JT-CR-001 · Emergency and acute care
Series
Nonclassic Chest Discomfort in Urgent Care
An original case on recognizing possible acute coronary syndrome when the first description sounds like indigestion rather than chest pain.
Daily clinical reasoning series
Clinical Reasoning Casebook
A daily series of case-based clinical analyses exploring diagnostic reasoning, evidence appraisal, communication, continuity, and systems safety.
16 topic areas
Scroll horizontally to inspect the full figure. A complete text version follows.
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The sequence starts by gathering cues while stabilizing urgent threats, then defines the problem, ranks a differential, chooses decision-linked tests, creates a management and safety-net plan, and closes follow-up. A return arrow explains that reassessment can reopen any earlier step.
JT-CR-002 · Cancer, blood, infection, and immunity
Series
Iron-Deficiency Anemia in Ambulatory Care
An original adult case on confirming iron deficiency, finding its cause, and reasoning through gastrointestinal blood loss and celiac disease.
JT-CR-003 · Aging and palliative care
Series
Falls, Dizziness, and Orthostatic Hypotension
An original older-adult case linking recurrent falls, postural symptoms, medication burden, mobility, and a tailored prevention plan.
JT-CR-004 · Children and adolescent health
Series
Fever in a Young Infant Without a Clear Source
An original case on age-banded evaluation, invasive infection risk, lumbar puncture uncertainty, and safe follow-up for infant fever.
JT-CR-005 · Mental, behavioral, and substance-use health
Series
Adolescent Depression, Safety, and Confidentiality
An original case on depression assessment, suicide safety, caregiver involvement, confidential care, and closed-loop follow-up.
JT-CR-006 · Reproductive and postpartum care
Series
Pain and Bleeding in Early Pregnancy
An original case on pregnancy of unknown location, ectopic danger, serial hCG limits, repeat ultrasound, and safe follow-up.
JT-CR-007 · Kidney, electrolytes, and digestive health
Series
Acute Kidney Injury With a Rising Potassium
An original inpatient case on acute kidney injury, dangerous hyperkalemia, temporary stabilization, potassium removal, and reassessment.
JT-CR-008 · Brain and neurologic health
Series
New Confusion During an Inpatient Stay
An original older-adult case on recognizing delirium, finding interacting causes, avoiding reflex treatment, and planning a safe transition.
JT-CR-009 · Lung and sleep health
Series
Chronic Cough at a Telehealth Visit
An original adult case on chronic-cough triage by video, red flags, in-person testing, treatable traits, and explicit telehealth limits.
JT-CR-010 · Children and adolescent health
Series
Childhood Asthma Control at Home and School
An original case on recognizing poor childhood asthma control and building one workable safety plan across home, school, sports, and two caregiving households.
JT-CR-011 · Medicines and care safety
Series
Medication Reconciliation After Heart Failure Discharge
A case on resolving discordant heart-failure medicine lists while monitoring volume, blood pressure, kidney function, and potassium.
JT-CR-012 · Prevention, rural health, and care systems
Series
Prioritizing Prevention When Visit Time Is Short
A case on prioritizing prevention when records are incomplete, time is limited, and completing screening requires more than placing orders.
JT-CR-013 · Kidney, electrolytes, and digestive health
Series
Fever, Jaundice, and Right-Upper-Quadrant Pain
An original emergency case on recognizing acute cholangitis, separating biliary mimics, and coordinating urgent drainage and sepsis care.
JT-CR-014 · Diabetes and metabolic health
Series
New Diabetes With Weight Loss and Ketosis
An original adult case on diabetic ketoacidosis triage, safe metabolic correction, and diabetes classification after the crisis.
JT-CR-015 · Cancer, blood, infection, and immunity
Series
Fever During Chemotherapy Before the Neutrophil Count Is Known
An original case on urgent fever triage during cytotoxic chemotherapy, source evaluation, antimicrobial timing, and disposition uncertainty.
JT-CR-016 · Musculoskeletal, sports, and rehabilitation
Series
The Hot Swollen Knee and the Aspiration Decision
An original case on septic arthritis, crystal mimics, urgent aspiration, synovial-test interpretation, treatment, and safety planning.
JT-CR-017 · Eye, skin, and digital safety
Series
Painful Red Eye With Photophobia and Reduced Vision
An original urgent-care case on separating microbial keratitis from angle closure, uveitis, scleritis, and common red-eye mimics.
JT-CR-018 · Emergency and acute care
Series
Altered Mental Status After an Unknown Ingestion
An original emergency case on stabilization, toxidrome reasoning, test limits, poison-center coordination, and safe disposition.
JT-CR-019 · Men's health and urology
Series
Lower Urinary Tract Symptoms With New Hematuria
An original case on lower urinary tract symptoms, retention risk, visible hematuria, medication safety, and accountable urology follow-up.
JT-CR-020 · Men's health and urology
Series
A Painless Testicular Mass and Fertility Priorities
An original case on a painless testicular mass, urgent ultrasound, tumor-marker limits, fertility preservation, and closed-loop referral.
JT-CR-021 · Mental, behavioral, and substance-use health
Series
Planning Alcohol Cessation When Withdrawal Risk Is High
An original case on predicting severe alcohol withdrawal, choosing level of care, medication safety, warm handoffs, and continuing treatment.
JT-CR-022 · Mental, behavioral, and substance-use health
Series
Opioid Use Disorder Across a Hospital-to-Clinic Transition
An original case on OUD treatment continuity, withdrawal, overdose prevention, pain, naloxone, stigma, and a closed-loop hospital handoff.
JT-CR-023 · Aging and palliative care
Series
Breathlessness During Serious Illness at Home
An original case on reversible causes of palliative dyspnea, symptom relief, opioid safety, goals, caregiver capacity, and home crisis planning.
JT-CR-024 · Aging and palliative care
Series
Nausea and Constipation During Serious Illness
An original case on cause-directed nausea and constipation assessment, obstruction, medication burden, deprescribing, antiemetic safety, and home follow-up.
JT-CR-025 · Kidney, electrolytes, and digestive health
Series
Mixed Acid-Base Disturbance After a High-Output Ostomy
An original case on high ostomy output, mixed acid-base interpretation, kidney injury, replacement, and safer post-discharge monitoring.
JT-CR-026 · Prevention, rural health, and care systems
Series
Longitudinal Multimorbidity When Rural Follow-Up Is Limited
An original case on competing guideline burdens, deprescribing, feasible rural monitoring, shared goals, and closed-loop escalation.
JT-CR-027 · Lung and sleep health
Series
Pulmonary Nodule Follow-Up Across Rural Systems
An original case on nodule risk, guideline scope, prior-image retrieval, rural imaging access, shared decisions, and closed-loop follow-up.
JT-CR-028 · Musculoskeletal, sports, and rehabilitation
Series
Pressure Injury Risk, Access, and Wheelchair Seating
An original case on accessible skin assessment, pressure injury staging, infection risk, seating, nutrition, continence, equipment, and home prevention.
JT-CR-029 · Eye, skin, and digital safety
Series
An Ungradable Retinal Screening Image and Closed-Loop Referral
An original case on image quality, non-diagnostic screening, closed-loop referral, and equitable follow-through.
JT-CR-030 · Brain and neurologic health
Series
The Transition Home After Stroke Rehabilitation
An original case on stroke discharge home, prevention, swallowing, mobility, communication, caregiver training, equipment, and rural follow-up.
JT-CR-031 · Musculoskeletal, sports, and rehabilitation
Series
Deconditioning and Recovery After Critical Illness
An original case on post-ICU weakness, differential diagnosis, cognitive and emotional recovery, rehabilitation, nutrition, medicines, and home safety.
JT-CR-032 · Diabetes and metabolic health
Series
Recurrent Hypoglycemia, Frailty, and Treatment Simplification
An original case on confirming recurrent hypoglycemia, frailty, kidney change, individualized goals, treatment simplification, devices, and home safety.
JT-CR-033 · Cancer, blood, infection, and immunity
Series
A Young Adult Cancer Survivor Reconnecting With Primary Care
An original case on rebuilding a cancer treatment summary, evaluating symptoms, risk-based surveillance, fertility, prevention, and care ownership.
JT-CR-034 · Children and adolescent health
Series
Adolescent Chronic Pain and School Reintegration
An original case on chronic pain, diagnostic reassessment, function-centered rehabilitation, mental-health safety, medicines, and school return.
JT-CR-035 · Children and adolescent health
Series
A Child's Hearing Concern and Learning Access
An original case on hearing-screen follow-up, diagnostic audiology, ear disease, language and learning assessment, communication access, and school support.
JT-CR-036 · Reproductive and postpartum care
Series
Postpartum Hypertension Across the Care Transition
An original case on postpartum hypertension triage, preeclampsia, home measurement, treatment safety, feeding goals, and primary-care transition.
