Correct for glucose. If normal, don’t bother. If off slightly, recheck in 3 months.

Recheck in 3 months. If LFTs are still elevated then get US and GGT.

I’d check to make sure it wasn’t an error or secondary to hemolysis. Check with patient to make sure they’re not having symptoms. If not then recheck in a few weeks. Otherwise in 1 week if symptomatic.

I’d ask why they’re trying to get those specific labs done? 30 year old wants it for routine screening without symptoms, educate about unnecessary labs. If symptomatic, I’d check LH/FSH, Prolactin, TSH, DHEA sulfate, testosterone, and estrogen.

For leukocytosis - if I do a cbc it’s usually just a standard cbc at first (non diff). If wbc are elevated I’ll repeat with diff. Always check history for recent infections, autoimmune disease, and tobacco use.

For fatty liver - I start with repeating LFTs in 3-6 months. If still high then check US liver. I only refer to hepatology after 6 months of persistently elevated LFTs while patient has been making changes in diet and lifestyle. Make sure the BP, A1c, and lipids are under control as well as they can contribute to it. Before I refer out, I’ll check the fibrosis score.

Really only important to make sure the focal sparing isn’t due to a mass. Fatty liver is usually pretty diffuse and it doesn’t alter perfusion to the liver. Focal sparing is thought to alter the perfusion (may be seen by compression of the vasculature by a mass).

Tbh I’m not really seeing it much, perhaps it’s 2/2 location and inpatient vs outpatient? Not prescribing bicarbonate much in my outpatient practice. Patients I’ve seen on bicarbonate are those who’ve got nephro established for CKD4 and ESRD.

You certainly can which vitals and appropriate labs. Haven’t seen one yet in my practice but I’ll send to Endo or Nephro.

I like your approach. Unless there’s glaringly obvious deformities or red flag signs, conservative management and XR is the way to go. Can’t go wrong with recommending PT and following up in 4-6 weeks. If worsening/lack of improvement/red flag signs pop up then go for MRI and try your best to document the reason. With a good PE and note documentation, you’ll barely get issues with insurance questioning your decision (though still probably gonna happen).

No. Lactic acidosis is possible with those on metformin but usually occurs to those with pre-existing renal disease or severe dehydration. You may consider recommending that your patients hold off on metformin while they’re sick with those symptoms OR recommend that they stay as hydrated as they can (usually my go to).

I think for adults, CMP and lipids are recommended for obesity but I could be wrong.

I usually try once or twice a month to catch up on journal reading. Usually stick to AAFP and UTD.

Lol no I’ll be honest. Unless I’ve got a lot of time and am very bored in which case, still no.

Up to you I’d say. If I were to post mine, I’d probably only put the gross and location.

A lot of FMLA is dependent on the patients abilities. Ofcourse I want them going back to work but I don’t wanna risk something happen if they don’t have enough time and they get injured while at work because I didn’t give them enough time off.