Clinical Documents

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Draft a comprehensive differential diagnosis for acute substernal chest pain in a 45-year-old male with hypertension and hyperlipidemia, diaphoresis, exertional onset, and normal initial ECG/troponin; include life-threatening causes first, key distinguishing features, and immediate diagnostic next steps.

Draft a detailed differential diagnosis for new-onset unilateral throbbing headache with visual aura and brief monocular vision loss in a 32-year-old female on oral contraceptives; include red-flag symptoms, stroke/TIA considerations, and recommended initial workup.

Draft an assessment and plan for stage-2 hypertension (BP 162/98) in an obese 52-year-old with suspected obstructive sleep apnea; include ASCVD risk estimate, lifestyle prescriptions, first-line pharmacotherapy with drug/dose/targets, baseline labs/monitoring, and 4–6 week follow-up.

Draft an assessment and plan for type 2 diabetes follow-up with A1c 9.2% on metformin 1,000 mg BID and eGFR 65; compare adding a GLP-1 receptor agonist vs an SGLT2 inhibitor, address weight loss goals, hypoglycemia education, vaccinations, and micro/macrovascular screening.

Draft a history and physical for a patient presenting with chest pain, including HPI using OLDCARTS, pertinent ROS, PMH/meds/allergies, FH/SH, focused cardiac/pulmonary exam, initial labs and imaging orders, prioritized differential, HEART score risk stratification, and early management.

Draft a history and physical for a new patient with progressive exertional dyspnea, orthopnea, and bilateral leg edema; include differential (heart failure, COPD, PE, anemia, renal disease), targeted exam maneuvers, and first-line diagnostics and management.

Draft a progress note for COPD follow-up two weeks after an acute exacerbation treated with prednisone and antibiotics; include symptom trajectory, CAT score (if available), inhaler technique/adherence, oxygen needs, spirometry plan, smoking cessation counseling, and return precautions.

Draft a progress note for post-operative day 2 after total knee arthroplasty; include pain control strategy, DVT prophylaxis, PT/OT milestones, wound status, bowel/urinary function, labs/vitals review, complications screening, and discharge readiness.

Draft a discharge summary for community-acquired pneumonia admission; include admission/discharge dates, presenting symptoms, radiology/labs, pathogen if identified, inpatient therapies and response, discharge medications with durations, pending tests, follow-up appointments, and return precautions.

Draft a discharge summary for myocardial infarction managed with PCI and drug-eluting stent placement; include cath findings, complications, inpatient course, discharge medications (DAPT, statin, beta-blocker, ACEi/ARB), cardiac rehab referral, and follow-up plan.

Draft discharge instructions for a patient hospitalized with acute decompensated heart failure; include daily weights, sodium and fluid restriction amounts, medication list with dosing, signs of worsening heart failure, follow-up appointments, and lab monitoring plan.

Draft discharge instructions for an asthma exacerbation; include controller and reliever regimen, steroid taper schedule, spacer technique, trigger avoidance, a written asthma action plan, return precautions, and follow-up timing.

Draft a patient handout on managing high blood pressure in plain language; explain what BP numbers mean, key lifestyle steps (DASH diet, sodium limits, alcohol moderation), home BP monitoring instructions, medication adherence tips, and when to call the doctor.

Draft a patient handout for type 2 diabetes education in plain language; cover A1c goals, the plate method, physical activity targets, self-monitoring of blood glucose, hypoglycemia signs and the 15-15 rule, foot care basics, and a vaccination checklist.

Draft a summary of the latest CDC and WHO guidelines for managing community-acquired pneumonia in adults, including empiric antibiotic choices, duration of therapy, and follow-up recommendations.

Draft a plain-language overview of the ADA and AACE guidelines for diabetes management, focusing on A1c goals, weight management, and the use of GLP-1 receptor agonists and SGLT2 inhibitors.

Draft a summary of the 2024 USPSTF breast cancer screening recommendations, including updated screening intervals, risk-based approaches, and the role of MRI for high-risk patients.

Draft a concise summary of NCCN guidelines for melanoma management, including staging, surgical margins, adjuvant therapy, and checkpoint inhibitor recommendations.

Draft treatment alternatives for community-acquired MRSA skin infections in patients allergic to sulfa drugs; include oral and IV options, dosing, and duration.

Draft treatment alternatives for patients with type 2 diabetes who are unable to tolerate GLP-1 receptor agonists due to nausea; include medication substitutions and lifestyle recommendations.

Draft a summary of options for treating refractory depression, comparing ketamine infusions, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).

Draft treatment options for advanced prostate cancer, including hormonal therapy, radiopharmaceuticals, and novel androgen receptor pathway inhibitors.

