Clinical Reasoning Cases

A 55-year-old male with history of hypertension and smoking presents with sudden onset crushing retrosternal chest pain radiating to the left arm, associated with diaphoresis and nausea. BP 100/60, HR 110, SpO2 94%.

2 decision points

A 22-year-old female presents with acute onset shortness of breath and right-sided pleuritic chest pain. She is tall and thin, on oral contraceptive pills. HR 115, BP 105/70, RR 28, SpO2 88% on room air.

3 decision points

A 35-year-old female presents with the worst headache of her life — sudden onset thunderclap headache reaching maximum intensity within seconds. Associated with photophobia, nausea, and neck stiffness. GCS 15, BP 160/95.

2 decision points

A 28-year-old G2P1L1 at 32 weeks presents with painless, bright red vaginal bleeding. She has had one previous C-section. Bleeding started suddenly while resting. Abdomen is soft, non-tender. Fetal heart rate 140 bpm, good variability. Maternal BP 110/70, HR 92.

2 decision points

A 30-year-old primigravida delivered a 3.5 kg baby vaginally 30 minutes ago. The placenta has been delivered. Now there is profuse vaginal bleeding. The uterus is boggy and poorly contracted despite uterine massage. Estimated blood loss is 800 mL and ongoing. BP 90/60, HR 120.

2 decision points

A 6-year-old boy presents with a limp and right hip pain for 2 weeks. He has low-grade fever (99.8°F). On examination, there is limited abduction and internal rotation of the right hip. He walks with an antalgic gait. No history of trauma.

3 decision points

A 38-week term neonate, birth weight 3.2 kg, develops jaundice on day 3 of life. Baby is feeding well, passing stools normally (yellow), and has no hepatosplenomegaly. Bilirubin: total 12 mg/dL, direct 0.5 mg/dL. Mother is O+, baby is B+.

2 decision points

A 2-year-old child presents with high-grade fever (103°F) for 3 days. The fever has now subsided, and today a rose-colored maculopapular rash appeared on the trunk and spread to the extremities. The child is playful, feeding well, and has no significant lymphadenopathy.

2 decision points

A 22-year-old male college student is brought by his parents with a 3-week history of social withdrawal, decreased sleep, and talking to himself. He believes his classmates are plotting against him and that the TV is sending him special messages. No past psychiatric history. No substance use. No medical comorbidities.

2 decision points

A 24-year-old male presents with abdominal pain that started periumbilically 12 hours ago and has now shifted to the right iliac fossa. He has nausea and low-grade fever (99.5°F). Tenderness and guarding at McBurney's point.

2 decision points

A 45-year-old male underwent an emergency open appendectomy for perforated appendicitis 3 days ago. Now he has a temperature of 102°F, HR 105, BP 100/65. He complains of right lower quadrant pain. Wound appears erythematous with purulent discharge.

2 decision points