GPA - Headache, confusion, depress, dizzi, LOC Numbness Flashcards by jennifer davidson

DDX:  HA
throbbing, unilateral temporal pain
2-3 hours
aura
weakness/numbness ipsolateral side
n/v

Migraine
tension HA
Cluster HA
Inter-cranial neoplasm
trigeminal neuralgia 
Seizure
CNS vasculitis
Pseudotumor cebrei

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WOrkup:  HA
throbbing, unilateral temporal pain
2-3 hours
aura
weakness/numbness ipsolateral side
n/v

CBC - Miningitis, infx,
ESR - Temporal arteritis, vasculitis
CT, MRI- stroke, neoplasm
LP - Atherclerosis, stroke

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DDX- HA
unilateral
Ipsilateral rhinorrhea, tearing, redness
nighlty at same time
45 min

Cluster ha
Migraine
tension HA
sinusitis
Trigeminal neuralgia
neoplasm

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Workup - HA
DDX- HA
unilateral
Ipsilateral rhinorrhea, tearing, redness
nighlty at same time
45 min

CBC - Miningitis, infx,
ESR - Temporal arteritis, vasculitis
CT, MRI- stroke, neoplasm
LP - Atherclerosis, stroke

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DDX - HA
Intermttent right temporal HA
Fever
Blurred vison, same side
jaw pain with chewing

Temporal arteritis
migraine, cluster, tension
Meningitis (fever)
TMJ ( jaw pain)
neoplasm (blurred vision)
Carotid artery dissection

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workup - HA
Intermittent right temporal HA
Fever
Blurred visson, same side
jaw pain with chewing

*ESR - Temporal arteritis, vasculitis
*Temporal artery biopsy -
* Ultrasoun - carotid artery
CBC - Miningitis, infx,
CRP - inflammation
MRI- stroke, neoplasm
LP - meningitis

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DDX - HA
frontal
fever
nasal discharge
pain with palpation

sinusitis
Migraine, tension,
meningitis (fever)
intercranial neoplasm

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workup - HA
frontal
fever
nasal discharge
pain with palpation

CBC - infection (miningitis, sinusitis)
XR - sinus
CT - Sinus
LP - Lumbar puncture

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DDX - HA
recurrent bilateral squeezing ha
3-4x weekly
end of day, stressful life

Tension*
migraine, Cluster 
depression
caffeine withdrawl
HTN
neoplasm
pseudotumor cerebri (LP)

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Workup - HA
frontal
fever
nasal discharge
pain with palpation

CBC - infx
CMP - electrolytes 
ESR - 
CT - neoplasm
LP - pseudo tumor

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DDX ha
sudden severe ha, 
vomit
confussion
unilateral hemiplegia
nuchal rigidity

* subarachnoid hemorrhage
meningitis
migraine
intercranial hemorrhage
acute HTN
neoplasm
vertebral artery dissection

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Workup - HA
sudden severe ha, 
vomit
confussion
unilateral hemiplegia
nuchal rigidity

Non contrast CT - Head
LP - meningitis, hemorrhage, meningitis
CBC - infection
PT/PTT/INR

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DDx -HA
high fever
severe HA
confusion
photophobia
nuchal rigidity
\+ brudzinski and kernig sign

Meningitis (bacterial)
Migraine
subarachnoid hemorrhage
sinusitis
intercranial abscess

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workup -HA
high fever
severe HA
confusion
photophobia
nuchal rigidity
\+ brudzinski and kernig sign

CBC - infection
CT - head
MRI - brain
LLP - CSF analysis - Gram stain, PCR, Glucose

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DDX HA
obease
pulsatile HA
vomit
blurred vison
2-3 weeks
meds- OCP

Pseudotumor cerebri (OCP)
Tension headache, migraine, cluster
meningitis
intercranial venous thrombosis (Vision)
neoplasm (vision)

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WOrkup -  HA
obease
pulsatile HA
vomit
blurred vison
2-3 weeks
meds- OCP

Urine hGC - Pregnancy test (female iwth vomit
CBC - infx
CT - inflammation, bleeding
LP - CFS anlysis (gram stain, pressure)

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DDX - HA
daily pain unilateral cheek x 1month
electric stabbinging
while shaveing
2-4 min

Trigeminal neuralgia
Migraine, tension, cluster
TMJ
intercranial neoplasm

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Workup - HA 
daily pain unilateral cheek x 1month
electric stabbinging
while shaveing
2-4 min

