72 y/o F

General medicine

Brought by EMS with sudden-onset right-sided weakness and aphasia. Last known well 90 minutes ago. NIHSS 14.

Review CT head, INR, platelets, and glucose, assess tPA eligibility, place alteplase and CTA orders, document the NIHSS, time last known well, contraindication screen, eligibility determination, BP management, and neurology consultation, then sign the encounter.

48 y/o M

General medicine

Presents with severe epigastric pain radiating to back after a heavy alcohol binge. Associated nausea and vomiting.

Review lipase and severity markers, place aggressive fluid resuscitation and CT imaging, document the etiology workup, severity scoring, and nutrition plan, then sign the encounter.

24 y/o M

General medicine

Presents with severe bilateral lower extremity and low back pain. Temperature 38.4 C, SpO2 91% on room air.

Review hemolysis markers and hemoglobin, place hydromorphone PCA (noting morphine allergy) and CXR for ACS screening, document the pain assessment, ACS evaluation, and transfusion threshold, then sign the encounter.

76 y/o F

General medicine

Admitted with progressive dyspnea on exertion, orthopnea, and bilateral lower extremity edema over 2 weeks.

Review BNP, electrolytes, and daily weights, place IV furosemide and renal monitoring, document the volume overload assessment and diuresis strategy, then sign the encounter.

84 y/o F

General medicine

Fell at home and unable to bear weight. X-ray confirms left intertrochanteric hip fracture. On warfarin.

Review the fracture imaging and supratherapeutic INR, place vitamin K reversal and orthopedic consult, document the fracture type, reversal plan, and surgical disposition, then sign the encounter.

19 y/o F

General medicine

Presents with severe headache, neck stiffness, photophobia, fever 39.6 C, and a petechial rash on trunk.

Review CSF analysis (cell count, glucose, protein, Gram stain), place IV ceftriaxone and adjunctive dexamethasone, document the meningeal exam, CSF interpretation, Gram stain findings, empiric regimen rationale, dexamethasone timing, and isolation precautions, then sign the encounter.

62 y/o M

General medicine

Found confused and disoriented by family. Known cirrhosis with prior variceal bleed. Asterixis noted on exam.

Review ammonia and hepatic function, place lactulose and rifaximin, document the encephalopathy grading, precipitant, and titration goals, then sign the encounter.

67 y/o M

General medicine

Post-operative day 3 after right hemicolectomy for colon cancer. Developing abdominal distension, nausea, absent bowel sounds, no flatus.

Review post-operative labs and imaging, place NGT decompression and IV potassium repletion, document the bowel status, electrolyte plan, and NPO rationale, then sign the encounter.

70 y/o F

General medicine

Presents with generalized weakness and palpitations. Missed last two hemodialysis sessions. ECG shows peaked T waves.

Review potassium and ECG, place emergent calcium gluconate and insulin-dextrose, document the potassium level, ECG changes, and management cascade, then sign the encounter.

71 y/o M

General medicine

Admitted with crushing substernal chest pain radiating to left arm. ECG showed ST elevations in II, III, aVF.

Review serial troponins and ECG findings, place heparin drip and echocardiogram, document the full ACS assessment including risk stratification, ECG interpretation, antiplatelet and anticoagulation rationale, and cardiology consultation, then sign the encounter.

38 y/o F

General medicine

Presents with fever 39.8 C, HR 156, agitation, and tremor. Non-adherent to propylthiouracil for 3 weeks.

Review TSH, free T4/T3, and vital sign instability, place PTU and IV propranolol for dual blockade and rate control, document the Burch-Wartofsky score, anti-thyroid therapy, rate control rationale, temperature management, and precipitant, then sign the encounter.

46 y/o M

General medicine

Admitted for elective procedure. Last drink 18 hours ago. Developing tremor, diaphoresis, and agitation. CIWA score 24.

Review CIWA score and seizure history, place lorazepam and IV thiamine, document the withdrawal severity, benzodiazepine plan, and DT risk, then sign the encounter.

66 y/o F

General medicine

Found in rapid atrial fibrillation (HR 142) during post-operative monitoring after hip replacement surgery.

