The Clinical Problem Solvers Episode 431: The Clinical Unknown Series with Anmolpreet Kaur
Nov 21, 2025
Anmolpreet Kaur, a clinician specializing in diagnostic reasoning, joins Mark for an engaging case discussion. They tackle a complex scenario involving a 71-year-old patient with altered mental status and delve into the MIST framework for diagnostics. Highlights include the importance of time course in symptoms, managing severe electrolyte imbalances, and interpreting symptoms tied to pneumonia and brain conditions. The conversation culminates in diagnosing glioblastoma and an MRSA lung abscess, illustrating the intricate connections within complex medical cases.
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Systematically Approach Altered Mental Status
- Use the MIST mnemonic to structure acute altered mental status: Metabolic, Infectious, Structural, Toxins.
- Prioritize fingerstick glucose, toxicology, pulse oximetry, and basic labs immediately at bedside.
Time Course Sharpens The Differential
- Time course refines your differential: hyperacute to chronic map to different causes.
- 'Subacute' (weeks) pushes you toward atypical infections, malignancy, or neurodegeneration rather than typical acute causes.
Get Collateral To Define Baseline
- Always get collateral from family to define baseline behavior and new changes.
- Use specific descriptors (inattention, hypoactivity, behavioral change) rather than vague 'altered mental status.'