Cases

Question 1

What is the DDx for ABD pain in the ER?

Answer 1

Cholecystitis 
R/o biliary duct obstruction
Doubt gastroenteritis 
Doubt gastric ulceration
Doubt duodenal ulceration

Question 3

What is the PLAN for cough w/muscle pains?

Answer 3

Acetaminophen 650 mg q4-6 hours prn fever, no more than 3 g/day
Increased fluids, rest
Nasal swab, CBC, CK
Return to clinic 1 week
Call if gets worse

Question 4

What OMT can you do for uri or otitis media?

Answer 4

Periauricular drainage

Question 5

PLAN for woman w/suspected hypothyroidism?

Answer 5

TSH, glucose, BUN/Cr, Na, K, Cl, BNP
U/A
Consider synthroid
Return to clinic 2 weeks after labs

Question 7

What OMT can you do for TMJ dysfunction?

Answer 7

Galbreath technique

Question 9

What is the DDx for ED outpt clinic?

Answer 9

Med SE
R/o venous steal syndrome
R/o testosterone def
R/o atherosclerotic disease

Question 10

What OMT can you do for upper back pain?

Lower back pain?

Answer 10

MFR perpendicular stretch

ME

Question 11

What is the DDx for neck pain with fever in the ER?

Answer 11

Meningitis - viral
R/o bacterial meningitis
R/o aseptic meningitis 
Doubt brain abscess
Doubt SAH

Question 12

What plan for ABD pain in ER?

Answer 12

IV ABx, Pain control
CBC, AST, ALT, bilirubin, chem studies
Pregnancy test
CT scan ABD
Surgery CONSULT

Question 13

What is the DDx for missed period for 3 months?

Answer 13

Secondary amenorrhea - suspect HPA suppression
Low BMI
Calorie deficit 
R/O pregnancy
Doubt Pituitary adenoma

Question 15

What is the plan for pt w/suspected meningitis in the ED?

Answer 15

IV access, NS at 125 mL/hr
IV Abx
CT scan head
Consult Neuro, LP
Call family, admit to hospital

Question 16

What test should you do for increasing forgetfullness in an old person?

Answer 16

Neuro exam
Check thyroid, carotid bruits
return to clinic for MMSE

Question 19

What is the DDx for HA in FM clinic?

Answer 19

Migraine HA
Sleep deprivation
Drug reaction/caffeine induced cephalgia 
Cranial SD
Doubt muscle tension HA

Question 20

What is the PLAN for a sports physical?

Answer 20

No restrictions to participation
Pt education on warning sx
Bring father for genital exam
RTC for annual

Question 21

What is the DDx for blood in the urine in the ED?

Answer 21

Nephrolithiasis 
Vit C excess
R/O dehydration
R/O UTI
Doubt pyelonephritis 
Doubt Bladder cancer

Question 22

What is the DDx for a skin lesion on a man?

Answer 22

Neoplasm R post shoulder, likely seborrheic keratosis
r/o BCC
R/o SCC
R/o actinic keratosis 
Doubt melanoma

Question 23

PLAN for old man w/stomach pain and fever in the ED?

Answer 23

NPO, get IV for IVF and Abx
CT scan ABD
CBC w/Diff, BUN/Cr, Na, K, Cl
Consult surgery
Admit to hospital

Question 25

What OMT can you do for sciatica?

Answer 25

ME anterior torsion for sacrum

Question 26

What is the DDx for depression in FM clinic?

Answer 26

Acute grief reaction
Depression
Anxiety
Adjustment disorder
R/O STI

Question 32

What is the DDx for stomach pain in the ED, old man w/fever?

Answer 32

Acute diverticulitis w/peritonitis
R/o ischemic bowel
R/o bowel obstruction
Doubt CRC

Question 33

What is the DDx for sports physical?

Answer 33

Healthy adolescent
Drug avoidance counseling
Hx of ____

Question 34

What is the DDx for ankle pain?

Answer 34

Ankle sprain
SD ankle
Contusion
Doubt ankle sprain
Doubt fracture

Question 35

What is the Plan for blood in the urine in the ED?

Answer 35

NPO, place IV, pain med
NS at 200 mL/hr
CT Scan kidney and ureters 
CBC, pregnancy test, BUN/Cr, Na, K, Cl
Consider consult to urology

Question 37

What OMT can you do for headache?

Answer 37

CV4

Question 38

What is the DDx for pain in the hands at wrist?

Answer 38

CTS Doubt cervical radiculopathy Doubt R.A. Ligament sprain

Question 39

What is the PLAN for depression?

