General Internal Medicine&nbsp;&nbsp;&nbsp;

Do you obtain liver biopsy to confirm the diagnosis of cirrhosis if cirrhotic liver morphology is noted on imaging?

Is methacholine challenge on its way out?

Is there any benefit to checking serum viscosity in patients with autoimmune disease and headaches/migraines to see if aspirin or clopidogrel may be beneficial?

SLE, APLS, Sjogrens, and RA can sometimes have associated serum hyperviscosity. Is the standard viscosity test sensitive enough for these conditions a...

How would you treat ESRD patients on hemodialysis with recurrent AV fistula thrombosis found with low protein C activity?

For ESRD patients with decreased Protein C activity level, the purported etiology may be a dialyzable substance in uremic plasma that interferes with ...

How would you approach an asymptomatic older female patient with eosinophilia to 17,000, present for years, and normal eosinophilia workup including marrow and negative FLIP1?

Would you treat a patient like this with Nucala and if so, what would be your marker of success?

What is your approach to therapy in patients with progressive Scedosporium pulmonary infection who are not candidates for surgical debridement?

How frequently would you consider IV iron treatment for ongoing iron loss and severe iron deficiency anemia?

For example, in a patient with ongoing GI bleeding already on monthly IV iron dextran 1000 mg, would you consider dosing more frequently at Q2 or Q3 w...

How do you manage patients desiring home hospice but with severe thrombocytopenia and/or anemia due to advanced malignancy?

Do you consider supportive transfusions, and if so, have you been successful with keeping patients on hospice while receiving transfusions? Do you us...

In ischemic stroke patients with low LDL levels (<30-50 mg/dl), would you consider lowering LDL levels to lower values without concern for any side effects?

How would you adjust statin therapy in these patients?

What work up do you recommend for persistent subclinical hyperthyroidism with decreased RAI uptake and negative thyroid antibody tests?

Has anyone incidentally diagnosed IgA deficiency in a patient who does not present with any recurrent infections?

Is it common to have IgA deficiency in absence of any recurrent infections?

What is the maximum diuretic regimen recommended in patients with end-stage kidney disease who have residual renal function and volume overload?

Is there a role for dual antibiotic treatment with ethambutol and macrolide only, as opposed to three-drug antibiotic therapy, in the treatment of treatment-naive pulmonary MAC without cavitary disease?

Do you transition to oral antibiotics to treat uncomplicated Staphylococcus aureus bacteremia after patients have improved with intravenous antibiotic therapy?

Do you treat patients with culture positive mycobacterium abscessus if they are asymptomatic and do not have progression on imaging?

Are there other scenarios besides prior history of TIA or stroke or LV dysfunction in which systemic anticoagulation for LV non-compaction would be considered?

Do you seek pathologic confirmation before proceeding with empiric immunosuppressive therapy in symptomatic patients with radiographic NSIP?

Would you ever consider oral doxycycline for treatment of either gram-negative or gram-positive uncomplicated bacteremia?

Would the diagnostic yield for ABIs or peripheral arterial duplex doppler in a patient with metal rods in both legs be similar or acceptable in comparison to those tests in a patient without metal rods?

How would you approach management of a patient with seropositive RA and UIP-ILD, with concern for active lung disease?

Joint symptoms are stable on Hydroxychloroquine. Is there benefit of adding methotrexate or Rituximab for lung disease? CT of chest with predominately...

When do you consider attributing isolated psychosis to an acute ischemic stroke?

When would you consider treatment with steroids in patients with diabetic radiculoplexus neuropathy?

Are there any alternative treatments?

How would you approach management of retroperitoneal fibrosis causing ureteral compression that has already caused irreversible loss of kidney function?

Renal perfusion scan shows 14 % perfusion on affected side.

In patients with moderate calcific mitral stenosis, possible HFpEF and dyspnea on exertion, how would you differentiate the etiology of the symptoms?

How do you approach management of recurrent idiopathic pleuropericarditis?

How do you approach new onset idiopathic intracranial hypertension (IIH) with someone who has history of systemic lupus erythematosus? Would you consider this to be neuropsychiatric SLE (NPSLE) manifesting as IIH?

How do you approach someone with a history of SLE that has been well controlled for decades on CellCept and Plaquenil, who develops dizziness with a w...

How would you manage recurrent migratory lower extremity thrombophlebitis that occurs despite being on therapeutic apixaban?

No DVT. AC started due to extensive size of initial LLE SVT, with continued SVT of contralateral RLE despite therapeutic anticoagulation with apixaban...

How would you manage persistent Norovirus diarrheal infections in a kidney transplant patient that are not responding to a decrease in the patient’s maintenance immunosuppressive regimen?

Do you recommend holding ACE inhibitors, ARBs, and SGLT2 inhibitors for patients with chronic kidney disease and malignancy who are about to start high-dose intravenous methotrexate?

Among patients with recovered LVEF on GDMT with a reversible cause for heart failure (i.e., tachycardia-mediated or alcohol-mediated cardiomyopathy), would you consider de-escalation of GDMT?

What is the role of surveillance imaging after first line therapy in patients with aggressive lymphomas?

Do you recommend to exchange nephrostomy tubes when a patient is diagnosed with a urinary tract infection in the absence of any overt signs of infection at the exit site?

In particular, in individuals who are know to have their urinary tract colonized with an organism, and they will periodically develop a urinary tract ...

How do you transition patients between different long-acting injectable antipsychotics?

When do you use seizure prophylaxis in patients on clozapine?

How do you approach the significance of +RNP III antibody in a patient with positive ANA but no other signs or symptoms of systemic sclerosis?

No history of malignancy. No Raynauds.

How do you approach a patient who develops a rest tremor after chemotherapy?

How do you approach management of bone marrow involvement in sarcoidosis?

Patient with mild cytopenias, but not requiring transfusions and no infection issues. Non-caseating granulomas on bone marrow biopsy.

How should clinicians balance the use of finerenone with other heart failure treatments like SGLT2 inhibitors, considering their glycemic benefits?

Butt et al., PMID 39818225

What work-up and treatment do you recommend for exertional headaches?

Is it safe to continue azathioprine in a patient with severe bilateral panuveitis (thought to be related to sarcoidosis) and benign ethnic neutropenia, given worsening neutropenia since starting the medication, or should an alternative immunosuppressive agent be considered?

Patient with a history of presumed benign ethnic neutropenia: PMN 1.5 prior to azathioprine and 1.2 after starting. The patient has an intolerance to ...

Do you make any dose adjustments for patients with ESKD who are on apixaban and do not otherwise meet criteria for reduced dosing?

How would you manage an elderly patient with type 3 achalasia who previously underwent POEM and has recurrent dysphagia, high Eckardt score, and dilated esophagus concerning for blown-out myotomy on esophagram?

Would you recommend repeat POEM, Heller myotomy, or pneumatic dilation?

How do you approach pharmacologic management of OCD in patients with comorbid bipolar disorder, particularly when considering SSRIs or clomipramine?

How long after initiating mycophenolate do you wait before tapering prednisone off in patients with myositis-associated ILD?

What is your treatment approach when managing patients with relapsing lupus nephritis who previously achieved remission with mycophenolate and steroids?

Do you recommend the use of albumin-adjusted calcium measurement formulas to accurately assess calcium levels?

Desgagnés et al., PMID 39836424

Do you prescribe linezolid to patients who are concomitantly on an SSRI?

Besides treadmill, what other exercises may be considered for post-exercise ABIs, and are their diagnostic parameters identical to standard post-exercise ABIs?

Do you routinely treat patients with neurosyphilis with IM penicillin for 1-3 weeks after completing a full treatment course of IV penicillin?

CDC Sexually Transmitted Infections Treatment Guidelines, 2021

Under what circumstances would you hold an ACE inhibitor or ARB prior to surgery in a patient with CKD?

Do you recommend any specific testing for patients with recurrent nephrolithiasis and suspected absorptive hypercalciuria?

Would you initiate antifibrotic therapy in a patient with CTD-ILD experiencing worsening symptoms and declining lung function, despite no clear evidence of fibrosis on CT scans?

CT changes are subsolid and ground glass nodules.

How do you approach consults regarding clearance of patients with chronic kidney disease for surgery?

How do you identify patients with false positive AcHR antibodies?

In patients who have positive AcHR antibody, how do you screen for those who are falsely positive?

How do you approach a patient with high titer ANA and a new diagnosis of ITP, but no other signs or symptoms suggestive of active rheumatologic disease?

Patient with +ANA 1:2560 for >10 years; rest of serologies are negative. Complements are normal. Negative dsDNA. Antiphospholipid labs are negative...

How long would you continue chronic transfusion therapy for adult sickle cell patients who have had a stroke?

Is treatment indefinite or do you consider discontinuing chronic transfusions at some threshold?

What is the optimal management of pain and loss of function due to pathologic compression fractures?

Assume no epidural/cord compromise. Is kypho/vertebroplasty, radiation therapy, or conservative management (brace, antiresorptive therapy) the superio...

Do you recommend any medical management for patients with evidence of intracranial atherosclerosis without evidence for stroke?

What treatment combination approach would you recommend for mucous membrane pemphigoid?

In a patient with cryptogenic stroke while on antecedent aspirin 81 mg, how do you decide between single antiplatelet therapy, dual antiplatelet therapy, or antiplatelet agent combined with anticoagulation such as rivaroxaban 2.5 mg BID?

What are some immunosuppression regimens to consider in a patient with refractory cardiac sarcoidosis?

What agent and for how long would you treat a patient with asymptomatic azole-resistant C auris candiduria who is planning to undergo a urological procedure?

How do you approach an otherwise healthy patient with an incidental 1 mm GIST involving the serosal surface in terms of staging workup, EGD, and surveillance?

How does trimethoprim-sulfamethoxazole's efficacy against S. pyogenes influence your empirical treatment of skin infections in regions with high resistance rates?

McCreary et al., PMID 37310038

What is your clinical threshold for treating a potential monoclonal gammopathy of thrombotic significance?

New data suggests monoclonal gammopathies can be associated with thrombotic events. Is your practice changing to include monoclonal gammopathy evaluat...

How would you manage and determine the duration of antibiotics for a patient with suspected chronic postoperative spinal implant infection, status post lumbar fusion, now presenting with loosened hardware on imaging, normal inflammatory markers, and no systemic infection symptoms?

In a patient with sicca symptoms and SS-B antibodies only, can a minor salivary gland lip biopsy with lymphoid aggregates, but also scattered areas of acute neutrophilic inflammation be consistent with Sjogren's Disease?

Lymphoid aggregates consistent with Sjogren's Disease, but current criteria suggest that if the minor salivary gland lip biopsy has neutrophilic foci,...

Would you consider opting for beta blocker withdrawal to improve exercise capacity in patients with heart failure with preserved ejection fraction and chronotropic incompetence?

What is your preferred approach in treating recurrent bleeding from GAVE?

What role does TIPS play when other approaches have been exhausted?

What treatment options would you consider for a young patient with limited mobility, low bone mass and multiple vertebral compression fractures who is on dialysis for advanced kidney disease?

What leads you to suspect that a foot drop is secondary to a myopathy rather than a neuropathic process?

In patients who are on 3 of the 4 pillars of HF therapy for HFrEF, would you add the 4th pillar if they are no longer in symptomatic HF and LVEF normalizes?

The basis of the question is that HFrEF trials enroll patients who have Class II-IV symptoms. If their LV systolic function recovers and they become a...

When do you consider Cheyne-Stokes respirations noted in download data from positive pressure machines to be normal vs abnormal requiring intervention?

What is the importance of finding a positive titer for TS-HDS and what treatment would be advised for these patients?

How do you treat extrapyramidal symptoms secondary to anti-psychotic use in patients who have not benefited from cogentin or benadryl?

For which patients with calciphylaxis would you recommend a parathyroidectomy?

At what point should aspirin therapy for stable cardiovascular disease be discontinued in patients with a diagnosis of chronic cerebral microbleeds or possible Cerebral Amyloid Angiopathy?

For stroke patients with ablated paroxysmal atrial fibrillation without known recurrence and ICAD, would you recommend dual antiplatelet therapy or anticoagulation with or without an antiplatelet agent?

What is the duration of each treatment choice and which drug is preferred by either group? What else should we take into consideration when deciding o...

Would you recommend dual antiplatelet therapy or anticoagulation for a patient previously on aspirin who has a breakthrough stroke with history of CADASIL?

What is the optimal antithrombotic management, if at all, in patients with incidentally identified findings of multiple silent embolic appearing cerebral infarcts?

What is your approach to the management of shrinking lung syndrome in SLE?

Young woman (20s) with history of active lupus for 3-4 years. Serologies/Labs include +ANA, +dsDNA,+ RNP, + Smith, hypocomplementemiaManifestations i...

How would you manage an ESKD patient who complains of severe fatigue after hemodialysis, but does not experience intradialytic or post-dialysis hypotension and has not responded to dry weight adjustments?

Do you use delayed-release budesonide over prednisone or methylprednisolone for the treatment of IgA nephropathy, considering the available safety and efficacy data?

When would you consider referring a patient with suspected cardiac sarcoidosis based on PET and MRI for endomyocardial biopsy given degree of patchy involvement, as opposed to initiating empiric immunosuppressive therapies?

Is there any utility in ACE levels and/or IL-2 levels in the diagnostic work-up of cardiac sarcoidosis?

Should you consider thromboprophylaxis, even for low-dose lenalidomide maintenance, post-autologous transplantation?

Do you treat non-albicans strains of Candida on sputum culture or BAL in patients who are immunosuppressed?

How do you approach the management of patients with mildly elevated mPAP (21-24 mmHg) and PVR (2-3 WU) who may be at risk of progression, given the recent changes in the hemodynamic definition of pulmonary hypertension?

Definition, classification and diagnosis of pulmonary hypertension (Kovacs et al., PMID 39209475).

Which patients, if any, treated according to PROSPECT for an early stage rectal cancer, would you offer surveillance if they achieved cCR after neoadjuvant chemotherapy?

Some patients have declined surgery knowing they achieved cCR. Would you observe or recommend chemoRT?

What workup do you recommend for otherwise healthy migraine patients that develop dizziness with episodes?

What laboratory workup do you perform in patients with symptoms consistent with erythromelalgia?

Do you typically give GI prophylaxis when providing patients with steroid taper for status migrainosus?

How do you interpret small joint effusions seen on ultrasound without power doppler signal in the setting of compatible inflammatory symptoms (i.e morning stiffness)?

Is there any evidence for amyloid/amyloidosis causing a spurious/false PSA reading?

What is the utility of a hypercoagulability workup in recurrent cryptogenic stroke, and what specific tests would you recommend?

Is there any utility in predominantly venous hypercoagulability labs?

How do you use gut microbiome or gut microbiota analysis in your clinical practice, if at all?

What type of visual disturbance qualifies as a visual aura?

Visual aura is commonly described as a scintillating scotoma. In practice, there is a much wider spectrum of visual symptoms in the migraine populatio...

What features on PFT or flow-volume loops do you look at to suspect small airway dysfunction?

Often distal flattening of expiratory limb or decreased Fev25-50/FVC is referred for small airway dysfunction but it is advised against using it give ...

What is your approach when surgeons want to stop hydroxychloroquine prior to surgery?

The index question is: "neurosurgeons lately want to stop hydroxychloroquine prior to spinal surgery. Anyone allowing this for lupus patients and for ...

Do you routinely prescribe an anticholinergic agent for EPS prophylaxis when starting or continuing antipsychotics or do you prefer to use it only as needed (prn) if/when symptoms develop?

Is there any role for prophylactic bronchial artery embolization in immunocompromised patients with invasive pulmonary aspergillosis?

What is your approach to treatment in a patient with radiographic UIP but pathologic evidence of both fibrotic NSIP and UIP?

Do you start anti-inflammatory agents, anti-fibrotic agents, or both?

Is there a BMI cutoff for which you would refer a patient needing a native kidney biopsy to interventional radiology?

Would you consider using DOACs as a bridge to warfarin instead of heparin or LMWH?

For example, would you consider this method in an ESRD/HD patient with antiphospholipid syndrome who had a major bleed requiring reversal of warfarin ...

Should GLP-1 agonists be held during chemotherapy?

What is your approach for patients with a history of nephrolithiasis who are being evaluated for living kidney donation?

How do you manage anticoagulation in a patient with DVT from likely malignant mechanical obstruction?

Patient has bilateral common, internal, and external iliac and femoral DVT from obstruction by a large uterine mass that is likely malignant and is pl...

Would you consider the use of an anabolic agent to promote fracture healing?

Would you recommend initiation of cinacalcet in a patient with hypercalcemia and recurrent nephrolithiasis attributed to an atypical presentation of familial hypocalciuric hypercalcemia?

Do you recommend routine neurosyphilis testing in patients being evaluated for dementia?

How do you manage pregnant individuals with newly diagnosed idiopathic intracranial hypertension?

Would you stop an ACE inhibitor/ARB or instead initiate a potassium binder to manage hyperkalemia in a patient with proteinuric CKD stage 5 who is on an ACEi/ARB?

What is the rationale/evidence to support doing 4 puffs of albuterol vs. 2 puffs for a reversibility study?

Do you recommend combined baseline cortisol and DHEA-S testing to improve the efficiency and accuracy of adrenal insufficiency diagnosis?

How would you approach the treatment of a patient with solid food esophageal dysphagia and GERD without a detectable esophageal stricture on upper endoscopy?

Would empiric esophageal dilation exacerbate GERD physiology?

Do you routinely check digoxin levels, and if so, when would you consider using Digibind in chronic digoxin use patients?

Is your pattern for drug monitoring different if digoxin is being given for afib vs HFrEF?

Would you consider sotalol to be a suitable non-selective beta blocker for primary prevention of variceal bleeding in a patient who requires sotalol for treatment of arrhythmia in the setting of Fontan-associated liver disease and clinically significant portal hypertension?

Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?

Labs with normal PT, but prolonged PTT (47 sec, ULN 40 sec) that does not correct on immediate mix. Lupus anticoagulant negative (DRVVT and hexagonal ...

Do you continue TNF inhibitors in patients with a new diagnosis of CLL?

Patient with long standing history of HLAB27 associated uveitis on adalimumab and new diagnosis of CLL.

Are there any contraindications using nurtec in patients with headaches in the setting of recent RCVS?

If a patient has potential arrhythmic-sounding syncope and a noninducible type 2 or 3 Brugada ECG pattern, have we excluded Brugada syndrome as the etiology for their syncope?

Should we then investigate for alternative syncopal etiologies before considering therapy (i.e. ICD implant)?

Is there a role for cinacalcet suppression testing when evaluating patients for suspected primary hyperparathyroidism who also have recurrent calcium containing kidney stone disease?

Do you recommend initiating immunosuppression and plasmapheresis in patients with dialysis dependent AKI in the setting of anti-GBM disease who do not have pulmonary involvement?

What type of DES should you opt for if a patient has or is concerned about possible nickel allergy?

How do you approach hematuria in a patient with diabetic nephropathy?

How would you decide between conservative management vs. ILR or pacemaker for asymptomatic nocturnal bradycardia/pauses (as an example rates in the 30s, pauses ranging 4-12 seconds) in the absence of bradyarrhythmias during the day and ECG with normal intervals, and not otherwise on medications to slow down HR?

For additional context, work up with TTE and exercise stress testing have all been reassuring and normal.

Would you expect cinacalcet to lower calcium levels in a patient with Familial Hypocalciuric Hypercalcemia (FHH)?

If a patient who has Familial Hypocalciuric Hypercalcemia (FHH) is misdiagnosed as PHPT (Primary Hyperparathyroidism) and treated with Cinacalcet, wil...

Based on most current research regarding the more widespread use of class IC antiarrhythmic drugs, what are your prescribing practices in patients with coronary artery disease?

To further elaborate, what level of obstruction with a normal stress test would be acceptable, and what would be too high risk? Would you consider an ...

How does your approach to subsegmental PE differ from segmental PE both diagnostically and therapeutically?

What is your approach to management of intradialytic hypotension and autonomic dysfunction in a patient with ESKD?

What are reasonable alternatives to invasive angiography for CAV surveillance in patients who are a few years out from cardiac transplant with impaired renal function?

What factors would influence your decision to use or avoid heparin bridging in patients with mechanical heart valves resuming anticoagulation after intracerebral hemorrhage?

In light of a publication by Sakusic et al., PMID 39102615 suggests an increased risk of ICH expansion in patients with heparin bridge compared to sta...

What is your approach to evaluating amiodarone induced interstitial pneumonitis?

How do you screen rheumatoid arthritis patients for lung disease (modality, frequency, patient selection)?

This question is part of our collaboration with ACR Convergence 2024 to Continue the Conversation from the meeeting. This question was inspired by the...

Can cardioversion be safely performed for recurrent atrial fibrillation in patients who have undergone left atrial appendage clipping during CABG, if they are not on chronic anticoagulation anymore?

What treatment would you offer a patient with extensive lymphangioma circumscriptum intermittently covering the entire abdomen?

When should one consider obtaining a cardiac MRI in ischemic stroke patients?

What is the utility of it?

What is the interpretation of an IGRA with positive TB wells and negative nil and negative mitogen wells?

A patient on meloxicam for LBP developed high, persistent fevers and no other symptoms. An IGRA, among many tests, was sent. The IGRA’s mitogen ...

For patients with spinal hardware infections, in what circumstances do you recommend 12 weeks over 6 weeks of antimicrobial therapy?

What 24 hr urine calcium cut off value do you use for recommending parathyroidectomy in patients with asymptomatic hyperparathyroidism?

Changes in criteria for hyperparathyroid surgery. In the 2022 5th International conference on asymptomatic hyperparathyroidism, the experts have chang...

With the FDA recently approving acoramidis for ATTR cardiac amyloidosis, how should should we decide on optimal drug therapy and options for our patients?

What is your preferred iron loading strategy for patients with anemia of chronic kidney disease?

Are there any varying treatment considerations to make when managing patients with carbonate apatite versus hydroxyapatite kidney stones?

Is active cocaine or methamphetamine use a contraindication to implanting defibrillators?

What additional treatment strategies would you recommend for a patient with a Mycobacterium chelonae and Mycobacterium abscessus infection following bilateral prophylactic mastectomies and implant insertion, who has undergone multiple surgeries and an extended course of IV antibiotics selected based on sensitivities?

How would you approach the workup of unilateral chorea with a normal MRI?

Can lupus anticoagulant be positive despite a normal aPTT?

How often does this occur and does this lower your suspicion for a "true" or clinically significant lupus anticoagulant?

How do you approach the treatment of Crohn's colitis in the setting of immunosuppression for liver transplant?

How would you plan a post-op, distal rectal adenocarcinoma s/p neo-adjuvant chemotherapy and APR with minimal treatment response?

How would your planning be influenced by a possible, single inguinal lymph node metastasis?

Should I treat a patient who doesn't know she has cancer?

My patient’s family has asked that I don’t tell her that she has metastatic cancer because it will devastate her. I am planning on palliat...

Do you routinely recommend suppressive antibiotic therapy for patients with spinal hardware infections who have undergone surgical debridement with retention of hardware?

How do you approach a patient with biochemical evidence of primary hyperparathyroidism, but normal parathyroid scan?

What is your approach to secondary stroke prevention in patients with atrial fibrillation and intracranial stenosis (>70%)?

What is your approach to management of tremors in a kidney transplant recipient who is taking a CNI for immunosuppression?

When do you attribute tremors to lamotrigine?

How do you differentiate between hyperactive delirium and excited catatonia?

Do you obtain an MSLT or start empiric therapy with modafinil in patients with residual excessive daytime sleepiness despite optimal adherence to PAP therapy?

In patients with an average of less than 5 respiratory events per hour, adequate sleep duration and hygiene were confirmed on the sleep log, absent ca...

What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?

How would your recommendation change if the patient has H63 homozygous mutation?

How do you approach the work-up for a patient with iron deficiency anemia who is not responding to oral iron therapy?

Presuming good medication adherence.

Do you try to treat the acidosis resulting from acetazolamide in patients with IIH?

Would you start treatment for MAC in a patient with nodular bronchiectatic disease who has demonstrated radiographic progression but remains asymptomatic and smear-negative?

How soon after excising a keloid do you inject kenalog?

Any particular concentration? Hayashi et al., PMID 22272655 Ekstein et al., PMID 32905614

Should CT coronary calcium score be avoided in dialysis patients in light of presumed high prevalence of CAC in this population?

What is your approach to patients with chronic kidney disease who are found to have pelviectasis without hydronephrosis on renal ultrasound imaging?

Where does dronedarone fall in your list of antiarrhythmics drugs to use in terms of efficacy and patient selection in contemporary management of atrial fibrillation?

Would you change treatment approach for rectal cancer with an associated intussusception?

Are there data to support full-dose anticoagulation added to an antiplatelet in recurrent peripheral arterial thrombosis requiring revascularization and stenting?

Assume the patient does not have another indication for AC like VTE or AFib. Could this be suggestive of a hypercoagulable state?

Is there any difference between colchicine 0.5mg vs 0.6 mg for high risk coronary artery disease?

European trials used 0.5mg dosing, whereas we have 0.6mg widely available in the US (but significantly less expensive than the 0.5mg dosing).

When do you consider revascularizing Chronic total occlusions after failing medical management?

Do you stop ACEi or ARB medications in patients with ESKD who are on hemodialysis and have issues with chronic hyperkalemia?

How do you address akathisia for patients who have had otherwise an excellent response to their antipsychotic treatment?

For patients with hypertension who have normal filling pressures following right cardiac catheterization, can hypertension still be attributed to volume overload?

