https://astramd.org/articles Evidence-based clinical guides from Astra MD. https://astramd.org/articles/community-acquired-pneumonia https://astramd.org/articles/community-acquired-pneumonia Fri, 21 Aug 2026 02:43:40 GMT A decision-focused approach to confirming community-acquired pneumonia, selecting site of care, identifying severe disease and resistant-pathogen risk, obtaining targeted microbiology, and reassessing response when initial therapy fails. https://astramd.org/articles/aspiration-pneumonia https://astramd.org/articles/aspiration-pneumonia Fri, 21 Aug 2026 02:42:54 GMT Manage suspected aspiration pneumonia as community-acquired pneumonia unless resistant-pathogen risk is independently present, while distinguishing infection from aspiration pneumonitis, pulmonary edema, and obstructing or cavitary disease. Prioritize oxygenation, radiographic confirmation, targeted microbiology, swallowing evaluation, and prevention of recurrent aspiration. https://astramd.org/articles/generalized-anxiety-disorder https://astramd.org/articles/generalized-anxiety-disorder Fri, 21 Aug 2026 02:42:04 GMT Diagnose generalized anxiety disorder clinically after defining severity, functional impairment, comorbidity, substance contributions, and acute safety risk; then match treatment intensity to patient preference, access, and prior response using cognitive behavioral therapy, an SSRI, or an SNRI. https://astramd.org/articles/congenital-hypothyroidism https://astramd.org/articles/congenital-hypothyroidism Fri, 21 Aug 2026 02:41:17 GMT Manage an abnormal newborn screen as a time-critical thyroid hormone deficiency: confirm with serum testing, begin levothyroxine promptly, monitor free T4 and TSH intensively, and use thyroid imaging to clarify permanence without delaying treatment. https://astramd.org/articles/abnormal-uterine-bleeding https://astramd.org/articles/abnormal-uterine-bleeding Fri, 21 Aug 2026 02:39:42 GMT Evaluate abnormal uterine bleeding by first excluding pregnancy and nonuterine bleeding, then stratifying endometrial cancer risk, identifying PALM-COEIN causes, and selecting imaging, sampling, medical therapy, or uterine intervention according to bleeding pattern and reproductive goals. https://astramd.org/articles/stroke-mimics https://astramd.org/articles/stroke-mimics Fri, 21 Aug 2026 02:38:46 GMT Acute focal deficits require parallel stroke treatment readiness and rapid mimic recognition. Use bedside pattern analysis, glucose testing, CT-based vascular imaging, and selectively MRI or EEG to identify seizure, migraine, metabolic, functional, vestibular, inflammatory, venous, and structural alternatives without delaying reperfusion decisions. https://astramd.org/articles/seizure https://astramd.org/articles/seizure Fri, 21 Aug 2026 02:37:55 GMT Manage a suspected seizure by identifying ongoing status epilepticus, rapidly separating acute provoked from unprovoked events, obtaining targeted metabolic, infectious, toxicologic, EEG, and neuroimaging data, and using recurrence-risk features to decide whether long-term antiseizure treatment is justified. https://astramd.org/articles/multiple-sclerosis https://astramd.org/articles/multiple-sclerosis Fri, 21 Aug 2026 02:37:04 GMT Diagnose multiple sclerosis by demonstrating typical dissemination and excluding mimics, treat clinically meaningful relapses promptly, and initiate disease-modifying therapy early while matching efficacy, safety, reproductive plans, and inflammatory activity. https://astramd.org/articles/lacunar-stroke https://astramd.org/articles/lacunar-stroke Fri, 21 Aug 2026 02:36:16 GMT Manage suspected lacunar stroke as an acute ischemic stroke while confirming the mechanism with diffusion MRI and vascular-cardioembolic evaluation. Long-term decisions hinge on distinguishing true small-vessel disease from parent-artery, embolic, or incidental infarction and avoiding harmful chronic dual antiplatelet therapy. https://astramd.org/articles/generalized-tonic-clonic-seizure https://astramd.org/articles/generalized-tonic-clonic-seizure Fri, 21 Aug 2026 02:35:25 GMT Manage an ongoing convulsion as status epilepticus at 5 minutes while establishing airway protection and reversible causes. After stabilization, distinguish generalized-onset