Discovery CPC: Back to Basics

In this Discovery Clinical Pathological Conference (CPC), Dr. Paige Farinholt, Resident, Department of Medicine at Baylor College of Medicine, introduces the patient case. The patient is a 39-year old woman with a history of an unspecified learning disability and chronic migraines who presents with 3 days of altered mental status and vision changes.

Dr. Elisha Acosta, Assistant Professor in the Department of Medicine at Baylor College of Medicine, serves as the faculty discussant for this case. She discusses pertinent information from the history, physical examination, and laboratory investigations. Dr. Acosta gives an overview of her differential diagnosis and discusses the next steps she would take in the care of this patient.

Subsequently, Dr. Farinholt returns to give further lab results for the patient, Dr. V. Reid Sutton, Professor of Molecular and Human Genomics at Baylor College of Medicine, offers his expert opinion on the patient's case, focusing on disease pathophysiology, diagnostic strategies, and treatment options. Dr. Farinholt concludes the CPC by reviewing the clinical course of the presented patient.

CME Information

CME Credit Available

You may claim CME credit after watching this activity.

Needs Statement

Faculty and trainees within the Department of Medicine who are involved in the care of patients need to be regularly updated with the recent advances and guidelines in the fields of medicine and quality improvement to increase clinical knowledge. This Grand Rounds series also aims to provide learners with the appropriate skills to implement the advances and guidelines in clinical practice to enhance the quality of patient care and outcomes.


At the conclusion of this activity, the participant should be able to:

  • Recognize the broad differential diagnosis of altered mental status in an adult.
  • Use a thorough patient history and initial laboratory data to tailor further diagnostic testing.
  • Discuss the causes of hyperammonemia.

Target Audience

  • Physicians
  • Medical Students
  • Fellows
  • Residents
  • Nurses
  • Other Health Professionals

Accreditation/Credit Designation

Baylor College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Baylor College of Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Program Director

Richard J. Hamill, M.D.
Department of Medicine
Baylor College of Medicine
Houston, Texas
Disclosure: Nothing to disclose.

Term of Approval

August 1, 2019 through August 31, 2021. Original release date: August 1, 2019.

Disclosure Policy

The Office of Continuing Medical Education (OCME) makes every effort to develop CME activities that are scientifically based, accurate, current, and objectively presented. In accordance with the Accreditation Council for Continuing Medical Education Standards for Commercial SupportSM, Baylor College of Medicine (BCM) has implemented a mechanism requiring everyone in a position to control the content of an educational activity (e.g., directors, planning committee members, contributors, peer reviewers) to disclose any relevant financial relationships with commercial interests (drug/device companies) and manage/resolve any conflicts of interest prior to the activity. Individuals must disclose to participants the existence or non-existence of financial relationships: 1) at the time of the activity or within 12 months prior; and 2) of their spouses/partners.

Baylor College of Medicine does not view the existence of interests or relationships with commercial entities as implying bias or decreasing the value of a presentation. It is up to the participants to determine whether the interests or relationships influence the presenter with regard to exposition or conclusions.

If at any time during this activity you feel that there has been commercial or promotional bias, please inform us by using the commercial bias comments box in the evaluation form. Please answer the questions about balance in the CME activity evaluation candidly.


The following individual(s) has/have reported financial or other relationship(s) with commercial entities whose products/services may relate to the educational content of this activity:


  1. Elisha M Acosta, M.D.

    Elisha M Acosta, M.D.

    Assistant Professor
    Baylor College of Medicine


    Nothing to disclose.

  2. Paige Farinholt, M.D.

    Paige Farinholt, M.D.

    Assistant Professor
    Baylor College of Medicine


    Nothing to disclose.

  3. V. Reid Sutton, M.D.

    V. Reid Sutton, M.D.

    Baylor College of Medicine


    Nothing to disclose.