Is there any utility to trending Histoplasma serology titers to guide duration of therapy or treatment response for pulmonary histoplasmosis with negative urine antigen?

How often do you rely on using the C1 inhibitor functional assay versus the quantitative level alone to diagnose HAE?

Do you recommend, based on current evidence, avoiding antimotility agents in patients with non-fulminant C. difficile infection who have no evidence of ileus?

What is your approach for patients with recurrent nephrolithiasis who you have a strong suspicion for primary hyperoxaluria though genetic testing returns without any abnormalities?

Is there a role for DOAC use for patients with unprovoked PE, that have had recent sleeve gastrectomy with duodenal bypass?

Or do you generally prefer warfarin/non-DOAC agents? Do you consider trialing DOACs and testing anti-Xa DOAC levels to assess for absorption?

How would you manage elevated vWF and FVIII levels in a patient with a family history of coagulopathy?

vWF and FVIII activities ~200% and were checked because of the patient's family history of "coagulopathy". Is there any utility in repeating the test...

Is there any benefit in maintaining statin or aspirin therapy in patients >75 years old with stable, multivessel ischemic heart disease in light of challenges encountered with polypharmacy?

Do you have any specific recommendations to prevent large fluctuations in sodium levels during a colonoscopy prep in patients with central diabetes insipidus on DDAVP?

Do you take any different approaches for patients with end stage kidney disease who are about to be initiated on intermittent hemodialysis and have residual renal function?

Is it ever safe to use a biologic DMARD in a patient with RA who is on suppressive antibiotics due to a history of septic prosthetic arthritis?

What criteria do you use to decide when to perform a BAL in hypersensitivity pneumonitis?

Do you perform it on every suspected case, or are there specific indications you look for before proceeding with BAL?

What are reasonable next steps in the work-up of suspected ATTR amyloidosis if the PYP scan is equivocal, in light of the potential risks of endomyocardial biopsy?

Especially if cMRI is not possible in the presence of non-MRI conditional devices and abandoned leads.

In patients with diffuse scleroderma and symptomatic lower extremity venous insufficiency, would you recommend treatment with endovenous laser/ablation?

The patient has tried conservative measures with compression stockings.

How do you approach the medical evaluation of new onset psychosis in elderly patients?

How do you view the balance between opting for percutaneous coronary intervention and prioritizing optimal medical therapy as the initial treatment choice for patients with stable angina?

ORBITA-2 Trial

How do you approach severe anemia and thrombocytopenia in an elderly patient whose bone marrow biopsy shows hypercellular marrow with mild dysplasia in erythroid and megakaryocytic lineage but normal cytogenetics and a negative NGS panel?

Hgb is 8 and platelets 10. A very small PNH clone (0.08%) detected. No evidence of hemolysis. No response to steroids. All other anemia/thrombocytopen...

Do you recommend checking 1,25-hydroxy vitamin D levels in patients with recurrent nephrolithiasis who have hypercalciuria of unknown etiology?

Would you treat an ESKD patient with renal artery stenosis in an attempt to improve blood pressure control and preserve residual renal function?

Would you initiate anti-arrhythmic drug therapy in patients who are asymptomatic and have normal LV function but with a PVC burden > 20 percent?

How do you interpret CSF pleocytosis in the context of significant leukocytosis on CBC?

For example, a patient with 100 WBCs in CSF with a peripheral WBC 43k/mm3 due to AML.

How do you approach PJP prophylaxis in patients with rheumatic disease on corticosteroids?

Does the presence of ILD change your approach?

What are the differential and workup for a patient with findings suggestive of idiopathic intracranial hypertension without papilledema on examination?

How do you use cardiac biomarkers, if at all, in prognostication for patients with ischemic stroke?

In light of data from Chang et al in J Neurol Aug 2024 showing that biomarkers such as LDH and troponin were associated with adverse clinical outcomes...

What further evaluation do you pursue for patients who present with vague symptoms such as subjective fevers or intermittent night sweats, who have no pulmonary symptoms but have a positive IGRA?

How would you approach the treatment for patients with renal-limited ANCA vasculitis who have persistent proteinuria, hematuria, and ANCA titers and have completed a steroid taper and received three doses of rituximab?

For how long would you treat a patient with dematiaceous fungi growing on a native heart valve discovered at the time of valve replacement?

How does one interpret an SPEP showing potentially obscured but non-quantifiable M-spike however an IFE showing monoclonal protein?

Can you elaborate on reasons for a non-quantifiable SPEP and how does one follow the paraprotein?

Has there been an observed interaction between ACE inhibitors and development of angioedema in a block demarcated superficial radiation therapy treatment volume (ex. lip)?

After discontinuing the ACE inhibitor, the angioedema resolves three to four days later and does not recur when radiation is resumed.

Do you pursue a cardiac evaluation in all patients with an excised cutaneous myxoma?

How do you approach the management of aortic stenosis in an elderly, frail patient with multiple comorbidities who is symptomatic but considered high risk for surgical aortic valve replacement?

How would you treat an asymptomatic patient with a positive Blastomyces antibody, evidence of prior granulomatous lung disease on imaging, and who may require immunosuppression in the future?

Would elevated bone mineral density/T-score be enough to make a diagnosis of osteopetrosis?

How long do oscillopsia and ataxia secondary to thiamine deficiency last after completing repletion?

How do you engage and approach a patient presenting with psychotic symptoms who has demonstrated a pattern of malingering and also has polysubstance use disorder?

Would you recommend transition to hemodialysis for a patient with calciphylaxis, hyperphosphatemia, and ESKD on peritoneal dialysis?

Do you always perform salivary gland biopsy to confirm the diagnosis In patients with suspected seronegative Sjogren's syndrome?

Does receiving IVIG confound the result of SPEP and/or UPEP?

What are some TTE findings that suggest worsening function of a bioprosthetic AVR that would require further surveillance or diagnostic imaging?

How many days prior to surgery do you recommend stopping SGLT2 inhibitors and when is it safe to resume therapy?

What is the clinical significance of a low titer RNP, negative Sm, but Sm/RNP that is very high titer?

I'm uncertain why both individual parts can be so low/negative but together very positive. Is there an assay discrepancy, a false positive?

What is the likelihood of recovery of parathyroid gland function for patients who underwent total thyroidectomy, found to have embedded parathyroid glands intra-operatively and then subsequently had them re-implanted into neck muscle?

How do you determine which patients with ANCA associated vasculitis may be good candidates for reduced dose glucocorticoid tapering?

This question is part of our collaboration with ACR Convergence 2024 to Continue the Conversation from the meeeting. This question was inspi...

Would it be reasonable to begin considering GLP1 RAs or finerenone for patients with heart failure with recovered LVEF in light of recent trials such as SELECT and FINEARTS-HF showing some success in HFpEF and HFmrEF populations?

Or should they be continued on maximally tolerated GDMT?

When and how should we use biomarkers (i.e., CRP, stool calprotectin, mAb levels) to guide or optimize medical management of Crohn’s disease or ulcerative colitis?

Do you interpret failure to develop hypernatremia with prolonged water deprivation (such as for 12 hours) as evidence against diabetes insipidus even if the urine osmolality is just below normal?

For a patient whose sodium remains 142 despite water deprivation from 8 pm to 8 am, with urine osm of about 500, is further testing needed?

What specific criteria or patient conditions would make you hesitant to use fluoroquinolones early in the treatment course for managing MSSA joint infections with oral antibiotics?

For example, baseline QT prolongation, elderly age group, or underlying heart disease?

How soon after starting treatment for Takayasu arteritis do you decide on the need for any vascular interventions to manage chronic damage?

Is there a role for use of GLP1 R agonist or dual agonist therapy for management of post bariatric hypoglycemia and dumping syndrome?

What other conditions should you consider in someone with presumed Tolosa Hunt but without significant improvement on steroid therapy?

Do you routinely consider FDG PET/CT imaging for workup of fever of unknown origin?

Do you recommend immediate catheter removal or anticoagulating for a certain amount of time before removing the tunneled dialysis catheter of a patient with an incidentally found, asymptomatic thrombus at the end of the catheter that does not interfere with hemodialysis?

What antidepressants are recommended for management of depression or anxiety in patients with spinal cord injuries?

Do you avoid certain antidepressants related to the risks on suppressing respiratory-drive which is potentially concerning in patients with high cord ...

Do you recommend obtaining both a parathyroid ultrasound and a parathyroid nuclear medicine scan when evaluating a patient with recurrent calcium based nephrolithiasis who is found to have an elevated PTH level, hypercalcemia, and hypercalciuria?

What is your approach to treatment of airway involvement, such as recurrent bronchial stenosis, in relapsing polychondritis?

Are there specific immunosuppressive agents effective for this manifestation?

What is the duration of steroids that you prescribe for organizing pneumonia?

What is the interpretation of two IGRAs with negative mitogen wells, in the absence of immunosuppression?

A patient on meloxicam for LBP developed high, persistent fevers and no other symptoms. An IGRA, among many tests, was sent. The IGRA’s mitogen ...

How do you evaluate a patient with MGUS and peripheral neuropathy?

Can you explain when would you consider light chain amyloidosis work up with fat pad biopsy?

How soon would you repeat PET/CT in a patient with cardiac sarcoid after starting treatment with infliximab?

Pre-treatment troponin was mildly elevated, while ILR2 receptor, ACE, CRP, ESR were normal.

How do you manage tacrolimus-related psychosis?

How would you manage a patient with Crohn's disease on a biologic and presents with non-bloody diarrhea, normal-appearing mucosa on sigmoidoscopy but severe colitis on biopsy with a positive CMV stain?

Would you send a CMV DNA PCR in blood, and if you elect to treat with anti-CMV medication, how long would you treat and what parameters would you use,...

How do you manage persistent rectal bleeding in the setting of rectal adenocarcinoma in a treatment-naive patient?

How do you approach management for CCUS with severe cytopenias?

Bone marrow biopsy does not meet criteria for MDS and no other identifiable cause of the cytopenias.

What are some indications that might lead you to pursue a kidney biopsy in a patient with presumed diabetic kidney disease?

What typical lab tests do you send off for evaluation of neuropathy?

When do you use specialized panels for neuropathy? Which panels do you typically use?

How do you determine if a pyoderma gangrenosum lesion is “burned out"?

What changes do you make to your treatment approach to adapt to this altered disease state?

In patients with post-MI LV thrombus which resolves after 3-6 months of anticoagulation, would you consider surveillance imaging for thrombus recurrence if there is persistent apical akinesis?

Do you find adding fludrocortisone helpful in treating persistent hypotension in HD patients already on midodrine and without evidence of adrenal insufficiency?

Do patients with central adrenal insufficiency on maintenance hydrocortisone therapy require doubling of their corticosteroid during chemotherapy cycles?

After corticosteroids, what second line agent do you select to treat drug induced hypersensitivity syndrome (also known as DRESS syndrome)?

Does the presence of diastolic dysfunction guide subsequent pharmacological, pacing and ablative therapies for atrial fibrillation?

If so, what diastolic parameters do you look at?

Do you ever use ocular ultrasound in evaluation of papilledema?

How do you medically manage uncontrolled Graves' disease in a patient awaiting surgery who is intolerant to methimazole and PTU and refusing RAI?

Patient had intolerance to methimazole and then developed agranulocytosis with PTU. FT4 is 2.9 (upper normal range is 1.7). I have started the patient...

How would you manage a patient with Takayasu arteritis controlled on TNFi who develops erythema nodosum that is only partially responsive to NSAIDs?

Would you view this as a sign that disease is not adequately controlled despite labs and imaging suggesting no active vasculitis?

Do you favor timely bronchoscopy for diagnostics over close surveillance in mildly symptomatic patients with CT findings suspicious for NTM infection who are not able to expectorate?

What role do anti-seizure medication levels, such as levetiracetam, serve in seizure-free patients?

Is there a role in adjusting the medication doses to levels in seizure-free patients; or is it sufficient to just monitor patients clinically?

Would you evaluate for thrombophilia in patients with incidental splenic infarcts in the setting of known cirrhosis, portal hypertension, and splenomegaly?

How would you approach anticoagulation in this situation? Does the presence of thrombocytopenia or hemorrhagic splenic infarcts change your manag...

Would you anticoagulate an SMV thrombosis caused by malignant obstruction in the setting of metastatic colorectal cancer?

For what duration and is there a preferred anticoagulation agent?

Do you use any urinary staining techniques when performing urine microscopy for patients with acute kidney injury?

Is there a specific INR cut-off value that would prompt you to consider administering vitamin K for patients with mechanical valves requiring urgent non-cardiac surgery and if so, what would be your starting dose?

What treatment do you use for stroke prevention in cervical artery dissection?

In light of the STOP-CAD study

What clinical sign or symptom do you consider to be the most specific for Cushing syndrome?

What prompts you to procure EEG and/or imaging in patients presenting with multiple simple febrile seizures?

With the recent trials such as SELECT and STEP-HFpEF demonstrating benefits of GLP1-agonists in terms of CV risk reduction and improved exercise function, have you begun to incorporate this class of medications into routine CV health maintenance for patients with HFpEF and/or pre-existing CAD?

What immunosuppressant will you choose in a patient with necrotizing myopathy partially responding to IV steroids and IVIG with a history of non Hodgkins lymphoma?

How do you approach the management of patients with suspected membranous lupus nephritis who are found to have positive PLA2R antibodies?

What would be the differential and initial workup for tongue fasciculation?

For which stroke patients, if any, do you recommend implantable loop recorder for long-term cardiac monitoring and why?

It seems clear that longer monitoring yields more AF detected. What is less clear to me is whether all ILR-detected AF is relevant and merits anticoag...

How do you interpret the presence of GAD antibody in a middle-aged patient with diabetes when all other type 1 diabetes antibodies are absent?

How do you counsel patients on peritoneal dialysis regarding the safety of engaging in aerobic and resistance exercises, considering the risk of developing abdominal wall complications?

How do you approach palliative conversations about what patients can expect when deciding to stop maintenance dialysis?

Do you recommend avoiding radial artery access for cardiac catheterization to preserve potential future dialysis access sites in patients with advanced CKD?

Would you start anticoagulation in a patient with RCC and related (tumor) thrombus with extension to renal vein and further?

Are there instances when you dose sodium zirconium cyclosilicate more than once daily for long term therapy for patients with end stage kidney disease and hyperkalemia?

How soon after starting treatment would you repeat imaging in patients with Takayasu to monitor response and ensure you have the correct diagnosis?

Do you monitor patients with CTAs or MRAs?

What is the best way to manage low systolic blood pressures on clozapine when the patient has failed multiple other antipsychotic trials?

Would you accept the diagnosis of SLE on the basis of an AVISE CTD panel where the results just showed a positive EC4d or BC4d, positive ANA>1/80 + one clinical criteria such as multiple tender joints but did otherwise not fulfill criteria for SLE?

How do you treat patients with stroke thought to be secondary to Lambl excrescence?

What is the utility of checking reverse T3 in clinical practice?

What is your approach to differentiating RA-ILD from medication toxicity (I.e. from methotrexate)?

Can you explain the block and replace approach in the treatment of thyrotoxicosis, including when it is most appropriate to use and how it compares to other treatment options?

What is the role for iothalamate clearance testing for glomerular filtration estimation in patients with chronic kidney disease?

What is the clinical significance of positive anti-thyroid antibodies in a patient that is post-thyroidectomy?

What is your diagnostic approach to patients referred for central sleep apnea on PSG but normal overnight EEG and MRI?

What techniques do you use in the lab to reduce the amount of contrast that needs to be used in patients with CKD?

How do you approach evaluation and management of a patient with recurrent monoarticular inflammatory arthritis of unclear etiology?

Synovial fluid analysis: cell count >100,000, > 80% neutrophils. Gram stain, cultures (including fungal and mycobacterial), synovial biopsy, and...

Do you generally prefer to continue hydroxychloroquine in lupus patients who develop ESRD despite the low likelihood of clinically active disease in this patient population?

How do you counsel patients who experience diarrhea from mycophenolate mofetil (Cellcept)?

Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies?

How do you manage significant asymptomatic indirect hyperbilirubinemia in patients with hemolytic diseases (SCD, HS, etc.)?

Do you consider starting Ursodiol? Do you perform routine abdominal ultrasound to monitor for cholelithiasis?

For patients with SLE, is there an ANC level for which you would hold or adjust hydroxychloroquine in an asymptomatic patient?

UpToDate recommends Hydroxychloroquine for all SLE patients, but neutropenia is sometimes ascribed to HCQ rather than the underlying disease. What lev...

How do you manage patients with atrial fibrillation having a thromboembolic infarct despite being on adequate anticoagulation?

Would you recommend left atrial appendage occlusion with or without continuing anticoagulation? In light of Maarse et al., JAMA Neurology 2024.

In a patient with anaphylaxis and loss of consciousness from stinging insect, suspected to be yellow jacket, the sIgE was significantly positive to all vespids, but honeybee and paper wasp were only 0.44, would you evaluate further with skin testing to wasp and decide on including wasp in treatment based on skin testing being positive or include it with just the low IgE level?

Have you adopted the use of low dose morphine for treatment of cough in patients with IPF?

If so, what dose and formulation of morphine do you prefer?The PACIFY COUGH trial utilized controlled-release morphine 5 mg BID, however the lowest do...

Do you administer immunosuppression to patients with idiopathic NSIP who have normal lung function and mild to moderate respiratory symptoms?

Do you avoid sodium zirconium cyclosilicate use in your patients with ESKD and hyperkalemia who also have peripheral edema?

How do you approach rising PSA following radical prostatectomy and early salvage radiation therapy?

What are your action points in terms of PSA thresholds?

Do you routinely recommend a lumbar puncture for patients with suspected ocular or otic syphilis in the absence of additional CNS symptoms?

Do you routinely treat chronic sacral osteomyelitis when there is no plan for debridement or flap?

When do you consider starting short-term DAPT in patients who present more than 24 hours after the onset of a high-risk TIA or minor stroke syndrome?

In light of the INSPIRES trial publication.

How would you approach management of nodular scleritis in the setting of suspected GCA?

Can nodular scleritis be a presenting manifestation of GCA?

How long do you treat retroperitoneal fibrosis with immunosuppression?

What imaging do you use to monitor disease activity? Imaging only shows chronic, fibrotic lesions making it hard to assess disease activity.

How do you approach the bronchoscopic evaluation of a cavitary lesion of the lung?

Do you routinely perform transbronchial biopsies in addition to BAL in all cases?

What is your approach to GDMT uptitration (particularly dosing for ARBs/ARNIs/MRA) if there is further evidence of renal dysfunction, especially in situations with worsening AKI on CKD?

Would a decrease in eGFR by more than 30% prompt you to consider decreasing or discontinuing these medications?

What postural change in FVC is suggestive of respiratory muscle weakness?

Would you consider treating empirically for AVP deficiency in a patient who had pituitary surgery 6 months earlier and complaints of polyuria/polydipsia with dilute urine (without performing water deprivation studies)?

What is your approach for steroid dosing for patients with ANCA vasculitis on induction treatment with rituximab, avacopan, and glucocorticoid therapy?

What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?

How do you manage patients with central sleep apnea due to heart failure with reduced ejection fraction?

Are there specific scenarios in which you employ BPAP with a back up rate?

How do you differentiate demoralization from depression during cancer treatment?

Should the age at which patients transition from pediatric to adult care differ depending on the disease diagnosis?

What nuances do adult rheumatologists need to understand about pediatric diseases?

How would you prioritize physiotherapy and cognitive behavioral therapy for functional movement disorders in a resource-limited setting where access to both might be constrained?

In light of the publication by Macías-García et al., PMID 39102249 on combined physiotherapy and cognitive behavioral therapy for functi...

How do you approach a patient with sarcoidosis who cannot tolerate steroids and who is developing ILD?

Do you use TNF-i or MMF?

How do you read a PFT with restrictive type spirometry but normal lung volumes?

What clinical significance does this have and how do you follow these patients?

When should metformin be stopped before surgery and when is it considered safe to resume?

Do you monitor CBCs to assess for drug toxicity in patients on nintedanib?

Would you treat a sputum culture positive for Aspergillus niger despite an atypical CT chest and a negative serum galactomannan in an immunosuppressed patient who is too high risk for bronchoscopy?

How do you approach management of ILD in the presence of weakly positive RF and ANA but no other objective systemic findings of connective tissue disease?

Is this managed as CTD-ILD with immunosuppressive +/- anti-fibrotic agents?

In a patient with low titer +anti-SAE antibody and known ILD, but no other clinical features of dermatomyositis, how would you approach further testing or would you treat the patient as dermatomyositis associated ILD?

When do you consider the use of clonidine in gabaergic withdrawal and how do you approach the risk of masking the autonomic signs of withdrawal when it is used?

Would you consider the risk of masking autonomic signs of alcohol withdrawal with clonidine different from beta-blockers?

How often do you see bony erosions in patients with Lyme arthritis?

How do you choose between finerenone and traditional steroidal MRAs for patients with heart failure and mildly reduced or preserved EF, considering recent results showing finerenone's efficacy in reducing heart failure events?

Soloman, et al., PMID 39225278

How do you approach a patient on anti-TNF with positive Quantiferon (previously negative) with negative chest x-ray and no symptoms?

What varying approaches do you take in suicide risk assessments?

Do you use different approaches in different settings (i.e., the ED vs. outpatient clinic)? Do you use different approaches for chronic vs acute suici...

How would you approach the workup and management of a young patient with recurrent biannual non-scarring oral ulcers and new onset neurologic symptoms with associated CNS white matter lesions concerning for Behcet’s?

How do you approach use of DMARDs and/or biologics for inflammatory arthritis in patients with a history of seizure disorder on anti-epileptic medications?

Is there any concern for drug interactions of DMARDs and/or biologics with anti seizure medications?

Do you recommend parathyroid adenoma resection or ablation for patients with primary hyperparathyroidism and recurrent nephrolithiasis who are found to have a single gland adenoma on parathyroid ultrasound and nuclear medicine imaging?

What parasites do you screen for in your workup of HES?

Is omalizumab an option for a patient needing a specific antibiotic with an IgE-mediated reaction who continues to have reactions during a desensitization?

What are some potential etiologies to consider for isolated, mildly elevated BNP levels with normal TTE findings in an asymptomatic, elderly patient?

What factors influence your choice between low-dose DOAC therapy and dual antiplatelet therapy for the first 3 months after percutaneous left atrial appendage occlusion?

Freixa, et al., PMID 39110427

Do you send CSF or serum ACE levels in the workup of neurosarcoidosis?

If not, are there any serum or CSF tests you consider to be helpful?

What infections should we rule out in patients who develop diarrhea on immunotherapy?

Chemotherapy is associated with acquiring C diff colitis. Does immunotherapy share that same risk and necessitate ruling out infection prior to anti-d...

What work up do you pursue for splinter hemorrhages in an otherwise healthy patient?

Do you utilize urinary leukotrienes as a marker for initiation of montelukast?

Do you prefer starting a SGLT2i before steroids in patients with IgA nephropathy and proteinuria > 1.0 gram/day who are unable to tolerate ACEi/ARB due to hypotension?

For patients with central hypothyroidism and a clear etiology (such as recent head irradiation), do you recommend brain imaging prior to starting thyroid hormone replacement therapy?

When would you consider using G-CSF in patients with rheumatic disease who have received cyclophosphamide?

How would you approach a patient with end stage kidney disease on peritoneal dialysis who has an adequate Kt/V but persistent azotemia?

Can TPO agonists, like avatrombopag or lusutrombopag, be used for patients with chronic thrombocytopenia and new acute portal vein thrombosis?

Do the presence of gastric varices and use of anticoagulation change the way you think about using these agents?

In your practice, when do you opt to treat unilateral primary hyperaldosteronism medically rather than surgically?

For patient with polycystic kidney disease and proteinuria who are on maximum dose of ACEi/ARB, what are other anti-proteinuric medications that should be considered?

How do you approach long-term blood pressure parameters in ischemic stroke patients with severe symptomatic intracranial stenosis?

How do you balance between having a higher long-term blood pressure to prevent flow failure and leading to worsening of stenosis or occlusion from the...

Do you use amyloid lowering therapy in patients on chronic anticoagulation?

How do you counsel them on the risk?

When treating pancreatic body/tail lesions that result in significant dose spread to the spleen, what is your threshold to offer pneumococcal, hemophilus influenza, and meningococcal vaccines?

What is your approach to immunosuppression in patients with preserved kidney function who are found to have nephrotic syndrome of unknown etiology and cannot safely undergo a kidney biopsy?

What workup do you recommend for patients with symptoms suggestive of saphenous neuropathy?

What criteria do you use to determine when to start a steroid-sparing agent for hypersensitivity pneumonitis?

Is there a role for suppressive antibiotic therapy when it comes to chronic femoral/tibial osteomyelitis?

How would you approach secondary stroke prevention in an adult with Hemoglobin SC disease?

Would you consider chronic RBC exchange versus HU?

For how long would you hold anticoagulation before percutaneous left atrial appendage closure with Watchman or Amulet devices?

In patients with possible Bartonella henselae infection and elevated IgG titer, what is the best way to confirm the diagnosis: tissue biopsy with Warthin-Starry staining, tissue sent for Bartonella henselae PCR, or tissue sent for culture?

Do you start immunosuppression for enlarging pulmonary nodules without symptoms, impaired pulmonary function, or extra-pulmonary disease in a patient with sarcoidosis?

What is your approach to DVT prophylaxis in patients who require IVIG but are at increased risk for thrombotic events?

E.g., a patient with newly diagnosed CIDP who is wheelchair-bound.