epilepsy from focal-to-bilateral tonic-clonic seizure, acute symptomatic seizure, convulsive syncope, and eclampsia to guide EEG, imaging, recurrence counseling, and antiseizure therapy. https://astramd.org/articles/brainstem-stroke https://astramd.org/articles/brainstem-stroke Fri, 21 Aug 2026 02:34:22 GMT Brainstem stroke requires immediate vascular imaging and reperfusion assessment because minor-appearing cranial nerve, gait, or consciousness findings may represent basilar occlusion, vertebral dissection, or perforator infarction with rapid respiratory, motor, and consciousness deterioration. https://astramd.org/articles/absence-seizure https://astramd.org/articles/absence-seizure Fri, 21 Aug 2026 02:33:21 GMT Confirm typical absence seizures with an event-capturing EEG, then classify childhood versus juvenile absence epilepsy and screen for myoclonic or generalized tonic-clonic seizures before selecting ethosuximide, valproate, or lamotrigine. https://astramd.org/articles/covid-19-vaccine https://astramd.org/articles/covid-19-vaccine Fri, 21 Aug 2026 02:32:36 GMT Use the current-season COVID-19 vaccine to restore protection against circulating SARS-CoV-2, then prioritize a second dose for adults 65 years or older and people with moderate or severe immunocompromise at 6 months, with individualized additional dosing for immunocompromised patients. https://astramd.org/articles/bacterial-pneumonia https://astramd.org/articles/bacterial-pneumonia Fri, 21 Aug 2026 02:31:49 GMT Manage suspected bacterial pneumonia by establishing illness severity and site of care, confirming a compatible pulmonary process, obtaining targeted microbiology in severe disease, and rapidly reconsidering alternative diagnoses or complications when empiric therapy fails. https://astramd.org/articles/pituitary-hyperplasia-in-primary-hypothyroidism https://astramd.org/articles/pituitary-hyperplasia-in-primary-hypothyroidism Fri, 21 Aug 2026 02:30:45 GMT In a patient with pituitary enlargement, markedly elevated TSH with low free thyroxine should redirect management toward primary hypothyroidism. Recognize diffuse thyrotroph hyperplasia, assess mass effect and pituitary axes, replace thyroid hormone, and document regression before considering pituitary surgery. https://astramd.org/articles/hypothyroidism https://astramd.org/articles/hypothyroidism Fri, 21 Aug 2026 02:29:53 GMT Use TSH and free T4 to distinguish primary from central hypothyroidism, identify myxedema coma immediately, individualize levothyroxine initiation for cardiovascular risk, and avoid routine treatment of mild persistent subclinical disease in older adults. https://astramd.org/articles/cushing-syndrome https://astramd.org/articles/cushing-syndrome Fri, 21 Aug 2026 02:29:06 GMT Confirm autonomous hypercortisolism before localization, then use ACTH to separate adrenal from pituitary or ectopic disease. Surgical cure is preferred, but urgent cortisol control, source-directed imaging, petrosal sampling, and medical bridging are essential when disease is severe or surgery is not curative. https://astramd.org/articles/cushing-disease https://astramd.org/articles/cushing-disease Fri, 21 Aug 2026 02:28:11 GMT Confirm persistent endogenous hypercortisolism before localization, then distinguish pituitary ACTH secretion from ectopic ACTH production with pituitary MRI and selective inferior petrosal sinus sampling. Transsphenoidal resection is first-line; recurrent or persistent disease requires individualized multimodal cortisol control. https://astramd.org/articles/mitral-regurgitation https://astramd.org/articles/mitral-regurgitation Fri, 21 Aug 2026 02:26:39 GMT A decision-focused approach to confirming severity, separating primary from secondary mitral regurgitation, selecting repair versus transcatheter therapy, and identifying patients whose ventricular remodeling or heart failure burden warrants multidisciplinary valve intervention. https://astramd.org/articles/patient-communication-in-substance-use-disorders https://astramd.org/articles/patient-communication-in-substance-use-disorders Fri, 21 Aug 2026 02:25:54 GMT Use nonjudgmental, person-centered communication to identify treatment goals, address ambivalence, reduce stigma, and connect patients