Daily Answers

07/28/2026
The Question A 72 year old woman with rheumatoid arthritis treated with methotrexate and prednisone 5 mg daily comes in with a three day history of a painful, burning rash on the right side of her forehead and the tip of her nose. She describes tingling in the area for two days before the rash appeared. She also notes mild right eye redness and tearing but says her vision is unchanged. Temperature is 37.1°C, blood pressure 128/76 mmHg, pulse 78/min. Examination shows grouped vesicles on an erythematous base distributed over... Read more...
07/27/2026
The Question A 52-year-old man is referred for his first screening colonoscopy. He is asymptomatic and feels well. His family history is notable for a father who had "colon polyps" removed in his 60s but no known colorectal cancer. The patient takes no medications. On colonoscopy, he is found to have 35 adenomatous polyps, ranging from 3 mm to 8 mm in size, distributed throughout the colon from the cecum to the sigmoid. The rectum is relatively spared. All polyps are removed, and pathology confirms them as tubular adenomas, none... Read more...
07/26/2026
The Question A 64-year-old woman is diagnosed with dermatomyositis. The diagnosis is made based on a 4-month history of progressive proximal muscle weakness, a heliotrope rash, Gottron's papules on her knuckles, a creatine kinase level of 4,500 U/L, and a positive anti-TIF1-gamma antibody. She is initiated on therapy with high-dose oral prednisone. Which of the following is the most important additional step in her management at this time? See the answer and explanation below: Post-Call Recovery Reads Finished your notes? Time to swap the pager for a crown. Kingdoms of... Read more...
07/25/2026
The Question A 68-year-old man with a history of hypertension and hyperlipidemia presents to the emergency department after an episode of slurred speech and right-hand clumsiness that lasted approximately 30 minutes. His symptoms have completely resolved. He has not been taking his prescribed lisinopril or atorvastatin for several months. His blood pressure is 162/94 mmHg and heart rate is 78/min and regular. A neurologic examination is now normal. A non-contrast CT scan of the head shows no acute hemorrhage, but a subsequent MRI reveals a 6-mm focus of diffusion restriction... Read more...
07/24/2026
The Question A 58-year-old woman with a history of HER2-positive breast cancer, treated 5 years prior with a doxorubicin-based regimen followed by trastuzumab, presents with a three-month history of progressive dyspnea on exertion and lower extremity swelling. Her blood pressure is 128/76 mmHg and her heart rate is 105/min. Physical examination reveals jugular venous pressure elevated to 10 cm H2O, bibasilar crackles on lung auscultation, and 2+ pitting edema to the mid-shins. A transthoracic echocardiogram demonstrates a new global hypokinesis with a left ventricular ejection fraction of 35%; her pre-chemotherapy... Read more...
07/23/2026
The Question A 22-year-old female with a history of generalized anxiety disorder is brought to the emergency department by her roommate after a syncopal episode. The patient reports several months of progressive fatigue, dizziness upon standing, and cold intolerance. She states she is "very disciplined" with her diet, which consists mainly of vegetables and protein shakes, and she runs for 90 minutes daily. Her weight has decreased by 15 kg (33 lbs) over the past six months. On review of systems, she endorses constipation but denies vomiting. Physical examination reveals... Read more...
07/22/2026
The Question A 68-year-old man with a history of myelodysplastic syndrome is admitted for symptomatic anemia. His baseline hemoglobin is 6.5 g/dL. He is initiated on a transfusion of one unit of leukocyte-reduced packed red blood cells. Thirty minutes into the transfusion, the nurse is called to the bedside because the patient has developed shaking chills and feels unwell. His temperature is 101.8°F (38.8°C), up from 99.0°F (37.2°C) pre-transfusion. His blood pressure is 128/76 mmHg, heart rate is 102 beats/minute, and respiratory rate is 18 breaths/minute. His oxygen saturation is... Read more...
07/21/2026
The Question A 68-year-old man is recovering on the surgical ward 7 days after undergoing coronary artery bypass grafting for three-vessel disease. His postoperative course has been unremarkable, and he has been receiving subcutaneous unfractionated heparin for venous thromboembolism prophylaxis. The nurse calls to report that the patient's platelet count has decreased significantly. His medical history is notable for hypertension and hyperlipidemia. On examination, his temperature is 37.1°C (98.8°F), blood pressure is 128/76 mm Hg, pulse is 88/min, and respirations are 14/min. He is well-appearing and in no distress. Cardiopulmonary... Read more...
07/20/2026
The Question A 34-year-old woman presents to a new primary care physician for evaluation of multiple chronic symptoms. For the past 5 years, she has experienced intermittent, migrating joint pain, persistent headaches, and chronic abdominal bloating and discomfort. She reports that these symptoms are distressing and have caused her to quit her job as a librarian. She brings a large binder containing records of numerous specialist consultations, including with rheumatologists, neurologists, and gastroenterologists. Extensive workups have been performed, including normal brain and abdominal MRIs, normal upper and lower endoscopies, and... Read more...
07/19/2026
The Question A 38-year-old man with no known medical history is brought to the emergency department by his partner due to two weeks of worsening headache, fevers, and confusion. His temperature is 38.4°C (101.1°F), blood pressure is 122/78 mm Hg, and heart rate is 104/min. On examination, he is lethargic and has nuchal rigidity. A non-contrast head CT shows no acute intracranial process. A lumbar puncture is performed, revealing an opening pressure of 35 cm H2O, a white blood cell count of 80/µL with a lymphocytic predominance, glucose of 30... Read more...
07/18/2026
The Question A 58-year-old man comes to your office to establish care and review recent test results. He is asymptomatic. He recently underwent his first screening colonoscopy, which was recommended by his previous physician. He has no significant past medical history and takes no medications. He has no family history of gastrointestinal cancers. His vital signs and physical examination are unremarkable. The colonoscopy report states that the cecum was reached and the preparation was adequate. The endoscopist removed a 12-mm sessile polyp from the sigmoid colon and two 5-mm polyps... Read more...
07/17/2026
The Question A 68-year-old woman with a history of hypertension and hyperlipidemia presents to the emergency department with a two-hour history of recurrent, severe spinning sensations. She reports the episodes last for about 30 seconds and are provoked by rolling over to her right side in bed or looking up. She feels nauseated during the episodes but has not vomited. She denies any headache, hearing loss, tinnitus, double vision, or focal weakness. On examination, her vital signs are stable. Her neurologic examination, including a full cranial nerve assessment, motor and... Read more...