Follow a fictional case from the SHO’s first presentation through registrar challenge and consultant synthesis. Commit to decisions before revealing the reasoning.
Enter the discussion →These fictional discussions are not point-of-care protocols or a substitute for current local guidance, senior advice or specialist assessment.
Each case contains three interactive checkpoints, evolving information, a Decision Trace, consultant feedback, safety errors, structured handover and an inspectable evidence passport.
Endocrinology and acute medicine
Separate symptom severity from the laboratory number, set an initial treatment goal and prevent overcorrection.
Open Grand Round →Haematology, oncology and infectious diseases
Recognise systemic illness after anticancer treatment, start the emergency pathway and avoid false reassurance from temperature or pending blood counts.
Open Grand Round →Cardiology and acute medicine
Avoid premature closure, describe risk explicitly and use serial clinical, ECG and biomarker assessment.
Open Grand Round →Geriatric medicine and psychiatry
Recognise hypoactive delirium, investigate the change from baseline and prevent a task-driven unsafe discharge.
Open Grand Round →Renal, cardiology and critical care
Recognise simultaneous electrolyte and fluid threats, avoid reflex fluid prescribing and discuss renal replacement therapy early.
Open Grand Round →Acute medicine and infectious diseases
Recognise evolving organ dysfunction, use structured risk assessment and coordinate treatment, monitoring and source control without anchoring on one score.
Open Grand Round →Gastroenterology, haematology and acute medicine
Balance immediate resuscitation with early definitive control, communicate anticoagulant risk and avoid treating a haemoglobin value in isolation.
Open Grand Round →Respiratory and critical care
Interpret a quiet chest and fatigue as danger, deliver acute treatment without delay and escalate before respiratory arrest.
Open Grand Round →Neurology, stroke and radiology
Separate last-known-well time from discovery time, obtain the right imaging and avoid excluding reperfusion options prematurely.
Open Grand Round →Endocrinology and acute medicine
Track ketone clearance and acidosis rather than glucose alone, preserve insulin-driven resolution and anticipate potassium risk.
Open Grand Round →Endocrinology and acute medicine
Recognise adrenal crisis risk, prevent diagnostic testing from delaying treatment and communicate steroid dependence clearly.
Open Grand Round →Gastroenterology, hepatology and critical care
Recognise acute liver failure, gather the information that changes prognosis and discuss transfer before encephalopathy makes it unsafe.
Open Grand Round →Infectious diseases and neurology
Coordinate urgent antibiotics and safe investigation, recognise when imaging changes the sequence and communicate uncertainty to relatives.
Open Grand Round →Respiratory, cardiology and critical care
Recognise high-risk physiology, avoid letting routine diagnostic pathways delay resuscitation and coordinate anticoagulation and reperfusion decisions.
Open Grand Round →Haematology and acute medicine
Stop the transfusion, stabilise the patient and distinguish life-threatening reaction patterns while preserving the evidence needed for investigation.
Open Grand Round →Allergy, acute medicine and critical care
Recognise refractory anaphylaxis, continue first-line priorities and escalate safely without inappropriate intravenous adrenaline boluses.
Open Grand Round →Neurology, acute medicine and critical care
Treat convulsive status epilepticus promptly, search for reversible causes in parallel and escalate when first-line treatment fails.
Open Grand Round →Neurology and critical care
Recognise impending ventilatory failure despite reassuring oxygen saturation and coordinate respiratory, neurological and medication review.
Open Grand Round →Gastroenterology and colorectal surgery
Recognise acute severe ulcerative colitis, investigate infection and toxicity, and plan rescue or surgery before deterioration dictates the choice.
Open Grand Round →Gastroenterology, surgery and critical care
Move beyond analgesia to organ support, appropriate nutrition and early pancreatic-centre advice while avoiding routine prophylactic antibiotics.
Open Grand Round →Oncology, neurology and spinal surgery
Recognise metastatic spinal cord compression as an oncological emergency and coordinate safe movement, urgent imaging and specialist planning.
Open Grand Round →Rheumatology and ophthalmology
Recognise sight-threatening giant cell arteritis, begin appropriate urgent treatment and obtain specialist assessment without waiting for confirmatory testing.
Open Grand Round →Endocrinology, oncology and renal medicine
Stabilise severe hypercalcaemia, assess renal and cardiac risk, and sequence rehydration and specialist therapy safely.
Open Grand Round →Endocrinology, neurology and neurosurgery
Recognise pituitary apoplexy, protect against adrenal failure and coordinate urgent endocrine, ophthalmic and neurosurgical assessment.
Open Grand Round →Acute medicine, psychiatry and gastroenterology
Treat severe alcohol withdrawal while recognising possible Wernicke’s encephalopathy and avoiding common medication errors.
Open Grand Round →Cardiology and renal medicine
Balance effective decongestion against evolving renal, electrolyte and haemodynamic risk in acute heart failure.
Open Grand Round →Respiratory medicine, thrombosis and critical care
Treat confirmed pulmonary embolism with right-heart strain while planning for deterioration and major postoperative bleeding risk.
Open Grand Round →Gastroenterology and colorectal surgery
Reassess acute severe ulcerative colitis objectively at day three and avoid delay when intravenous corticosteroids are failing.
Open Grand Round →Endocrinology, acute medicine and critical care
Recognise SGLT2-associated euglycaemic ketoacidosis and continue insulin safely until ketosis resolves.
Open Grand Round →Neurology, psychiatry and critical care
Recognise a possible anti-NMDA receptor encephalitis phenotype without delaying infection cover, seizure care or specialist escalation.
Open Grand Round →Respiratory and acute medicine
Recognise exhausted severe asthma, run resuscitation and escalation in parallel, and avoid false reassurance from a quiet chest.
Open Grand Round →Cardiology, stroke and infection
Identify suspected infective endocarditis with neurological embolism and coordinate microbiology, cardiology, stroke and surgical decisions.
Open Grand Round →Hepatology, toxicology and critical care
Recognise evolving acute liver failure after paracetamol exposure and organise senior critical-care and specialist liver-unit discussion early.
Open Grand Round →Renal and acute medicine
Separate membrane stabilisation, temporary potassium shift and definitive removal while preparing early renal/critical-care escalation.
Open Grand Round →Neurology, infection and spinal surgery
Recognise spinal epidural abscess as a possible compressive neurological emergency and coordinate urgent imaging, cultures and specialist review.
Open Grand Round →Obstetric medicine and critical care
Treat eclampsia as an immediate maternal emergency while coordinating obstetric, anaesthetic and critical-care decisions.
Open Grand Round →Rheumatology, ophthalmology and acute medicine
Recognise suspected giant cell arteritis with visual symptoms and act through an urgent local pathway before confirmatory testing returns.
Open Grand Round →Oncology and gastroenterology
Recognise potentially serious immune-related colitis, exclude important differentials and use oncology-led toxicity pathways.
Open Grand Round →Cardiology, emergency medicine and toxicology
Assess cocaine-associated chest pain for acute coronary syndrome, aortic syndrome and other time-critical pathology before treatment becomes anchored on one diagnosis.
Open Grand Round →Haematology and acute medicine
Use a structured pre-test probability assessment for possible HIT, stop all heparin when indicated and obtain urgent specialist advice on non-heparin anticoagulation.
Open Grand Round →Grand Rounds demonstrates Clinora’s clinical reasoning approach. Related MRCP questions, personalised review and saved progress remain part of the question-bank pathway.