with substance use disorders to evidence-based medications, behavioral treatment, harm reduction, and longitudinal follow-up. https://astramd.org/articles/low-back-pain https://astramd.org/articles/low-back-pain Fri, 21 Aug 2026 02:24:55 GMT A decision-focused approach to low back pain that prioritizes cauda equina syndrome, spinal infection, fracture, malignancy, and progressive neurologic deficit; limits low-value imaging; and selects function-oriented nonpharmacologic, medication, injection, or surgical pathways. https://astramd.org/articles/anion-gap-metabolic-acidosis https://astramd.org/articles/anion-gap-metabolic-acidosis Fri, 21 Aug 2026 02:23:57 GMT Use blood gas confirmation, anion-gap classification, potassium, kidney function, and urinary ammonium surrogates to rapidly distinguish life-threatening organic acid accumulation from gastrointestinal bicarbonate loss, renal tubular acidosis, chronic kidney disease, and chloride-related acidosis. https://astramd.org/articles/perioperative-management-of-congenital-heart-disease https://astramd.org/articles/perioperative-management-of-congenital-heart-disease Fri, 21 Aug 2026 02:23:03 GMT Noncardiac surgery in patients with congenital heart disease requires lesion- and physiology-specific planning. Determine residual obstruction, shunt direction, ventricular function, pulmonary vascular disease, rhythm risk, and procedural stress before selecting surgical setting, monitoring, anesthesia, and postoperative disposition. https://astramd.org/articles/pediatric-asthma https://astramd.org/articles/pediatric-asthma Fri, 21 Aug 2026 02:22:10 GMT Confirm variable airflow limitation when feasible, treat exacerbations promptly with bronchodilation and early corticosteroids, and adjust long-term therapy according to current control, exacerbation risk, adherence, inhaler technique, and age-specific treatment options. https://astramd.org/articles/orbital-cellulitis https://astramd.org/articles/orbital-cellulitis Fri, 21 Aug 2026 02:21:19 GMT Orbital cellulitis requires immediate distinction from preseptal infection because pain with eye movement, ophthalmoplegia, proptosis, or visual impairment signals postseptal disease, urgent contrast imaging, hospital-based intravenous therapy, and ophthalmology-ENT coordination to prevent vision-threatening or intracranial extension. https://astramd.org/articles/myasthenia-gravis https://astramd.org/articles/myasthenia-gravis Fri, 21 Aug 2026 02:20:38 GMT Myasthenia gravis requires rapid separation of respiratory or bulbar deterioration from stable ocular or generalized disease, confirmation with antibody and electrodiagnostic testing, chest imaging for thymoma, and phenotype-directed escalation from pyridostigmine to immunotherapy or rescue treatment. https://astramd.org/articles/osteomyelitis https://astramd.org/articles/osteomyelitis Fri, 21 Aug 2026 02:19:43 GMT Osteomyelitis management depends on anatomic syndrome, microbiologic confirmation, source control, and a feasible antimicrobial route. In diabetic foot disease, probe-to-bone, radiography, MRI, and bone biopsy guide diagnosis; selected patients can receive medical therapy or conservative bone resection. https://astramd.org/articles/cellulitis https://astramd.org/articles/cellulitis Fri, 21 Aug 2026 02:18:53 GMT Manage presumed cellulitis by first excluding a drainable abscess and necrotizing infection, then matching antibiotics to purulence, systemic severity, and MRSA risk. Most uncomplicated nonpurulent cases require streptococcal coverage, source-control assessment, and reassessment within 48 hours. https://astramd.org/articles/non-hodgkin-lymphoma https://astramd.org/articles/non-hodgkin-lymphoma Fri, 21 Aug 2026 02:18:10 GMT Non-Hodgkin lymphoma requires rapid conversion of a suspected lymphoid malignancy into a specific histologic diagnosis, stage, and tempo category. Management diverges sharply between aggressive entities requiring prompt systemic therapy and indolent entities in which symptom burden and disease distribution determine treatment timing. https://astramd.org/articles/multiple-myeloma https://astramd.org/articles/multiple-myeloma Fri, 21 Aug 2026 02:17:06 GMT Multiple myeloma management requires confirmation of a myeloma-defining