history of stroke presents for follow-up with new onset of dysphagia and weight loss. His speech is slurred, and a head CT reveals chronic ischemic changes. What is the most likely cause of his dysphagia?
What is a swallowing dysfunction due to stroke-related dysphagia (possibly oropharyngeal)?
A 78-year-old patient with dementia has been refusing meals for the past week. She has lost 8% of her body weight over the past month. What is the most appropriate next step in management?
What is a comprehensive nutritional assessment and, if indicated, starting enteral feeding?
A 56-year-old man presents with lower extremity weakness, loss of proprioception, and a positive Romberg test. His vitamin B12 levels are severely low. What is the likely diagnosis?
What is Subacute Combined Degeneration (of the spinal cord, often due to Vitamin B12 deficiency)?
This drug is a second-line treatment for acute exacerbations of Crohn’s disease and is associated with a risk of bone marrow suppression.
What is Methotrexate?
A patient with a history of bipolar disorder and new-onset psychosis is started on this antipsychotic, which requires regular metabolic monitoring for weight gain, diabetes, and dyslipidemia.
What is Olanzapine?
This chronic condition characterized by systemic inflammation and vascular damage can lead to end-stage renal disease, myocardial infarction, and stroke.
What is Chronic Kidney Disease (CKD) with comorbid hypertension?
This drug is used to treat agitation and psychosis in elderly patients with dementia but has a black box warning due to its association with increased mortality in elderly patients with dementia-related psychosis.
What is Risperidone or Olanzapine?
A patient with chronic renal failure develops worsening hyperkalemia, muscle weakness, and ECG changes (peaked T-waves). What is the first-line treatment to stabilize the cardiac membrane?
What is Cauda Equina Syndrome?
A 65-year-old patient on long-term warfarin presents with an INR of 5.2. What is the recommended initial treatment?
What is withholding warfarin and administering oral Vitamin K?
A 72-year-old woman with a history of ischemic heart disease presents with fatigue and exertional dyspnea. An echocardiogram reveals a left ventricular ejection fraction of 30%. What is the best pharmacologic therapy to reduce mortality in this patient?
What are ACE inhibitors, beta-blockers, and aldosterone antagonists (spironolactone)?
A 70-year-old female with a history of a myocardial infarction is started on dual antiplatelet therapy. Which of the following should be avoided to reduce the risk of gastrointestinal bleeding in this patient?
What is the concurrent use of NSAIDs?
This clinical syndrome is defined by the sudden onset of confusion in elderly patients, typically triggered by illness, infection, or medication changes.
What is Delirium?
A patient with a history of chronic back pain presents with a sudden onset of severe back pain, bilateral leg weakness, and bowel/bladder incontinence. MRI reveals compression of the cauda equina. What is the diagnosis?
What is Cauda Equina Syndrome?
In patients with chronic pain and opioid use, this medication is recommended to reduce opioid-related constipation without affecting pain relief.
What is Naloxegol?
In managing a patient with refractory hypertension despite the use of three or more antihypertensive agents, including a diuretic, what is the next step in management?
What is evaluating for secondary causes of hypertension, such as hyperaldosteronism or pheochromocytoma?
In patients with stage III heart failure, this therapy has been shown to significantly improve survival and reduce hospitalizations.
What is the use of a combination of hydralazine and nitrates?
When managing a patient in the last stages of life, a palliative care approach may be appropriate. What is the primary goal of palliative care for end-of-life patients?
What is to improve quality of life and relieve symptoms, rather than to prolong life?