JT-CR-037 · Prevention, rural health, and care systems
Series
Persistent Fatigue, Weight Change, and When Telehealth Is Not Enough
An original case on diagnostic reset, verified weight change, targeted testing, telehealth limits, Graves disease, and closed-loop follow-up.
JT-CR-038 · Children and adolescent health
Series
Recurrent Abdominal Pain and School Absence in a Child
An original pediatric case on abdominal pain, targeted evaluation, constipation, gut-brain care, school access, and functional recovery.
JT-CR-039 · Brain and neurologic health
Series
Migraine, Hypertension, and Contraceptive Choice
An original case on migraine aura, blood-pressure confirmation, contraceptive eligibility, reproductive autonomy, and follow-up.
JT-CR-040 · Heart and vascular care
Series
New Atrial Fibrillation With Dyspnea and Volume Overload
An original inpatient case on new atrial fibrillation, acute congestion, hemodynamic assessment, rate and rhythm decisions, stroke prevention, and longitudinal heart failure care.
JT-CR-041 · Kidney, electrolytes, and digestive health
Series
Severe Hyponatremia After a Medication Change
An original inpatient case on symptomatic hypotonic hyponatremia, thiazide exposure, diagnostic classification, controlled correction, water diuresis, and prevention of recurrence.
JT-CR-042 · Kidney, electrolytes, and digestive health
Series
Melena, Orthostasis, and Antithrombotic Tradeoffs
An original inpatient case on upper gastrointestinal bleeding, hemodynamic resuscitation, endoscopic hemostasis, anticoagulant interruption, antiplatelet necessity, and safe restart decisions.
JT-CR-043 · Emergency and acute care
Series
Sudden Severe Headache With a Normal Neurologic Examination
An original emergency case on thunderclap headache, time-sensitive subarachnoid hemorrhage evaluation, test sequencing, and diagnostic safety after a normal neurologic examination.
JT-CR-044 · Emergency and acute care
Series
Pleuritic Chest Pain and Breathlessness After Immobilization
An original emergency case on pulmonary embolism probability, D-dimer and imaging choices, early severity assessment, anticoagulation, disposition, and follow-up.
JT-CR-045 · Emergency and acute care
Series
Rapidly Progressive Hives, Wheeze, and Lightheadedness After a Meal
An original emergency case on recognizing and treating food-triggered anaphylaxis, distinguishing adjuncts from first-line care, risk-based observation, trigger evaluation, and recurrence prevention.
JT-CR-046 · Musculoskeletal, sports, and rehabilitation
Series
Acute Low-Back Pain With Saddle Numbness and Urinary Difficulty
An original emergency case on recognizing possible cauda equina syndrome, examining lower sacral function, obtaining emergency MRI, and coordinating spinal decompression and rehabilitation.
JT-CR-047 · Musculoskeletal, sports, and rehabilitation
Series
Progressive Shin Pain and Low Energy Availability in a Distance Runner
An original sports-medicine case on tibial bone stress injury, imaging after normal radiographs, low energy availability, menstrual and bone health, and criteria-based return to running.
JT-CR-048 · Musculoskeletal, sports, and rehabilitation
Series
Persistent Shoulder Pain and Weakness After a Fall
An original musculoskeletal case on persistent weakness after shoulder trauma, occult injury, acute-on-degenerative rotator cuff tears, appropriate imaging, treatment choices, and return to work.
JT-CR-049 · Heart and vascular care
Series
Severe Hypertension Without Obvious Acute Organ Injury
An original primary-care case on confirming a very high blood pressure, separating hypertensive emergency from severe hypertension without acute organ injury, and building accountable outpatient treatment.
JT-CR-050 · Kidney, electrolytes, and digestive health
Series
Fever, Flank Pain, and Complicated Urinary Infection With CKD
An original case on recognizing pyelonephritis with systemic illness, separating infection from asymptomatic bacteriuria, evaluating obstruction, and choosing kidney-aware culture-directed treatment.
JT-CR-051 · Lung and sleep health
Series
Worsening Breathlessness in COPD: Exacerbation or Another Emergency?
An original case on acute COPD worsening, controlled oxygen, respiratory failure assessment, and distinguishing pneumonia, pulmonary embolism, and heart failure before discharge.
JT-CR-052 · Men's health and urology
Series
Transient Unilateral Weakness: TIA, Minor Stroke, or Mimic?
An original emergency case on resolved focal neurologic symptoms, urgent brain and vascular imaging, early recurrence prevention, and distinguishing TIA from minor ischemic stroke and mimics.
JT-CR-053 · Reproductive and postpartum care
Series
Heavy Irregular Uterine Bleeding With Anemia and Anticoagulant Use
An original case on acute and chronic abnormal uterine bleeding, iron-deficiency anemia, endometrial-risk assessment, structural disease, and anticoagulant tradeoffs.
JT-CR-054 · Eye, skin, and digital safety
Series
Painful Expanding Leg Redness in a Person With Diabetes
An original case on distinguishing cellulitis from abscess, venous thrombosis, stasis inflammation, Charcot change, osteomyelitis, and necrotizing infection while preserving limb and antibiotic safety.
JT-CR-055 · Men's health and urology
Series
Fever, Headache, and Neck Stiffness in an Adult
Rapidly distinguishes meningitis threats, imaging needs, lumbar puncture timing, and treatment priorities without delaying stabilization.
JT-CR-056 · Brain and neurologic health
Series
Exertional Syncope With a Family History of Sudden Death
Interprets exertional fainting, inherited cardiac risk, structural disease, and the limits of a normal resting electrocardiogram.
JT-CR-057 · Mental, behavioral, and substance-use health
Series
Incidentally Elevated Liver Enzymes at a Preventive Visit
Builds a longitudinal evaluation of liver-test patterns, metabolic risk, alcohol, viral hepatitis, medicines, and fibrosis.
JT-CR-058 · Children and adolescent health
Series
Poor Weight Gain and Feeding Fatigue in an Infant
Integrates growth trajectory, observed feeding, cardiac and respiratory clues, safeguarding, and family resource constraints.
JT-CR-059 · Diabetes and metabolic health
Series
Severe Hyperglycemia Without Ketosis: Crisis Assessment
Distinguishes hyperosmolar crisis from uncomplicated hyperglycemia while controlling fluid, electrolyte, insulin, and osmolality hazards.
JT-CR-060 · Men's health and urology
Series
A Dermatomal Rash in an Immunocompromised Adult
Recognizes localized and disseminated zoster, ocular and neurologic complications, and infection-control needs in immunocompromise.
JT-CR-061 · Men's health and urology
Series
A First Seizure in an Adult
Separates provoked seizure, epilepsy risk, and mimics while coordinating imaging, toxic-metabolic evaluation, and safety restrictions.
JT-CR-062 · Reproductive and postpartum care
Series
Headache and Right-Upper-Quadrant Pain Late in Pregnancy
Recognizes preeclampsia with severe features and HELLP while coordinating maternal stabilization, fetal assessment, and delivery planning.
JT-CR-063 · Musculoskeletal, sports, and rehabilitation
Series
Sudden Calf Pain During a Run
Distinguishes muscle injury, ruptured Baker cyst, thrombosis, and compartment syndrome while planning safe return to activity.
JT-CR-064 · Mental, behavioral, and substance-use health
Series
First-Episode Psychosis With Recent Substance Exposure
Evaluates first psychosis across toxic, medical, mood, delirium, and primary psychotic causes while addressing safety and capacity.
JT-CR-065 · Kidney, electrolytes, and digestive health
Series
Generalized Edema and Heavy Proteinuria
Frames nephrotic syndrome through edema physiology, secondary causes, thrombosis and infection risk, and biopsy decision-making.
JT-CR-066 · Kidney, electrolytes, and digestive health
Series
Acute Epigastric Pain Radiating to the Back
Confirms acute pancreatitis, identifies cause and severity, and calibrates fluids, nutrition, imaging, and complication monitoring.
JT-CR-067 · Eye, skin, and digital safety
Series
Sudden Painless Vision Loss in One Eye
Treats acute monocular vision loss as an ocular and vascular emergency while separating retinal and media causes.
JT-CR-068 · Mental, behavioral, and substance-use health
Series
Progressive Memory Change and Missed Bills
Evaluates cognitive decline through function, reversible contributors, collateral history, driving, caregiving, and supported decisions.
JT-CR-069 · Cancer, blood, infection, and immunity
Series
Fever, Bruising, and Pancytopenia: Marrow Emergency
Recognizes neutropenic sepsis and marrow emergencies while distinguishing leukemia, aplasia, medicines, infection, and destructive causes.
JT-CR-070 · Cancer, blood, infection, and immunity
Series
Coughing Up Blood With a Normal Initial Radiograph
Verifies true hemoptysis, protects the airway, and localizes malignant, infectious, inflammatory, and vascular causes despite normal radiography.