Review electrolytes, thyroid function, and telemetry, place IV diltiazem and potassium repletion, document the rhythm analysis, CHA2DS2-VASc score, rate control strategy, and anticoagulation decision, then sign the encounter.

82 y/o F

General medicine

Found altered and febrile at nursing home. BP 82/48, HR 112, temp 39.4 C. Foley draining cloudy urine.

Review lactate, urinalysis, and blood cultures, place empiric IV antibiotics and fluid resuscitation within the SEP-1 bundle, document the full sepsis workup including source, bundle timing, hemodynamic response, and reassessment, then sign the encounter.

22 y/o F

General medicine

Presents with severe dyspnea, inability to speak full sentences, and accessory muscle use. Peak flow 35% of predicted.

Review ABG (noting ominous normal pCO2), peak flow, and accessory muscle use, place IV magnesium and systemic steroids, document the severity classification, bronchodilator response, intubation readiness, and ICU escalation criteria, then sign the encounter.

68 y/o F

General medicine

Admitted with weakness and oliguria after several days of poor oral intake.

Review the creatinine trend and urine output, assess volume status, place IV fluid and repeat BMP orders, document your renal assessment with differential, then sign the encounter.

45 y/o M

General medicine

Presents with acute-onset pleuritic chest pain and dyspnea. Recently had right knee arthroscopy two weeks ago.

Review D-dimer and Wells criteria, place CTA chest and heparin drip, document the PE probability, hemodynamics, and anticoagulation rationale, then sign the encounter.

59 y/o F

General medicine

Presented with hematemesis and melena. Tachycardic and hypotensive on arrival. History of liver cirrhosis.

Review hemoglobin trend and coag panel, place PRBC transfusion and IV pantoprazole, document the bleed severity, hemodynamics, and GI consultation need, then sign the encounter.

58 y/o M

General medicine

Found lethargic with sodium 118 on routine labs. Known small cell lung cancer. Currently on SSRI.

Review sodium, serum and urine osmolality, and urine sodium, place hypertonic saline with serial BMP monitoring, document the hyponatremia classification, SIADH diagnostic criteria, and safe correction rate plan with osmotic demyelination risk, then sign the encounter.

52 y/o M

General medicine

Seen for fever, productive cough, and exertional dyspnea.

Review the chest imaging and culture results, document the antibiotic course and respiratory status, order a follow-up chest X-ray, then sign the encounter.

73 y/o F

General medicine

Readmitted with profuse watery diarrhea (8 episodes/day), abdominal cramping, and low-grade fever after recent cephalosporin course.

Review C. diff PCR and severity markers (WBC, creatinine), place oral vancomycin and CT abdomen, document the severity classification, prior antibiotic exposure, and treatment plan, then sign the encounter.

28 y/o F

General medicine

Presented with nausea, vomiting, abdominal pain, and Kussmaul breathing. Blood glucose 456 with anion-gap acidosis.

Review the metabolic panel (glucose, anion gap, pH, bicarbonate), start an insulin drip with serial BMP monitoring, document the DKA severity, precipitant workup, fluid and insulin management, potassium monitoring, and gap closure criteria, then sign the encounter.

34 y/o F

General medicine

Developed diffuse urticaria, angioedema, and wheezing within minutes of IV ceftriaxone. BP dropped to 78/42.

Review tryptase and vital sign trajectory, place epinephrine infusion and IV steroids, document the anaphylaxis diagnostic criteria, causative agent, airway assessment, epinephrine dosing, hemodynamic response, and biphasic reaction monitoring plan, then sign the encounter.

55 y/o M

General medicine

Presents with expanding erythema, warmth, and purulent drainage from left lower extremity. Fever to 38.9 C.

Review inflammatory markers and drug allergies, place vancomycin and wound culture orders, document the MRSA risk, antibiotic choice, and allergy consideration, then sign the encounter.

74 y/o M

General medicine

Brought in with worsening dyspnea, increased sputum production, and wheezing over 3 days. SpO2 84% on room air.

Review the ABG showing hypercapnic respiratory failure, place IV steroids and nebulizer, document the respiratory acidosis, ABG findings, oxygen needs, and steroid plan, then sign the encounter.