Case Discussion
Clinical teaching and practical ideas for your next study session.
Low TSH, Fast Pulse: When Methimazole Helps—and When It Won’t
A suppressed TSH with tremor and sinus tachycardia does not by itself establish Graves disease. Use the hormone-production-versus-leakage distinction to choose the next tests and avoid prescribing methimazole for destructive thyroiditis.
Adolescent Depression: Why a PHQ-9A Is Not the Diagnosis
A 16-year-old’s insomnia, irritability, school decline, and self-harm raise concern—but do not establish MDD automatically. Learn how to use the PHQ-9A as a prompt, confirm the episode and functional change, and check for overlapping or alternative explanations.
Pediatric ITP With Platelets of 8,000: Let Bleeding Severity Set the Plan
A platelet count of 8,000 is alarming, but it does not decide admission or transfusion by itself. Learn how mucosal bleeding, diagnostic red flags, and follow-up reliability shape the next step.
Febrile Child With a Limp: Septic Hip and Safeguarding
A febrile, non-weight-bearing child with a hip effusion needs urgent assessment for joint infection. Learn how Family Medicine can pursue safeguarding concerns in parallel without delaying care or jumping to conclusions.
Frozen Shoulder and Diabetes: Plan Glucose Monitoring Before a Steroid Shot
An A1c of 7.8% does not automatically rule out a shoulder injection. Weigh its potential short-term benefit against a temporary glucose rise, then agree on a practical monitoring and follow-up plan.
Crystals in a Hot Knee: Why Gout Does Not Clear a Septic Joint
Urate crystals support gout, but they do not prove a hot knee is sterile. Learn how to assess infection risk and act safely while cultures are pending.
Acute Sciatica and New Urinary Symptoms: Catching Cauda Equina Early
Acute unilateral sciatica can evolve before frank urinary retention appears. Learn which new bladder, bowel, or saddle-sensation changes should prompt emergency assessment.
Giant Cell Arteritis With Normal ESR and CRP: What Should Primary Care Do?
Normal ESR and CRP lower the likelihood of giant cell arteritis, but they do not close the case when the symptom pattern remains concerning. A primary-care approach to probability, urgency, and confirmatory testing.
Febrile Prostatitis With a Weak Stream: When to Escalate for Retention
A febrile man with dysuria, perineal pain, a weak dribble, and a palpable bladder may need more than outpatient antibiotics. Learn how to check for acute retention, decide on urgent escalation, and frame bladder drainage without assuming one catheter route fits every patient.
Fishy Discharge, Positive BV Wet Prep: Why STI Testing Still Matters
A bedside pattern can support bacterial vaginosis, but it does not answer whether a patient also has an STI. In a 24-year-old with a new partner, separate the vaginitis diagnosis from the decisions to test for chlamydia, gonorrhea, trichomoniasis, and HIV.
New-Onset Heavy Menstrual Bleeding: When to Test for VWD
In new-onset heavy menstrual bleeding, the lifetime pattern—not a bruising question or routine PT/aPTT alone—helps decide when to test for von Willebrand disease while continuing uterine evaluation.
PID Follow-Up at 72 Hours: When Persistent Pelvic Pain Needs a New Workup
A follow-up after outpatient PID is a diagnostic checkpoint, not just an adherence check. Learn which findings should improve, how to judge the clinical trajectory, and when persistent pain calls for urgent reassessment.