JT-CR-071 · Medicines and care safety
Series
A High-Severity Medication Alert Hidden in Alert Fatigue
Verifies a dangerous interaction while redesigning clinical decision support to reduce false positives and preserve escalation reliability.
JT-CR-072 · Mental, behavioral, and substance-use health
Series
Confusion During a Hot-Weather Endurance Event
Recognizes exertional heat stroke, prioritizes immediate cooling, and separates hyponatremia, exhaustion, and other collapse mechanisms.
JT-CR-073 · Diabetes and metabolic health
Series
Resistant Hypertension and Low Potassium
Plans primary aldosteronism screening, accounts for medication interference, confirms subtype, and reduces long-term cardiovascular risk.
JT-CR-074 · Aging and palliative care
Series
Unintentional Weight Loss in an Older Adult
Investigates weight loss through malignancy, mood, oral health, medicines, endocrine disease, function, and food access.
JT-CR-075 · Children and adolescent health
Series
Fever and Refusal to Bear Weight in a Child
Prioritizes septic hip and osteomyelitis while distinguishing transient synovitis, trauma, and malignancy without delaying aspiration.
JT-CR-076 · Diabetes and metabolic health
Series
Hypotension After Abruptly Stopping Long-Term Steroids
Recognizes adrenal crisis, treats before confirmation, preserves sepsis evaluation, and prevents recurrence through safe steroid transitions.
JT-CR-077 · Cancer, blood, infection, and immunity
Series
Fever, a New Murmur, and Injection Drug Use
Coordinates endocarditis cultures, imaging, embolic assessment, source control, and evidence-based addiction care without stigma.
JT-CR-078 · Brain and neurologic health
Series
Fatigable Ptosis and Diplopia: Neuromuscular Localization
Distinguishes myasthenia from brainstem, thyroid, orbital, and cranial nerve disease while monitoring respiratory and medication hazards.
JT-CR-079 · Reproductive and postpartum care
Series
Postpartum Fever and Uterine Tenderness
Treats postpartum endometritis while separating retained tissue, urinary, wound, breast, thrombotic, and septic complications.
JT-CR-080 · Eye, skin, and digital safety
Series
New Temporal Headache and Jaw Claudication
Recognizes giant cell arteritis, protects vision before confirmation, and coordinates ultrasound or biopsy with polymyalgia assessment.
JT-CR-081 · Mental, behavioral, and substance-use health
Series
Little Sleep, Grandiosity, and Risky Spending
Distinguishes mania from substances, thyroid disease, psychosis, and delirium while selecting the least restrictive safe setting.
JT-CR-082 · Men's health and urology
Series
Visible Hematuria After an Upper-Respiratory Illness
Localizes glomerular bleeding, evaluates IgA nephropathy and nephritic urgency, and preserves urologic assessment when features conflict.
JT-CR-083 · Kidney, electrolytes, and digestive health
Series
Progressive Difficulty Swallowing Solids: Obstruction Assessment
Evaluates mechanical obstruction, cancer, eosinophilic disease, and motility while protecting nutrition and aspiration safety.
JT-CR-084 · Eye, skin, and digital safety
Series
Forehead Vesicles and Eye Pain
Recognizes ophthalmic zoster, starts timely antiviral care, and coordinates urgent eye evaluation despite limited bedside examination.
JT-CR-085 · Kidney, electrolytes, and digestive health
Series
Confusion and Urinary Retention After a Medication Change
Identifies anticholinergic toxicity, delirium, constipation, and obstruction while using safe deprescribing and transition follow-through.
JT-CR-086 · Cancer, blood, infection, and immunity
Series
Persistent Incidental Lymphocytosis: Clonal Risk Assessment
Separates reactive from clonal lymphocytosis through trend, smear, flow cytometry, red flags, and proportionate surveillance.
JT-CR-087 · Eye, skin, and digital safety
Series
Daytime Sleepiness, Snoring, and a Near-Miss Crash
Evaluates obstructive sleep apnea, insufficient sleep, narcolepsy, sedatives, and driving risk after a near-miss collision.
JT-CR-088 · Medicines and care safety
Series
Diagnostic Closure During a Language-Discordant Visit
Uses professional interpretation, teach-back, symptom reconstruction, and record design to recover missed diagnostic information safely.
JT-CR-089 · Reproductive and postpartum care
Series
New Postpartum Breathlessness and Orthopnea
Recognizes peripartum cardiomyopathy while evaluating pulmonary embolism, preeclampsia complications, infection, and physiologic recovery.
JT-CR-090 · Brain and neurologic health
Series
Claudication With a Nonhealing Toe Wound
Recognizes chronic limb-threatening ischemia, excludes acute limb danger, and integrates perfusion, wound, neuropathy, and revascularization care.
JT-CR-091 · Diabetes and metabolic health
Series
Polyuria, Constipation, and Hypercalcemia: Etiologic Assessment
Confirms clinically meaningful hypercalcemia and separates parathyroid, malignant, medication, and volume-related causes using targeted physiology.
JT-CR-092 · Children and adolescent health
Series
Bilious Vomiting in a Newborn
Treats green emesis as surgical obstruction until proven otherwise, prioritizing stabilization, urgent imaging, and neonatal surgery coordination.
JT-CR-093 · Diabetes and metabolic health
Series
Fever, Agitation, and Extreme Tachycardia With Thyrotoxicosis
Recognizes thyroid storm as decompensated organ physiology while distinguishing sepsis, stimulant toxicity, and other hyperadrenergic states.
JT-CR-094 · Musculoskeletal, sports, and rehabilitation
Series
A Deep Diabetic Foot Ulcer With Exposed Bone
Assesses osteomyelitis probability, perfusion, cultures, off-loading, source control, and multidisciplinary limb preservation in a deep ulcer.
JT-CR-095 · Brain and neurologic health
Series
Ascending Weakness and Absent Reflexes
Recognizes Guillain-Barre syndrome, excludes spinal and metabolic mimics, and monitors respiratory and autonomic failure before crisis.
JT-CR-096 · Reproductive and postpartum care
Series
Secondary Amenorrhea in a Distance Athlete
Evaluates pregnancy, hypothalamic suppression, PCOS, thyroid and prolactin disorders while protecting bone and reproductive health.
JT-CR-097 · Musculoskeletal, sports, and rehabilitation
Series
Prolonged Morning Stiffness and Swollen Small Joints
Recognizes early inflammatory arthritis, separates mimics, and coordinates prompt referral, baseline safety, and treat-to-target monitoring.
JT-CR-098 · Diabetes and metabolic health
Series
Palpitations and Fear Labeled as Panic
Reopens panic-like episodes through cardiac, endocrine, toxic, pulmonary, and metabolic danger assessment before behavioral diagnosis.
JT-CR-099 · Emergency and acute care
Series
Sudden Unilateral Hearing Loss: Time-Sensitive Assessment
Distinguishes sensorineural emergency from conductive loss using bedside testing, timely treatment, audiometry, and targeted imaging.
JT-CR-100 · Medicines and care safety
Series
Refusal of Recommended Treatment After a Stroke
Applies decision-specific capacity, supported communication, surrogate standards, and barrier analysis after stroke-related treatment refusal.
JT-CR-101 · Musculoskeletal, sports, and rehabilitation
Series
Abdominal and Back Pain With Hypotension
Recognizes ruptured abdominal aortic aneurysm and coordinates permissive resuscitation, bedside imaging, blood products, and operative activation.
JT-CR-102 · Kidney, electrolytes, and digestive health
Series
Sudden Maroon Stools and Lightheadedness
Reasoning through brisk gastrointestinal bleeding, stabilization, source localization, transfusion, and antithrombotic tradeoffs.
JT-CR-103 · Heart and vascular care
Series
Palpitations After Stimulant Use and Rhythm Change
Distinguishing physiologic tachycardia, re-entrant SVT, atrial arrhythmia, and stimulant toxicity while capturing the rhythm safely.
JT-CR-104 · Kidney, electrolytes, and digestive health
Series
Chronic Diarrhea With Weight Loss
A structured differential for persistent diarrhea with weight loss across inflammatory, malabsorptive, infectious, endocrine, and medication causes.
JT-CR-105 · Children and adolescent health
Series
Jaundice and Poor Feeding in a Newborn
Distinguishing common unconjugated jaundice from hemolysis, neurotoxicity risk, infection, and neonatal cholestasis.
JT-CR-106 · Kidney, electrolytes, and digestive health
Series
Recurrent Kidney Stones and High Calcium
Linking recurrent nephrolithiasis and hypercalcemia to hyperparathyroidism, FHH, medicines, bone risk, and surgical criteria.
