Preventive Medicine
Astra Clinical Library
General medicine
Practical general medicine guides for clinical decisions, with cited evidence, testing strategies, and actionable next steps.
28 guides
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Urology and Preventive Medicine
Prostate Cancer Screening
PSA-based screening offers a small, delayed reduction in prostate cancer mortality for selected men but increases false-positive testing, biopsy, overdiagnosis, and treatment-related harm. Use shared decision-making, life expectancy, baseline risk, and a planned diagnostic pathway rather than PSA testing alone.Hospital Medicine
Delirium
Delirium is an acute, fluctuating disturbance in attention and cognition that requires prompt bedside recognition, confirmation with structured assessment, and a search for reversible precipitants. Multicomponent prevention and careful attention to baseline cognition, medication exposure, hydration, mobility, sleep, and sensory impairment are central to care.Internal Medicine
Long COVID
Long COVID is a heterogeneous postinfectious syndrome diagnosed after excluding alternative disease. Evaluation should be phenotype-directed, prioritize cardiopulmonary and neurologic danger signals, avoid indiscriminate testing, and use individualized rehabilitation that does not provoke postexertional symptom worsening.Internal Medicine
Acute Sinusitis
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.Primary Care and Musculoskeletal Medicine
Low Back Pain
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.Infectious Diseases and Preventive Medicine
COVID-19 Vaccine
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.Psychiatry and Primary Care
Generalized Anxiety Disorder
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.Preventive Medicine
Cancer Screening
Select cancer screening by organ-specific eligibility, expected benefit, test performance, downstream diagnostic capacity, and patient ability to complete follow-up. Screening tests are not interchangeable: an abnormal stool, imaging, or biomarker result generally requires diagnostic evaluation rather than repeat screening.Hospital Medicine and Clinical Nutrition
Refeeding Syndrome
Identify malnourished patients before carbohydrate delivery, obtain phosphate, potassium, magnesium, renal function, and glucose, give thiamine, initiate nutrition cautiously when risk is high, and respond promptly to falling electrolytes or cardiopulmonary dysfunction during the first days of refeeding.Primary Care and Hand Surgery
Carpal Tunnel Syndrome
Use a clinical pattern to identify typical mild carpal tunnel syndrome, reserve nerve conduction studies for diagnostic uncertainty or severe disease, initiate neutral-position night splinting, and refer promptly when weakness, thenar atrophy, or persistent symptoms warrant decompression.Cardiology and Internal Medicine
Secondary Hypertension
Identify secondary hypertension when presentation, treatment resistance, or target-organ injury suggests a remediable cause; confirm true resistance, remove iatrogenic contributors, then prioritize renal disease, primary aldosteronism, obstructive sleep apnea, renovascular disease, and selected endocrine disorders.Psychiatry, Family Medicine, Internal Medicine
Somatic Symptom Disorder
Diagnose somatic symptom disorder positively when distressing symptoms coexist with persistent, disproportionate symptom-related thoughts, anxiety, or behaviors; continue indicated medical evaluation while replacing fragmented testing with structured follow-up, functional goals, and integrated behavioral care.Cardiology and Internal Medicine
Resistant Hypertension Secondary Cause Testing
In apparent resistant hypertension, first confirm sustained out-of-office blood pressure elevation and treatment exposure, then pursue targeted testing for primary aldosteronism, obstructive sleep apnea, kidney disease, renovascular disease, medication effects, and selected endocrine disorders.Internal Medicine
Hypokalemia Replacement and Monitoring
Triage hypokalemia by severity, symptoms, ECG findings, and ability to take oral therapy; replace potassium safely, correct magnesium and ongoing losses, and use urine potassium with acid-base status to identify renal wasting or extrarenal loss.Hospital Medicine
Red Cell Transfusion Thresholds
Use a restrictive hemoglobin threshold for most hemodynamically stable hospitalized adults, but distinguish acute myocardial infarction, cardiac surgery, orthopedic surgery, and preexisting cardiovascular disease, where trial populations and current recommendations support different decision thresholds.Hospital Medicine
Refeeding Syndrome Prevention
Identify patients with recent nutritional deprivation before calories are increased, obtain baseline phosphate, potassium, and magnesium, limit initial carbohydrate-energy exposure, provide thiamine, and use early electrolyte surveillance to slow feeding and correct clinically consequential shifts.Hospital Medicine and Endocrinology
Inpatient Insulin Regimen Selection
Select insulin by acuity, nutritional reliability, prior diabetes treatment, and glucose trajectory. Use IV insulin for critical illness, scheduled subcutaneous insulin for sustained ward hyperglycemia, and correction-only therapy selectively for new, mild stress hyperglycemia while preventing hypoglycemia during changing intake.Endocrinology and Hospital Medicine
HHS Fluid Management
Manage HHS by restoring intravascular volume before insulin, tracking osmolality and sodium to prevent overly rapid tonicity shifts, replacing potassium as needed, and individualizing crystalloid rate for cardiac or renal vulnerability.Nephrology and Hospital Medicine
Hyponatremia Correction Limits
For symptomatic hyponatremia, achieve an early 4-6 mEq/L sodium rise to reverse cerebral edema, then limit further correction according to chronicity and osmotic demyelination risk. Unknown duration should be managed as chronic, with frequent sodium measurements and prompt relowering after excess correction.Hospital Medicine
Inpatient Hypoglycemia Treatment
Treat any inpatient glucose below 70 mg/dL immediately, then identify the medication, nutrition, organ-failure, or acute-illness trigger before recurrence occurs. Route dextrose or glucagon to mental status and enteral access, recheck promptly, revise the causative regimen, and intensify surveillance for prolonged drug-related events.Emergency Medicine and Hospital Medicine
Acute Anemia
Manage acute anemia by first identifying unstable hemorrhage or oxygen-delivery failure, then separating blood loss from hemolysis and impaired production with serial hemoglobin, reticulocyte response, smear, and targeted hemostatic testing. Transfuse to physiologic need while obtaining definitive bleeding control or cause-directed therapy.Cardiology and Internal Medicine
Hyperlipidemia
Manage hyperlipidemia by separating established ASCVD, severe LDL-C elevation, and risk-based primary prevention; use statins as the foundation, refine borderline decisions with coronary artery calcium, and add nonstatins when LDL-C reduction is inadequate or statins are not tolerated.Internal Medicine
Orthostatic Hypotension
Confirm a reproducible orthostatic blood-pressure fall, identify acute volume, medication, cardiac, or neurogenic drivers, and treat disabling cerebral hypoperfusion while avoiding treatment-induced supine hypertension.Cardiology and Internal Medicine
Dyslipidemia
Manage dyslipidemia by separating LDL-C–driven ASCVD risk from triglyceride-driven pancreatitis risk, excluding secondary causes, identifying familial disease, and escalating from maximally tolerated statins to evidence-based nonstatins according to residual risk and lipid response.Internal Medicine
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Diagnose ME/CFS clinically by identifying delayed post-exertional malaise, functional decline, unrefreshing sleep, and cognitive or orthostatic symptoms; exclude competing causes without delaying symptom-directed pacing and comorbidity management.Internal Medicine
Fever of Unknown Origin
Evaluate persistent unexplained fever by separating classic FUO from neutropenic, nosocomial, and HIV-associated syndromes; repeatedly pursue localizing clues, obtain targeted microbiology and imaging, use FDG-PET/CT after unrevealing standard evaluation, and biopsy metabolically active or clinically abnormal tissue before empiric therapy.Internal Medicine