How do you workup patients with neuropathy suspected to be secondary to sarcoid?

Is a biopsy or EMG helpful in confirming the etiology? What is the best treatment for sarcoid neuropathy?

Do progesterone only oral contraceptive pills affect cortisol binding globulin?

When would be your threshold to consider obtaining an exercise RHC for undifferentiated dyspnea to help diagnose HFpEF?

What 60 minute cortisol threshold value do you use for diagnosis of adrenal insufficiency after ACTH stimulation?

Zha et al., PMID 35487459

How would you approach post-operative VTE prophylaxis for renal transplant in patients with a prior history of provoked VTE?

Are there specific guidelines for managing this patient population?

What would be your recommendation for treatment of worsening lung disease in a patient with long-standing scleroderma after long-term mycophenolate therapy which is no longer an option due to side effect/intolerance?

How do you determine the severity of restrictive lung disease?

Is there a role for phenotyping patients with CSU outside of a research setting by ordering IgG-anti-TPO, IgG-anti-FceRI , total IgE, total IgA etc.?

What is your approach to initiating spironolactone in patients with end stage kidney disease and heart failure?

For patients who have previously undergone MAZE ligation presenting with paroxysmal atrial fibrillation, how would you counsel them on the risk of stroke long-term when deciding whether or not to start or continue anticoagulation?

How do you dose gabapentin in patients with renal failure?

Which fracture sites outside of the classical spine and hip are considered to be osteoporotic fractures even in the absence of a bone density diagnosis?

Do you continue methotrexate in patients with inflammatory arthritis who develop non-melanomatous skin cancer while on therapy?

Do you hold anticoagulation prior to performing bronchoalveolar lavage?

What is your preferred, first-line class of anti-anginals for MINOCA with proven epicardial coronary vasospasm?

In patients with sicca symptoms and positive SSA/SSB how often do you perform other diagnostic testing such as salivary gland ultrasound, biopsy, Shirmers, ocular staining, stimulated salivary flow, etc?

Is the diagnosis of Sjogren's mostly clinical in a patient with a consistent history and physical with positive serologies?

Would you consider adding or switching to pirfenidone for a patient with progressing UIP (based on imaging and PFTs) who is currently on nintedanib?

When would you consider offering PVC ablation for otherwise healthy patients with preserved LV systolic function?

If PVC burden exceeded 10-15%, would you offer ablation in the absence of specific symptoms?

Should presence of coronary artery calcifications on CT/CTA be considered as presence of vascular disease on CHA2DS2-VASc score?

Are there instances when you would recommend obtaining a 24 hour urine protein measurement in place of spot urine protein studies in patients with acute kidney injury and proteinuria?

How would you manage a patient with morbid obesity who presents with new symptomatic pulmonary embolism a few days after he was started on DOAC for DVT?

What is your preferred anticoagulation in patients with BMI >50?

Do you recommend thiamine for patients presenting with acute symptoms of TGA?

How do you identify the subset of heart failure patients who are likely to benefit from cardiac resynchronization therapy in the setting of an RBBB pattern?

What patient characteristics prompt you to prescribe vericiguat for patients with heart failure with reduced ejection fraction who are already on standard therapy?

How would you approach treatment duration for patients with persistent candida species fungemia with a history of a prosthetic heart valve but negative TEE/CT PET and no other identifiable source of infection?

Does aspirin dose (81 mg vs 325 mg) matter for secondary stroke prevention?

Should some patients get 325 mg instead of 81mg at least for a certain amount of time, such as patients in the acute phase of ischemic stroke or patie...

Would you recommend a CT venogram or MR venogram in patients with concern for venous sinus thrombosis?

Does anyone utilize P2Y12 assays to determine if clopidogrel may be ineffective when used for DAPT?

If yes, if the assay shows they are a non-responder, do you switch to ticagrelor?

Do you recommend daily topical exit site antibiotic use for patients with a peritoneal dialysis catheter that is only currently being accessed for once weekly flushes?

What workup do you perform for elevated B12 levels in an adult who is not taking supplements?

For B12 levels >2000-4000.

Is there any indication for hydroxyurea in patients with sickle cell trait?

What is your approach to management of radiation-induced bullous pemphigoid?

Would you transition from IV to oral antibiotics in a solid organ transplant recipient with uncomplicated gram-negative bacteremia?

Nussbaum et al., PMID 38195100

Do you still consider hepatorenal syndrome in patients with renal impairment and liver disease who are found to have rare muddy brown casts on urine microscopy?

How would you approach pursuing a kidney biopsy in a patient with suspected lupus nephritis who is on warfarin for antiphospholipid antibody syndrome?

How would you approach the workup and management of isolated inflammatory subglottic stenosis in a young previously healthy patient that is steroid responsive with a completely negative serologic autoimmune workup?

Would you push for biopsy before deciding on treatment?

How do you manage arthritis resulting from deferiprone in transfusion dependent thalassemia?

How do you approach managing perioperative anxiety in Mohs patients?

In light of the NOAH-AFNET6 and ARTESiA trials, how would you approach the decision regarding anticoagulation for patients with incidentally-detected AF <24 hrs on pacemakers/defibrillators?

How would you balance the stroke risk against the bleeding risk? And how would the AF burden play into your decision- would you treat 6 minutes of AF ...

How do you approach management of new onset ILD in a patient with RA who is otherwise well controlled on methotrexate or leflunomide?

How would you manage cardiac sarcoid with intolerance/contraindications to methotrexate, azathioprine, and mycophenolate/mycophenolic acid and that has proven refractory to adalimumab and infliximab as determined by PET?

Do you treat prosthetic joint infections after a two-stage revision arthroplasty with oral antibiotics for the full duration of therapy, assuming a susceptible oral option is available?

Does your evaluation of a young person with spontaneous upper extremity DVT vary as compared to lower extremity DVT?

Do you do additional workup for venous obstruction or any other different testing/evaluation?

Do you use direct oral anticoagulants to treat port-a-cath related VTE in patients with an active malignancy?

Do social or economic factors (i.e., relative cost of acquiring LMWH, the patient being injection averse) affect your decision to use DOACs? Do you s...

What is your threshold to repeat a kidney biopsy in a patient with a history of lupus nephritis who is on maintenance therapy and develops subtle changes in urinary protein excretion or microscopic hematuria?

What is your approach to managing pyoderma gangrenosum recalcitrant to oral steroids?

When do you switch to steroid-sparing medications? What steroid-sparing therapies do you prefer?

Is there a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients?

Would you switch azathioprine to a different immunosuppressant if a controlled patient with SLE develops melanoma and/or non-melanoma skin cancer?

In obese men presenting with gynecomastia, elevated estrogens, and hypogonadism, what clinical factors would push you to obtain testicular and/or adrenal imaging to rule out an estrogen-producing tumor?

Do you base the decision off of the acuity and course of symptoms? The degree of estradiol elevation? Other factors?

What is your approach to radiographically suspicious lung nodules for which initial biopsy was negative for malignancy?

What are the implications of immunosuppressive therapy in a chronic asymptomatic T cell lymphopenic adult undergoing lung transplant evaluation?

What is your approach to managing hypokalemia in patients with Bartter syndrome who are on high doses of potassium chloride but cannot tolerate amiloride or ACEi/ARBs due to low blood pressures?

Under which circumstances is there a role for reduction in immunosuppression post-SOT in a patient with recurrent CMV viremia and/or disease?

What is your approach to monitoring of inflammatory markers during treatment of native vertebral osteomyelitis?

Do you prefer cinacalcet or etelcalcetide for patients with hyperparathyroidism in the setting of kidney disease?

Is there a role for routine LP in HIV patients with disseminated histoplasmosis even in the absence of CNS signs/symptoms?

Extrapolating from standard practice for management of cryptococcal antigenemia?

How do you approach the treatment of indeterminate UIP on HRCT with grossly positive MPO antibody and no other features consistent with AAV?

Can transudative pleural effusions lead to trapped lung?

In trapped lung, a fibrous peel over the visceral pleura restricts pleural expansion. Could transudative pleural effusions lead to this condition?

How do you approach the workup of clinically diagnosed cutaneous vasculitis in healthy young individuals without systemic symptoms?

Should there be a role for sacubitril-valsartan in the management of patients with heart failure with preserved ejection fraction?

PARAGON HF trial, PMID: 31475794

Do you favor 24 hour urinary metabolites over random urine collection when screening for MCAS?

Do you recommend parathyroid imaging testing for patients with recurrent nephrolithiasis who are incidentally found to have an elevated PTH but who do not have hypercalciuria, hypercalcemia, hypovitaminosis D, or chronic kidney disease?

Are there instances when you recommend performing a kidney biopsy in patients with presumed acute interstitial nephritis who are already on steroids and have improving renal function?

Would you add cholecalciferol or ergocalciferol to calcitriol therapy in patients with post operative hypoparathyroidism who have low 25 OH vitamin D levels?

Can 25 OH vitamin D be converted to activated vitamin D outside of PTH mediated mechanisms in some organs?

When would you add a third antibacterial agent in addition to macrolide and ethambutol for treatment of a patient with HIV and disseminated MAC?

How do you approach the work up of pulmonary artery aneurysm in the absence of other clinical features of Behcet’s?

How do you apply the 2HELPS2B score into clinical decision making for determining duration of cEEG testing?

Do you prefer monitoring creatinine over cystatin C levels in patients with lymphoma and chronic kidney disease given the potential for cystatin C levels to be increased with certain malignancies?

Hammouda et al., PMID 28282874

What imaging do you recommend for patients with suspected CSF leak?

How do you counsel newly diagnosed patients with ALS on dietary recommendations?

Patients often see a dietician at ALS centers, but what do you discuss with patients before they have a formal consult with a dietician?

Do you consider administration of nintedanib or pirfenidone via enteral tube in patients unable to take PO due to recurrent aspiration?

Do you find HZV titers useful in diagnosing shingles sine herpete?

Do you prefer assessing cystatin C or creatinine when monitoring a patient’s eGFR who is receiving chemotherapy for malignancy?

Would you recommend genetic testing to determine if there is a potential underlying primary process in a patient with congenital solitary kidney who is presumed to have secondary FSGS?

How would you approach a patient with anti-scl70 ab positive sine scleroderma complicated by ILD who also has seropositive RA with active arthritis?

Arthritis did not respond to HCQ.

How long do you recommend patients hold aspirin for prior to and after undergoing a native kidney biopsy?

What is your approach to progressive calvarial hyperostosis found in an elderly adult not caused by Pagets, acromegaly or hypercalcemia?

No evidence for acromegaly or Pagets.

Given the risk of hypocalcemia in dialysis dependent patients treated with denosumab, what is the best method of treatment for osteoporosis for these patients, and should we be transitioning to a different agent?

What features on CTA/MRA are most helpful for differentiating large vessel vasculitis from atherosclerosis?

How do you time 24 hour urine collections when calculating creatinine clearance for patients receiving thrice weekly hemodialysis?

What is your approach to monitoring blood parasite smears in an immunocompetent patient with babesiosis?

Do you continue smears until documented resolution, or by clinical progress?

What is your approach to managing patients with new laboratory evidence of hypopituitarism (e.g. very low plasma ACTH level and low morning serum cortisol) and a remote history of trans-sphenoidal surgery for NFPA?

Should GLP1 R agonists be used as first line glucose lowering agents in patients with ESKD and DM2?

What is your approach to anticoagulation in patients with hypertrophic cardiomyopathy and an apical aneurysm?

In patients presenting with classical findings of primary hyperparathyroidism (i.e mild hypercalcemia, high 24hr urine calcium, elevated 1,25 Vit D but normal PTH), can spontaneous normalization of calcium be explained by episodic hypersecretion of PTH?

What is your approach to differentiating tender spots (as in fibromyalgia) and enthesitis (as in axSpA)?

Does growth hormone (GH) replacement therapy reduce the risk of fractures in patients with GH deficiency?

How do you manage hyperalgesia in patients with sickle cell disease?

Are there instances when you recommend against a kidney biopsy in a patient with a single kidney who otherwise has indications for a biopsy, consents, and has no medical contraindications for the procedure?

Do you rule out active urinary tract infections prior to performing a kidney biopsy?

Under what circumstances would you recommend early fecal microbiota transplantation over antibiotic treatment or bezlotoxumab in a patient with recurrent C. difficile infection?

Have you used Karius to aid in the diagnosis of a non-resolving pneumonia, with negative bronchoscopy, biopsy, and other infectious work up in an immunocompetent patient?

What are the clinical indications and major limitations of lipoprotein apheresis?

How exhaustive (especially considering cost) should an immunological workup be for patients with extensive, recurrent, or deep seated Staph aureus infections without obvious immunocompromise (e.g. cancer, diabetes, steroids) or recurrent breaks in skin integrity?

How do you approach work up for underlying rheumatologic disease in patients referred for chronic urticaria?

Are there clinical circumstances in which there is a role for steroids in treatment of calcified neurocysticercosis associated with perilesional edema and seizures?

How do you determine which atrial fibrillation patients with a high thromboembolic risk and a contraindication for oral anticoagulation should undergo left atrial appendage occlusion?

Marcus et al., PMID 34775507

Does biotin interfere with the measurement of other metabolites of the Vitamin D pathway outside of the 25-hydroxy Vitamin D assay?

What treatments options may be considered in patients with POTS who also need daily diuretics to treat heart failure and are already wearing compression garments?

When would you consider utilizing bone scintigraphy in the assessment of inflammatory arthritis?

How often do you pursue malignant transformation screening In patients with lymphomatoid papulosis or pityriasis lichenoides?

And what workup do you pursue?

Do you check EPO levels in patients with anemia of chronic kidney disease?

Do you use the peri-operative management of biologics and DMARDs guidelines, which were mainly based on total hip and knee replacement surgeries, for all peri-operative surgical management?

Are there certain surgeries (including orthopedic) that you recommend continuing biologic DMARDs?

Do you diagnose MCAS if a patient is concurrently on drugs known to cause non-specific mast cell degranulation?

How do you manage stroke-related abulia?

Do you always comment on VA and KCO when reading PFT's when gas transfer is ordered?

How do you counsel patients with ALS on the benefits of enteral nutrition?

E.g., PEG tube placement.

Are there instances when you recommend femoral vein dialysis catheter placement in patients newly started on hemodialysis in an effort to preserve upper extremity future fistula options?

How would you best evaluate and manage a patient with hemiplegic migraine and a history of ischemic stroke?

How would you approach management of a patient with rapidly progressive systemic sclerosis with worsening skin disease, myositis, arthritis, dysphagia and failure to thrive developing within 6 months?

The patient is a young African American female of reproductive age with positive Fibrillarin antibody and nucleolar antibody. No ILD.

What instances will you start outpatient steroids in patients with nephrotic syndrome of unknown etiology prior to obtaining a kidney biopsy?

Do you favor the use of maximal inspiratory/expiratory pressure measurement or supine spirometry in the evaluation of a patient with suspected respiratory muscle weakness?

Is it true that a ferritin above 200 essentially rules out iron deficiency?

Does this hold true when the patient has significant inflammation?

How do you approach restarting cDMARDS/bDMARDS in a patient with active RA after incidence of disseminated CNS VZV infection while on tofacitinib?

When would you phlebotomize patients with secondary hemochromatosis, such as due to NAFLD/cirrhosis?

HFE gene mutations in C282Y and H63D are negative.

How do you approach treatment of a patient with active RA and a history of Lynch Syndrome?

Does your choice of DMARD/biologics change due to increased risk of malignancy?

What is your approach for de-escalation of antiarrhythmics for patients with a history of ventricular arrhythmias?

For example, for younger patients on amiodarone or those who wish to come off antiarrhythmics because of medication side effects.

Do you consider Anti-carbamylated protein antibodies (anti-CarP) as having any significance in evaluation of patients if RF and ACPA negative and clinically no active synovitis yet widespread arthralgias and generalized osteoarthritis?

How do you utilize cytokine panels in your clinical practice?

Is there utility when classic inflammatory markers (ESR,CRP) or disease specific markers (C3, C4, dsDNA) do not correlate with patients disease activi...

How do you decide when to obtain genetic testing for suspected autoinflammatory conditions in adults?

What is the utility of an oral calcium loading test to differentiate FHH from secondary hyperparathyroidism due to low calcium intake?

The patient has very low urinary calcium despite calcium supplements, vitamin D used to be low now normal. Continues to have elevated PTH with normal ...

What is your approach to management of pulmonary fibrosis in patients with a history of microscopic polyangiitis who do not have other active organ involvement?

Patient is with past history of glomerulonephritis in remission after rituximab for the past 2 years. +MPO/P-ANCA

What is your approach to managing intradialytic cramping that recurs despite multiple dry weight adjustments in a patient with ESKD?

How do you approach hypocomplementemia in Sjogren’s without features of lymphoma?

Is there a risk of hepatitis C activation with rituximab in a patient who has a history of HCV treated with antivirals and who is in sustained viral response?

Can Milwaukee shoulder present with a large subacromial bursitis, or does it predominantly cause joint effusion/destruction?

How do you manage patients with a prior intracerebral hemorrhage from probable cerebral amyloid angiopathy who develop new small vessel ischemic infarcts?

Would you consider using cilostazol instead of antiplatelets?

What is your preferred initial imaging choice for a patient suspected of having renal artery stenosis who does not have any contraindications to imaging contrast media?

What is a reasonable class of antihypertensive to start in patients with HCM who remain hypertensive and symptomatic in spite of maximal doses of beta blockade or calcium channel blockers?

How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...

How would you approach a young patient with bilateral lower extremity muscle weakness and positive anti-Smith, dsDNA, RNP, Raynaud’s, and pericardial effusion but normal muscle enzymes?

MRI with muscle edema but biopsy pending. Would you consider this overlap myositis even though muscle enzymes are normal?

What further work up do you recommend for patients with a chronic high anion gap metabolic acidosis with normal eGFR who have been ruled out for lactic acidosis, ketosis, toxic alcohols, and other usual culprits of high anion gap metabolic acidosis?

How would you treat pemphigus foliaceous in an elderly patient intolerant to oral steroids?

How do you treat persistent headache after RCVS?

What is your approach to managing asymptomatic ORN of the mandible?

Do you recommend sending an autoimmune work up for patients with recurrent nephrolithiasis and 24 hour urine chemistries consistent with distal renal tubular acidosis?

What specific markers or symptoms guide your decision to adjust or stop prophylactic calcium supplementation and calcitriol in managing postoperative hypoparathyroidism following thyroidectomy?

Would you consider exploratory surgery in a young patient with normocalcemic hyperparathyroidism that meets one or more criteria for parathyroidectomy but has no localized pathology on advanced neck imaging?

How do you choose between spironolactone and finerenone for patients with proteinuric diabetic kidney disease and heart failure?

In what clinical scenarios should we use the 2-day 2mg DST instead of the 1mg overnight DST for screening of Cushing syndrome?

How would you treat a sarcoid patient whose only manifestations are B symptoms and generalized lymphadenopathy?

How long after surgical repair of a pleuroperitoneal leak do you resume peritoneal dialysis?

What is the management strategy for patients who develop AKI and nephrotic range proteinuria secondary to biopsy proven FSGS during immune checkpoint inhibitor therapy?

How do you approach using DMARDs for patients with CPP arthritis who have frequent flares?

For example, I have a patient who has frequent (monthly) large to medium joint flares (Knee, Ankle) with crystal proven disease. Did not tolerate colc...

Would you recommend delaying left heart catheterization until development of ESKD in a patient with CKD Stage 5 and stable coronary artery disease given concern for contrast-induced nephropathy?

Do you consider late latent syphilis adequately treated if a patient receives a 10-14 day course of IV ceftriaxone for another indication?

Or would you still offer penicillin G benzathine once weekly concurrently?

When do you consider stenting in patients with recurrent stroke with ICAD?

Is ABI (Ankle Brachial index) lower limb arterial doppler not recommended if patient already has arterial stents in the legs, and if so, what other imaging modality would you consider as first-line?

What is the preferred approach to managing non-occlusive or partially occlusive venous sinus thrombosis?

How long do you treat uncomplicated gram-negative rod bacteremia in solid organ transplant recipients?

Do you avoid ESAs in patients with anemia and chronic kidney disease who also have Factor V Leiden?

What are alternate approaches to medical therapy and/or interventions to consider in patients with refractory, severe coronary vasospasm despite short-acting nitrates, calcium channel blockers, L-arginine, and clonidine?

How do you approach evaluation for underlying rheumatologic disease in patients with chronic asymptomatic thrombocytopenia?

Thrombocytopenia is moderate (80-100,000 microL). No concomitant cytopenias present.

When do you recommend testing for APOL1 variants in patients with proteinuric chronic kidney disease?

How do you manage patients with end stage kidney disease and recurrent ascites who do not have any evidence of cardiac or liver disease?

What is your approach to differentiating primary from secondary hyperparathyroidism in recurrent kidney stone formers who also have chronic kidney disease, an elevated PTH, and hypercalcemia?

When would you consider neuro-stimulants in post-stroke patients?

Is there management guidance on when to start after stroke onset?

What serologic biomarkers do you send to assess for sarcoidosis at baseline and/or during flares, in patients where it may correlate with disease activity?

Specifically, do you check for any of these: ACE, Vitamin D 1,25, serum lysozyme, soluble IL2 or Adenosine deaminase levels?

What criteria do you utilize in deciding when to treat or not treat frequent VPC’s?

Do you get volumetric MRI in all patients with cognitive difficulties?

How would you approach evaluation of a patient with persistent elevated ACE (angiotensin converting enzyme) level without evidence of cutaneous, ocular, or pulmonary granulomatous disease?

Patient with alcoholism referred to rheumatology for elevated ACE level in the setting of new onset mild sensory peripheral neuropathy on nerve conduc...

How do you approach management of adult patients with CVID and sarcoid-like syndrome?

Are there patients with granulomatosis with polyangiitis on maintenance rituximab therapy for whom you do not co-administer glucocorticoid therapy?

Do you routinely check a TSH level in patients with recurrent kidney stones who have hypercalciuria of unknown cause?

What is your preferred method for subclinical CAD screening prior to initiation of class IC antiarrhythmic drugs for atrial fibrillation?

Would you stop azathioprine in a patient with ANCA vasculitis who has been in long term remission on azathioprine, but has a new diagnosis of lung cancer requiring initiation of immunotherapy?

What are your preferred strategies to manage mild to moderate rectal ulceration causing tenesmus and discomfort after chemoradiation for rectal adenocarcinoma?

Or, to manage tenesmus and discomfort after any type of pelvic radiation.

What is your approach to a patient with undetectable MMR titers checked prior to or during immunosuppression and a history of MMR vaccination in childhood?

Is there a role for booster vaccination and if so, how do you approach the timing when a patient is already on a biologic for immunosuppression?

Would you consider using IVIG for POTS in the absence of any clear autoimmune condition or abnormal antibodies?

Do you ever consider close clinical monitoring over antifibrotic therapy in patients ascribed an MDD diagnosis of IPF who have normal lung function and are asymptomatic?

When is brain biopsy useful/warranted as part of the diagnostic work-up in patients with suspected primary CNS angiitis?

How often do you check carnitine levels in your patients with end stage kidney disease on hemodialysis?

What is your approach to managing osteoporosis in patients with end stage kidney disease?

How do you approach weakly positive PL-7 antibody in a patient who initially presented with muscle weakness, rhabdomyolysis and non specific muscular edema on MRI that resolved with IV fluids?

What is your approach to counseling a patient with stable but severe multivessel coronary disease if the patient does not wish to undergo bypass surgery?

And when would you consider referral for staged/complex PCI instead?

Do you extend the duration of maintenance therapy past 24 months for patients with ANCA glomerulonephritis who have multiple organ involvement?

For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?

How soon following pacemaker implantation can patients safely undergo elective cardioversion?

When would you initiate chronic therapeutic phlebotomy in a patient with erythrocytosis secondary to a high hemoglobin-oxygen affinity hemoglobinopathy?

Given that high coronary calcium scores portend significantly increased cardiac mortality rates over 5-6 years, is there any data to support performing coronary angiography when the score is very high, e.g. over 1000, even in asymptomatic patients with no objective evidence of ischemia?

In patients with concurrent, CAD and atrial fibrillation, more than 1 year post-PCI, the most recent AHA/ACC guidelines state that “oral anticoagulation monotherapy is recommended over the continuation of oral anticoagulant therapy and a single antiplatelet therapy.” If this individual undergoes surgery, the anticoagulant will be held. Would you then bridge with aspirin?

Joglar et al., PMID 38033089

How do you manage diarrhea in a patient with CTD-ILD on MMF who was recently started on full dose nintedanib?

What is the right approach in terms of GDMT and device consideration for patients with intermittent LBBB (QRS duration exceeding 150ms) and HFrEF?

Besides HR variability how can we explain resolution of the intermittent LBBB with HF GDMT (especially with ARNI use)?

In what situations would you treat a rectal mass as cancer despite negative biopsies?

For example, if mass is ulcerated and cannot be excised with polypectomy? Would you ever consider radiation and chemotherapy?

What are your next steps when managing patients with suspected Gitelman syndrome for whom genetic testing reveals variants of uncertain significance or novel mutations not well characterized?

Is there a role for repeat surveillance blood cultures in patients with prosthetic valve endocarditis without associated cardiac abscess after a 6 week course of antibiotic treatment without surgical intervention?

Following cardiac MRI, what imaging modality would you consider to further evaluate mild aortic regurgitation (regurgitant fraction on cardiac MRI of 26%) and mild to moderate mitral regurgitation secondary to mild bi-leaflet mitral valve prolapse (RF 30%) with low-normal LVEF and incomplete RBBB?