JT-CR-107 · Cancer, blood, infection, and immunity
Series
Persistent Fever After International Travel
Using itinerary, incubation, repeat testing, and syndrome severity to prioritize malaria, dengue, enteric fever, and other travel infections.
JT-CR-108 · Men's health and urology
Series
Progressive Slowness and a Shuffling Gait
Distinguishing Parkinson disease from medication-induced, vascular, hydrocephalic, and atypical parkinsonian syndromes.
JT-CR-109 · Reproductive and postpartum care
Series
Sudden Unilateral Pelvic Pain and Nausea
Prioritizing ovarian torsion and ectopic pregnancy when imaging is imperfect and time to fertility-preserving surgery matters.
JT-CR-110 · Musculoskeletal, sports, and rehabilitation
Series
A Low-Trauma Vertebral Compression Fracture
Treating a fragility vertebral fracture while evaluating secondary bone loss, malignancy signals, pain, function, and future fracture risk.
JT-CR-111 · Mental, behavioral, and substance-use health
Series
Intrusive Harm Thoughts Without Desire to Act
Separating ego-dystonic OCD intrusions from intent, psychosis, and other safety risks through a shame-sensitive assessment.
JT-CR-112 · Kidney, electrolytes, and digestive health
Series
Rising Creatinine and Rash After an Antibiotic
Reasoning through suspected acute interstitial nephritis while excluding sepsis, obstruction, glomerular disease, and drug-related uncertainty.
JT-CR-113 · Cancer, blood, infection, and immunity
Series
Bloody Diarrhea and Falling Platelets
Recognizing Shiga toxin-associated HUS, distinguishing mimics, supporting organ function, and avoiding potentially harmful early treatments.
JT-CR-114 · Eye, skin, and digital safety
Series
A Changing Pigmented Lesion Requiring Timely Biopsy
Moving from melanoma recognition to complete biopsy, pathology, staging boundaries, and risk-calibrated skin surveillance.
JT-CR-115 · Mental, behavioral, and substance-use health
Series
Insomnia Treated With Multiple Sedatives
Reassessing chronic insomnia, sedative stacking, falls and cognition, withdrawal risk, and a patient-centered deprescribing sequence.
JT-CR-116 · Cancer, blood, infection, and immunity
Series
Microcytosis With a Normal Ferritin
Interpreting microcytosis when ferritin appears normal across thalassemia, inflammation, early iron deficiency, and testing limitations.
JT-CR-117 · Lung and sleep health
Series
A New Unilateral Pleural Effusion
Using thoracentesis and clinical context to distinguish infection, malignancy, heart failure, embolism, and other unilateral effusions.
JT-CR-118 · Medicines and care safety
Series
A Sepsis Alert That Conflicts With the Bedside Picture
Managing a high-risk algorithm alert through bedside reassessment, calibration awareness, override documentation, and closed-loop monitoring.
JT-CR-119 · Emergency and acute care
Series
Facial Swelling and Fever After Dental Pain
Recognizing airway and deep-space dental infection, choosing imaging, antibiotics, drainage, and reliable dental source control.
JT-CR-120 · Heart and vascular care
Series
Positional Chest Pain After a Viral Illness
Distinguishing acute pericarditis from myocarditis, acute coronary syndrome, pulmonary embolism, and other urgent chest pain causes.
JT-CR-121 · Men's health and urology
Series
Daily Headache and Frequent Analgesic Use
Recognizing medication-overuse headache while reassessing migraine, secondary warning signs, withdrawal, and preventive care.
JT-CR-122 · Children and adolescent health
Series
Barking Cough and Stridor in a Child
Grading croup severity, minimizing agitation, and recognizing foreign body, epiglottitis, bacterial tracheitis, and impending obstruction.
JT-CR-123 · Diabetes and metabolic health
Series
Recurrent Hypoglycemia Without Diabetes or Clear Exposure
Confirming Whipple's triad and using a critical sample to distinguish exposure, insulinoma, adrenal, liver, and other causes.
JT-CR-124 · Musculoskeletal, sports, and rehabilitation
Series
Painful Swelling Around a Prosthetic Joint
Distinguishing prosthetic-joint infection from aseptic failure and coordinating aspiration, cultures, surgery, and antimicrobial timing.
JT-CR-125 · Men's health and urology
Series
Acute Continuous Vertigo and Vomiting
Distinguishing vestibular neuritis from posterior circulation stroke while respecting bedside-exam and early-imaging limitations.
JT-CR-126 · Reproductive and postpartum care
Series
Gestational Diabetes Across Pregnancy and Postpartum
Connecting gestational diabetes testing, fetal and maternal risk, treatment escalation, delivery planning, and postpartum prevention.
JT-CR-127 · Musculoskeletal, sports, and rehabilitation
Series
A Red, Exquisitely Tender First Toe Joint
Distinguishing gout from septic arthritis, trauma, CPPD, and cellulitis while interpreting crystals and comorbidity.
JT-CR-128 · Children and adolescent health
Series
Food Restriction, Bradycardia, and Dizziness
Recognizing medical instability in restrictive eating, preventing refeeding harm, and balancing confidentiality with family-supported safety.
JT-CR-129 · Kidney, electrolytes, and digestive health
Series
CKD With Acidosis and Bone-Mineral Abnormalities
Integrating CKD progression, metabolic acidosis, potassium, phosphate, PTH, bone risk, medicines, and referral decisions.
JT-CR-130 · Kidney, electrolytes, and digestive health
Series
Painless Jaundice and Weight Loss
Evaluating pancreatic and biliary obstruction through cholestatic patterns, staged imaging, tissue strategy, drainage, and resectability.
JT-CR-131 · Children and adolescent health
Series
Infant Eczema With Crusting and Feeding Restrictions
Treating infected eczema and barrier failure while correcting unsupported food avoidance and protecting infant nutrition.
JT-CR-132 · Aging and palliative care
Series
Coughing During Meals in Advanced Cognitive Disease
Evaluating dysphagia and aspiration while addressing reversible factors, feeding support, comfort, and goals in advanced cognitive disease.
JT-CR-133 · Cancer, blood, infection, and immunity
Series
Falling Platelets After Heparin Exposure
Applying HIT probability, stopping all heparin, selecting alternative anticoagulation, and interpreting immunoassay and functional tests.
JT-CR-134 · Lung and sleep health
Series
Progressive Dyspnea With Interstitial Opacities
Integrating exposure, autoimmune, physiologic, and HRCT data to classify interstitial lung disease before treatment.
JT-CR-135 · Medicines and care safety
Series
A Critical Result Released to the Portal Before Follow-Up
Designing result ownership, urgent outreach, portal communication, escalation, and audit after a critical finding reaches the patient first.
JT-CR-136 · Men's health and urology
Series
Sudden Severe Scrotal Pain and Suspected Torsion
Prioritizing testicular torsion over epididymitis, hernia, trauma, and other causes when ultrasound could delay salvage.
JT-CR-137 · Reproductive and postpartum care
Series
Palpitations and Breathlessness During Pregnancy
Separating physiologic pregnancy change from arrhythmia, anemia, thyroid disease, pulmonary embolism, and peripartum cardiomyopathy.
JT-CR-138 · Musculoskeletal, sports, and rehabilitation
Series
New Proximal Weakness During Statin Therapy
Distinguishing common statin muscle symptoms from rhabdomyolysis, immune necrotizing myopathy, endocrine disease, and deconditioning.
JT-CR-139 · Children and adolescent health
Series
A Toddler Refusing Fluids During Gastroenteritis
Grading dehydration, delivering oral or nasogastric rehydration, identifying dangerous mimics, and setting safe discharge criteria.
JT-CR-140 · Men's health and urology
Series
Headache and Visual-Field Loss With a Pituitary Mass
Protecting vision and adrenal function while characterizing a pituitary mass, hormone excess or deficiency, and surgical urgency.
JT-CR-141 · Cancer, blood, infection, and immunity
Series
Recurrent Diarrhea After C. difficile Treatment
Distinguishing recurrent C. difficile infection from colonization, post-infectious symptoms, and other diarrhea while applying stewardship.
JT-CR-142 · Men's health and urology
Series
Acute Facial Weakness With Ear Pain
Separating Bell palsy from stroke, Ramsay Hunt syndrome, Lyme disease, otologic infection, and other facial-nerve causes.
JT-CR-143 · Reproductive and postpartum care
Series
Postmenopausal Bleeding Requiring Timely Endometrial Evaluation
Evaluating endometrial cancer risk with ultrasound and biopsy while ensuring persistent or recurrent bleeding reaches definitive follow-up.
JT-CR-144 · Emergency and acute care
Series
Back Pain, Fever, and Injection Drug Use
Recognizing spinal epidural abscess and vertebral infection through neurologic examination, cultures, MRI, and rapid source control.