event, urgent control of organ-threatening complications, risk-informed induction and transplant planning, and sequencing of cellular or T-cell–redirecting therapies at relapse. https://astramd.org/articles/mantle-cell-lymphoma https://astramd.org/articles/mantle-cell-lymphoma Fri, 21 Aug 2026 02:16:05 GMT Confirm mantle cell lymphoma with tissue-based cyclin D1/CCND1 testing, distinguish its key diagnostic mimics, stage before treatment, and select induction intensity by fitness. Relapse management depends critically on prior BTK inhibitor exposure and eligibility for cellular therapy. https://astramd.org/articles/hodgkin-lymphoma https://astramd.org/articles/hodgkin-lymphoma Fri, 21 Aug 2026 02:15:12 GMT Confirm Hodgkin lymphoma on adequately sampled tissue, stage with FDG-PET/CT, and use disease extent, bulk, prognosis, and PET-adapted response to select curative-intent treatment while minimizing late toxicity. https://astramd.org/articles/hairy-cell-leukemia https://astramd.org/articles/hairy-cell-leukemia Fri, 21 Aug 2026 02:14:30 GMT Confirm classic HCL with integrated morphology, immunophenotyping, and BRAF V600E assessment; treat only clinically consequential disease, then select purine analog, BRAF-directed therapy, or relapse-directed treatment by infection status, fitness, and remission duration. https://astramd.org/articles/follicular-lymphoma https://astramd.org/articles/follicular-lymphoma Fri, 21 Aug 2026 02:13:38 GMT Manage follicular lymphoma by confirming grade and excluding transformation, staging with FDG PET/CT, reserving therapy for clinically consequential disease, and tailoring relapse treatment to timing, prior exposure, refractoriness, fitness, and planned cellular or T-cell–engaging therapy. https://astramd.org/articles/diffuse-large-b-cell-lymphoma https://astramd.org/articles/diffuse-large-b-cell-lymphoma Fri, 21 Aug 2026 02:12:47 GMT Diffuse large B-cell lymphoma requires prompt tissue-confirmed classification, molecular risk assessment, stage-directed curative-intent therapy, and early referral for cellular therapy when relapse occurs within 12 months or disease is refractory. https://astramd.org/articles/burkitt-lymphoma https://astramd.org/articles/burkitt-lymphoma Fri, 21 Aug 2026 02:11:54 GMT Burkitt lymphoma requires urgent expert confirmation, staging that specifically interrogates marrow and cerebrospinal fluid, tumor-lysis planning, and prompt rituximab-containing multiagent therapy with central nervous system-directed treatment selected by disease risk and CNS involvement. https://astramd.org/articles/gastroesophageal-reflux-disease https://astramd.org/articles/gastroesophageal-reflux-disease Fri, 21 Aug 2026 02:10:59 GMT Manage GERD by separating unproven reflux from proven reflux with persistent symptoms, selecting ambulatory testing on or off proton pump inhibitors accordingly, and reserving invasive therapy for objectively documented reflux with an appropriate anatomic and physiologic phenotype. https://astramd.org/articles/hyperthyroidism https://astramd.org/articles/hyperthyroidism Fri, 21 Aug 2026 02:10:10 GMT Confirm biochemical thyrotoxicosis, rapidly identify thyroid storm, then distinguish hormone overproduction from destructive or exogenous hormone exposure to select thionamides, definitive therapy, or non-antithyroid management. https://astramd.org/articles/aortic-stenosis https://astramd.org/articles/aortic-stenosis Fri, 21 Aug 2026 02:09:20 GMT Aortic stenosis management hinges on confirming hemodynamic severity, resolving low-gradient discordance, and selecting valve replacement modality through anatomy, operative risk, life expectancy, concomitant disease, and transfemoral access. https://astramd.org/articles/systemic-lupus-erythematosus https://astramd.org/articles/systemic-lupus-erythematosus Fri, 21 Aug 2026 02:08:34 GMT Manage SLE by confirming a clinical autoimmune phenotype, rapidly identifying renal, neurologic, hematologic, thrombotic, and cardiopulmonary threats, then using hydroxychloroquine and early steroid-sparing therapy to control activity while limiting glucocorticoid damage. https://astramd.org/articles/schizophrenia https://astramd.org/articles/schizophrenia Fri, 21 Aug 2026 02:07:37 GMT Manage schizophrenia with