General Internal Medicine   

Both VTE and arterial thrombosis (CVA) prior to starting warfarin. Lupus anticoagulant positive. Has severe post menopausal symptoms.

Are there any potency or effectiveness preferences that lead to that decision?

What patient factors would make you more likely to recommend? Cost-effectiveness discussion as published in Annals of Internal Medicine: Laprise et al...

Does frailty change your threshold?

How do you counsel patients on this off-label use?

Are there any pearls re: which therapies that may be slightly safer vs to be strongly avoided?

(i.e., isolated elevation in MCHC, RDW.) Especially when all other lab results are normal and reassuring.

For your recommended medication, are you doing a scheduled set dose, or is it primarily symptom-driven? 

I.e., adrenal/renal mass vs cysts, pancreatic lesions 

Considering the recent article in CHEST that describes the increasing incidence of fungal pneumonia Azar. Chest 2024

Risk factors such as hereditary thrombophilia without personal thrombosis, family history of thrombophilia or thrombosis, etc.

Are there situations in which you still feel comfortable giving IV iron? If not, do you consider PO iron?

Do you prescribe it universally or based on specific risk factors?

As studied here: Fitzpatrick MB, Behrens CM, Hibler K, et al. Clinical Validation of a Vaginal Cervical Cancer Screening Self-Collection Met...

Do you still find urinalysis helpful in this situation, or do you rely on more specific culture data, imaging studies, etc.?

If so, you have a recommended tapering strategy? 

As studied in Tang H, Donahoo WT, DeKosky ST, et al. GLP-1RA and SGLT2i Medications for Type 2 Diabetes and Alzheimer Disease and Related De...

How do you risk-stratify this otherwise low-risk young patient given the lack of specific guidelines for this rare cancer? Additionally, at what point...

How do you approach shared decision-making when patients express hesitancy about medication exposure in utero? What is your approach when a patient is...

Referring to podiatry vs MRI vs referring PT with therapies like shock wave.

Do you ever continue medications such as rate-control agents for tachyarrhythmias, anticoagulation for blood clots, immunosuppression to prevent trans...

For example, how do you address tendency to "over-order" these tests in patients with common aches/pains but no structural abnormalities on advanced i...

Are there situations in which you would continue the possible offending agent with close monitoring?

For example, do you find trending WBC, procalcitonin, CRP, etc., more or less helpful?

Do you extend the course of fidaxomicin past initial 10 days to at least 3-7 days after completion of antibiotics?

For example, do you find it most useful for outpatient disease assessment/management, consideration of further imaging or specialist referral, or tria...

Do you use the traditional strict limit of 1.5 L, or do you consider removing more volume if a patient appears to tolerate it?

The controlled trial below demonstrated improvement in dysphagia among Parkinson's patients. Might this have greater potential for benefit than modifi...

What non-pharmacological interventions do you recommend? Do you routinely prescribe prophylactic laxatives to patients initiating opioids? How do you ...

In low-risk patients (age < 40) or patients with very obvious causes of blood loss or iron deficiency (menorrhagia, pregnancy), do you routinely pe...