JT-CR-145 · Mental, behavioral, and substance-use health
Series
Dependence on Long-Term Prescribed Benzodiazepines
Distinguishing physiologic dependence from use disorder and building an individualized taper around withdrawal, co-use, and anxiety.
JT-CR-146 · Cancer, blood, infection, and immunity
Series
Persistent Hoarseness in a Smoker
Escalating persistent dysphonia to laryngeal visualization while considering malignancy, vocal-fold dysfunction, reflux assumptions, and airway risk.
JT-CR-147 · Aging and palliative care
Series
Frailty Before Major Elective Surgery
Using frailty, cognition, function, medication, goals, and prehabilitation to improve elective-surgery decisions beyond age alone.
JT-CR-148 · Emergency and acute care
Series
Smoke Inhalation With a Normal Pulse-Oximeter Reading
Recognizing carbon monoxide, cyanide, delayed airway edema, and lower-airway injury despite deceptively normal pulse oximetry.
JT-CR-149 · Heart and vascular care
Series
Abdominal Pain Out of Proportion to Examination
A high-risk abdominal pain analysis on early mesenteric ischemia, lactate limits, CTA, and time-sensitive revascularization.
JT-CR-150 · Heart and vascular care
Series
Exertional Breathlessness With a Harsh Systolic Murmur
A structured approach to suspected aortic stenosis, symptom attribution, echocardiography, severity, and timely valve referral.
JT-CR-151 · Cancer, blood, infection, and immunity
Series
Persistent Generalized Lymphadenopathy With Constitutional Symptoms
A probability-led evaluation of generalized lymphadenopathy spanning infection, autoimmunity, malignancy, node choice, and biopsy.
JT-CR-152 · Children and adolescent health
Series
Polyuria and Weight Loss in an Adolescent
An urgent recognition case for new type 1 diabetes before ketoacidosis, including metabolic assessment and safe handoff.
JT-CR-153 · Brain and neurologic health
Series
Easy Bruising and Proximal Weakness With Steroid Exposure
A medication-first analysis of Cushing features, exogenous exposure, endogenous testing pitfalls, and adrenal-suppression safety.
JT-CR-154 · Cancer, blood, infection, and immunity
Series
Cough, Fever, and Weight Loss With TB Exposure
A tuberculosis case integrating airborne precautions, microbiology, false-negative interpretation, treatment, and public-health action.
JT-CR-155 · Men's health and urology
Series
Progressive Weakness With Hyperreflexia and Focal Atrophy
A localization-first case distinguishing motor neuron disease from cervical myelopathy and reversible metabolic or inflammatory mimics.
JT-CR-156 · Reproductive and postpartum care
Series
Severe Dysmenorrhea, Pelvic Pain, and Infertility
An endometriosis case balancing symptom-led care, structural mimics, fertility priorities, imaging limits, and laparoscopy.
JT-CR-157 · Cancer, blood, infection, and immunity
Series
A Swollen Finger After a Bite Injury
A hand-infection case on flexor tenosynovitis, deep-space spread, foreign body, antibiotics, and timely surgical review.
JT-CR-158 · Mental, behavioral, and substance-use health
Series
Nightmares, Hypervigilance, and Substance Coping
A trauma-informed PTSD case integrating suicide and withdrawal assessment with evidence-based psychological and substance care.
JT-CR-159 · Musculoskeletal, sports, and rehabilitation
Series
Hematuria, Kidney Injury, and Pulmonary Symptoms
A pulmonary-renal emergency case spanning ANCA vasculitis, anti-GBM disease, infection, serology limits, and urgent biopsy.
JT-CR-160 · Kidney, electrolytes, and digestive health
Series
Chronic Reflux Symptoms With New Dysphagia
An alarm-symptom case separating reflux complications from malignancy, eosinophilic disease, and motility disorders.
JT-CR-161 · Cancer, blood, infection, and immunity
Series
Rapidly Spreading Purpura With Fever
A meningococcemia emergency case integrating sepsis care, DIC, vasculitis mimics, isolation, prophylaxis, and public health.
JT-CR-162 · Men's health and urology
Series
Apparent Cognitive Decline With Untreated Hearing Loss
A cognition case showing how sensory access, depression, medicines, function, and valid testing prevent diagnostic misclassification.
JT-CR-163 · Men's health and urology
Series
Macrocytosis and Progressive Neuropathy With Gait Imbalance
A sequence-sensitive case on vitamin B12 deficiency, folate, alcohol, liver and thyroid disease, medicines, and marrow disorders.
JT-CR-164 · Cancer, blood, infection, and immunity
Series
Pneumonia That Does Not Resolve as Expected
A reassessment case for nonresolving pneumonia, obstruction, resistance, aspiration, organizing disease, and follow-up imaging.
JT-CR-165 · Heart and vascular care
Series
A Wearable Device Reports Possible Atrial Fibrillation
A signal-verification case on wearable irregular-rhythm alerts, pretest probability, ECG confirmation, and safe next steps.
JT-CR-166 · Lung and sleep health
Series
Severe Adult Asthma With a Quiet Chest
A life-threatening asthma case on quiet-chest recognition, repeated reassessment, ventilatory failure, and escalation.
JT-CR-167 · Heart and vascular care
Series
Sudden Leg Pain, Pallor, and Loss of Pulses
An acute limb ischemia case on bedside staging, embolic versus thrombotic mechanisms, immediate anticoagulation, and revascularization.
JT-CR-168 · Eye, skin, and digital safety
Series
Chronic Generalized Pruritus Without a Primary Rash
A symptom-led pruritus case spanning liver, kidney, hematologic, endocrine, medicine, neuropathic, and occult skin causes.
JT-CR-169 · Children and adolescent health
Series
Persistent Fever, Rash, and Red Eyes in a Child
A pediatric vasculitis case on Kawasaki recognition, viral and MIS-C mimics, inflammatory markers, echocardiography, and timing.
JT-CR-170 · Reproductive and postpartum care
Series
Abnormal Thyroid Tests During Pregnancy
A pregnancy-specific thyroid case on trimester ranges, assay limits, overt disease, fetal effects, and coordinated treatment.
JT-CR-171 · Eye, skin, and digital safety
Series
Recurrent Painful Skin Abscesses in Intertriginous Areas
A recurrence-focused abscess case spanning drainage, culture, MRSA, hidradenitis, diabetes, household factors, and decolonization.
JT-CR-172 · Men's health and urology
Series
Brief Recurrent Episodes of Déjà Vu and Confusion
A focal-seizure case distinguishing panic, syncope, sleep, and metabolic mimics while using EEG and MRI appropriately.
JT-CR-173 · Emergency and acute care
Series
Infertility Evaluation That Includes Both Partners
A parallel infertility evaluation covering ovulation, reserve, tubal anatomy, semen analysis, and shared reproductive decisions.
JT-CR-174 · Musculoskeletal, sports, and rehabilitation
Series
Inflammatory Back Pain in a Young Adult
A diagnostic case on axial spondyloarthritis, mechanical mimics, imaging interpretation, extra-articular disease, and referral.
JT-CR-175 · Children and adolescent health
Series
Severe Agitation and Delusions Soon After Delivery
A postpartum psychosis emergency case integrating bipolar risk, medical mimics, suicide, infant safety, and family-centered care.
JT-CR-176 · Kidney, electrolytes, and digestive health
Series
Flash Pulmonary Edema and Difficult-to-Control Hypertension
A renovascular case on recurrent pulmonary edema, bilateral renal-artery disease, testing, medication hazards, and revascularization.
JT-CR-177 · Kidney, electrolytes, and digestive health
Series
New Ascites in Cirrhosis With Mild Confusion
A decompensated-cirrhosis case on immediate paracentesis, SBP, portal causes, kidney risk, and transplant referral.
JT-CR-178 · Eye, skin, and digital safety
Series
Facial Pain, Ophthalmoplegia, and Diabetes
An invasive fungal sinusitis emergency case on orbital signs, tissue diagnosis, metabolic reversal, and surgical source control.
JT-CR-179 · Aging and palliative care
Series
Bruising, Fear, and Financial Control in an Older Adult
An elder-mistreatment case on private assessment, injury, capacity, reporting duties, financial exploitation, and safety planning.
JT-CR-180 · Cancer, blood, infection, and immunity
Series
Cancer-Associated Thrombosis With Thrombocytopenia
A dynamic clot-versus-bleeding case on cancer-associated VTE, platelet trends, treatment intensity, and repeated reassessment.
JT-CR-181 · Lung and sleep health
Series
Wheeze That Improves Away From Work
An occupational-asthma case on exposure chronology, serial peak flow, objective testing, and worker-protective action.
JT-CR-182 · Medicines and care safety
Series
A Wrong-Patient Order Caught Before Administration
A patient-safety case on identity design, interruption recovery, near-miss disclosure, reporting, and systems analysis.