Do you diagnose obstruction by the criteria of FEV1/FVC < 70% or < LLN?

Do you avoid ESAs in patients with end stage kidney disease who also have heart failure due to increased risk of stroke?

In SIADH due to malignancy, do you prefer to use free water restriction or salt tablets?

Or other therapy - e.g., tolvaptan? Free water restriction may hinder QOL. Salt tablets may raise levels more quickly but have risks of edema and hype...

How do you approach interpreting a low titer dsDNA (such as crithidia 1:40 to 1:80) in the setting of a moderately elevated ANA without other specific features of SLE?

For example, the patient may have other findings such as an elevated CRP. Would you diagnose SLE, or would you want to see other serologies or finding...

How would you work up a patient with cutaneous mastocytosis?

Is a BM biopsy a must when there is skin involvement? If tryptase level is mildly elevated but less than 20 would you recommend a BM biopsy?

What is your approach to treatment of macrolide-sensitive localized bone/joint MAC disease?

Does a low serofast RPR titer (such as 1:1 or 1:2) in the setting of a remote history of appropriately treated latent syphilis in a patient with now uveitis of yet unknown etiology referred from ophthalmology for possible ocular syphilis make a diagnosis of ocular syphilis less likely?

What is your approach to guiding ophthalmologists regarding our clinical suspicion for ocular syphilis and does the quantification of the titer help i...

Do you recommend a kidney biopsy for patients who develop acute kidney injury after starting sacituzumab?

How would you approach a patient with axial spondyloarthritis who develops new-onset proteinuria?

How do you interpret the results of oligoclonal bands ordered to evaluate for demyelinating disease in patients with brain MRI lesions of unclear etiology?

Does the number of bands matter in making the diagnosis? Does it make a difference whether isolated or also in the serum? How do you interpret other r...

Have you applied the POET trial to clinical practice?

How would you manage a patient pre-operatively with a prolonged PTT that does not correct on mixing, with lupus anticoagulant testing that is abnormal by LA-PTT only?

Confirmatory tests with DRVVT, hexagonal phase assay, and PNP are all normal. No bleeding history

Is there any benefit from oral vs topical steroids in herpes zoster opthalmicus?

Would the management change if there were complications with optic neuritis?

When do you use MRI to evaluate patients with spontaneous subdural hemorrhage?

In light of the evidence associating cerebral amyloid angiopathy (CAA) with subdural hemorrhage; Rivier et al., PMID 38147345.

What is the indication for phlebotomy in compound heterozygous hemochromatosis?

What is the ferritin target that you would aim for? What would be your approach for a ferritin >500? When do you order an MRI liver for iron quanti...

How do you manage patients with ice-pick headaches?

What are your management strategies for patients with nephrolithiasis and hypercalciuria who have a severe sulfa drug allergy and are unable to tolerate thiazide diuretics?

Do you typically use NOACs or Lovenox in patients with stroke due to hypercoagulability from malignancy?

What is current best practice with regards to antibacterial prophylaxis in patients with hematologic malignancy and resolved neutropenic fever (>72 hours)?

How long do you continue antibiotics after cholecystostomy tube placement for acute cholecystitis?

Since the COVID-19 pandemic, increasingly we see management of acute cholecystitis with cholecystostomy tubes as opposed to surgery, even amongst pati...

Do you avoid SSRIs in patients with a history of RCVS?

How would you approach the work up of SLE in a patient over 80 years old?

How would you work up an elderly female with persistent anemia secondary to warm AIHA requiring almost monthly transfusion, with positive ANA,dsDNA (b...

Is there a role for nintedanib in the management of patients with radiation-induced pulmonary fibrosis?

When do you check macroprolactin in the evaluation of hyperprolactinemia?

For patients who have undergone ablation for atrial fibrillation with elevated bleeding risk, what is your risk/benefit approach when deciding to continue oral anticoagulation long-term?

Do you pursue a skin biopsy or kidney biopsy in patients whom you suspect have X-linked Alport syndrome?

Is there utility in monitoring IgE levels in patients with IgG4-RD?

How would you manage a patient with highly active ankylosing spondylitis, iritis and Crohn’s, controlled with weekly adalimumab with co-morbid IgG4RD and intolerance of azathioprine due to elevated LFTs?

IgG4 manifestations include autoimmune pancreatitis and periaortic soft tissue mass.

In patients with active IBD and rectal cancer, do you take any precautions before starting TNT?

Would you wait until bowel symptoms are controlled or ever pursue diversion before starting treatment?

Do you pursue a malignancy workup beyond age-appropriate malignancy screening in patients with antibody negative necrotizing myopathy?

In which patients do you prefer daily standard three-drug therapy for non-cavitary pulmonary MAC as opposed to three times a week dosing?

What are your management strategies for patients with end stage kidney disease on hemodialysis who develop hypercalcemia of immobility?

Is whole body PET scan sufficient to rule out cardiac involvement in sarcoidosis?

Do you repeat a lumbar puncture in a patient living with HIV diagnosed with and treated for neurosyphilis and if so, when?

Is there a role for SGLT-2 inhibitors in the treatment of chronic hypomagnesemia?

How would you manage a patient with diffuse Systemic Sclerosis who develops severe rapidly progressive calcinosis?

How would you approach the work up of a patient with nasal septal perforation, a negative infectious workup, and negative ANCA titers?

When do you re-image patients with a diagnosis of venous sinus thrombosis?

How do you interpret negative HMGCR antibody test results in a patient with necrotizing myopathy who has already been on treatment with steroids and whose CK has normalized?

Given that antibody levels seem to fluctuate with disease activity in a subset of patients would you assume that prednisone therapy could turn an HMGC...

Do you use serum or urine biomarkers other than creatinine when evaluating patients with acute kidney injury?

Should patients who develop primary hyperparathyroidism after 5 years of Prolia treatment for osteoporosis be referred for parathyroidectomy?

If so, when? Does surgery need to be timed with last dose of Prolia injection?

Do you recommend placement of a backup AV fistula in an advanced CKD patient who is planning to do peritoneal dialysis?

Prior retrospective studies have suggested a lower rate of future catheter use with a backup AVF in place (Haralabopoulos et al., PMID 32852703).

Is there a role for phlebotomy in secondary polycythemia?

Aside from addressing the underlying case, is there a role for phlebotomy in secondary polycythemia such as in COPD or post-renal transplant erythrocy...

Is there a risk of increased skin toxicity with combined radiation and doxycycline?

Does PT/PTT elevation due to severe vitamin K deficiency protect against thrombosis?

In the setting of requiring anticoagulation for atrial fibrillation and bioprosthetic valve, but also having severe vitamin K deficiency, would you st...

Do you recommend patients temporarily hold cilostazol prior to and after a kidney biopsy?

Is a bone marrow necessary in patient with splenomegaly and polycythemia vera?

How do you distinguish between primary and tertiary hyperparathyroidism in a patient with ESRD?

Is a biopsy of either skin or muscle always indicated in the diagnosis of dermatomyositis?

What is your approach to a patient with IgG4RD with past pulmonary involvement (biopsy proven) managed with steroids alone, now with new hematuria/proteinuria, but stable renal function?

Would you obtain renal biopsy first or treat with additional immunosuppression for suspected renal involvement related to IgG4?

What is the approach to use of ACE inhibitors for suspected scleroderma renal crisis in patients with only mildly elevated BP and renal artery stenosis?

Should methotrexate be stopped prior to radiation therapy if a patient has rheumatoid arthritis?

In which patients with suspected IgA nephropathy and microalbuminuria would you recommend a kidney biopsy?

Would you start any treatment for radiation pneumonitis if there is a large area of consolidation in the irradiated lung field but the patient is asymptomatic?

Would you consider pentoxifylline and vitamin E to mitigate fibrosis?

What is the preferred treatment regimen for cardiovascular syphilis, specifically syphilitic ostial coronary artery disease?

What are the important aspects that you mention when consenting patients for hemodialysis?

How do you manage severe intra-dialytic hypertension that is not responsive to dry weight challenge in an asymptomatic patient with ESKD?

Are there instances when you prefer serum creatinine over cystatin C when estimating GFR in a patient with CKD?

How would you lead a goals of care discussion in terms of prognosis/survival likelihood for patients with inotropic dependent HFrEF with CRT-D on maximally tolerated GDMT?

How do you discuss harms of MGUS screening with other medical providers?

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...

Can romosozumab be used in patients on dialysis?

How do you approach patients with RA and severe bronchiectasis with associated findings of UIP?

What is your approach to working up diarrhea in an immunocompromised patient?

How would you approach a patient with new temporal headache, temporal artery tenderness and TA biopsy with mild thickening, but normal inflammatory markers?

Do you typically adjust or hold immunosuppression in a well-controlled RA patient who is being treated for Mycobacterium avium-intracellulare (MAI)?

How do you approach the timing of DMARD initiation in patients with active RA who are on treatment for latent TB?

Is it different between DMARDs (csDMARDs, biologic DMARDs, and target synthetic DMARDs)?

How do you determine if pulmonary hypertension is disproportionate to the severity of lung disease?

What is your approach to diagnosis and evaluation of nonbacterial thrombotic endocarditis (Libman-Sacks)?

Patient with negative blood cultures, completed 6 weeks of IV antibiotics and vegetation persists. CT imaging without evidence of malignancy. No evide...

In which patients with nephrocalcinosis and an incomplete distal RTA would you consider further testing for medullary sponge kidney?

What is your preferred method for subclinical CAD screening prior to initiation of class IA antiarrhythmic drugs for atrial fibrillation?

What else do you consider in the differential diagnosis for pulmonary-renal syndromes if there is low clinical and serologic evidence of AAV, Goodpasture's or other rheumatologic disease (SLE, RA, APS, Scleroderma)?

How would you manage cognitive changes in a patient with memory impairment and significant brain atrophy with no diagnostic testing consistent with Alzheimer's disease?

Would you recommend genetic polymorphic testing before the initiation of antiplatelet medication in patients with ICAD?

Do you utilize post-vaccination IgG titers to detect common variable immunodeficiency in patients who are about to start or are actively on B cell depleting therapy?

Would you consider switching choice of P2Y12 inhibitor for patients with ISR (non-ACS presentation), with acceptable bleeding risk?

Would you use sumatriptan in a patient with a history of cerebral aneurysm rupture?

What is the next step in management of a thyroid nodule that was biopsied and classified as Bethesda III, but Afirma genetic testing reveals parathyroid signature?

Patient does not have hypercalcemia.

Do patients with an elevated IGF-1 level and features of acromegaly need to have confirmatory growth hormone suppression testing with OGTT?

Can a diagnosis of acromegaly be made with just an elevated IGF-1 level in patients with features of acromegaly?

How would you manage autoimmune pancreatitis in a patient after Whipple's procedure?

For how long do you treat an early spinal hardware infection secondary to MSSA after operative washout and retention of hardware?

How do you risk stratify patients with different WHO groups of pulmonary hypertension prior to non-cardiac surgeries?

And who would you not recommend to undergo surgeries?

How do you manage incidentally found venous sinus thrombosis?

Do you recommend obtaining a spot urine or 24-hour urine magnesium measurement when evaluating patients with persistent hypomagnesemia of unknown etiology?

How do you decide when to refer patients with obstructive hypertrophic cardiomyopathy for alcohol septal ablation versus septal myectomy?

What are your management strategies for patients with recurrent uric acid nephrolithiasis and chronic kidney disease who have persistent hypocitraturia and acidic urine pH?

How do you approach a patient at intermediate ASCVD risk who has been referred to you because of an abnormal coronary CTA (obstructive lesion ~90%) but an excellent exercise capacity on treadmill without angina and a negative MPI?

Had you seen the patient immediately after the coronary CTA results, would you have directly proceeded with cath or also ordered an noninvasive functi...

Would you treat a patient aggressively for lupus nephritis if they have persistent proteinuria over 1 gram but cannot get a timely kidney biopsy?

What is your approach to further workup and treatment of abdominal aortitis found on imaging in asymptomatic individuals with elevated inflammatory markers?

Is there a role in temporal artery biopsy?

Should colchicine be considered in patients with ischemic heart disease and persistently elevated hsCRP despite statin and aspirin therapy and appropriate physical activity?

What are your management strategies for patients with chronic kidney disease attributed to deferasirox use who require frequent blood products for a hematologic disorder?

Do you typically obtain an EEG in patients undergoing workup for cognitive dysfunction?

Would you consider dual antiplatelet therapy for stroke prevention for ICAD in patients with a history of SAH?

What criteria are used to choose a specific dose of aspirin in ischemic stroke?

We have seen 81 vs 162 vs 325 mg up to 1300 mg.

How do you approach tapering immunosuppression in a patient with a history of Susac Syndrome who has stabilized on MMF and IVIG?

How would you manage an elderly patient with mild pancytopenia who refuses bone marrow biopsy and whose flow cytometry is suggestive of CMML/MDS?

How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?

Given that there are a fair number of myocarditis cases without a troponin elevation, how do you clinically approach the diagnosis of myocarditis?

For a patient who has T4 squamous cell esophageal carcinoma on imaging, and who has biopsy-confirmed disease in an involved local lymph node, are EUS or EGD still indicated to complete workup?

How do you manage a patient with severe RA or SLE that worsens after stopping immunosuppressants due to having chronic foot ulceration?

Are there circumstances when you may consider imaging enthesitis in patients with psoriatic arthritis?

What imaging modality would be most helpful?

What additional testing is recommended with heterozygous HFE C282Y mutation whose ferritin is elevated and transferrin saturation percentage is at baseline?

Ferritin >2200, TSAT >80%

What is your preferred formulation of parenteral iron?

There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...

How would you treat a young patient who presents with coronary vasculitis and aortitis with persistently positive MPO but no other features of AAV?

Do you typically screen patients for antiphospholipid antibodies in autoimmune diseases besides lupus in the absence of a clotting event?

How would you manage asymptomatic osseous sarcoidosis of the lumbar spine without any other systemic involvement?

Would you use with DMARDs/biologics or monitor?

What is your approach to establishing a dry weight in a pregnant patient with ESKD on hemodialysis given the expectation of weight increase and pregnancy-related edema?

Do you use FVIII levels to differentiate between DIC and coagulopathy of liver disease?

Common thought is that FVIII may be used for differentiating coagulopathy in liver disease (normal to increased, from reduced clearance of VWF/FVIII) ...

How do you screen dermatomyositis patients for malignancy if they have a high risk antibody profile (NXP-2/TIF1gamma positive) and their initial screen is negative?

Does phosphatidylserine antibody play a role in the diagnosis of antiphospholipid antibody syndrome?

What is your approach to a patient with a low alkaline phosphatase?

What level or additional signs/symptoms trigger a workup? What does your workup typically consist of?

Do you consider immunosuppressive agents in progressive interstitial pneumonias or pneumonitis without a clear driving etiology?

What is your approach for an RA patient with lung cancer who is starting immunotherapy?

How would you interpret a temporal artery biopsy demonstrating focal chronic inflammation in the adventitia associated with small adventitial vessels and nerves without inflammation of the intima and media and without giant cells?

How do you approach anticoagulation in the setting of HIT and thrombocytopenia?

I.e. platelet count <30. Would your management change if HIT were only suspected rather than confirmed?

For a pedunculated rectal polyp found to be adenocarcinoma after endoscopic removal, with PNI as the only adverse feature, would you recommend additional treatment such as surgery or chemoradiation?

Consider some stalk invasion, but no deep submucosal extent and negative margins by 9 mm.

Do you consider pulmonary hypertension related to sarcoidosis to be an indication to start steroids?

Do you use biomarkers or PET scanning to stratify patients who may benefit most from therapy?

Do you use anti-DFS70 Ab to help reduce the posttest probability of ANA-positive patients having a systemic autoimmune disease if other autoantibodies are negative?

ANA patients referred to rule out CTD is a work-intensive, costly referral type. If they are positive for Anti-Dense Fine Speckled Protein 70 kDa (DFS...

How would you approach medication de-escalation in a patient with a history of rapidly progressive CTD-ILD who responded to and is currently on mycophenolate 3 grams daily and IVIG 2mg/kg monthly infusions and has been stable for two years?

What is your approach to determining the need for continued isolation in the dialysis unit for an ESKD patient who had a positive hepatitis B surface antigen one year ago but who now has a negative HbsAg in the absence of treatment?

Do you avoid ESA use in patients with anemia and chronic kidney disease who also have APLS and risk for thrombosis?

What is your preferred choice of anticoagulant (VKA vs. DOAC) in patients with an LV thrombus and apical infarct?

Would you extend length of time for anticoagulation if the apex remained akinetic on surveillance TTEs?

How do you approach management of a patient with Sjogren's disease and lung mass biopsy revealing amyloidosis?

How would you approach a stage II colon cancer with negative ctDNA but markedly elevated CEA level post-colectomy?

Is history of radiation an absolute contraindication to using parathyroid hormone (PTH) analogues?

Does it depend on location of radiation, length of radiation, and time since radiation?

Should oral combined contraceptives be held prior to overnight dexamethasone suppression test to rule out Cushings?

If so, how long should OCPs be held to reliably trust the dex suppression test results?

Does hepatitis B vaccination reduce the risk of HBV reactivation associated with immunosuppressive therapy?

For example, in patients who are HbSAg negative, anti-HBc positive and HbSAb negative, does vaccination reduce reactivation risk?

What is the normal range of spinal tap opening pressure?

Are there variations with different patient populations?

Can combined oral contraceptive use cause falsely elevated 24-hour urine-free cortisol?

How do you approach a negative ANA and positive dsDNA in patients with arthralgia, hair loss, or other UCTD features?

What duration of dual antiplatelet therapy do you use for secondary prevention of ischemic stroke due to intracranial atherosclerotic disease?

While some have the practice of 90 days per SAMMPRIS trial, the lower rates of ischemic stroke in the medical therapy group were driven by events with...

Would you continue Rituximab infusions in a patient with GPA and renal involvement who has been in remission on Avacopan and Rituximab, but had PRES post Rituximab infusion?

Are there any possible scenarios where you would do phlebotomies for heterozygous hemochromatosis?

In patients with secondary osteoporosis due to primary hyperparathyroidism, should parathyroidectomy be recommended in the setting of recent prior bisphosphonate use?

Would a surgical decompression be indicated in a patient with amyloidosis and severe median neuropathy at the wrist?

Would you add voclosporin to mycophenolate for refractory proteinuria in a patient with low EF?

Low EF in the range of 30%

How do you approach differentiating infectious vs inflammatory tenosynovitis?

For patients with microscopic hematuria, do you prefer a lab submitted urinalysis sample undergoes automated urine analysis or microscopic analysis by laboratory staff for quantification of red blood cells?

Which class(es) of antihypertensives do you recommend for first-line therapy for hypertension in severe aortic stenosis?

What is a reasonable length of time for systemic anticoagulation in patients presenting with MI in the setting of coronary artery aneurysm with large thrombus formation?

How do you approach management of a patient with idiopathic PAH and +ANA, but no other current symptoms/signs of active rheumatologic disease?

What is the preferred imaging modality to evaluate subaortic membranes in patients with aortic valve disease?

Based on results from the VOYAGER PAD trial, when would you consider the primary use of rivaroxaban with aspirin +/- clopidogrel as opposed to conventional aspirin +/- clopidogrel in patients undergoing lower extremity revascularization?

What management do you recommend in patients with backpack palsy?

What is your approach to managing patients with labile blood pressures secondary to baroreflex failure?

What considerations do you take when evaluating a patient for kidney transplantation who has a history of kidney disease and an abdominal aortic aneurysm treated with past stenting?

When would you consider CT aortic valve calcium score over TEE to further delineate the severity of LFLG aortic stenosis?

How would you approach additional workup and management of a patient with active Crohn’s disease, who has multiple lung and brain nodules, with lung pathology demonstrating necrotizing granulomatous inflammation and brain biopsy with granulomatous inflammation and medium-large vessel vasculitis?

The patient is on mesalamine for Crohn’s and CellCept and HCQ for skin manifestations (currently on hold during workup). The infectious workup i...

What would be the clinical role of SGLT-2 inhibitors for lupus nephritis given it has an indication for proteinuria related to CKD?

Is there a role for monitoring serum ANCAs to assess ANCA associated vasculitis disease activity?

This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).

Do you start aspirin for patients with incidentally found intracranial vertebral stenosis?

In patients with suspected RCVS, is there a role for preventative CCB if headache has resolved/now asymptomatic?

How reliable is an exercise stress echo in the diagnosis of exercise-induced heart failure with preserved ejection fraction?

Do you have a specific protocol you follow during the stress echo, and if so, what echo parameters are you using to evaluate for exercised-induced hea...

Is it safe to combine mycophenolate and adalimumab for management of pulmonary sarcoidosis in a patient that could not tolerate methotrexate?

How would you interpret a positive single specific markers like SSA or SSB in setting of working up an connective tissue disease, especially when ANA is negative?

What are the current clinical practices for TEE to guide cardioversion and anticoagulation duration post-cardioversion for Afib/flutter in patients following left atrial appendage closure?

Is there a role for systemic therapy for a patient with scleroderma sine sclerosis, with esophageal strictures and Raynaud’s syndrome, but no pulmonary involvement?

When would you consider a kidney biopsy in a patient with longstanding diabetes and hypertension (baseline creatinine 4-5, 4+ proteinuria) who was recently found to have dsDNA positivity?

For patients with kidney stone disease and chronic kidney disease, is there an eGFR threshold at which you no longer recommend pursing 24 hour urine stone risk studies?

Should intervention be considered for an intermediate flow-limiting coronary lesion that does not correlate with perfusion defects on stress testing in a patient with atypical anginal symptoms?

How long do you anticoagulate for cirrhosis patients who have portal vein thrombosis extending to the mesenteric veins?

What is your approach to considering geriatric patients for complex PCI given their overall frailty and increased risk of complications such as bleeding and stroke?

In what situations/patient population would you consider placing an implantable cardiac monitor in favor of external monitors for long-term dynamic monitoring of atrial fibrillation?

What are the real-life implications of the MONITOR-AF study to the routine management of AF?

What is your approach to monitoring patients with cardiac sarcoid while tapering immunosuppression?

Do you obtain serial cardiac PET scans?

Are there any indications to close a PFO during pregnancy if a woman had a cryptogenic stroke in her first trimester?

How do you dose apixaban in patients with CrCl <30 mL/minute?

How do you approach immunosuppression in patients with a positive Interferon Gamma Release Assay and prior intravesicular BCG treatment for bladder cancer?

Assuming no symptoms of TB, should patients be treated for latent TB prior to starting TNF inhibitors or other immunosuppressive agents?

Would you check ANCA titers in a patient with a history of PR-3-ANCA glomerulonephritis in remission and a stable creatinine but with recurrent microscopic hematuria?

Are there instances when you would pursue a kidney biopsy in a pregnant patient instead of waiting to perform the procedure post-delivery?

What treatment options do you recommend in a patient with idiopathic granulomatous mastitis that has not improved on steroids and methotrexate?

Does IVIG or subcutaneous Ig interfere with monoclonal antibody therapy (i.e. dupilumab, infliximab, rituximab, etc)?

How should IVIG and either biologic injections or infusions be spaced?

For an asymptomatic patient discovered during workup for elevated PT/PTT to have mild prothrombin deficiency, would you suggest any preoperative prophylaxis?

Level >60%. No family or surgical h/o of bleeding but heavy postpartum bleeding.

Which patients do you recommend referral to interventional radiology to perform a kidney biopsy?

Is it safe to use quinacrine in SLE patients with a history of hydroxychloroquine-associated retinopathy?

Would you treat a hemochromatosis carrier with IV iron if they have iron deficiency anemia in conjunction with elevated ferritin?

Hb <11, low iron saturation (<10%), high ferritin (>900), and low reticulocyte hemoglobin equivalent.

How should one approach an incidentally found T-cell gene arrangement?

Work-up was performed for isolated anemia which resolved to >11 g/dl after the reversible cause was treated.

How extensive of a workup do you do for systemic AL amyloidosis for a patient with a resected amyloidoma, localized AL amyloid deposition in their airway or lungs, who has no other symptoms?

Would you do a 24-hour urine and echocardiogram in all of these patients? Cardiac biomarkers, PT/PTT, or any other such blood tests?

Would you avoid combining JAK inhibitors with IVIG given the risk of thromboembolism?

How would you approach peri-operative immunosuppressive management of a patient with Behcet's, currently controlled on azathioprine, who needs genital surgery?

The patient has not responded/has contraindications to apremilast, colchicine, and adalimumab. When they were off azathioprine for 5 days in the past,...

In a patient with a history of HIT, how would you reintroduce Heparin?

Is it only done when heparin is used in an emergency?

How do you manage immunosuppressive medications in patients who develop a pneumonia?

How would you evaluate and treat a disabling tongue tremor?

The tremor fluctuates and can last for 45 minutes with the inability to talk, eat, or drink.

How would you approach treating a patient with Rheumatoid arthritis/Psoriatic arthritis and alcoholic cirrhosis?

Do you recommend monitoring IgG level in patients with AAV receiving rituximab?

And when do you consider (if ever) IGRT?

In which patients awaiting a kidney transplant do you evaluate for primary hyperoxaluria given the high risk of allograft dysfunction following transplantation?

What therapies do you routinely use to prevent mucus plug formation after endobronchial stent placement?

Is it possible to have undetectable cortisol levels in secondary adrenal insufficiency?

Young, previously healthy male with normal growth presenting with two syncopal episodes. Currently, only symptom is mild fatigue. Labs showed: Cortiso...