Answer 39

Refer to psychologist Offer meds Return to clinic in 1 week

Question 40

What OMT can you do for asthma or post op ileus?

Answer 40

Rib raising: MFR

Question 43

Plan for constipation and abd pain in old person presenting to the office?

Answer 43

Refer to ER CT scan ABD CBC, CEA, BUN/Cr, electrolytes Colonoscopy

Question 44

What is the DDx for unintentional weight gain in a female?

Answer 44

``` Hyopthyroidism Weight gain R/O Heart failure Doubt Cushing’s Doubt DM ```

Question 45

What is the DDx for shoulder pain in old male, FP clinic?

Answer 45

Adhesive capsulitis Possible impingement syndrome R/o rotator cuff tendinopathy Doubt bursitis

Question 47

What is the PLAN for ED?

Answer 47

Sildenafil 50mg once a day Lipid panel, testosterone level Daily exercise, improve diet Return to clinic 2 weeks, genital exam

Question 48

What OMT can you do for frozen shoulder? Steps?

Answer 48

Spencer Extension Flexion Circumduction Circumduction w/traction Abduction IR Traction

Question 49

What is the DDx for pain on the bottom of your foot?

Answer 49

``` Plantar fasciitis Plantar SD R/O tendinitis R/O fracture Doubt rupture of plantar fascia ```

Question 51

What OMT can you do for elbow pain?

Answer 51

Effleurage - lateral and cephalad

Question 52

What is the DDx for hand burn at an urgent care center?

Answer 52

Localized 1st degree burn Doubt secondary burn Doubt secondary infection

Question 54

What is the DDx for smoking cessation?

Answer 54

Tobacco use disorder Hx of something else If BP is elevated, say it is w/out diagnosis

Question 55

What is the DDx for cough?

Answer 55

``` Bacterial bronchitis Consider viral bronchitis R/O PNA Doubt Influenza Doubt GERD ```

Question 56

What is the DDx for cough with muscle aches at FP clinic?

Answer 56

Influenza Consider viral uri Consider bronchitis Doubt PNA

Question 57

What OMT can you do for ankle sprain?

Answer 57

Functional technique or ME for posterior fibular head

Question 60

What is the DDx for sore throat in FM Clinic?

Answer 60

``` Mono Consider viral pharyngitis R/O streptococcal pharyngitis Doubt environmental allergies Anticipatory guidance in teen ```

Question 62

What medication has a SE of erectile dysfunction?

Answer 62

Chlorathalidone - thiazide diuretic

Question 63

What is the DDx for constipation and ABD pain in outpt geriatric clinic?

Answer 63

Partial bowel obstruction - r/o colorectal cancer Hemorrhoids R/o mesenteric ischemia Doubt diverticulitis

Question 68

What is the DDx for knee pain?

Answer 68

Knee sprain Consider meniscal tear Doubt MCL tear Doubt ACL tear

Question 70

What is the DDx for chest pain in 26 y/o female FP Clinic?

Answer 70

``` GERD Slight dysphagia R/O hiatal hernia R/O peptic ulcer disease R/O BArrett’s R/O esophageal webs, Schatzki ring ```

Question 72

What is the DDx for forgetfullness?

Answer 72

``` Mild anxiety FH of dementia R/O Hyperlipidemia R/O UTI Doubt thyroid disorder Doubt depression ```

Question 73

What OMT can you do for gluteal/upper leg pain?

Answer 73

ME - piriformis hypertonicity

Question 75

What is the plan for chest pain in the ED?

Answer 75

``` ACS protocol: O2, ASA, BB, Morphine, Nitro CBC, INR, trops, BUN/Cr, Na, K, Cl Start IV 12 lead ECG, portable CXR Admit to hospital ```

Question 76

What OMT can be done for cough?

Answer 76

Rib raising

Question 79

What is the DDx for pain in both hands, old woman?

Answer 79

OA Doubt RA R/O osteopenia If they have HTN

Question 80

What OMT can you do for knee injury?

Answer 80

Lymphatic effleurage

Question 84

What OMT can you do for sinuses?

Answer 84

frontal and maxillary efflurage

Question 85

What is the DDx for chest pain in the ED?

Answer 85

``` Dissection AAA CHF ACS Angina ```

Question 89

What is the DDx for cold in the nose?

Answer 89

Allergic rhinitis Environmental rhinitis Doubt URI

Question 98

What OMT can you do for Neck pain?

Answer 98

Counterstrain Post TP w/FPR

Question 102

FED TACOS = what?

Answer 102

``` Food Exercise Drugs Tobacco Alcohol Caffeine Occupation Sexual - LMP ```