JT-CR-183 · Mental, behavioral, and substance-use health
Series
Hypothermia, Bradycardia, and Altered Mental Status
An environmental emergency case on gentle handling, staged rewarming, arrhythmia risk, and endocrine or toxic mimics.
JT-CR-184 · Heart and vascular care
Series
Tearing Chest Pain With Unequal Pulses
An acute aortic syndrome case on probability, CTA, impulse control, branch ischemia, and immediate surgical pathways.
JT-CR-185 · Musculoskeletal, sports, and rehabilitation
Series
An Incidental Positive ANA Without Systemic Features
A pretest-probability case on ANA false positives, symptom-led testing, reflex panels, and avoiding an unsupported autoimmune label.
JT-CR-186 · Children and adolescent health
Series
Hypertension in an Adolescent With Obesity
A pediatric blood-pressure case on accurate measurement, ambulatory confirmation, obesity, kidney and endocrine causes, and family care.
JT-CR-187 · Aging and palliative care
Series
Hypernatremia in an Older Adult With Limited Water Access
A water-balance case on deficit, impaired access, AVP disorders, osmotic losses, correction, and recurrence prevention.
JT-CR-188 · Cancer, blood, infection, and immunity
Series
A New HIV Diagnosis in Primary Care
A stigma-aware case on diagnostic confirmation, rapid linkage, baseline evaluation, treatment, prevention, and durable retention.
JT-CR-189 · Eye, skin, and digital safety
Series
Painful Monocular Vision Loss in a Young Adult
An optic-neuritis case distinguishing demyelination from ischemic, infectious, retinal, orbital, and pressure emergencies.
JT-CR-190 · Eye, skin, and digital safety
Series
Painful Vulvar Lesions After a New Partnership
A confidential genital-ulcer case on herpes, syphilis, inflammatory dermatoses, trauma, testing windows, and prevention.
JT-CR-191 · Men's health and urology
Series
Nocturnal Hand Numbness and Weak Grip
A localization case separating carpal tunnel syndrome from cervical radiculopathy, polyneuropathy, and urgent motor loss.
JT-CR-192 · Mental, behavioral, and substance-use health
Series
An Adult Requesting an ADHD Diagnosis
A lifespan case on developmental history, impairment, mood, sleep, anxiety, substances, trauma, and safe treatment planning.
JT-CR-193 · Eye, skin, and digital safety
Series
A Painful Ulcer That Worsens After Debridement
A pyoderma-gangrenosum case on pathergy, infection and vasculitis exclusion, biopsy purpose, pain, and coordinated wound care.
JT-CR-194 · Men's health and urology
Series
Driving Concerns With Mild Cognitive Impairment
A mobility-centered case on functional driving risk, vision, medicines, law, reporting, and preserving community access.
JT-CR-195 · Emergency and acute care
Series
Escalating Pain Under a New Cast
An acute-compartment-syndrome case on serial examination, analgesia misconceptions, pressure testing, and emergency decompression.
JT-CR-196 · Diabetes and metabolic health
Series
Hypotension Without Fever in an Immunosuppressed Adult
Recognizes afebrile septic shock, adrenal crisis, hemorrhage, and cardiogenic causes when immunosuppression blunts expected signs.
JT-CR-197 · Heart and vascular care
Series
A Bicuspid Aortic Valve Found Incidentally
Turns an incidental bicuspid valve into a structured assessment of valve function, aortic dimensions, family screening, and surveillance.
JT-CR-198 · Cancer, blood, infection, and immunity
Series
A Positive Stool Screening Test With No Symptoms
Explains why an abnormal stool screening result needs diagnostic colonoscopy, timely navigation, and closure even without symptoms.
JT-CR-199 · Children and adolescent health
Series
Bronchiolitis in an Infant With Increased Work of Breathing
Uses feeding, apnea risk, oxygenation, hydration, and serial respiratory effort to guide supportive bronchiolitis care.
JT-CR-200 · Musculoskeletal, sports, and rehabilitation
Series
Fragility Fracture in Advanced CKD
Separates fracture care, osteoporosis risk, and renal osteodystrophy before choosing bone therapy in advanced chronic kidney disease.
JT-CR-201 · Kidney, electrolytes, and digestive health
Series
Fever and Diarrhea After Travel
Uses itinerary, incubation, severity, malaria testing, cultures, and public health clues to evaluate febrile diarrhea after travel.
JT-CR-202 · Men's health and urology
Series
Recurrent Visual Aura in an Older Adult
Distinguishes stereotyped migraine aura from retinal ischemia, TIA, seizure, and ocular disease when visual episodes begin later in life.
JT-CR-203 · Reproductive and postpartum care
Series
Preconception Review for Chronic-Disease Medicines
Balances disease control, reproductive timing, medicine risk, contraception, monitoring, and shared decisions before pregnancy.
JT-CR-204 · Musculoskeletal, sports, and rehabilitation
Series
An Ankle Inversion Injury With Difficulty Walking
Applies fracture rules, targeted examination, imaging, functional support, and reassessment after an acute inversion injury.
JT-CR-205 · Prevention, rural health, and care systems
Series
Multiple Physical Symptoms After Repeated Negative Tests
Builds a validating, bounded evaluation and functional treatment plan for persistent symptoms without missing new objective disease.
JT-CR-206 · Kidney, electrolytes, and digestive health
Series
Fever and Reduced Urine Output After Kidney Transplant
Prioritizes sepsis, obstruction, rejection, drug toxicity, and graft perfusion when fever accompanies acute allograft dysfunction.
JT-CR-207 · Diabetes and metabolic health
Series
Markedly Elevated Aminotransferases After Strenuous Exercise
Distinguishes muscle release from acute hepatic injury using CK, bilirubin, INR, exposure history, kidney risk, and enzyme trajectory.
JT-CR-208 · Eye, skin, and digital safety
Series
Blisters, Skin Pain, and Mucosal Erosions After a New Medicine
Recognizes Stevens-Johnson syndrome and toxic epidermal necrolysis, stops culprit exposure, and protects skin, eyes, airway, and fluids.
JT-CR-209 · Aging and palliative care
Series
Preventing Delirium Around Major Surgery
Builds a multicomponent perioperative plan around cognition, medicines, mobility, sleep, sensory access, hydration, and family knowledge.
JT-CR-210 · Cancer, blood, infection, and immunity
Series
Sickle-Cell Pain With Fever and Falling Oxygen Saturation
Recognizes evolving acute chest syndrome during a pain episode and coordinates analgesia, oxygenation, infection treatment, spirometry, and transfusion.
JT-CR-211 · Heart and vascular care
Series
Progressive Dyspnea With Signs of Pulmonary Hypertension
Moves from echocardiographic probability to etiologic classification and right heart catheterization before pulmonary vascular therapy.
JT-CR-212 · Medicines and care safety
Series
A Copied-Forward Diagnosis That No Longer Fits
Repairs an inherited diagnosis by tracing provenance, comparing current evidence, correcting downstream records, and preserving uncertainty.
JT-CR-213 · Men's health and urology
Series
Head Trauma While Taking an Anticoagulant
Balances urgent CT, neurologic observation, reversal decisions, delayed bleeding risk, anticoagulant interruption, and safe discharge.
JT-CR-214 · Cancer, blood, infection, and immunity
Series
Breathlessness Years After Anthracycline Treatment
Connects remote anthracycline exposure to late cardiac dysfunction while testing ischemic, valvular, pulmonary, thrombotic, and cancer causes.
JT-CR-215 · Cancer, blood, infection, and immunity
Series
Smoking Cessation and Lung-Cancer Screening in COPD
Combines evidence based tobacco treatment with eligibility, shared decisions, annual completion, and incidental finding follow-up for low dose CT.
JT-CR-216 · Children and adolescent health
Series
Unexplained Bruising in a Child
Evaluates bruise pattern, development, trauma history, bleeding disorders, occult injury, and child safety without premature attribution.
JT-CR-217 · Diabetes and metabolic health
Series
Early Satiety and Vomiting in Diabetes
Confirms delayed gastric emptying only after excluding obstruction and addresses nutrition, glucose variability, medicines, and prokinetic risks.
JT-CR-218 · Men's health and urology
Series
Expanding Erythema With Facial Weakness
Recognizes early disseminated Lyme disease, localizes facial palsy, checks meningitic and cardiac involvement, and selects evidence based testing.
JT-CR-219 · Men's health and urology
Series
Back Pain and New Leg Weakness in a Person With Cancer
Treats new weakness with cancer-related back pain as metastatic spinal cord compression until urgent MRI and expert review define anatomy.
JT-CR-220 · Reproductive and postpartum care
Series
Breast Pain and Fever During Lactation
A lactation-focused analysis of inflammatory mastitis, bacterial infection, abscess risk, milk drainage, antibiotics, and follow-up.