Do you have a preference between Quantiferon Gold and T-spot TB for screening in patients starting immunosuppressive agents?

What is your strategy for managing immunosuppression in patients with a kidney transplant who develop metastatic cancer?

What is your approach to evaluation in patients who present with erythromelalgia?

What is your approach to using bisphosphonates in those with severe hypercalcemia and chronic kidney disease?

How often would you repeat testing in a patient suspected of Cyclic Cushing's?

And is there a preferred diagnostic test? Whenever cyclic hypercortisolemia is suspected, it is advised that evaluation should be repeated for months,...

What would be your approach to a patient with new diagnosis of seropositive rheumatoid arthritis manifesting as a constrictive pericarditis with no joint pain complaints?

Would you begin with DMARD therapy like MTX or would you consider starting with an IL-1 antagonist such as Acralyst?

What workup do you initiate for thoracic outlet syndrome?

How do you manage drug-drug interactions between oral anticoagulants and the ARSI agents such as apalutamide and enzalutamide?

Do you recommend continuing SGLT2 inhibitors in patients with diabetic kidney disease and congestive heart failure who have been taking the medication for several years and later develop end stage kidney disease?

How do you counsel patients with postmedian sternotomy plexopathy?

How do you manage cases of levodopa intolerance due to nausea or drowsiness?

Particularly when ondansetron and taking it with food are not beneficial.

In patients taking biologics who are planning joint replacement and are known MRSA carriers do you perform decolonization prior to surgery?

Given recent trials for the management of atrial fibrillation with an early ablation strategy (for example, EAST-AFNET 4, EARLY-AF, PROGRESSIVE-AF, STOP-AF), what is your approach to determining the appropriate timing for ablation in patients with atrial fibrillation?

And how do patient characteristics affect your decisions?

When do you recommend neuropsychiatric testing in patients with post-concussive syndrome?

What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?

Would you anticoagulate a patient with splenic infarctions in the setting of CMV viremia?

If so, for how long?

Can joint replacement surgery be performed in someone with active Paget’s disease elsewhere?

What further work-up (if any) should be considered in patients with pituitary microadenoma and stigmata of Cushing's disease but low ACTH and repeatedly normal plasma, urinary, and salivary cortisol levels?

Do you routinely obtain baseline vascular imaging (CTA, MRA, PET) in patients with suspected GCA, but negative temporal artery biopsy?

Per 2021 GCA Vasculitis Guidelines: low evidence, but conditional recommendation for CTA neck, chest, abd/pelvis. Is anybody following this or do you ...

What is your approach to determining if an SPEP abnormality is causal or coincidental in peripheral neuropathy work up?

What are the indications for anticoagulation in splenic infarctions?

What is the work up and what is the duration of anticoagulation if used?

What is the differential for elevated T3 (with suppressed T4 and normal TSH) in a patient not taking any thyroid hormones?

Female is in her later 40s with surgical oophorectomy taking Sertraline 50 mg daily and prn Trazodone and Lamotrigine. Has some weight loss and fatigu...

Is there an indication for adrenalectomy in patients with subclinical Cushing syndrome and adrenal nodule?

When do you consider genetic testing in patients with concern for hemiplegic migraine?

What is your approach to steroid sparing therapy in patients with suspected CTD-ILD?

How long do you normally wait before considering any bronchoscopic procedure (EBUS-TBNA, Transbronchial biopsy) after an episode of acute PE in a patient needing these procedures?

Normally, waiting 6-12 weeks of therapeutic anticoagulation after an acute PE is suggested for any bronchoscopic procedure, however there is always a ...

How do you interpret a low VWF activity/antigen ratio, when both activity and antigen levels are above 50%?

E.g. Normal F8, VWF activity ~50%, VWF antigen ~100%, ratio 0.5 sent in a patient with positive bleeding history Is there any clinical significance t...

How would you approach immunomodulatory treatment for systemic lupus associated protein losing enteropathy (PLE) in a patient whose clinical course has been complicated by significant infection?

Additionally, is it correct to assume that IV therapies might be preferred vs oral treatment given alterations in GI absorption in PLE?

What is your approach to bridging anticoagulation in patients with history of recent HIT?

Do you always avoid heparin/enoxaparin or rechallenge if antibodies are negative?

How do you treat patients with hemiplegic migraine?

When do you consider use of ketamine in patients with migraine with aura?

What is the ideal period to wait until curative surgery for patients with acute pulmonary embolism and solid malignancy?

Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer.

Are there any non-beta-lactam antibiotic options for treatment of neurosyphilis in non-pregnant adults?

For a patient with a lung tumor that is radiographically consistent with early-stage NSCLC but pathology with characteristics overlapping with upper GI origin, what additional diagnostic procedures would you consider before treating?

For example, there are no abnormalities on CT or PET in the upper GI and the pathology demonstrates strong CK7 staining and mucinous features with neg...

What are your top takeaways from CHEST 2023?

How do you counsel cancer patients when they ask if they should avoid sugar?

9 Answers available

How do you manage patients with suspected cholangiocarcinoma that presents with biliary obstruction but has repeated negative brushings/biopsies?

Is liquid biopsy helpful? Would you treat if this shows somatic mutation?

What is your mmHg threshold to cancel a kidney biopsy for patients with pre-procedural elevated blood pressures?

What is your approach to a patient who has a cardiac PET scan suggestive of sarcoid but no other supporting evidence of a diagnosis of sarcoid?

Do you typically push for myocardial biopsy in this case?

Are the results of the BOREAS trial generalizable to non-white populations?

The cohort in the study was predominantly white. Do these results highlight significant disparities in COPD care?

How would approach the management of a patient with significantly positive anticardiolopin and beta 2 glycoprotein antibodies in the absence of any clotting (including obstetric) history but with significant thrombocytopenia (but no other features of active connective tissue disease)?

What is your approach in differentiating IPAF (interstitial pneumonia with autoimmune features) versus "CTD ILD" in patients with serologic abnormalities but do not fulfill criteria for autoimmune disease?

How do you manage incidentally identified pituitary lesions on brain imaging?

What workup do you typically recommend?

Have you seen rheumatoid nodules or RA-ILD in patients with seronegative RA?

While classically described as seen in seropositive patients, have they been reported in seronegative RA?

How do you manage a DOAC if interested in testing for lupus anticoagulant?

Significant history of autoimmune diseases and DVT in family, recent PE/DVT for a month

When would you consider proceeding with antiarrhythmic drug load concurrently with DCCV as opposed to DCCV alone in patients with new-onset atrial fibrillation?

Have you seen drug induced SCLE from IL-17 inhibitors?

And if so, what is your approach to the diagnosis?

In which situations do you preferentially use an MCOT in lieu of a standard event monitor?

How can hepatic venous pressure gradients in patients with cirrhosis be used to differentiate between cardiac cirrhosis and portopulmonary hypertension?

In which clinical scenario(s) would you consider checking HVPG?

How would you approach management of incidentally identified unilateral retinal vasculitis with subsequent labs revealing +P-ANCA?

Patient is asymptomatic. Labs showed +P-ANCA 1:160. Negative MPO and PR3.

What is your preferred method for diagnosing adenine phosphoribosyltransferase (APRT) deficiency in a patient with recurrent kidney stones and abnormal crystalluria?

How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?

How do you recommend tapering IVIG in patients whose inflammatory myositis has achieved remission?

Are there instances when you perform a repeat kidney biopsy in patients whom tolerated the first procedure but are still without a definitive diagnosis?

How do you time PET/CT surveillance and COVID boosters?

Is anyone advising delaying COVID booster until after PET/CT to avoid false positive?

Do you consider hyperuricemia as a potential etiology of an anion gap metabolic acidosis in patients with elevated uric acid levels and no other readily explainable causes of acidosis?

How would you manage a patient with new renal failure and mild anemia in the setting of a moderate M-Spike and low kappa/lambda ratio, but with negative PET and bone marrow with <10% plasma cells?

What is your approach to initial work up for a young patient with bronchiectasis?

Are there instances when you would recommend against pursuing adrenal vein sampling in a patient with primary hyperaldosteronism and normal adrenal imaging?

Should we routinely include geriatric functional assessments to determine candidacy for TAVR?

(ie., assessing gait speed, cognition, physical function, fall history, orthostatic vital signs, etc.)

Would you recommend mycophenolate mofetil for patients with progressive IgA nephropathy who do not tolerate corticosteroids?

Based on the results of the MAIN trial; Hou et al., PMID: 36745456

What is your approach to the management of patients with isolated cervical adenopathy related to sarcoidosis?

Lymph node biopsy with non-caseating granulomas and other etiologies (malignancy, infection, vasculitis) ruled out.

What initial workup do you perform when there is a concern for porphyria?

What additional studies would you obtain for a patient with end stage kidney disease on hemodialysis who has persistent hypercalcemia and low PTH?

In patients with secondary Sjogren's how do you approach screening for lymphoproliferative malignancy?

What screening tests do you perform and at what intervals?

Can you use apixaban or rivaroxaban in case of dabigatran failure?

When do you restart antiplatelet therapy in patients with hemorrhagic conversion of stroke?

How do you approach a persistently elevated mean platelet volume and immature platelet fraction in an otherwise healthy patient with a normal platelet count?

Provided that the platelet count is normal, do you usually consider this to be a potential erroneous result or do you pursue additional workup for RBC...

For patients undergoing TNT for rectal cancer with planned operative management, what is the optimal sequencing and timing of workup imaging and procedures?

Do you have a preference in ordering MRI, endoscopy, CT scan (chest, abdomen, pelvis), EUS, or other testing before starting any treatment, for re-sta...

What is your approach to pacemaker lead thromboses in terms of threshold for lead extraction and initiation of systemic anticoagulation?

Is there a kidney length for which you would no longer recommend attempting a kidney biopsy due to safety concerns and lack of diagnostic yield?

What is your approach to continuing or altering therapy when inheriting a patient with combined biologic immunosuppression that is in excess of guidelines?

How do you approach de-escalation or justify therapy maintenance? Do you have tiers of medications that you attempt to de-escalate first? In one parti...

Do you reduce the steroid regimen for patients with acute interstitial nephritis who have a high risk for developing side effects from glucocorticoid therapy?

Are there instances when you do not perform urine microscopy and rely solely on laboratory performed urinalysis when evaluating a patient for acute kidney injury?

Do you personally review all imaging you order or rely judiciously on radiologist interpretation?

If you do not review all imaging, how do you triage for which studies you personally review the images vs. the written interpretation only?

What is your initial treatment of choice in patients with RA and associated interstitial lung disease?

For patients maintained on antiplatelet monotherapy post-DAPT following PCI, what is your recommendation for holding antiplatelet therapy prior to non-cardiac surgery?

Do you ever recommend "bridging" with low-dose aspirin?

How would you manage patients with exposed bone due to injured gingiva after recent chemoradiation?

Any experience using phenytoin?

Do you recommend noninvasive testing or coronary angiography as the initial test for pre-kidney transplant evaluation of an asymptomatic patient older than 50 years of age with ESKD secondary to diabetic nephropathy and no known history of CAD?

Which medications do you deem necessary to stop prior to measuring plasma renin and plasma aldosterone when evaluating a patient for possible primary aldosteronism?

Is there a correlation between spleen size and degree of thrombocytopenia?

Are there preventative measures that you take in your cancer patients with chronic kidney disease who require periodic iodinated contrast CT studies for monitoring of their malignancy?

When do you avoid or stop erythropoietin-stimulating agents in patients with anemia and end stage kidney disease?

Is it reasonable to consider the use of DOACs for LV thrombus management instead of coumadin?

Is there a role for vascular intervention in patients with renal artery stenosis found during work up of resistant hypertension?

What is your preferred method for confirming the diagnosis of primary aldosteronism in a patient with an elevated plasma aldosterone to renin ratio?

How would you treat active rheumatoid arthritis in a patient in complete response on loralatinib for stage IV ALK positive NSCLC?

Patient already on methotrexate and plaquenil.

How would you manage warfarin in a patient with APLS and alcoholic cirrhosis?

Nonreliable INR, given hepatic coagulopathy

What is the risk of serious bacterial infection in a febrile solid tumor patient who has not yet started cancer-directed therapy and has normal cell counts with no central line?

When do you avoid or stop iron agents in patients with anemia and end stage kidney disease?

In a patient with history of scleroderma renal crisis resulting in ESRD, would you recommend using steroids for when needed?

What is your approach to treating crowned dens syndrome?

How long can you treat dermatomyositis with IVIG?

Do you recommend a kidney biopsy in a patient with myelodysplastic syndrome diagnosed two years prior who develops new onset proteinuria?

How do you approach the concept of spondyloarthritis disease activity "burning out" and no longer requiring immunosuppression?

Is there a certain disease duration or age beyond which you taper immunosuppressive treatments?

How do you manage GI side effects related to CFTR modulator therapy?

Is concomitant use of azathioprine and febuxostat safe from a bone marrow toxicity standpoint?

Would you recommend anti-platelet or anticoagulation in a patient with recurrent strokes, CADASIL, and Antiphospholipid Syndrome?

Would you consider a primary prevention ICD in a patient with hypertrophic cardiomyopathy and non-sustained ventricular tachycardia, in the absence of any other high risk predictors for sudden cardiac death?

How do you diagnose and manage patients with hypnagogic shooting headache?

What are the diagnosis and treatment for hypnagogic shooting headache?

Are there concerns with using sulfasalazine in SLE?

Extrapolating from reactions with other sulfa medications potentially causes flares.

How frequently do you monitor EKGs for patients newly initiated on lacosimide?

What factors should prompt a kidney biopsy to evaluate for monoclonal gammopathy of renal significance in a patient with MGUS and suspected chronic diabetic nephropathy?

How would you approach microcytosis without anemia with high TSAT and ferritin?

How often do you see non transfusion-dependent thalassemia and how do you approach the treatment?

How is transferrin saturation a reliable indicator for any parameter if serum iron is not reliable?

Although TIBC is negative acute phase reactant, would it be a better indicator of iron deficiency (in combination with ferritin)?

Can an acid loading test be used to assist with the diagnosis of RTAs other than an incomplete distal RTA?

How do you manage patients with systemic sclerosis and chronic thrombotic microangiopathy on renal biopsy, but no other evidence of scleroderma renal crisis?

Patient with nephrotic range proteinuria, but there is no evidence of active TMA on renal biopsy.

Do you find MRI helpful to differentiate early erosive OA from psoriatic arthritis when early X-ray changes in both conditions may be hard to distinguish?

Is there a role for biologics to help patients with ABPA who are steroid responsive and have removed their allergen insult, but continue to have an elevated serum IgE and incomplete resolution of symptoms return to their baseline functional status?

Would you recommend avoiding PICC line placement in a kidney transplant patient with an estimated GFR of more than 45 ml/min/1.73m2 and no functional AV access?

What are common indications for ordering NGS of peripheral blood?

Would a negative NGS eliminate the possibility of MDS? Is bone marrow biopsy indicated in a patient with pancytopenia with a negative NGS panel?

What would be the utility of calcium scoring for the evaluation of low-flow low-gradient aortic stenosis, and what cut-off values typically fall within the severe range?

How accurate of an indicator is reticulocyte hemoglobin equivalent for iron deficiency?

Is it safe to treat checkpoint inhibitor-induced arthritis with methotrexate or biologics?

What is your practice for work up and treatment of incidental splenic infarcts with or without splenomegaly in patients without sickle cell disease?

What is your approach to abbreviated DAPT in post-PCI patients (ACS and non-ACS) with high bleeding risk?

For patients with microcytosis MCV 75-79 and normal Hb, low TIBC, and normal ferritin do you always rule out thalassemia?

What else would you consider in your differential?

Should patients with co-existing moderate-severe valvular disease (particularly AS and MS) and malignancy requiring radiation therapy undergo more frequent surveillance surface echocardiograms?

What is your approach to management of elevated liver enzymes in patients who recently started treatment with tocilizumab?

Is there a role for the use of biologics as steroid sparing agents in treating patients with ABPA who are intolerant to prednisone?

What is your approach to patients with membranous glomerulonephritis who have persistently elevated PLA2R titers but largely improved proteinuria and creatinine?

Do you recommend discontinuing IVIG for a newly diagnosed HMGCR+ statin induced necrotizing myopathy who developed a recent brachial DVT?

The patient was diagnosed with statin-induced necrotizing myopathy (HMGCR +) and received RTX and IVIG (one cycle over 3 days) but developed bra...

Is a significant rise in cortisol post cosyntropin stimulation sufficient to rule out adrenal insufficiency in patients with low albumin?

What is your approach to using nintedanib in patients on baseline immunosuppression?

Patients on baseline mycophenolate and azathioprine were excluded from the INBUILD trial however many patients with CTD-ILD will be on some form of im...

Does your goal rate of correction in patients with chronic hypoosmolar hyponatremia differ based on the degree of hypoosmolarity?

What workup do you recommend on patients with suspected ischemic cranial nerve six palsy?

How would you approach a patient with elevated CPK in the 500-1000 range with no weakness on exam or myositis on MRI but with positive HMGCoA ab?

What is your approach to urate lowering therapy in patient with gout who is on azathioprine (for example, for transplant), where allopurinol and febuxostat are both contraindicated?

Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?

Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...

Considering only cerebrovascular indications, are there circumstances in which you would use aspirin along with a DOAC in patients with atrial fibrillation and stroke?

Do you recommend continuing peritoneal dialysis in an ESKD patient on peritoneal dialysis who is diagnosed with encapsulating peritoneal sclerosis since abdominal symptoms may worsen when peritoneal dialysis is stopped?

How long would you wait before performing a kidney biopsy in a patient with possible AIN whose creatinine has plateaued, but not improved, after discontinuing the suspected offending agent?

In patient s/p definitive chemoRT for vulvar cancer with complete response, how do you manage a non-healing vulvar defect if biopsy is negative for residual disease?

In antiphospholipid syndrome with recurrent strokes, would you consider adding antiplatelets to warfarin?

Also how would you manage this perioperatively?

What is the recommended follow-up/surveillance schedule following organ preservation treatment approach for cT1-2N0 rectal cancer?

Taking into account follow up from NEO, OPERA and other organ preservation trials?

How do you manage recurrent hemodialysis filter clotting in an in-center ESKD patient with heparin-induced thrombocytopenia?

Would testing for ATTR cardiac amyloidosis be considered in an older patient with bilateral carpal tunnel surgeries and multiple spinal stenosis surgeries, but no obvious cardiac symptoms?

Do you recommend targeting a higher Kt/V in an ESKD patient on hemodialysis with pruritis and a Kt/V of 1.4?

Is intracranial hemorrhage a contraindication for valproic acid?

Would you consider the use of dual antifibrotic therapy (nintedanib and pirfenidone together) for progressive fibrosing ILD?

How common are nasal telangiectasia in patients with systemic sclerosis?

Patient with pulmonary hypertension (mixed group 1, 2, 3), COPD, HFpEF, Raynaud’s phenomenon, UCTD (ANA, PM-Scl, SSA-52kd), and recurrent severe...

How would you work up an elevated copper level without cytopenias in a patient with history of bariatric surgery not on supplements or using copper utensils?

Often see bariatric surgery ordering these tests, is there any clinical relevance?

What is the role of kyphoplasty or vertebroplasty in patients with osteoporotic spinal fractures?

When is it safe for a rectal biopsy in a patient with prior prostate radiation?

Is the patient permanently at elevated risk for rectourethral fistula with rectal biopsy? Do you have any threshold for the GI to biopsy a rectal lesi...

Does your approach to treating latent tuberculosis differ in a patient on anti-fibrotic therapy?

Would you recommend giving N-acetylcysteine in addition to holding diuretics in a patient with chronic kidney disease and mild hypervolemia who is planned to have a contrast study?

What is your approach to evaluating a patient with known rheumatologic disease and elevated free kappa:lambda ratio, but no evidence of monoclonal immunoglobulins?

What would be your index of suspicion for AL amyloidosis with cardiac involvement in a patient with MGUS to prompt further imaging (and which modality would be preferred)?

How slowly do you taper a dopamine agonist to prevent dopamine agonist withdrawal syndrome (DAWS)?

What is your approach to risk stratification of asymptomatic patients with pre-excitation syndrome?

Below what platelet count would you avoid using an AV fistula in a patient with ESKD and thrombocytopenia?

Should vasodilatory therapies be considered first-line in the management of hypertension in patients with severe aortic regurgitation?

Do you recommend obtaining a vasculitis work up for all patients seen for chronic kidney disease who are without a kidney biopsy?

What is your approach to managing a patient with a history of tardive dyskinesia on a VMAT2 inhibitor, presenting with parkinsonism and found to have an abnormal DAT scan?

How do you manage patients with post spinal tap headaches?

Are there any diagnostic tests or imaging that you recommend?

How do you approach treating patients with lupus profundus?

Do you typically start the patient on hydroxychloroquine? What work-up do you perform?

How do you approach a patient with atrial fibrillation on apixaban who has a new cardioembolic stroke?

What labs do you order to monitor patients on JAK1 inhibitiors (abrocitinib or upadacitinib)?

How often do you order labs?

In patients with Afib on anticoagulation and concurrent intracranial atherosclerotic disease, would you consider adding an anti-platelet to anticoagulation if there are recurrent events that could be related to the ICAD?

Does pregabalin contribute to esophagitis or gastroparesis?

Do you routinely use hypertonic saline for pulmonary toileting in patients with non-CF bronchiectasis?

Do you use 24 hour urine stone risk profiles for purposes other than managing nephrolithiasis?

In patients with embolic stroke and a PFO, how often do you go beyond venous Doppler of the lower extremities to screen for DVT (e.g. MRV or CTV abdomen and pelvis)?

Would you anticoagulate if this screening is negative pending PFO closure?

What work-up do you recommend in patients with early-onset dementia?

Which genetic/other testing should be considered in an early-onset dementia work-up?

Is there a reason to repeat HMGCR antibody level for monitoring disease activity once documented positive in patients with IMNM?

Is it sufficient to maintain patients with atrial fibrillation and established PAD on a DOAC or VKA alone, or is there an additional benefit to adding an antiplatelet agent for CVD benefit?

If so, would you prefer a P2Y12i over low-dose aspirin?

When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?

For patients presenting with spontaneous coronary artery dissection, what other non-cardiac/vascular work-up can be considered to further risk stratify them as a predictor for any future cardiovascular events?

When should I consider anticoagulation in an unprovoked upper extremity superficial venous thrombosis?

Would it change your management if the thrombus was symptomatic? Or if larger >3 cm?

Does the presence and location of cerebral microbleeds affect your decision for antithrombotic treatment in patients with atrial fibrillation?

Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practi...

What is your approach to elevated CK in patients without clinical or serologic evidence of immune mediated myopathy?

Should we have a lower threshold to consider revascularization of coronary lesions in athletes, compared to non-athletes?

Do the level of positive lupus anticoagulant titers correlate with the risk of VTE?

Is there any clinical benefit in referring patients with SLE or Sjogren's with cognitive impairment for neuropsychological testing?

How do you differentiate symptoms related to centralized pain syndrome from possible cognitive dysfunction?

When do you begin antifibrotic therapy for a patient with newly diagnosed ILD that is not IPF?

Do you base the decision on FEV1, 6MWD or symptoms at initial evaluation, or progression over time?

How do you evaluate patients with suspected pseudo-dementia?

When prescribing hydroxychloroquine, how do you explain the mechanism of action and how this translates into clinical benefit for the patient?

There are studies that show hydroxychloroquine inhibits autophagy (the orderly degradation and recycling of the contents of the cytoplasm for the cell...

How do you approach the diagnosis of erythronychia?

Is there a validated risk prediction model you favor to risk stratify patients for cardiotoxicity prior to initiation of chemotherapy?

How long would you continue prednisone in an ESKD patient with a failed kidney transplant who develops mild graft pain when steroids are tapered?

What is your approach to management of elderly patients with cardiopulmonary comorbidities and severe pulmonary hypertension?

What is your approach to assessing whether oral/nasal ulcerations are features of systemic lupus erythematosus versus from another etiology?

Classically, lupus mouth ulcers are large non-painful blisters at the roof of the mouth. What do you do with small scattered blisters, painful or not ...

What is your preferred workup for patients who present with concern for autonomic neuropathy?

How do you diagnose and treat patients with cervicogenic headache?

Do you screen for interstitial lung disease in patients with newly diagnosed polymyositis or dermatomyositis in the absence of respiratory symptoms?

How do you define an adequate EBUS when staging NSCLC?

Is there a minimum standard for which stations to sample? Does lymph node size affect your recommendations?

Do you stop tolvaptan below a certain eGFR in a patient with autosomal dominant polycystic kidney disease?

What is your approach to further work-up and management of neutropenia in patients with SLE/RA overlap?

For example, a patient with a bone marrow biopsy that shows normocellular bone marrow. Prior management with leflunomide and HCQ with neutropenia attr...

What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?

Are there any instances where you would prefer a biosimilar rather than the reference product?

When would it be reasonable to consider enhanced external counter-pulsation therapy in patients with refractory angina despite maximally tolerated anti-anginal therapy?

How do you manage hyponatremia in patients with renal cell carcinoma on cabozantinib and nivolumab?

How soon after an end stage kidney disease patient receives a MRI study with gadolinium contrast do you perform their next hemodialysis session?

How do you treat sarcoidosis associated hypercalcemia in a patient with adenopathy and no other signs of systemic involvement?

How do you re-stratify patients with a primary prevention ICD in need of a generator change if their LVEF has improved to >40% and they have not previously required any device therapies?

What additional testing besides LAC/APLS, factor V Leiden, prothrombin gene mutation, JAK 2 do you draw for unprovoked cerebral venous sinus thrombosis?