Draft a summary of recent research on mRNA vaccine technology beyond COVID-19, including applications in oncology and autoimmune disease prevention.

Draft an easy-to-understand overview of long COVID research, summarizing major symptoms, hypothesized mechanisms, and emerging treatment approaches.

Draft a summary of current research on Alzheimer’s disease biomarkers, including amyloid and tau imaging, and discuss how they influence diagnosis and trial design.

Draft an explanation of the interaction between warfarin and antibiotics such as ciprofloxacin or TMP-SMX, including INR effects and management recommendations.

Draft a summary evaluating drug interactions for patients taking Paxlovid and common cardiovascular drugs; include mechanism and recommended dose adjustments.

Draft a summary of the common and serious side effects of semaglutide, including GI intolerance, gallbladder disease, and thyroid-related warnings.

Draft an overview of potential side effects associated with long-term corticosteroid use, including osteoporosis, glucose intolerance, and adrenal suppression.

Draft a summary of essential lab tests to order in suspected acute pancreatitis, including amylase, lipase, liver enzymes, and metabolic panels, with interpretation guidance.

Draft laboratory workup recommendations for suspected hypothyroidism, including TSH, free T4, thyroid antibodies, and when to consider secondary causes.

Draft an explanation of which labs should be monitored in patients receiving methotrexate therapy, including CBC, LFTs, renal function, and frequency of monitoring.

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Course: SCOPE of Pain: Safer/Competent Opioid Prescribing Education

CME Credits: 2.00

Released: 0000-00-00

From Dr. Daniel Alford, MD, MPH
Professor of Medicine & Course Director
SCOPE of Pain


Dear Colleagues:
If you are looking for strategies on the safer use of opioids when managing acute and chronic pain, the newly revised SCOPE of Pain program is here to help.
Updated to adhere to the FDA’s new “Opioid Analgesics Blueprint for Prescriber Education,” and aligned with the CDC guideline, SCOPE of Pain offers the latest best practices, guidelines, and clinical pearls to help you address the challenges of providing patients adequate pain management while also confronting the risks associated with opioid prescribing.
We hope you'll find SCOPE of Pain a benefit to you and your practice.
Sincerely,


Daniel P. Alford, MD, MPH
Professor of Medicine
Associate Dean, Continuing Medical Education
Director, Clinical Addiction Research and Education (CARE) Unit
Boston University Chobanian & Avedisian School of Medicine
Boston Medical Center
SCOPE of Pain Colleague to Colleague Podcast Series Looking for clinical pearls on safer opioid prescribing that you can listen to in 4 minutes or less?

The SCOPE of Pain Colleague to Colleague Podcast Series addresses the safer opioid prescribing challenges commonly faced by clinicians.

Click here to listen now or to download audio files or transcripts for on-the-go learning.

Be sure to check back often, as new Podcasts will be added throughout the year.

Program Description
SCOPE of Pain is a series of continuing medical education/continuing nursing education activities designed to help you safely and effectively manage patients with acute and/or chronic pain, when appropriate, with opioid analgesics. Our program consists of a free 2-module, case-based online activity and live conferences held around the US. Through the case of Michelle Jones, a 36-year-old who has a displaced right femoral neck fracture due to a motor vehicle crash, you'll learn how to:
1. Optimize safety when prescribing opioids for acute pain
2. Determine when opioid analgesics are indicated for chronic pain
3. Assess pain and prescription opioid misuse risk
4. Educate patients about opioid risks and realistic benefits
5. Monitor patients on opioid therapy for benefits and harms
6. Assess and manage worrisome opioid-taking behaviors
7. Safely taper long-term opioid therapy
8. Identify and manage patients with an opioid use disorder
Intended Audience
Physicians, nurse practitioners, registered nurses, physician assistants, nurses, dentists, pharmacists, and allied health professionals whose practices manage acute and chronic pain.
Disclosure of Support
This activity is supported by an independent educational grant from the Opioid Analgesic REMS Program Companies. Please see a listing of REMS Program Companies. This activity is intended to be fully compliant with the Opioid Analgesic REMS education requirements issued by the US Food and Drug Administration.


Educational Objectives
At the conclusion of these activities, participants will be better able to:
Optimize safety when prescribing opioids for acute pain
Determine when opioid analgesics are indicated for chronic pain
Assess pain and prescription opioid misuse risk
Educate patients about opioid risks and realistic benefits
Monitor patients on opioid therapy for benefits and harms
Assess and manage worrisome opioid-taking behaviors
Safely taper long-term opioid therapy
Identify and manage patients with an opioid use disorder
For questions about CME, please contact [email protected] or www.bu.edu/cme.


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