JT-CR-221 · Eye, skin, and digital safety
Series
Shoulder and Hip Stiffness With Systemic Symptoms
Diagnostic calibration for polymyalgia rheumatica, giant cell arteritis, inflammatory mimics, steroid response, and relapse monitoring.
JT-CR-222 · Mental, behavioral, and substance-use health
Series
Self-Harm Thoughts After Starting an Antidepressant
Urgent assessment of new self-harm thoughts after antidepressant initiation, including intent, activation, bipolarity, means safety, and follow-up.
JT-CR-223 · Men's health and urology
Series
An Incidental Renal Mass
A renal mass analysis covering image characterization, malignancy risk, biopsy limits, surveillance, nephron preservation, and result ownership.
JT-CR-224 · Kidney, electrolytes, and digestive health
Series
Suspected Celiac Disease After Starting a Gluten-Free Diet
A celiac diagnosis analysis after gluten restriction, covering serology limits, gluten challenge, biopsy, nutritional injury, and access barriers.
JT-CR-225 · Cancer, blood, infection, and immunity
Series
Recurrent Nosebleeds While Taking Anticoagulation
Management of recurrent epistaxis during anticoagulation, balancing airway and hemorrhage control against thrombosis and reversal harms.
JT-CR-226 · Brain and neurologic health
Series
Syncope With Several QT-Prolonging Medicines
Recognition of drug-related long QT and torsades after syncope, with ECG verification, interaction review, electrolyte correction, and monitoring.
JT-CR-227 · Cancer, blood, infection, and immunity
Series
An Isolated Prolonged aPTT Before Surgery
A preoperative aPTT analysis using repeat sampling, bleeding history, mixing studies, heparin checks, factor assays, and procedure-specific risk.
JT-CR-228 · Cancer, blood, infection, and immunity
Series
Bilateral Hilar Adenopathy and Breathlessness
Diagnostic reasoning for bilateral hilar adenopathy with dyspnea, separating sarcoidosis from infection, malignancy, exposure, and cardiac disease.
JT-CR-229 · Heart and vascular care
Series
Severe Home Blood Pressures From the Wrong Cuff Size
Measurement-safety reasoning for severe home blood pressure values caused by an undersized cuff, without missing true hypertensive emergencies.
JT-CR-230 · Medicines and care safety
Series
Tongue Swelling During ACE-Inhibitor Therapy
Airway-first reasoning for ACE-inhibitor angioedema, distinguishing bradykinin swelling from anaphylaxis and preventing unsafe rechallenge.
JT-CR-231 · Musculoskeletal, sports, and rehabilitation
Series
Resting Bradycardia in a Competitive Athlete
Risk calibration for athletic bradycardia, distinguishing physiologic adaptation from conduction disease, energy deficiency, and myocarditis.
JT-CR-232 · Reproductive and postpartum care
Series
Chronic Pelvic Pain With Normal Initial Imaging
Longitudinal reasoning for chronic pelvic pain after normal imaging, integrating endometriosis, pelvic floor, bladder and bowel causes, and trauma-aware care.
JT-CR-233 · Children and adolescent health
Series
A Child Swallows a Button Battery
Time-critical management of button-battery ingestion, including immediate imaging, esophageal removal, mitigation, delayed injury, and prevention.
JT-CR-234 · Brain and neurologic health
Series
Enlarging Hands, Headache, and New Diabetes
Diagnostic reasoning for acromegaly, using IGF-1, glucose-suppressed growth hormone, pituitary imaging, visual assessment, and comorbidity care.
JT-CR-235 · Cancer, blood, infection, and immunity
Series
An Animal Bite With Uncertain Vaccination History
A bite assessment integrating wound injury, infection, tetanus protection, rabies risk, animal observation, public health, and access.
JT-CR-236 · Men's health and urology
Series
Gait Change, Urinary Urgency, and Cognitive Slowing
A normal-pressure hydrocephalus analysis using objective gait testing, brain imaging, drainage response, mimic review, and shunt-risk counseling.
JT-CR-237 · Children and adolescent health
Series
Low Milk Supply and Poor Infant Weight Gain
A paired feeding assessment for low milk supply and poor growth, distinguishing milk production, transfer, infant illness, and supplementation needs.
JT-CR-238 · Musculoskeletal, sports, and rehabilitation
Series
Atraumatic Hip Pain After Repeated Steroid Exposure
Early recognition of femoral-head osteonecrosis after cumulative steroid use, including MRI, collapse risk, infection exclusion, and joint preservation.
JT-CR-239 · Lung and sleep health
Series
Insomnia in a Rotating-Shift Worker
A circadian and occupational analysis of rotating-shift insomnia, sleepiness, drowsy-driving risk, schedule design, and adapted insomnia care.
JT-CR-240 · Brain and neurologic health
Series
A Chronic Lower-Leg Ulcer
A mechanism-based leg-ulcer assessment covering venous and arterial disease, neuropathy, infection, atypical wounds, compression, and healing.
JT-CR-241 · Aging and palliative care
Series
Weight Loss, Weakness, and Poor Dentition in Later Life
A geriatric malnutrition analysis linking oral disease, swallowing, chronic illness, mood, medicines, food access, refeeding risk, and recovery.
JT-CR-242 · Mental, behavioral, and substance-use health
Series
Hyperthermia and Rigidity After Medication Changes
Emergency differentiation of neuroleptic malignant syndrome, serotonin toxicity, malignant catatonia, heat illness, and other hypermetabolic crises.
JT-CR-243 · Children and adolescent health
Series
Pallor, Oliguria, and Thrombocytopenia After Bloody Diarrhea
Clinical reasoning for suspected hemolytic uremic syndrome after bloody diarrhea, with renal, neurologic, and hematologic risk assessment.
JT-CR-244 · Cancer, blood, infection, and immunity
Series
Redness and Drainage Over a Cardiac Device Pocket
A device-pocket infection analysis covering bacteremia, echocardiography, extraction planning, pacing dependence, and safe reimplantation.
JT-CR-245 · Cancer, blood, infection, and immunity
Series
Persistent Night Sweats Without a Clear Diagnosis
A calibrated workup for persistent drenching night sweats using tempo, exposures, examination, targeted tests, and scheduled reassessment.
JT-CR-246 · Children and adolescent health
Series
Recurrent Infections in a Child
A longitudinal analysis of recurrent childhood infections using verified episodes, growth, immune screening, anatomy, and family history.
JT-CR-247 · Diabetes and metabolic health
Series
A Newly Discovered Thyroid Nodule
Risk-stratified thyroid nodule reasoning using TSH, ultrasound patterns, lymph-node assessment, selective biopsy, and surveillance.
JT-CR-248 · Brain and neurologic health
Series
Fever, Headache, and Low Platelets After a Tick Bite
Time-sensitive tick-borne illness reasoning using exposure, cytopenias, transaminases, PCR timing, and treatment without delay.
JT-CR-249 · Men's health and urology
Series
Painful Wrist Drop With Systemic Symptoms
Localization of painful wrist drop with systemic findings, separating compression from vasculitic mononeuritis multiplex and organ threat.
JT-CR-250 · Reproductive and postpartum care
Series
Severe Vomiting and Ketosis in Pregnancy
Management reasoning for severe pregnancy vomiting with ketosis, acid-base disturbance, dehydration, and competing euglycemic ketoacidosis.
JT-CR-251 · Musculoskeletal, sports, and rehabilitation
Series
Knee Locking After a Twisting Injury
Recognition of a truly locked knee after rotation, with meniscal displacement, fracture exclusion, imaging, and timely orthopedic review.
JT-CR-252 · Mental, behavioral, and substance-use health
Series
Depression Presenting as Cognitive Change in Later Life
Longitudinal reasoning for late-life depression with cognitive complaints, safety assessment, functional collateral, and reassessment.
JT-CR-253 · Kidney, electrolytes, and digestive health
Series
Hypertension and a Family History of Kidney Cysts
Longitudinal reasoning for possible inherited polycystic kidney disease, including imaging, blood pressure, genetics, and complications.
JT-CR-254 · Kidney, electrolytes, and digestive health
Series
Acute Hepatitis With Very High Aminotransferases
Recognition of severe acute hepatocellular injury using encephalopathy, coagulation, exposure timing, viral testing, and transfer thresholds.
JT-CR-255 · Children and adolescent health
Series
Patchy Hair Loss and Scalp Scale in a Child
A child-scalp analysis distinguishing tinea capitis from alopecia areata, traction, hair pulling, and inflammatory dermatoses.
JT-CR-256 · Aging and palliative care
Series
Recurrent Hospitalization and Caregiver Exhaustion
A systems analysis of repeated admissions that integrates acute illness, medication reconciliation, caregiver capacity, and transition reliability.