What would be your next step in workup for a patient with IgG Kappa Monoclonal protein detected on SPEP and free lambda light chains found in the urine, with chronic diarrhea for 3 years and concern for GI amyloidosis?

Are you using NAC in lieu of hypertonic saline amidst the current shortage of hypertonic saline in patients with either CF or non-CF bronchiectasis?

What is your approach to the monitoring and management of a never-smoker with respiratory symptoms and a nonspecific ventilatory pattern on pulmonary function testing?

Which factors favor extended dual antiplatelet therapy beyond one year in ACS patients with low bleeding risk?

Are there any concerns regarding side effects in changing from denosumab to zolendronic acid or vice versa?

When do you perform a kidney biopsy in a patient with AKI that is thought to be related to an immune checkpoint inhibitor?

Do you wait to monitor response to empiric corticosteroids before pursuing a kidney biopsy?

How do you approach the workup for a patient with persistently elevated inflammatory markers (CRP and ESR) whose history and exam do not point to a clear cause?

Are there cases of glomerulonephritis where you do not perform a kidney biopsy in a patient deemed safe to undergo the procedure?

What is the best approach to manage iron overload secondary to both heterozygous HFE gene mutation and two heterozygous aceruloplasminemia gene mutations?

Any particular labs or imaging indicated?

What are your recommendations for adult sickle cell patients who end up being admitted several times a year for pain crises despite hydroxyurea, crizanlizumab, voxelotor, etc?

What can you recommend that might help keep them out of the hospital? Do you consider a program of exchange transfusions in this situation?

What is your PTH threshold for referring an ESKD patient with secondary hyperparathyroidism on maximum medical therapy for parathyroidectomy?

Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?

Would you be comfortable using a JAK inhibitor in a patient with baseline thrombocytosis?

Would the etiology of the thrombocytosis play a role in your decision-making?

When is an appropriate time to consider endomyocardial biopsy for non-ischemic cardiomyopathy?

What is your approach to discordant dsDNA testing, such as positivity to dsDNA by crithidia but negativity to dsDNA by other modalities?

I get a lot of low false positive ds dna (sometimes high- 300) in quest and labcorp but their crithidia specific dsDNA labs when repeated are ne...

When is a kidney biopsy warranted in a patient with possible scleroderma renal crisis?

Do patients on eculizumab or ravulizumab require repeat vaccination against meningococcal infection after a certain interval?

How would you interpret a positive dsDNA in a patient with a negative ANA performed via indirect immunofluorescence?

How would you approach a non-healing wound following lumpectomy for recurrent disease in a patient who underwent breast conservation therapy with radiation 10 years prior?

The patient had lumpectomy with standard radiotherapy to 50 Gy whole breast, followed by 10 Gy boost 11 years ago, and was recently found to have a sm...

When do you recommend lumbar puncture in patients with concern for memory loss?

How do you approach the workup of transverse myelitis without any abnormality on spine MRI?

If a patient has classic TM symptoms but a normal MRI, are there specific causes you look for?

What dose and duration of steroid therapy do you use in steroid responsive ILD?

Do you recommend chlorhexidine mouth rinse for prophylaxis against oral complications in patients undergoing dental work who are immunosuppressed?

What is your response to the question, "Is this terminal?"

How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?

Is there utility of modifying DMARD treatment in a seropositive rheumatoid arthritis patient with recurrent pleural effusions and RA nodules without other signs of active disease?

In a patient with bisphosphonate induced bilateral atypical femur fractures, how would you approach timing of alternative osteoporosis treatments and surgical management?

How do you explain TTP to patients?

When should we consider screening patients with systemic sarcoidosis for cardiac involvement using cardiac MRI or PET given their high risk for sudden cardiac death and discrepancies between reported cardiac symptoms (2-5%) and evidence of cardiac inflammation on advanced imaging and autopsy findings (>25% of cases)?

What changes to immunosuppressant medications do you adopt for kidney transplant patients who contract COVID-19?

What is your approach to the medical management of struvite kidney stones?

How do you counsel patients about the malignancy risk associated with azathioprine?

How do you approach the usage of hydroxychloroquine in patients with rheumatologic conditions and baseline cardiomyopathy or heart failure?

What is the optimal frequency and duration of post-operative radiological surveillance following resection of a solitary fibrous tumor?

What is your approach to checking IgG levels post vaccination to detect common variable immunodeficiency in patients with systemic lupus?

If a deficiency is present, do you consider IVIG to treat non-infectious symptoms such as skin rash, arthritis or hematological abnormalities?

Do you offer immunosuppression to patients with CTD-ILD with concomitant well controlled HIV?

Do you check for EGFR and other mutations in patients with squamous cell lung cancer, including in adjuvant setting before considering immunotherapy?

Are you using the microbial cell-free DNA “Karius” test to aid in the diagnosis of an atypical pulmonary infection such as PJP or NTM?

Would you anticoagulate a patient with an asymptomatic gonadal vein thrombosis on CT scan, found on surveillance imaging for colorectal cancer?

Is there a role for hydroxychloroquine for secondary prevention in patients with APS without SLE?

When would you consider implantable loop recorders for athletes with nonspecific complaints of palpitations/dizziness, without known history of arrhythmias?

How do you manage recurrent inflammatory pleural effusions in lupus pleuritis?

Do you continue to utilize ESR and CRP in patients on tocilizumab?

When do you consider intrathecal baclofen pump in patients with acquired spasticity?

For example, patients with spasticity due to hypoxic or anoxic brain injury.

What is the differential for a patient with unilateral arm swelling, MRI with muscle edema, and markedly elevated CPK?

There is no history of trauma or substance abuse.

Does recent COVID-19 infection result in elevated PSA?

Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?

If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...

What is your approach to therapy for pulmonary sarcoidosis resistant to methotrexate?

What are your preferred treatment options for patients with cholestatic pruritus who do not respond to light therapy?

How would you treat a patient with combined pre- and post-capillary pulmonary hypertension after successfully optimizing post-capillary pressures through a valvular intervention?

What is the preferred timing for removal of a peritoneal dialysis catheter in a patient who has transitioned to hemodialysis?

Is there utility in obtaining pericardial fluid autoimmune labs such as ANA or RF in patients with recurrent idiopathic pericardial effusions, but no other clinical or serologic evidence of rheumatic disease?

Do you routinely isolate and test for TB in a patient incidentally found to have a miliary pattern of nodules on chest CT?

What is your preferred rate control agent for atrial fibrillation with rapid ventricular rate, and why?

How do you approach evaluation of hypocomplementemia in a patient with arthralgias and a history of Hodgkin's lymphoma treated in the past?

ANA and ENA negative

When would you consider obtaining a cardiac CT in lieu of standard TEE for the detection of a left atrial appendage thrombus in atrial fibrillation?

Do you typically get muscle MRI in patients with symptoms of myopathy?

How do you approach the diagnostic workup for patients with suspected Fabry's disease?

How do you manage severe Raynaud's phenomenon with ulceration in scleroderma patients that is refractory to oral agents (CCBs, PDEis, ARBs, and ERAs)?

Is there any role of sympathectomy in Raynaud’s disease?

What is your approach to pulmonary vasodilator therapy in patients with COPD and Severe Group 3 Pulmonary Hypertension?

Would you recommend switching to DAPT for patients on anticoagulation who develop symptoms of a TIA secondary to ICAD?

Do you prefer transtubular potassium gradient (TTKG) or urine potassium to urine creatinine ratio when evaluating patients with abnormal potassium levels?

Would you empirically elective to anticoagulate patients with a remote (i.e. >10 year) history of paroxysmal atrial fibrillation presenting with newly diagnosed CVA, presumed cardioembolic in etiology, without any documented recurrence of AF?

What is the antifungal prophylaxis regimen that you use in patients on peritoneal dialysis who are receiving antibiotics?

How do you approach low to moderate titer of APLS when working up unprovoked DVT if it is persistent on repeat testing?

Would you consider using DOACs in a young patient with SLE and Libman-Sacks endocarditis, who is negative for APS?

Do you routinely monitor the QTc when adding voclosporin to hydroxychloroquine in a patient with lupus nephritis?

What is your approach to rectal cancer staging in patients who cannot undergo an MRI?

How do you approach management of a patient with lower extremity ulcers from livedoid vasculopathy with a history Sjogren’s and Factor V Leiden?

4 cutaneous biopsies with no evidence of vasculitis. Sjogren’s diagnosis based prominent sicca symptoms and a significantly elevated SSA.

In which clinical scenarios is relying on the urine protein-to-creatinine ratio as a measure of proteinuria unreliable, and interpretations should be made looking at urine protein and urine creatinine separately?

How do you manage a patient with progressive cerebellar ataxia and positive cardiolipin antibodies?

Do you wait 12 weeks for confirmation to begin treatment if patient is declining?

How would you manage an adult patient status post subtotal resection of spinal osteoblastoma?

The patient presented with spinal cord compression, had subtotal resection and instrumentation with metallic hardware. Main concern is that post op su...

What antithrombotic regimen do you recommend prior to and in anticipation of CEA for patients with symptomatic carotid stenosis?

How should elevated PT of unclear etiology and significance be evaluated?

In the absence of concerning bleeding or thrombosis, family history of coagulopathy, current anticoagulant use, or malnutrition

Do you feel comfortable using azathioprine for dermatomyositis in patients with cirrhosis?

For example, in the setting of cirrhosis incidentally found on imaging.

What is your approach to patients who present with unilateral Raynaud's?

How would you approach treating a patient with active rheumatoid arthritis and a history of treated lymphoma that is currently in remission?

Given the controversy in the literature regarding TNFi or MTX associated lymphoma in patients with RA.

How would you counsel a patient with active SLE on treatment, low to moderate level of one of the APLS antibodies, and remote history of provoked blood clot regarding perioperative anticoagulation?

Is SLE-related APLS managed differently in terms of anticoagulation?

What are the reasons for SLE specific labs to turn negative?

Patients frequently mention diagnosis of SLE years ago but recent Sm, dsDNA (crithidia) and complements can be normal. Can treatment with medications ...

When is the index of suspicion high for paraneoplastic systemic sclerosis in terms of clinical and serological presentation and how will you work it up?

Does it mirror the same approach as SSc without malignancy? Do patients with paraneoplastic SSc present atypically (without usual serologies or featur...

What is your approach to initiating and titrating midodrine for both inpatient and ambulatory settings?

When do you recommend genetic testing in patients with neuropathy?

How do you approach the symptomatic management of central vertigo in a patient with minimal improvement on (or contraindication to) meclizine?

How do you balance aspiration risks with encouraging PO intake for HN cancer patients during and after chemoradiation?

Encouraging aggressive PO intake in patients with swallowing dysfunction may place them at risk for aspiration pneumonia, especially risky if undergoi...

When is an appropriate time to consider genetic testing for cardiomyopathies for athletes as part of risk stratification for sudden cardiac death, in light of heightened prevalence of cardiac remodeling confounded by exercise and athletic conditioning?

Does your approach to the management of a patient with an acute exacerbation of CPFE where the ILD is attributed to IPF differ from the management of a patient with an exacerbation of IPF alone?

Do you send an antiphospholipid antibody panel routinely for all patients with an unprovoked thrombus?

When is a paraneoplastic panel indicated when working up patients with neuromuscular conditions?

Is rituximab for refractory ITP contraindicated in the setting of an active COVID infection, particularly in a patient with asymptomatic COVID?

What is your approach for using anticoagulation/aspirin in patients with multiple myeloma?

What is your approach to the diagnosis and management of lupus cystitis?

What is your approach to managing RA patients with history of organ transplant already on immunosuppressive therapy such as cyclosporine or cellcept?

What is your go to steroid regimen for post SRS headache?

If a patient calls you after hours with a headache following SRS and have not been given steroids, what is your preferred regimen?

How will you treat a young man with recurrent cryptogenic strokes with no identifiable cause, with MTHFR A1298C homozygous mutation and normal homocysteine level?

Are there any risk factors for IO induced rhabdomyolysis and how do you approach and manage it?

How would you approach a patient with incidentally noted infrarenal periaortitis with positive C-ANCA, normal inflammatory markers and no systemic symptoms?

MPO/PR3, P-ANCA negative. IgG4 normal.

For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?

Do you routinely check G6PD level prior to initiation of hydroxychloroquine?

Would you consider clearing a patient with essential thrombocytosis for a kidney donation?

How would you work up a mildly neutropenic patient (ANC >800) with family history of neutropenia and personal history of occasional mouth sore?

What are indications to order gene mutation studies (e.g. ELANE) and how would it help the patient?

How do you counsel NSCLC patients receiving SBRT on fatigue?

I've noticed that these patients have been having greater than expected fatigue that persists for months after SBRT. This is very different than the f...

How would you approach an elderly patient with tibial plateau insufficiency fracture and normal DEXA?

Tibial plateau insufficiency fxs are not discussed in the guidelines for dx or treatment.

How do you manage an infection that occurs in the treatment field while under treatment?

Do you stop treatment? What if an abscess is also present?

How do you typically treat aortitis associated with spondyloarthritis?

For a rectal cancer with questionable T3 or questionable N+ by MRI, can short course radiation be given followed by surgery and the pathology still be interpreted to guide adjuvant chemotherapy?

I.E., can a patient with a questionable 5 mm node (MRI T2N1) which is negative on pathology after short course radiation be staged T2N0 and receive no...

What is the appropriate management of arthralgias associated with bosutinib?

In patients with lupus nephritis on maintenance therapy, is there additional benefit in utilizing 2 grams vs 3 grams of mycophenolate mofetil (MMF) daily?

What are the perceived implications of broader genomic sequencing as it pertains to interpreting variants of unknown significance and germline predisposition mutations?

Increased genomic testing is likely to increase the frequency with which we encounter these mutations, which we might not otherwise have tested for. H...

What is your approach to the management of a patient with PAH who is resistant to contraception and planning a pregnancy?

How do you work up a young patient with increasing ferritin and normal TSAT without infectious, inflammatory, or liver disorders?

Ferritin uptrending >1000, no additional lab abnormalities. HFE wildtype. Too young for age-appropriate cancer screening. Asymptomatic except fatig...

Among asymptomatic patients with structurally normal TTE undergoing treatment with anthracyclines or alkylating agents that develop mildly elevated BNP and/or troponin levels, would you consider referring them for cardiac MRI to evaluate for subclinical cardiotoxicity?

What is the optimal management of a patient needing surgical clearance for a knee replacement with VWF Ag and factor VIII between 40-50 and no bleeding history?

Is LP indicated for patients with recurrent thunderclap headaches over a 4-week period and negative head imaging for SAH?

In a patient with Type I von Willebrand disease with history of VTE and heavy menses, would tranexamic acid be a treatment option?

Is thrombotic risk too significant? Patient failed OCPs.

Do you initiate management of new onset diabetes in a patient on immunotherapy or refer immediately to endocrinology given the risk of rapid worsening?

Do you routinely provide GI protection in the form of a PPI or histamine blocker for patients with immunobullous disease initiated on high doses of oral corticosteroids?

Do you routinely screen for pulmonary artery aneurysm in patients with Behcet's?

How would you treat a patient with rectal cancer with a solitary lung metastasis, who now has no evidence of disease after total neoadjuvant therapy followed by rectal surgery and resection of the solitary metastasis?

Would you give additional treatment after surgery?

How do you follow up a patient with esophageal adenocarcinoma who is not a surgical candidate after finishing chemoradiation?

Do you prescribe antifibrotics to patients with combined pulmonary fibrosis and emphysema (CPFE)?

How do you approach the management of patients on lamotrigine who develop a minor rash?

Should one restart lamotrigine or look for an alternative? If no other alternative available, is slow titration vs regular titration preferred?

When can abdominal surgery be safely performed for presumptive ovarian cancer in a patient with recent pulmonary emboli?

(Normal oxygenation and echo)

Can APLS cause a false positive HIT ELISA?

If so, is there one type of antibody that is more likely to cause this false positive test?

In what circumstances do you pursue labial salivary gland biopsy in an asymptomatic patient with high titer ANA and positive SSA?

How do you risk stratify and monitor such patient for disease progression or organ involvement?

How do you manage a diabetic patient with generalized myasthenia gravis post thymectomy previously treated with Imuran?

At what ferritin threshold would a patient with anemia of inflammation or malignancy no longer benefit from iron supplementation for functional iron deficiency?

For example, if TSAT is less than 20% but ferritin is over 200.

What is your approach to tapering therapy in a patient with recurrent pericarditis now well-controlled on rilonacept?

How should you work up calvarium or other osseous lesions when found during the initial staging of a patient with a new diagnosis of NSCLC otherwise non-metastatic?

How do you workup splenomegaly related to possible hematologic etiology in the absence of abnormal blood counts, adenopathy or severe constitutional symptoms?

For instance, evaluation by primary care and GI without other etiology for splenomegaly

How would you approach initiating belimumab in a patient with serologic evidence of prior hepatitis B infection?

Such as patients with negative Hepatitis B surface antigen and negative viral load but with positive hepatitis b core antibody.

How do you approach the diagnosis and treatment of recurrent neurosyphilis in a previously treated patient?

Are VDRL titers useful?

Do you recommend continuous antibiotic prophylaxis for patients on complement inhibitors such as eculizumab?

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

When do you consider immunosuppression in patients with Sjogren's neuropathy?

How would you confirm the diagnosis of splenic marginal zone lymphoma without utilizing splenic biopsy or splenectomy?

How do you approach the workup of a patient with incidentally found pachymeningitis?

Do you treat secondary erythrocytosis caused by SGLT2 inhibitor?

Do you treat Candida spp isolated from a bronchoalveolar lavage?

Is there a role for biologic therapies in asthma-COPD overlap syndrome with evidence of type 2 inflammation?

How do you manage patients on biologics peri-operatively?

Are there any medications that surgeons like discontinued before their procedure?

When performing salivary gland ultrasound for Sjogren's, what else do you include in the differential diagnosis?

How do you manage a case of dermatomyositis that is proven on skin biopsy and clinically has proximal muscle weakness but normal muscle enzymes, including CK, aldolase?

How do you manage dermatomyositis related to underlying malignancy?

Is there a role of immunosuppression or treating underlying malignancy will be enough?

How do you approach RA management in a patient who develops a new solid tumor while on therapy?

What is your approach to the work up and management of interstitial lung abnormalities?

What is your practice for the timing of resumption of oral anticoagulation after ICH?

Do you order any imaging beforehand? Are there other studies that you order?

Why do we not typically see features of rhabdomyolysis or acute kidney injury with idiopathic inflammatory myopathies?

How do you evaluate asymptomatic patients referred for benign intracranial hypertension?

If patients are asymptomatic, what work up do you typically proceed with?

When would you consider a workup for C. diff in a patient with diarrhea under-going concurrent chemoradiotherapy for rectal cancer?

If the patient is outpatient and coming into clinic each day, at what point would you initiate a C. diff workup?

How do you approach work-up for a patient suspected for monoclonal gammopathy of renal significance for whom renal biopsy is contraindicated?

E.g. a patient with monoclonal protein with mild light chain ratio elevation. Do we need to get a BM biopsy in all such patients?

When considering the use of DOACs in APLS, does the number of positive APLS antibodies influence your decision?

How do you manage refractory hyponatremia in patients on active therapy in small cell lung cancer?

How do you manage osteonecrosis and pelvic insufficiency fractures after pelvic radiotherapy?

What is your treatment algorithm for management of retroperitoneal fibrosis that does not respond to high-dose glucocorticoids?

How do you manage and/or prevent ruxolitinib withdrawal syndrome?

What symptomatic management do you recommend in patients with post LP headaches?

When do you consider a blood patch?

How do you approach treating idiopathic aortitis?

What are your primary and secondary agents?

Do you avoid intra-articular and bursa/tendon sheath corticosteroid injections in patients with a history of avascular necrosis?

Do you routinely continue airway clearance therapies in the setting of mild to moderate hemoptysis in a patient with CF?

How do you manage orthostatic hypotension in patients with Parkinsonian syndromes?

We often use abdominal binders and compression stockings, in addition to hydration and midodrine/fludricortisone. However, are there more targeted the...

Would you consider prophylactic antifungal treatment prior to immunosuppressive therapies in a patient with previously treated pulmonary coccidiomycosis and residual parenchymal changes?

How do you approach the workup for patients with hyperCKemia and positive NXP2 with no clinical symptoms?

Do you do recommend further mediastinal staging for patients with SCLC or inoperable NSCLC with N1 disease on PET?

If a patient clearly has N1 disease with high SUV on PET, do you routinely recommend EBUS or mediastinoscopy to evaluate for N2 disease?

What is the most effective treatment for a patient with persistent post-stroke headache?

Do you hold IV iron in the setting of active infection?

What patient characteristics would lead you to opt for triple therapy versus double therapy in newly diagnosed PAH?

What is the recommended management approach in regard to diagnostic evaluation and treatment for patients with homocystinuria and cerebral thrombosis?

Do we prophylactically place patients on anticoagulation after one episode? Besides MRI/MRV brain, are there other diagnostic imaging that should b...

When do you use levocarnitine in patients on Depakote therapy for seizures?

What is the diagnostic utility of ordering an "Early Sjogren's Syndrome Profile", which tests novel autoantibodies, to support a diagnosis of Sjogren's syndrome in patients who test negative for SSA/SSB?

How do you approach the initiation and/or continuation of antiseizure medication in a patient who has experienced one lifetime seizure with a normal EEG and MRI with a comorbid health condition that is associated with an increased risk of epilepsy?

(e.g. Alzheimer's disease)?

What steroid regimen do you employ in the treatment of patients with post COVID-19 pulmonary fibrosis?

How do you manage dyschezia and tenesmus following TNT with short course RT?

In your experience, is there an association between interstitial cystitis and systemic lupus erythematosus?

Do you counsel patients with an ileostomy about significant diarrhea when treating the pelvis with radiotherapy?

Have you noted significant diarrhea until the ileostomy is reversed?

How would you approach a rising PR3 in a patient with limited GPA who is currently asymptomatic on methotrexate?

Would you obtain imaging? If so, what type of imaging?

What workup and initial treatment should be considered for suspected autoimmune myelofibrosis?

What is the best treatment for radiation recall skin reaction of the breast?

If a patient develops a new erythematous macular rash in the exact area of the prior radiation portal months following completion of RT without new me...

How do you approach a mildly positive finding on an autoimmune encephalitis panel when there is no other evidence of encephalitis (such as elevated CSF protein, abnormal imaging, or EEG findings)?

For example, a GAD65 Ab of 0.07 when the cut-off is 0.02. Does this answer change if you consider adult vs pediatric populations?

When do you trial pyridostigmine in a patient with suspected myasthenia gravis?

Is there a role for using a trial of pyridostigmine as a diagnostic aid in a patient with suspected (but not confirmed) myasthenia gravis?

How would you manage polymyalgia rheumatica refractory to prednisone, methotrexate and tocilizumab?

Patient has no current evidence of underlying vasculitis or malignancy.

What is your approach in a patient who develops interstitial lung disease while on anti-TNF therapy?

Do you change therapy? If they are also on methotrexate, which medication would you potentially stop first?

How would you work up and manage persistent lymphopenia in an asymptomatic patient?

ALC<200

How would you manage an incidental catheter-related thrombosis in a functioning dialysis catheter?

- Dialysis catheter used for hemodialysis- RIJ thrombus in dialysis catheter was incidentally found- Patient asymptomatic with no prior history of VTE...

Do you favor the use of Fick or thermodiluation to measure cardiac output in patients with interstitial lung disease with suspected pulmonary hypertension?

Occasionally, supplemental oxygen may alter Fick measurements giving falsely high CO and falsely low PVR, therefore is Thermodilution method preferred...

Which images do you routinely request when ordering a HRCT chest?

How would you treat systemic polyarteritis nodosa with orchitis, mononeuritis and glomerulonephritis in a person who is being treated for HiV with low level viremia?

Is an elevated CRP an expected finding in an otherwise healthy patient with hemoglobin S - alpha thalassemia?

CRP 39 mg/L (normal < 10) and normal ESR

Does the overall conclusion of the CHANCE-2 trial make ticagrelor + ASA a worthwhile transition given the data showing cumulative hazard of stroke diverged during the first week and was subsequently similar, which suggests the benefit of ticagrelor over clopidogrel is seen predominantly soon after stroke?

How would you manage someone with antithrombin deficiency who has recurrent VTE on a DOAC?

APLA syndrome, obesity, non compliance ruled out and prefers another oral anticoagulation. Is higher dose of rivaroxaban or apixaban an option?

How much weight would you place on a low titer Ku antibody in a patient with mild CPK elevation but no weakness on exam and no other features of CTD overlap syndrome?

Would you consider EMG, muscle biopsy, repeat myositis panel? Would you consider starting immunosuppression?

How do you approach differentiating segmental arterial mediolysis from abdominal vasculitis?

Do you avoid PTH/PTHrP analogs in patients with recurrent/severe CPPD?

When do you consider tapering tocilizumab in patients with GCA in remission?

How do you manage/treat acute radiation-induced enteritis?

Are there any medications that you can prescribe? Diet changes? Does this typically resolve on its own after time?

What is your approach to the workup for an underlying systemic condition in a patient presenting with retinal vasculitis?

Does normal methylmalonic acid levels absolutely rule out vitamin B12 deficiency?

How do you evaluate livedo reticularis (not livideo racemosa)?

Does your evaluation hinge on nonresolution with warming? How extensive is your workup?

What is your work-up for acquired keratoderma?

Does morphology guide your workup?