measurement-based antipsychotic treatment, early detection of nonresponse and nonadherence, adverse-effect-directed drug selection, and timely clozapine for treatment resistance, persistent suicidality, or aggression. Long-acting formulations can strengthen relapse prevention when oral adherence is unreliable. https://astramd.org/articles/infantile-hypertrophic-pyloric-stenosis https://astramd.org/articles/infantile-hypertrophic-pyloric-stenosis Fri, 21 Aug 2026 02:06:42 GMT In an infant with progressive nonbilious projectile emesis, rapidly distinguish pyloric obstruction from bilious or systemic emergencies, confirm suspected hypertrophic pyloric stenosis with ultrasound when needed, correct dehydration and metabolic alkalosis before anesthesia, then proceed to pyloromyotomy. https://astramd.org/articles/croup https://astramd.org/articles/croup Fri, 21 Aug 2026 02:05:53 GMT Manage croup by recognizing impending upper-airway failure, separating viral disease from epiglottitis, bacterial tracheitis, and foreign body, then using corticosteroids for symptomatic disease and nebulized epinephrine for clinically important obstruction with repeated bedside reassessment. https://astramd.org/articles/acute-sinusitis https://astramd.org/articles/acute-sinusitis Fri, 21 Aug 2026 02:05:00 GMT Acute rhinosinusitis is usually viral; identify the clinical patterns that increase the likelihood of bacterial disease, reserve imaging for complications or alternative diagnoses, and use watchful waiting or targeted antibiotics with defined reassessment and escalation thresholds. https://astramd.org/articles/stroke-reperfusion-injury https://astramd.org/articles/stroke-reperfusion-injury Fri, 21 Aug 2026 02:04:11 GMT Recognize reperfusion injury after thrombolysis or thrombectomy by separating hemorrhagic transformation, malignant edema, and procedural complications; use serial neurologic examinations and urgent brain imaging to identify deterioration requiring blood pressure reassessment, intensive monitoring, and neurosurgical intervention. https://astramd.org/articles/atypical-parkinsonism https://astramd.org/articles/atypical-parkinsonism Fri, 21 Aug 2026 02:03:22 GMT Evaluate progressive parkinsonism for early autonomic failure, vertical gaze dysfunction, falls, cortical deficits, cognitive fluctuation, or poor levodopa response to distinguish multiple system atrophy, progressive supranuclear palsy, corticobasal syndrome, and dementia with Lewy bodies from Parkinson disease. https://astramd.org/articles/parkinson-disease https://astramd.org/articles/parkinson-disease Fri, 21 Aug 2026 02:02:28 GMT Parkinson disease is a clinical diagnosis requiring bradykinesia plus rest tremor or rigidity. Confirm the parkinsonian syndrome, identify exclusion criteria and atypical red flags, use dopaminergic response as longitudinal diagnostic evidence, and individualize symptomatic therapy while actively screening motor and nonmotor disability. https://astramd.org/articles/febrile-seizure https://astramd.org/articles/febrile-seizure Fri, 21 Aug 2026 02:01:29 GMT Classify the event promptly, treat ongoing convulsions as status at 5 minutes, and direct testing toward meningitis or another cause of fever. A neurologically normal child with a simple febrile seizure generally needs fever-focused evaluation rather than EEG, imaging, or antiseizure prophylaxis. https://astramd.org/articles/alzheimer-disease https://astramd.org/articles/alzheimer-disease Fri, 21 Aug 2026 02:00:39 GMT Evaluate cognitive impairment clinically, establish or exclude Alzheimer pathology with validated amyloid and tau biomarkers when results will alter management, treat symptoms selectively, and refer eligible early-stage patients for anti-amyloid treatment assessment with MRI-based ARIA surveillance. https://astramd.org/articles/infection-related-glomerulonephritis https://astramd.org/articles/infection-related-glomerulonephritis Fri, 21 Aug 2026 01:59:45 GMT Infection-related glomerulonephritis requires prompt recognition of a nephritic urine sediment, identification and eradication of active infection, volume and blood-pressure control, and kidney biopsy when rapidly progressive injury or competing immune glomerular disease would change treatment.