JT-CR-257 · Cancer, blood, infection, and immunity
Series
Marked Leukocytosis After Steroid Treatment
Interpretation of marked neutrophilic leukocytosis after glucocorticoids while preserving detection of infection and marrow disease.
JT-CR-258 · Cancer, blood, infection, and immunity
Series
Bronchiectasis Exacerbation in an Adult With Cystic Fibrosis
Management reasoning for a cystic-fibrosis pulmonary exacerbation using prior cultures, severity, airway clearance, and recovery targets.
JT-CR-259 · Eye, skin, and digital safety
Series
An Oxygen-Saturation Algorithm That Performs Differently Across Skin Tones
A systems-safety analysis of pulse-oximetry bias using paired validation, subgroup performance, escalation rules, and governance.
JT-CR-260 · Kidney, electrolytes, and digestive health
Series
Delayed Vomiting and Liver Injury After Wild-Mushroom Ingestion
Recognition of delayed amatoxin poisoning using exposure reconstruction, symptom-free interval, serial liver tests, antidotal care, and transfer.
JT-CR-261 · Heart and vascular care
Series
Myocardial Infarction With No Obstructive Coronary Lesion
A MINOCA working-diagnosis analysis using angiographic review, cardiac MRI, intracoronary imaging, and cause-directed prevention.
JT-CR-262 · Cancer, blood, infection, and immunity
Series
Post-Infectious Fatigue With Post-Exertional Worsening
Longitudinal reasoning for post-infectious fatigue with post-exertional symptom worsening, orthostatic features, and pacing.
JT-CR-263 · Children and adolescent health
Series
Irregular Menses in an Adolescent
A confidential adolescent evaluation of irregular cycles using pregnancy testing, pubertal timing, androgen signs, nutrition, and follow-up.
JT-CR-264 · Diabetes and metabolic health
Series
Polyuria and Hypernatremia After Pituitary Surgery
Postoperative polyuria reasoning using paired serum and urine data, desmopressin response, free-water access, and phase changes.
JT-CR-265 · Cancer, blood, infection, and immunity
Series
A Positive TB Test Before Biologic Therapy
A pre-biologic tuberculosis pathway separating latent infection from active disease, then coordinating treatment, interactions, and timing.
JT-CR-266 · Men's health and urology
Series
Electric-Shock Facial Pain
Localization and risk assessment for brief triggered facial pain, separating classical trigeminal neuralgia from secondary and dental causes.
JT-CR-267 · Reproductive and postpartum care
Series
Painful Contractions Before Term
Management reasoning for possible preterm labor using gestational age, cervical change, membrane status, fetal condition, and transfer.
JT-CR-268 · Musculoskeletal, sports, and rehabilitation
Series
Elbow Pain and Hand Numbness at Work
Occupational reasoning for ulnar-distribution numbness using localization, ergonomic exposure, electrodiagnostics, and weakness follow-up.
JT-CR-269 · Men's health and urology
Series
Confusion and Gait Instability With Heavy Alcohol Use
Recognition of possible Wernicke encephalopathy using clinical findings, immediate thiamine, magnesium, and parallel evaluation.
JT-CR-270 · Musculoskeletal, sports, and rehabilitation
Series
Dark Urine and Kidney Injury After Extreme Exercise
Management of exertional rhabdomyolysis using potassium, kidney function, compartment checks, individualized fluids, and recurrence review.
JT-CR-271 · Kidney, electrolytes, and digestive health
Series
Chronic Constipation With New Alarm Features
A constipation analysis that responds to weight loss, anemia, bleeding, obstruction signs, and change from baseline with timely evaluation.
JT-CR-272 · Cancer, blood, infection, and immunity
Series
A Nonhealing Oral Ulcer
Recognition of a persistent indurated oral ulcer requiring prompt tissue diagnosis while comparing trauma, infection, and inflammation.
JT-CR-273 · Aging and palliative care
Series
Secondary Fracture Prevention After Hip Fracture
A post-hip-fracture pathway integrating osteoporosis treatment, secondary causes, falls, rehabilitation, and reliable follow-through.
JT-CR-274 · Cancer, blood, infection, and immunity
Series
Fever, Splenomegaly, and Cytopenias
Recognition of possible hemophagocytic lymphohistiocytosis using trends, organ injury, trigger search, and early hematology coordination.
JT-CR-275 · Cancer, blood, infection, and immunity
Series
Acute Hypoxemia After Vaping
A vaping-associated lung injury analysis that prioritizes oxygenation, confidential exposure history, infection exclusion, and close follow-up.
JT-CR-276 · Heart and vascular care
Series
Duplicate Anticoagulants Across Multiple Patient Portals
A medication-safety analysis of possible duplicate anticoagulants using source reconciliation, exposure timing, bleeding assessment, and repair.
JT-CR-277 · Eye, skin, and digital safety
Series
A Chemical Splash to the Eye
Immediate chemical-eye injury reasoning centered on irrigation, serial pH, particle removal, limbal assessment, and urgent ophthalmology.
JT-CR-278 · Brain and neurologic health
Series
Syncope With a Prolonged QT and a Family History of Seizures
An arrhythmic-syncope analysis using manual QT review, medication and electrolyte correction, telemetry, and inherited-risk assessment.
JT-CR-279 · Men's health and urology
Series
Irresistible Daytime Sleep Episodes
A hypersomnolence analysis using sleep opportunity, cataplexy history, overnight testing, valid MSLT conditions, and driving safety.
JT-CR-280 · Children and adolescent health
Series
New Bedwetting in a School-Age Child
A nonpunitive evaluation of secondary bedwetting using prior dryness, urine testing, bowel and sleep review, and family goals.
JT-CR-281 · Brain and neurologic health
Series
Episodic Headache, Sweating, and Palpitations
A pheochromocytoma analysis using spell context, metanephrine collection conditions, medication review, imaging, and inherited risk.
JT-CR-282 · Eye, skin, and digital safety
Series
Migratory Joint Pain, Tenosynovitis, and a Pustular Rash
Recognition of disseminated gonococcal infection using multisite testing, blood and synovial cultures, joint assessment, and partner care.
JT-CR-283 · Men's health and urology
Series
Progressive Hand Clumsiness and Gait Imbalance
Recognition of degenerative cervical myelopathy using upper-motor-neuron findings, functional change, MRI, and timely spine referral.
JT-CR-284 · Reproductive and postpartum care
Series
Persistent Bleeding After Pregnancy Loss
Management reasoning for ongoing bleeding after pregnancy loss using hemodynamics, ultrasound, pregnancy location, infection, and support.
JT-CR-285 · Musculoskeletal, sports, and rehabilitation
Series
Heel Pain in a High-Mileage Athlete
A calcaneal stress-injury analysis using focal loading pain, early imaging limits, training load, nutrition, and return criteria.
JT-CR-286 · Mental, behavioral, and substance-use health
Series
Stimulant Misuse, Anxiety, and Insomnia During an ADHD Reassessment
A nonpunitive ADHD reassessment integrating extra stimulant use, anxiety, sleep, cardiovascular safety, substance risk, and function.
JT-CR-287 · Children and adolescent health
Series
Eyelid Swelling and Painful Eye Movement in a Child
Recognition of orbital cellulitis using vision, pupils, eye movement, proptosis, imaging, antibiotics, and surgical coordination.
JT-CR-288 · Aging and palliative care
Series
Feeding Decisions in Advanced Dementia
A goals-based advanced-dementia feeding analysis integrating reversible causes, assisted oral feeding, aspiration, and surrogate decisions.
JT-CR-289 · Lung and sleep health
Series
Massive Hemoptysis With Worsening Oxygenation
Management of life-threatening hemoptysis centered on airway protection, bleeding-side positioning, CTA, bronchoscopy, and embolization.
JT-CR-290 · Men's health and urology
Series
Diplopia, Dysphagia, and Descending Weakness After Preserved Food
Recognition and emergency management of foodborne botulism through cranial neuropathies, respiratory monitoring, antitoxin, and outbreak control.
JT-CR-291 · Reproductive and postpartum care
Series
Heavy Bleeding and Shock Soon After Vaginal Birth
Stage-based reasoning for primary postpartum hemorrhage, including rapid cause assessment, uterotonics, tranexamic acid, transfusion, and source control.
JT-CR-292 · Cancer, blood, infection, and immunity
Series
Rapidly Worsening Leg Pain and Toxicity After a Minor Wound
Systems reasoning for suspected necrotizing soft tissue infection, linking early recognition, resuscitation, antibiotics, and urgent surgical transfer.
JT-CR-293 · Lung and sleep health
Series
Cough and Wheeze That Ease on Days Away From Work
Continuity reasoning for work-related asthma, using serial peak flow diaries, removal from the causative agent, and long-term follow-through.
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