Do you ever do surveillance MR imaging in patients with stable exam and history of cardioembolic stroke?

How do you decide on initiation of treatment with steroids or immunomodulatory therapy in patients with statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy?

In patients presenting with likely statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy - how do you approach the decision re...

Would you generalize the data from the CHANCE-2 trial to a broader clinic population given that the study was specific to Han Chinese patients?

How do you plan to incorporate the results of the CHANCE-2 trial (Wang et al., PMID 34708996) in your own practice?

Do you recommend genetic testing after a patient on clopidogrel has a stroke based on the results of the CHANCE-2 trial?

Would you consider anticoagulation for a young patient with a recent embolic stroke and newly diagnosed global cardiac hypokinesis with ejection fraction of less than 25%?

No thrombus detected on echocardiogram and no evidence of atrial fibrillation is present.

How would you approach a patient with refractory polymyositis (elevated CK, weakness) despite MMF, IVIG, and moderate dose prednisone?

Would you consider adding tacrolimus in this situation?

What workup do you do for patients who have PL-7 elevation when screening for myopathy?

Would you recommend short-term dual antiplatelet therapy for a patient who received tPA, and is otherwise eligible for dual antiplatelet therapy per POINT or SAMMPRIS trial?

How do you mitigate the risk of renal crisis from corticosteroids in a patient with UCTD?

How do you work up patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance?

For patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance, what work up process do you typi...

How do you interpret a mildly positive NT5C1A lab test in patients with hyperCKemia?

Do you always initiate hypercoagulable work up in a patient with recurrent stroke?

If so, what would you consider ordering?

In a patient with a bleeding disorder, how would one approach anticoagulation during active COVID infection?

Bleeding disorder such as vWD

What is the negative predictive value of a negative extended myositis panel in dermatomyositis patients?

How do you manage psoriatic arthritis in patients who are planning to start treatment with checkpoint inhibitors for underlying malignancy?

What is your approach to workup for an underlying disorder in a patient with bilateral hip avascular necrosis?

At what platelet count would you feel comfortable dosing aspirin 81 mg for coronary artery disease in a patient with ITP?

Presuming strong indication for ASA - eg history of NSTEMI

How do you counsel patients with elevated factor VIII levels for their thrombosis risk?

Should we stop checking factor VIII levels as part of thrombosis workup?

With the approval of oral JAK inhibitors such as Upadacitinib for atopic dermatitis, how are you considering its safety profile in comparison to traditional immunosuppressants such as prednisone, methotrexate, azathioprine, and mycophenolate?

Especially in the setting of these being more narrow acting than tofacitinib, should we consider them safer than our old drugs?

If you have clinical suspicion for a paraneoplastic process (e.g. dermatomyositis or pemphigus), what work-up do you pursue?

How would you approach protein S deficiency found on hypercoagulability work-up in a patient with a post-operative central retinal vein occlusion?

In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...

Do you stop treatment for a prostate cancer patient diagnosed with acute radiation proctitis with significant pain?

If the diagnosis was made by an outside physicain, how do you confirm/refute the diagnosis? Would an alternative diagnosis like a thrombosed hemorrhoi...

Do you routinely order a thoracic or brachial plexus MRI for patients with apical lung cancers?

Would you consider this standard in asymptomatic patients for workup and treatment planning? Or do you reserve MRI for symptomatic patients only?

How do you interpret elevations in antiphospholipid antibodies that are lower than Sapporo criteria?

(e.g. beta 2 glycoprotein IgM > 20 but <40)

Are adults with IDD at increased risk for adverse events like NMS or central anticholinergic syndrome?

At what point do you recommend muscle biopsy in the workup for myositis?

How do you approach the management of capmatinib induced edema?

How important do you feel HLAB51 testing is in diagnosing Behcet's disease?

In your experience, are there specific disease manifestations in which HLAB51 is particularly helpful?

How do you manage insomnia in cancer patients that is refractory to traditional sleep aides?

In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?

How does the FDA safety warning on the cardiac effects of lamotrigine, based on in vitro data, inform your clinical practice?

This question is intended to include consideration of cardiac diagnostic screening, as well as initiation & maintenance of lamotrigine, in epileps...

Would you give antithrombin concentrate for surgical VTE prophylaxis in case of congenital AT deficiency?

What is the role of non-prednisone oral glucocorticoids in the management of systemic rheumatologic disease?

Such as oral methylprednisolone, dexamethasone, prednisolone, etc.

To what extent does the degree of thrombocytopenia correlate with the severity of cirrhosis?

How do you manage patients who develop minor antigen antibodies and require multiple blood transfusions?

e.g. K, Fya, s, etc

What criteria do you use to consider pleurodesis vs indwelling tunneled catheters in patients with malignant pleural effusion?

How do you counsel patients regarding prognosis following a diagnosis of IPF?

How long after starting anticoagulation would you remove an IVC filter in a patient with a DVT presenting with stroke and PFO which is now closed?

How do you approach a thoracic lymph node that is highly suspicious on CT and PET but negative on EBUS in patients with NSCLC?

How do you approach relapsing ANCA-associated vasculitis in a patient who has already undergone kidney transplant?

In what conditions can you see roving eye movements?

Do you adjust immunosuppression in lung transplant recipients diagnosed with COVID-19?

Is there a role for the use of inhaled corticosteroids in patients with pulmonary sarcoidosis who have stage II or III disease with abnormal lung function but only mild respiratory symptoms?

How do you clinically distinguish between group I and group III PH in patients with CTD-ILD?

Do you recommend patients wait to have a total hip sx after salvage radiation for RP?

If so, what is timing after salvage radiation that you would recommend?

Do you utilize soluble IL-2 receptor or ACE levels as serum biomarkers to monitor disease activity in pulmonary sarcoidosis?

Based on findings of the INCREASE trial, are you routinely prescribing inhaled treprostinil to patients with group 3 pulmonary hypertension secondary to interstitial lung disease?

How do you treat patients with sarcoid who have persistent symptoms after an initial 6 week course of corticosteroids?

Do you stop PPI when starting patients on immunotherapy?

Which medications have the lowest risk of tuberculosis reactivation in patients with uncertain tuberculosis history and active rheumatologic disease?

Do you consider the use of antifibrotics at presentation in patients with a radiographic UIP pattern of pulmonary fibrosis in the presence of positive serologies without any symptoms of CTD who have not yet demonstrated evidence of a progressive phenotype?

When would you consider biopsy for an incidentally noted, PET negative, solid, solitary pulmonary nodule that is >8mm in size?

Is there a role for antifibrotic therapy in post COVID-19 pulmonary fibrosis?

Do you consider EBUS TBNA in the diagnostic evaluation of patients with mediastinal lymphadenopathy with concern for lymphoma?

Can giant cell arteritis present with a partial cranial neuropathy?

How do you approach the treatment of SREAT (steroid-responsive encephalopathy with autoimmune thyroiditis) after initial pulse dose steroids?

What is the difference between Multisystem Inflammatory Syndrome in Adults (MIS-A) and MAS/HLH?

How do you approach treating cutaneous PAN?

Other than inflammatory markers and following symptoms/exam, do you need any other specific monitoring for progression to systemic disease?

What are the alternatives to anticoagulation in an individual with an atrial thrombus and absolute contraindications to anticoagulation?

How does evidence of cerebral amyloid angiopathy/microbleeds affect choices for secondary stroke prevention in patients with a history of ischemic stroke and atrial fibrillation?

How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...

When staging prostate cancer, does MRI pelvis/prostate replace CT A/P?

Does calcinosis appear differently in patients with dermatomyositis compared to systemic sclerosis?

What are best practices for engaging with multidisciplinary colleagues to ensure patients with earlier stage NSCLC are being appropriately considered for novel adjuvant therapies?

How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...

How do you approach DMARD therapy in patients with rheumatoid arthritis and chronic hepatitis B?

Hepatitis screening labs revealing Hep B ag and core positivity with positive PCR

Do you offer adjuvant therapy for rectal intramucosal carcinoma within a large rectal adenoma?

Would you follow the same guideline recommendations for adenocarcinoma if the adenoma component is invading miscle wall?

Would you give a TPO agonist for thrombocytopenia in alcoholic cirrhosis?

Would you check vitamin B6 routinely in the work up of anemia?

Are there best practices or data regarding the use of open notes among oncology patients?

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

How do you approach heparin management in patients who have suprathetherapeutic Xa levels on minimal heparin?

What is your recommended management algorithm for bleeding associated with an acquired factor VIII inhibitor?

How would you approach a patient with imaging and labs suggestive of potentially resectable cholangiocarcinoma when several core biopsies reveal bridging fibrosis with no malignant cells?

What is your treatment paradigm for rectal cancer in the setting of COVID-19?

Are you doing more TNT to prolong time to surgery? If so, do are you starting with CRT or chemotherapy?

When would you suspect metabolic myopathy and what is your approach to initial workup?

How do you differentiate a lupus flare versus drug-induced lupus in patients with SLE on a drug associated with DILE?

How would you qualify and treat a patient with neutropenia, anemia, and abnormal NK cell population with normal trilineage marrow maturation?

Peripheral blood flow shows prominent NK cell population but marrow aspiration/bx shows normocellular marrow with trilineage hematopoiesis.

Does 4G/5G polymorphism in the plasminogen activator inhibitor (PAI-1) gene increase the risk of thrombosis?

In the absence of a VTE would you consider prophylaxis after a surgical procedure? Often non-hematologists order this testing but we are consulted for...

What is the role of x-ray of the cervical or lumbar spine in patients presenting with radicular symptoms?

I teach my students/residents that they should hardly ever get routine X-rays in patients presenting with radicular symptoms. MRI far better for seein...

Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

What is your approach to treatment for a patient with progressive ILD (UIP pattern) with high titer RF but no articular symptoms?

At what stage of the neuropathy workup do you screen for B6 toxicity?

How do you treat lupus-associated small fiber neuropathy?

Is antiplatelet or anticoagulant therapy preferred for the secondary prophylaxis of cryptogenic stroke in a patient with underlying malignancy?

What is your approach to initial assessment of disease extent in patients with Behcet's disease?

How does this vary from continued disease monitoring?

What is the significance of elevated fractionated catecholamines in POTS?

What would be the next steps in these cases?

For treatment of ITP, what would you add to dexamethasone to achieve the fastest recovery in a patient waiting for a procedure?

IVIG, TPO, or other agents?

What infectious prophylaxis do you use for patients with newly diagnosed multiple myeloma?

How do you decide how long to continue?

How do you think about biologic use in patients with underlying HIV infection?

How would you approach evaluation and treatment of a patient on pembrolizumab therapy who presents with symmetric, proximal, upper extremity and lower extremity painful weakness without an elevated CK?

How soon after completion of salvage RT to the prostate bed do you allow urethral dilation?

Eg patient has been catching for years but now developing stenosis towards end of salvage RT course.

How would you approach new-onset large vessel vasculitis in a young patient with Crohn's disease?

Have you seen patients who develop neuromuscular disorders following COVID-19 vaccination?

How should one manage a patient with leukocytosis and borderline detectable BCR-ABL without other clinical features of CML such as basophilia or splenomegaly?

e.g. IS < 0.002% by qPCR

How does one interpret persistently positive lambda light chains on serum immunofixation but without measurable serum monoclonal protein and a normal light chains and ratio?

Is a repeatedly abnormal serum immunofixation all it takes for MGUS?

How do you approach the workup and management of patients with suspected functional neurologic disorders?

What testing do you typically proceed with?

In which subset of patients with concussion do you recommend further brain imaging?

Do you typically recommend MRI or CT?

At what point is a skin biopsy indicated in patients with neuropathy?

What are your considerations for peri-operative anticoagulation in patients with a mechanical heart valve undergoing a major noncardiac surgery?

Please comment on bridging.

Does testing for elevated serum homocysteine have any relevance in thrombophilia management?

What should be done with a high level?

Do you always perform temporal artery biopsy in patients with positive inflammatory markers and high clinical suspicion of GCA?

Is either ESR or CRP more sensitive or specific for the diagnosis of GCA?

Additionally, what is the current role for temporal artery ultrasound in workup for GCA?

What is your approach to evaluation of underlying autoimmune disease in patients with bilateral scleromalacia?

How do you treat post-IVIG headache that is not responsive to Tylenol or NSAIDs?

Specifically, how do you treat the delayed headache, not the headache that develops during the infusion where pre-hydration and slowing down the rate ...

Are you comfortable using DOACs in obese patients with VTE?

What is the utility in repeating a temporal ultrasound (US) in a previously US diagnosed positive GCA patient who has received treatment and is presenting with recurrent GCA symptoms?

How do you approach the management of immunosuppression in patients with lupus nephritis that go on to dialysis?

For patients with atrial fibrillation on DOAC, when should they resume DOAC after a thalamic bleed without intraventricular bleed?

How does presence of intraventricular hemorrhage change your recommendations?

For rectal adenocarcinoma initially staged as T2N0 and treated with upfront surgical resection, but pathologically upstaged to pT3N0 without high risk features, how do you approach adjuvant therapy?

How do you counsel patients on the benefit of adjuvant therapy who thought surgical resection was curative?

How would you approach asymptomatic hepatic sarcoid?

Multiple lesions on PET

Is there a role for immunosuppression in patients with triple positive antiphospholipid antibodies who do not meet the clinical criteria for APS?

What particular pre-operative considerations should we consider for SLE patients undergoing elective surgery?

How do you approach DMARD therapy in a patient with lupus and recurrent pericarditis?

How do you approach the use of commercial testing such as AVISE CTD in clinical practice?

Do you find 14.3.3 eta or vectra DA helpful in clinical practice?

In a patient with inflammatory orbital disease without a discrete mass to biopsy and recent bisphosphonate use, how much additional workup would you do if basic labs, urine studies, ANCA serologies, thyroid studies, chest imaging (to r/out sarcoid) are normal, before concluding that the process is likely secondary to bisphosphonate use?

Without a discrete mass to biopsy, is there any utility of any blind biopsies to rule out IgG4 related disease, infectious or neoplastic process?

How do you manage a patient with inclusion body myositis?

Is there a role for immunomodulatory therapy?

How do you approach immunosuppressive therapy in lupus-associated pulmonary arterial hypertension?

What is your approach to a patient with normal LFTS and high titer auto-antibodies suggestive of autoimmune hepatitis?

Is a liver biopsy ever helpful?

Do you approach the diagnosis and treatment of HIT patients differently in the outpatient setting or in a resource-limited community setting?

For example, for outpatients or resource-limited settings with a moderate probability 4-T score (but low clinical suspicion), would you ever consider ...

Is there any experience of using sarilumab instead of tocilizumab for steroid sparing effect in GCA during national tocilizumab shortage?

What workup do you recommend for patients with stabbing headaches?

How do you approach treatment?

How do you manage HIT in a patient with high bleeding risk?

e.g. in the setting of using prophylactic heparin in the past but now requiring therapeutic anticoagulation

What DHE migraine protocol works best for acute treatment both in terms of dosage and timeframe?

What is your typical workup for a patient with a spontaneous renal infarct?

Please also discuss the type and duration of anticoagulation.

How do you clinically distinguish between cutaneous lupus with photosensitivity and polymorphic light eruption-like reactions?

What is the importance of finding a positive titer for FGFR3 and what treatment would be advised for these patients?

In patients with high-risk polycythemia vera with a history of thrombosis, should aspirin be used in addition to indefinite anticoagulation and cytoreduction for prevention of recurrent thrombosis?

What if there are no cardiovascular risk factors? Are VKAs preferred or can DOACs be used?

How do you approach patients with underlying psychiatric disorders who refuse CML treatment due to not believing their diagnosis?

What is the role for angiography in the workup of digital ischemia?

Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?

Is there a role for antibody testing to confirm vaccine response for patients on rituximab after COVID-19 vaccination?

When would you consider checking JC virus prior to initiating biologic therapy?

What immunosuppressive agents would be available to patients with a history of melanoma?

Would you use immunosuppression in patients several years after curative treatment for melanoma?

Do you routinely check for copper deficiency as part of workup for bicytopenia with leukopenia/anemia or pancytopenia?

What is your preferred approach for patients with anti-phospholipid syndrome with recurrent thrombosis on coumadin and LMWH?

How will you use REGEN-COV (casirivimab/imdevimab-monoclonal antibody treatment recently approved under EUA as post-exposure prophylaxis for Covid) in rheumatic patients on immunosuppressive therapy?

Would you consider this for patients on B-cell depleting therapies or more broadly for other immunosuppressive agents?

How would you approach moderate neutropenia (ANC < 1000) in a solid organ transplant recipient?

Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...

Do you routinely obtain a chest x-ray prior to initiating anti-TNF or other biologic therapy?

Does Quantiferon gold replace the need for baseline chest x-ray screen?

What was the rationale for abrupt discontinuation of etanercept rather than gradual tapering in the SEAM-RA trial?

The ACR 2021 RA Guidelines suggest the gradual tapering approach is preferable.

What are your recommendations regarding methotrexate usage in patients with persistent chest CT changes post COVID pneumonia?

Would you have a different opinion based on whether it is a new therapy or an existing and previously well-tolerated therapy for the patient?

How do you approach the use of steroids for active muscle disease in patients with scleroderma-myositis overlap syndromes?

How do you diagnose sickle hepatopathy?

What suspected myositis manifestations drive you to start empiric therapy before the work-up is complete?

Myositis specific antibodies and pathology results often take weeks to result. In which cases do you start therapy before the diagnosis is solid...

How do you approach conversations regarding discontinuation of transfusions in patients with advanced hematologic malignancies who are otherwise appropriate for hospice?

Are there other supportive care interventions that would otherwise be covered by hospice?

How would you manage VTE in a patient with bleeding disorder such as hemophilia?

Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?

What is your approach to managing sclerosing mesenteritis (mesenteric panniculitis)?

Do you have a preferred initial immunosuppressive regimen?

How would you manage a patient with acquired von Willebrand disease who requires DAPT for arterial disease?

How do you diagnose and treat patients who develop uveitis while on bisphosphonate therapy for osteoporosis?

Are there specific features that suggest drug-induced uveitis versus de novo uveitis?

How do you determine if a patient is safe to drive after having a PCA infarct?

What is the best way to determine if patients with new PCA territory infarct can drive? Upon discharge from the hospital, do you routinely refer them ...

What is your steroid-sparing agent of choice to treat GCA given the current tocilizumab shortage?

Thoughts on sarilumab vs methotrexate, or just treat with steroids alone

What hematologic conditions are contraindications for a COVID vaccine?

How would you manage a patient with type 1 cryoglobulinemia secondary to MGUS?

What if the patient is no longer responding to steroids?

How do you evaluate a suspicious, but negative pleural effusion when working up NSCLC and SCLC?

Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...

How would you manage early-stage low rectal cancer in a patient unable or unwilling to undergo surgery?

Would you pursue temporal artery biopsy in patients with PMR who develop cranial GCA symptoms and have been on PMR dose steroids for one year?

What is your approach to differentiating SLE flare in pregnancy vs pre-eclampsia?

Do you recommend that patients undergoing radiation treatment get a COVID vaccine booster?

If so, what patients do you recommend get one and do you have concerns for patients who also may be receiving chemotherapy as the CDC guidelines recom...

In which patients with oncologic or hematologic disorders are you recommending a 3rd dose of mRNA COVID vaccine?

What criteria do you use on echocardiogram and PFT to determine who needs further evaluation for CTD-associated pulmonary hypertension?

Do you recommend anticoagulation for a splenic infarct in patients with myelofibrosis and splenomegaly?

What indicators do you use to identify patients with CTD-ILD who do not have potential to improve from continued immunosuppressive therapy?

Do you use imaging (fibrosis vs. pneumonitis), PFTs, duration of prior immunosuppressive therapy?

How do you approach treatment of vasculitis in a sickle cell disease patient?

There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...

What is your differential for a patient presenting with multiple digits affected by flexor tenosynovitis, dupuytren's, and no evidence of peripheral inflammatory arthritis?

What studies do you find helpful to determine if an axial spondyloarthritis patient presenting late in the disease course with significant irreversible joint damage may benefit from immunosuppression?

Do you advise patients to hold DMARDs for conditions such as psoriasis or rheumatoid arthritis while actively undergoing radiation treatment?

Does it depend on the DMARD type (biologic, targeted synthetic, or conventional synthetic)?

What are your thoughts on use of 14-3-3 serum levels in rheumatoid arthritis in conjunction with RF and ACPA?

For low rectal adenocarcinoma that extends to the anus through the internal sphincter muscle, would you recommend neoadjuvant therapy in a patient who will undergo APR?

Does extension to the anus affect your determination of T classification? Would you consider this a T2 tumor if it does not extend to the external sph...

What is your perioperative approach to holding and restarting hydroxyurea in patients with essential thrombocythemia?

Are there any specific circumstances when you would consider the use of immunosuppression for DISH?

There is some emerging evidence that there is an inflammatory component.

Should assessing for a MTHFR mutation be part of the thrombophilia evaluation in a patient presenting with a thrombus?

When is the best time to consider left atrial appendage closure for secondary stroke prevention in patients with atrial fibrillation?

For example, with a Watchman device? What is the evidence behind this?

What is the best way to approach elevated liver enzymes in patients treated with combination TKI and immunotherapy?

Are there any clinical features that can inform etiology/which medication to hold?

Can you use other iron formulations if a patient develops Stevens-Johnson Syndrome with ferumoxytol?

How do you approach screening for inflammatory bowel disease prior to starting IL-17 inhibitors?

Is there any role for iron chelation in a patient with iatrogenic transfusion-induced iron overload such as in patients with end-stage kidney or liver disease?

Does transplant eligibility make a difference for management?

How do you approach the treatment of eosinophilic fasciitis refractory to glucocorticoids and methotrexate?

Do you routinely obtain bone marrow biopsy in newly diagnosed autoimmune hemolytic anemia when working up potential underlying etiologies?

What is your approach to immunotherapy-related pancreatitis?

How do you manage the initial event, including length of steroid taper and the role of pancreatic enzyme monitoring? What is your experience of subse...

How do you manage acute tenesmus related to SpaceOAR?

Do you manage post radiotherapy onset of tensmus differently?

How do you approach evaluation of pulmonary vein thrombosis?

Is there any difference between anticoagulants in this clinical context (e.g. anti-Xa inhibitors vs warfarin vs LMWH)?

What immunosuppressive agents aside from steroids would you use to treat bronchiolitis obliterans in a patient with long-standing seropositive RA?

Is an EMG/NCS required to clinically diagnose Guillain barre syndrome?

How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?

Is there a role for empiric antibiotics if there is history of opportunistic infection?

How do you approach the treatment of drug-induced thrombotic microangiopathy?

When do you consider initiating eculizumab?

How do you manage oxaliplatin-induced acute peripheral nerve hyperexcitability?

Patients can develop sensory and motor symptoms such as paresthesias, jaw/facial pain and stiffness, cramping and twitching, ptosis and vision changes...

How do you approach treatment for arthritis associated with multicentric reticulohistiocytosis?

Would you use inhaled steroids with or without oral steroids for the treatment of radiation pneumonitis?

Would inhaled steroids help reduce the PO dose and/or significantly accelerate tapering? If s, for what pneumonitis grade? What specific steroid...

In patients with recurrent ischemic infarcts on the same side as an internal carotid artery lesion, is intervention warranted even if there is less than 50% obstruction?

When would you consider stenting or CEA even if there is less than 50 obstruction when no other etiology has been found?

What is your approach following R1 resection in a patient who has received total neoadjuvant therapy for rectal cancer?

Would you start tocilizumab in a patient with temporal arteritis and cirrhosis?

Given the long half-life of dexamethasone, what is an appropriate dose schedule?

For a patient receiving 16 mg/day, it is frequently prescribed as 4 mg q 6 hrs. This results in the patient being awoken at night, when sleep di...

How would you evaluate a patient with an isolated high RBC count but with a normal hemoglobin and hematocrit?

Would you consider this type of patient as having polycythemia?

Which patients with rectal cancer who have not received neoadjuvant treatment do you offer adjuvant radiation to?

Is there a subset of patients you would avoid neoadjuvant CRT and operate first?

Should the use of avacopan be limited to those patients at increased risk of steroid toxicity given the anticipated high cost of this medication?

ADVOCATE trial

Are there scenarios where you send additional antibodies beyond anti-centromere, Scl-70, and RNA polymerase III in suspected scleroderma patients?

How would you manage an active rheumatoid arthritis patient on suppressive antibiotic therapy for ocular HSV who has abnormal liver function tests?

When (if ever) do you check for anti-platelet antibodies for workup of thrombocytopenia?

Do you offer iron supplementation to a patient with iron studies that are normal (including normal ferritin) except for low iron saturation?

What is the potential differential diagnoses for low iron saturation?

Are there any concerns about using nintedanib in a patient with progressive fibrosing ILD on background mycophenolate?

Do you recommend checking anti-drug antibodies for patients on TNF inhibitors?

If so, how would positive levels guide your management?

When is it necessary to monitor the QTc interval in patients on hydroxychloroquine?

What aspects on history and physical exam could help differentiate genetic muscular dystrophy from immune-mediated myopathy?

How do you treat CTD-associated organizing pneumonia?

How is your approach to treatment different than other ILD patterns such as NSIP? Does treatment response vary based on underlying CTD?

How do you approach peri-operative management of anti-resorptive therapies such as denosumab in patients undergoing joint replacement?

Does denosumab effect knee replacement or hip replacement? Should replacement occur right before or after injection?

How do you interpret and utilize PSA values in patients on dialysis?

How does dialysis affect PSA lab values?

