Case Discussion
Clinical teaching and practical ideas for your next study session.
Pancreatitis With Gallstones and TG 1,250: Is Plasma Exchange Needed?
When gallstones and triglycerides near 1,250 mg/dL coexist, the triglyceride result supports a possible contributor—not an automatic insulin drip or plasma-exchange order. Separate cause from treatment, and assess for biliary obstruction.
Esophageal Cancer Work-up on Warfarin: Biopsy vs EUS-FNA
For progressive dysphagia in a patient with a mechanical mitral valve, distinguish diagnostic biopsy from EUS-guided sampling before deciding whether to interrupt warfarin.
Cirrhotic Variceal Bleeding: Should INR and Platelets Be Corrected?
With suspected variceal bleeding, an INR of 1.8 and platelets of 45,000/µL can trigger reflex transfusions. Learn why those results alone should not delay endoscopic hemostasis.
TMP-SMX in ANCA Glomerulonephritis: PJP Prophylaxis, Not Relapse Prevention
In ANCA-associated glomerulonephritis, TMP-SMX is used to prevent Pneumocystis during induction—not as routine vasculitis-maintenance therapy. Learn to separate the indications and monitor potassium and kidney function in active AKI.
Positive Anti-PLA2R With Nephrotic Syndrome: When Can Kidney Biopsy Wait?
A positive anti-PLA2R may establish membranous nephropathy without kidney tissue in selected adults. Learn how kidney function, urine sediment, secondary causes, and a new DVT change the biopsy decision.
After Severe Hyperkalemia in CKD: When to Restart an ACE Inhibitor
After emergency treatment, decide whether lisinopril should remain stopped or be restarted by weighing the drug’s indication, reversible triggers, potassium control, and a concrete monitoring plan.
HHS Resuscitation: Why a Rising Sodium Is Not a Fluid Order
A rising sodium can be expected as glucose falls in HHS. Learn why serial osmolality, perfusion, fluid balance, and cardiac risk—not one lab value—should guide fluid changes.
Abdominal Pain in DKA: When to Look Beyond Ketoacidosis
Abdominal pain may accompany DKA or signal its trigger. Learn when fever, focal findings, or persistent pain warrant evaluation beyond metabolic treatment.
Pulmonary Embolism With sPESI 0: What Still Has to Be True Before ED Discharge?
A zero sPESI score estimates low short-term clinical risk; it is not a discharge order. This case shows how teams pair the score with current physiology, treatment barriers, medication access, and follow-up before choosing home care.
Delirium, Pneumonia, and a Positive Urinalysis: When to Treat the Urine
A positive urinalysis does not automatically make delirium a UTI. Learn how to reassess urine findings when pneumonia already explains the systemic illness.
Apixaban Before Type A Aortic Dissection Repair: Protect the Bypass Plan
A recent apixaban dose complicates emergency Type A dissection repair. Learn how to assess residual drug, weigh reversal, and avoid compromising heparinization for cardiopulmonary bypass.
Severe Aortic Stenosis With Iron-Deficiency Anemia: Don’t Call It Heyde Syndrome Too Early
A low ferritin in severe aortic stenosis is a diagnostic clue, not a completed diagnosis. Learn how to separate stabilization, occult GI bleeding evaluation, and timely valve intervention.