Is it okay to use medications associated with drug-induced lupus in patients with SLE?

How would you approach refractory gangrenous Raynaud's secondary to type one cryoglobulins?

What if the patient has MGUS? Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?

Do you routinely start anticoagulation for a patient with newly diagnosed hepatocellular carcinoma presenting with a portal venous thrombosis?

How do you approach patients with a history of lymphoma in remission who are in need of immunosuppressive (e.g. TNF blockers, 6MP) or other therapies (e.g. JAK inhibitors) for autoimmune disease that have been linked with the development of lymphoma?

Do you image the spine in addition to the sacroiliac joints when you suspect axial spondyloarthritis?

Can axSpA affect the spine without affecting the sacroiliac joints?

What could explain discordant iron studies?

For a patient with low ferritin, but high TSAT?

How do you treat RA in patients with pulmonary mycobacterium avium complex (MAC) infections?

How would you approach a patient with MPO-positive isolated peripheral nerve vasculitis?

How would you label such a patient? Would you treat differently if they have poor functional status?

How do you workup erythrocytosis with a normal or elevated serum erythropoietin?

What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?

Are there particular concerns related to the use of B-cell depletion therapies such as rituximab for rheumatic disease during the COVID-19 pandemic?

Should all patients with suspected giant cell arteritis get a PET scan to look for large vessel disease?

Do you account for the effect of coffee on platelet aggregation studies?

Why are autoantibodies not often detected on monoclonal gammopathy assays (SPEP/IFE, quantitiative immunoglobulins)?

For example, in cold agglutinin disease or AIHA, antibodies can be detected via DAT, but are often not observed on assays for monoclonal gammopathies.

How would you time COVID-19 vaccination with someone on R-CHOP chemotherapy?

How do you manage intractable hiccups from radiation?

Have you found any of the more common medical treatments (chlorpromazine, baclofen) to be most effective in the setting of throacic radiation or head ...

What is the utility of MRI for identifying disease activity in myositis patients when physical exam and labs are inconclusive?

Is there an equivalent test for serum viscosity in sickle cell disease?

Is there a role for G-CSF treatment for SLE patients with persistent neutropenia?

How do you counsel patients who are candidates for a clinical trial regarding their options?

Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?

Can liquid biopsy be substituted for tissue biopsy in a lung mass that is radiologically suspicious for primary lung cancer when CT-guided biopsy cannot be done?

For example, a patient with a large (>3cm), spiculated, FDG-avid lung lesion, who has poor lung function and is refusing a CT-guided biopsy?

How do you perform geriatric assessment for cancer patients?

Do you use specific tools or take into account certain factors when considering treatment options for older adults?

How will you counsel patients receiving radiation therapy regarding COVID-19 vaccine administration?

What is the appropriate timing and what factors do you consider when making such a recommendation?

Do you escalate treatment in patients with myositis who achieve clinical remission but continue to have elevated CPK?

Is there risk for local recurrence if thymoma received CT guided biopsy transgressing the capsule prior to surgery?

Is there a role for measuring hydroxychloroquine blood levels in clinical practice?

If so, are there specific patient populations for which you would use this metric?

What is your threshold for pursuing bone marrow biopsy in a lupus patient with cytopenias?

How do you approach the management of a patient with symptomatic iron deficiency anemia who is intolerant of iron?

Such as a patient who cannot tolerate oral iron and has had a anaphylaxis to intravenous iron

What is considered an adequate treatment period to assess response of AAV induction therapy with rituximab or cyclophosphamide?

How do you approach a patient found to have a coronary lesion suggestive of vasculitis on coronary CT?

What is the target ferritin level for patients with hereditary hemochromatosis and signs of end-organ damage?

For example, a patient with hypogonadism unless it matters which organ is involved. Are other markers of iron storage useful in guiding therapy?

How would you approach diagnosis of residual ovarian tissue in a patient with ER positive breast cancer, history of BSO, and a rising estradiol level on tamoxifen?

How does a history of splenectomy alter how you counsel patients on the infection risk of TNF inhibitors or other biologics?

How do you manage early rectal symptoms such as tenesmus in a patient undergoing pelvic radiation for prostate cancer?

Assume patient has no history of IBD, UC, etc.

For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?

What are the benefits of sending HLA B27 genotype over HLA B27 antigen when evaluating for spondyloarthritis?

Do you correct the synovial fluid white blood cell count for red blood cells, and if so, is there a rough approximation/equation you use?

Should venous thrombosis in a patient with Behcet syndrome be treated with both immunosuppression and anticoagulation?

How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?

Is there a role for anti-neutrophil antibody testing in the workup of neutropenia?

If autoimmune neutropenia already suspected, is this test informative or unnecessary?

Do hemoglobin S levels always correlate with SCD phenotype?

What is the lowest level you have seen with uncomplicated or complicated crises?

How does the presence of myositis alter your interpretation of cardiac enzymes when evaluating acute chest pain?

i.e., Troponin I, Troponin T, and CK-MB

What is your approach to treating refractory thrombocytopenia in lupus?

How do you approach diagnosing a patient with Iron Refractory Iron Deficiency Anemia (IRIDA)?

Do you go straight to TMPRSS2 genetic testing or what other lab testing (e.g. hepcidin) could be helpful?

In gout, do MSU crystals form only in tissue, or are there circulating microcrystals of MSU within blood vessels?

If so, does this have clinical significance?

At what point in GCA management do you typically introduce tocilizumab?

Is there a role for PCSK9 inhibitors in patients with statin-associated immune mediated necrotizing myopathy?

How would you approach a fit older (>70 years) with grade I-II, bulky, follicular lymphoma causing ureteral obstruction and renal failure?

Bulky adenopathy compressed bilateral ureters, CrCl < 30, post stent placement, but renal function has plateaued

How do you manage hand-foot syndrome associated with capecitabine (and other conventional chemotherapy agents)?

Do you prescribe creams (e.g., urea) to prevent HFS, or is their use generally more reactive?

Do you recommend medical therapy for extensive atraumatic osteonecrosis of the femoral head to mitigate pain or prevent femoral head collapse?

Which immunosuppressed patients with SLE would benefit from antibiotic prophylaxis to prevent pneumocystis pneumonia?

Would you hold all immunosuppressive medications for the first month of LTBI treatment, or just biologics?

Do you recommend getting a muscle biopsy in a patient with suspected IMNM with statin exposure, weakness, elevated CK, and positive HMGCR antibody?

Is it ever appropriate to use hydroxychloroquine temporarily in higher doses (more than 5mg/kg) to control lupus activity such as skin manifestations?

How do you interpret a high positive RNP in the setting of a negative ANA and negative sm/RNP?

To my understanding, sm/RNP should also be positive in this situation (and one would assume a positive ANA as well)

Is there an increased risk of COVID-19 in patients on immunosuppressants?

How do you counsel Takayasu patients on their prognosis?

How do you manage VTE in the setting of persistent severe thrombocytopenia?

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

Are stress-dose steroids indicated in patients with adrenal insufficiency receiving radiation therapy?

How would you attempt to determine the etiology of intracranial hemorrhage in a patient with newly diagnosed lupus and an active viral infection?

How does your treatment algorithm differ for drug-induced ANCA vasculitis compared to non drug-induced ANCA vasculitis in cases with severe/organ-threatening manifestations?

Do you avoid any specific biologic therapies in HIV positive patients?

What is your inflammatory arthritis differential when a patient presents with unilateral TMJ synovitis?

What is your approach to screening for cardiac involvement in patients with myositis and how does the finding of cardiac involvement change your management?

Are there certain subsets of ANCA vasculitis patients for whom you would consider life long maintenance therapy?

Which steroid-sparing agent do you prefer to treat multi-organ Sweet's syndrome?

Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?

What if this was "triple-negative" antiphospholipid syndrome?

How often do you utilize soluble transferrin receptor or hepcidin testing in the diagnosis of ambiguous iron deficiency, such as with concomitant anemia of chronic disease?

Does recent iron intake affect the iron panel, and if so, do you often order fasting labs in practice?

What is your first treatment of choice in patients with dermatomyositis sine myositis?

For which subset(s) of APS patients do you recommend an INR of 3 or higher?

How do you assess transaminitis in a patient with sarcoidosis with known liver involvement being treated with methotrexate?

How do you treat small fiber neuropathy associated with rheumatic conditions like Sjogren’s syndrome?

What would be the recommended management for patients with rectal adenocarcinoma with rectovaginal fistula at presentation?

Would preop RT still be the treatment option for these kind of patients? Assuming that the rectovaginal fistula was from tumor progression.

Would you anticoagulate a patient with an isolated arterial thrombosis in the setting of an inherited thrombophilia?

Does your opinion change based on the specific underlying inherited thrombophilia? The original case was a central retinal artery occlusion in a patie...

How do you evaluate an isolated prolonged aPTT in patients?

Especially in a patient without hemophilia or thrombosis history?

Do you continue hydroxychloroquine in lupus patients who develop cardiomyopathy?

When a patient presents with 2 lung lesions, do you routinely recommend a biopsy of both lung lesions?

Would your practice change if the patient had N2 disease?

When is a biopsy necessary to diagnose relapsing polychondritis?

What is your approach to bladder cancer surveillance in patients who have received cyclophosphamide?

In what situations do you check for HIV status in your workup for inflammatory arthritis?

What would be your differential for a wrist monoarthritis in an elderly female with erosions on MRI after less than 3 months of symptoms?

How would you manage gastrointestinal bleeding after radiation therapy for pancreas cancer?

Is it possible or common for patients to have mucosal telangiectasias along the portions of the GI tract in the radiation fields? If present, would yo...

How do you handle post-op, pre-radiation breast seromas and hematomas?

What do you use to treat a GCA patient refractory to methotrexate who responded but had adverse effects with both tocilizumab and sarilumab?

What is your work up and management for patients who develop neuropathy on a TNF inhibitor?

Do you have any suggestions about how to improve rheumatology training in internal medicine residency programs?

Due to the shortage of rheumatologists, primary care physicians may need to manage some rheumatologic issues.

How do steroids and/or DMARDs affect biopsy results if a renal biopsy for suspected lupus nephritis is delayed?

How do you interpret granulomatous features on a muscle biopsy?

How do you manage patients who are Hepatitis B core antibody positive/surface antigen negative and starting a biologic DMARD (other than rituximab)?

Would you avoid the use of a TNF inhibitors in patients with a remote history of melanoma, including those with ocular melanoma?

Are there any clinical situations in which checking for anti-chromatin antibodies is helpful?

In patients with inflammatory bowel disease with low rectal cancer with planned proctocolectomy, would you consider creation of a pouch?

What is the optimal work-up for patient with repeatedly negative biopsies of a mid-rectal lesion with signs of malignant etiology?

If biopsies consistently show high grade adenoma and there is a locally advanced rectal tumor with MRF involvement on imaging, what is the next step i...

Is there a minimum work-up necessary in patients with an ANA greater than 1:160 and no clinical symptoms suggestive of lupus (i.e., specific antibodies, UA)?

How would you approach post op management of a patient s/p BSO for cystic pelvic mass with fallopian STIC lesion on final pathology?

Patient with remote history of hysterectomy for benign disease

How do you differentiate between axial psoriatic arthritis and axial spondylitis with psoriasis, and is it important to distinguish between these two conditions from a prognostic and treatment perspective?

When do you use tacrolimus in patients with myositis-related interstitial lung disease?

When suspecting a diagnosis of complex regional pain syndrome (or reflex sympathetic dystrophy), what workup should be done to confirm or exclude it?

Should new patients requiring chemotherapy be tested for COVID-19 prior to starting treatment?

Would you re-challenge patients who have had a TNF-associated paradoxical adverse event (such as inflammatory bowel disease) with a different TNF inhibitor?

What is your treatment algorithm for RS3PE?

What baseline work-up or "staging" do you do in patients with a new diagnosis of Sjogren's (i.e., PFT, cryoglobulins, complement, RF, UA)?

When do you stop immunosuppressants in patients with GPA?

What is your next step in patients with polymyositis without interstitial lung disease who are refractory to methotrexate?

What surveillance do you recommend for a patient with locally advanced rectal adenocarcinoma who had a complete clinical response to total neoadjuvant therapy and declines to undergo surgery?

MRI? Endoscopy? Physical exam?

How do you approach the decision of whether and when to initiate therapy in patients who remain COVID-19 positive >2 weeks after infection but are asymptomatic from the virus?

E.g. a patient with progression of their primary cancer but still is testing COVID19+ over a month after infection?

When sending patients for follow up chest CT's after SBRT or chemoRT, how do you determine whether to send for scans with or without IV contrast?

How do you talk to patients about clinical trials?

I care deeply about clinical trials but have always struggled on how to approach this topic. I would really appreciate tips from those of you who have...

Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?

Are you placing more weight on patient risk factors such as age >65 or co-morbidities?

Do you routinely prescribe anticoagulation for patients on active chemotherapy?

Would you consider giving ESA for anemia secondary to chronic kidney disease in a patient with follicular lymphoma in remission and on rituximab maintenance?

Should patients about to start radiation be required to have COVID-19 testing, if resources are available?

Our hospital is currently testing (PCR) for COVID-19 in all inpatients and outpatients undergoing surgical/"aerosolizing" procedures. Since radiation ...

Would you stop current immunosuppressive therapy or delay starting immunosuppressive therapy in a patient with aplastic anemia who has been infected with COVID-19?

Are patients with bleeding disorders receiving plasma-derived products at increased risk of acquiring COVID-19?

What are best practices for taking care of lung cancer patients during the COVID-19 pandemic?

Due to the thrombotic nature of COVID-19, should we be discontinuing tamoxifen temporarily in patients with an active infection?

What form of surveillance do you recommend for esophageal adenocarcinoma s/p NACRT and resection at what frequency?

How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?

Should staging and treatment decisions be made based on imaging alone?

What are the current official guidelines regarding managing patients during COVID-19?

Is your approach to managing immune related adverse events altered at all in light of COVID-19?

How do you manage neurocognitive decline associated with chemotherapy (i.e. chemo brain)?

Is there specific workup you perform? Are there preventive measures? Once established, are there non-pharmacological and pharmacological treatments yo...

What screening criteria do you use to give patients IV contrast for the CT sim?

Are there kidney issues in which you would omit IV contrast?

Is it possible to have diffuse, bilateral pulmonary fibrosis as a late side effect of unilateral radiation therapy for breast cancer?

Would you clear a patient who completed treatment for breast DCIS to donate her kidney to her husband?

Germline genetic testing negative

How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?

Do you insist on biopsy confirmation of invasive disease in the setting of in situ pathology findings but otherwise clinical/radiographic evidence of invasive cancer?

How would you approach a patient with a recent MI s/p DES who is being considered for neoadjuvant chemotherapy for TNBC?

2D Echo - Normal Ejection Fraction

How do you explain progression free survival to patients?

When do you recommend patients get vaccinations with respect to their chemotherapy course?

How would you manage an elderly patient with GE junction adenocarcinoma who is not interested in surgery and who has ulcerative colitis (not currently on medication or symptomatic)?

Would you be concerned about toxicity given that he has ulcerative colitis?

How long do you continue surveillance imaging for NSCLC after definitive treatment?

NCCN recommends annual CT surveillance indefinitely after year 5, but I’m curious how many physicians continue and for how long?

Should breast cancer patients with never-treated latent TB and for whom chemotherapy is indicated be treated for latent TB during chemotherapy?

How do you approach rectal cancer with a solitary bone metastasis that is biopsy proven?

Do you recommend definitive therapy? Would your approach change if there are more than 1 site of bone metastases, such as 2-3?

In what situations do you obtain both a pelvic MRI and EUS for rectal cancer staging and treatment planning?

For instance, in borderline cases for neoadjuvant therapy (e.g. T2N1 disease), should both be obtained to increase accuracy?

What is your routine workup and treatment approach to patients with NSCLC NOS discovered in mediastinal nodes but without obvious primary lung lesions or metastatic disease?

What is the preferred clinical management of hyperglycemia related to alpelisib?

What is a safe time interval from completion of hormones and external beam radiation to TURP in patients who develop refractory obstruction?

For small peripherally located NSCLC, when do consider referral for mediastinal evaluation prior to curative surgery vs proceeding to resection with mediastinal eval at time of surgery?

How do you manage soft tissue necrosis in a patient who underwent TORS followed by RT?

What stage is bilateral orbital/conjunctival NHL (limited only to the bilateral orbit/conjunctiva)?

Should patients with idiopathic pulmonary fibrosis be placed on nintedanib or pirfenidone before starting radiotherapy for lung cancer?

Do you perform a bone health assessment in men who will be receiving short term androgen deprivation for localized prostate cancer?

If so, does it differ from the assessment you would perform in men receiving long term ADT?

Do you refer patients to cardiology if they have no history of cardiac disease but will be receiving XRT with high mean doses to the heart?

Is there an established benefit for this? For instance if your patient has cardiac calcifications on imaging but no history of cardiac disease are the...

How do you approach rectal spacer for the patient with renal failure?

Given that it is cleared from the body by renal filtration, are you concerned about clearance issues?

How do you manage acute esophagitis that persists > 1-2 months after completing chemoradiation for lung cancer?

Would you recommend empiric diflucan? Would EGD be indicated? At what point would you consider hyperbaric oxygen?

How would you approach a biopsy proven NSCLC patient with mediastinum negative disease and contralateral suspicious spiculated PET avid nodule without pathologic diagnosis?

No other site of metastatic disease. It is unclear if this situation should be managed as two separate primaries or metastatic disease.

What are your recommendation for vaccines in patients while on immunotherapy?

Do you recommend or withhold influenza and pneumonia vaccines while on treatment with checkpoint inhibitors?

Would you continue treatment of a rectal metastasis in a patient who is found to have radiographic evidence of contained rectal perforation during the treatment?

Would you continue treating the patient (in spite of the risk of causing a frank perforation, sepsis, and subsequently devastating consequences), or w...

How do you approach incidentally diagnosed mantle cell lymphoma found on a routine screening colonoscopy?

Are there any treatment related considerations in a patient with HIV who is on antiretroviral therapy and receiving adjuvant radiation for breast cancer treatment?

What if CD4 count was low?

How do you manage a patient with multiple similar appearing ground glass opacities (~8-9) on Chest CT where one has been surgically removed and confirmed to be adenocarcinoma in situ?

There is no evidence of disease outside the lung on PET, and the patient is completely asymptomatic with negative EGFR, ALK, ROS1, and BRAF and a PD-L...

What is your preferred treatment to ameliorate bone pain from G-CSF?

Is there anything you use for patients with anticipatory nausea who has failed Ativan and Zyprexa?

If a patient develops intermittent painless hematuria during standard prostate RT do you attribute this to cystitis or would you work it up further?

How would you manage a patient with a very large adenocarcinoma of the rectum (10 cm) that extends to the anal verge with positive peri-rectal and inguinal lymph nodes, but no distant organ involvement?

Is this patient considered to have metastatic disease? Should definitive surgery be considered?

How would you manage a patient who presented with synchronous squamous cell carcinoma of the anus (cT2N0) and adenocarcinoma of the rectum (cT3N0) at 7cm from the anal verge?

How are you making the diagnosis of chronic lymphocytic leukemia transforming to prolymphocytic leukemia?

Technically, you can have up to 55% of larger cells circulating and still be called CLL.

How do you manage urgency and frequency of bowel movements secondary to radiation proctitis?

When would you recommend hyperbaric oxygen treatments for skin ulceration/non-healing wounds in a radiated field?

How do you decide which lab to use for multi-gene hereditary testing?

Is there a difference among all the commercial genetic testing labs? Is there anything beyond CLIA- and CAP-certification that we should look for...

How would you manage a patient with distal rectal adenocarcinoma involving the anal canal and a single non-bulky inguinal nodal metastasis?

Is curative intent surgery off the table?

How do you handle the situation where a curative-intent patient unexpectedly passes away while under treatment?

Obviously the details matter a lot, but are there guiding tenets one should follow beyond expressing condolences to the family?

Among the many assays/tests available for "liquid biopsies" in metastatic NSCLC, are there any situations where you would want to use one specific assay over the others?

For patients with a history of seizures secondary to brain metastases, what are your criteria for discontinuing antiepileptic medications if the seizures have been controlled since SRS or surgery?

What is the appropriate follow up after chemoradiotherapy for patients with anal SCC?

Is obtaining serial MRIs or other imaging appropriate?

How do you approach rising gastrin and chromogranin levels without radiographic evidence of disease in patients with gastrinoma that has been fully resected?

Specifically, rising levels noted while on somatostatin analogue.

What is your approach to a low grade appendiceal mucinous neoplasm found incidentally at appendectomy?

How do you present the trade off between a small chance of a sustained response for a new drug at the expense of potential worsening quality of life?

How do you follow patients after SBRT for NSCLC?

Which imaging studies do you perform and what is the timing after treatment?

Do you take patients off anticoagulation for tandem and ovoid or tandem and ring procedures?

When is it appropriate to recommend a diverting colostomy for treatment of anal cancer or low lying rectal cancer?

Fecal incontinence can be one indication. What are others?

Does it matter whether one uses MSI PCR testing versus IHC for MMR deficiency testing inorder to determine eligibility for immunotherapy?

How do you approach the workup of subcentimeter contralateral nodules in cases of locally advanced NSCLC?

When there is biopsy proven mediastinal disease, do you offer definitive chemoradiation and monitor, or do you try to prove the presence/absence ...

Would you ever omit adjuvant therapy for rectal cancer in patients who underwent primary resection (TME), without any neoadjuvant therapy?

What about T3N0 disease? Would you use a recurrence score to help inform decisions?

How do you treat hiccups in cancer patients?

Does your management differ if the hiccups are felt to be related to chemotherapy as opposed to the disease itself?

How do you manage dental care, oral hygiene, and nutrition in patients with trismus?

How do you manage a rib fracture caused by SBRT?

What is the average healing time? What medications and/or procedures do you recommend for pain control? Does management differ for those with chest wa...

For patients with brain tumors without a history of seizure, what is your policy on driving?

Do you treat pre- or post-operatively for HO prophylaxis?

What is your approach to deciding when to treat these patients? Or is it solely dependent on when surgeons refer them?

When TPN is a barrier to enrollment in hospice for an eligible cancer patient with an irreversible malignant bowel obstruction, how do you approach the conversation about discontinuation of TPN?

The immediate response by patients in this situation seems almost universally to be, "But I'll starve to death!" Referencing literature about lack of ...

In a patient with a history of treated stage II seminoma with rising bHCG while on surveillance, do you routinely recheck the bHCG with a different assay?

When are you concerned for a false positive? FDA guidelines include a suggestion to try another assay in case heterophile antibodies are causing a fal...

How would you approach the management of a patient with oligometastatic NSCLC characterized by a LUL mass and a solitary adrenal metastasis, assuming a good performance status?

How do you approach disease monitoring in patients with localized rectal cancer who have received treatment with chemoradiation?

Is MRI being considered the primary mode of imaging in multidisciplinary tumor boards, especially in light of the results of the MERCURY trial (JCO 20...

What scans do you order for follow-up in locally advanced non-small cell lung cancer patients who have completed definitive radiation with concurrent chemotherapy?

What is the role of PET?

How do you manage an open wound that is not healing after radiation treatment for an ulcerated SCC of the scalp?

If the patient is a poor surgical candidate and is a symptomatic, can he or she live with this?

When do you perform HER2 testing in patients with colorectal cancer?

When is it considered inappropriate to omit pathological mediastinal lymph node staging for non-small cell lung cancer?

The NCCN guidelines call for pathological mediastinal lymph node staging for all NSCLC except in solid tumors <1cm and non-solid lesions < ...

What is the best way to discuss an early palliative care referral with a patient?

We have a great palliative care clinic and I like to refer many patients with metastatic disease, even if I feel that they will live a year or two lon...

When do you start steroids for radiation pneumonitis?

Following lung RT, I have rarely seen patients present with pneumonia-like symptoms of radiation pneumonitis. I'm more likely to see a patient with wo...

When does a rising PSA after prostatectomy indicate growth just of normal prostate?

Guidelines dont seem to account for this possibility. Could it just be normal prostate tissue growing back that is leading to PSA, why just assume it ...

Should early referral to palliative care be standard of care for all patients with metastatic cancer?

I know that some would argue that healthy patients with an excellent performance status may not need an early palliative care referral, but wouldn't i...

How do you manage dabrafenib fever?

Decrease the dose? Treatment break? Steroids?

For elderly patients with locally advanced rectal cancer who are not candidates for surgery or chemotherapy, what would be an appropriate palliative regimen?

How are patients on anticoagulation managed in the context of intracranial SRS?

Is heparin or warfarin routinely held prior to treatment?

How do you take tumor seeding into account when staging NSCLC?

In the case where there is a PET avid subpleural nodule in the exact same location as needle biopsy 3 months prior, is this considered a chest wall me...

Should I decline to treat a patient with a first site of metastasis who refuses a biopsy?

More specificlaly, in a non-emergent situation?

Should we be more concerned about cardiac toxicity following breast radiotherapy?

In a case-control study by Darby et al in the New England Journal of Medicine, patients treated for breast cancer with radiation were found to have an...

Has pelvic MRI replaced EUS as the standard of care for rectal cancer staging?

Are there any indications to choose one over the other?

What is your management strategy for patients with positive lymph nodes after radical prostatectomy?

What is your institution's active surveillance protocol?

If a PET/CT scan is positive for mediastinal lymph node involvement, is a mediastinoscopy or EBUS still required for NSCLC staging?

In practice, do you send patients with N2/3 disease for mediastinal staging if not offered upfront?

What is the difference between involved node and involved site irradiation?