CBC
ESR
MRI - brain

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DDX - Confusion
progressive confusion x 3 years
memory loss
clumsiness
hx: HTN, DM, strokes, 
stepwise decline in cognitive function

Vascular dementia (strokes)
Alzheimers
Normal pressure hydrocephalus
intercranial tumor
depression
B12 deficiency
neurosyphilis
hypothyroidism

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workup - Confusion
progressive confusion x 3 years
memory loss
clumsiness
hx: HTN, DM, strokes, 
stepwise decline in cognitive function

CBC - infx
VDRL/RPR - syphilis
Serum b12
TSH
MRI/CT - 
LP -

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DDX - Confusion
Forgetfullnes
lost way
difficult performing daily activities
gradual progression

Alzheimers
Vascular demention
depression
hypothyroid
B12
syphillus
neoplasm

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Workup- Confusion
Forgetfullnes
lost way
difficult performing daily activities
gradual progression

CBC
CT/MRI - Head
LP - pressure, and CSF analysis 
Serum B12
VDRL/RPR - syphilis
TSH

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DDX - Confusion
memory loss
gait distubance
urinary incontinence
6 months

Normal pressure hydrocephalus
Alzheimers
Vascular demential
subdural hematoma
neoplasm
depression, B12, syphillus, Hypothyroid

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workup - Confusion
memory loss
gait distubance
urinary incontinence
6 months

CT - Head
LP - pressure, and CSF analysis 
Serum B12
VDRL/RPR - syphilis
TSH

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``` DDX - Confusion rapidly progression change in mental status inability to concentrate memory impairment x 2 months myoclonus ataxia ```

``` Crueztfelt- Jacop vascular dementia lewy body dememtia Normal pressure hydrocephalus depression delirium B12, syphillus, ```

``` workup - Confusion rapidly progression change in mental status inability to concentrate memory impairment x 2 months myoclonus ataxia ```

``` CBC, CMP B12 VDRL/RPR - syphilis MRI EEG- brain electroactivity LP - CSF analysis ```

``` DDX - confusion insulin dependent confusion dizziness palpitation diaphoresis weakness ```

``` hypoglycemia TIA - transient ischemic attack Arrhythemia Delirium Angina ```

``` Workup - confusion insulin dependent confusion dizziness palpitation diaphoresis weakness ```

``` Glucose CBC, CMP (electrolytes) Echocardiogram - heart function ECG - heart function MRI - TIA Doppler US - carotid ```

DDX - Confusion altered mental status hit head 2 weeks ago LOC of 2 minutes

subdural hematoma SIADH - cause hyponatremia Intracranial neoplasm

Workup - Confusion altered mental status hit head 2 weeks ago LOC of 2 minutes

Electrolytes CT/MRI LP

``` DDX - Dizziness intermittent vertigo tinnitis nausea hearing loss x 1 week ```

``` Menieres vestibular neuronitisitis Labrynthitis Benign positional vertigo acoustic neroma ```

``` Workup- Dizziness intermittent vertigo tinnitis nausea hearing loss x 1 week ```

CBC VLDR/RPR - syphilis is cause of mineres MRI- neuroma

``` DDX - Dizziness Dizziness x 1 day fain severe diarrhea x 32 days furosemide for HTN ```

``` Dehydration orthostatic HTN Vestibular neuronitis Labyrinthitis - Hearing loss/vertigo Benign positional vertigo Vertebrobasilar insufficency ```

``` workup - Dizziness Dizziness x 1 day fain severe diarrhea x 32 days furosemide for HTN ```

Orthostatic vital signs CBC Electrolytes- dehydration Stool - fecal leukocytes, occult blood

DDX - Dizziness postural dizziness/unsteadiness HTN new medications

``` Drug induced orthostatic hypotension vestibular neuronitis labrynthitis BPV cerebellar tumor Acute renal failure ```

workukup - Dizziness postural dizziness/unsteadiness HTN new medications

Orthostatic vital signs CBC Electrolytes- dehydration MRI

DDX - Dizziness dizziness upon moving head to left room is spinning Tilt test = nystagmus + Nausea

Benign positional vertigo Vestibular neuronitis Labrynthisit meneres disease

Workup - Dizziness dizziness upon moving head to left room is spinning Tilt test = nystagmus + Nausea

MRI AUdiogram Dix-Halpike test

``` DDX - Dizziness dizziness this morning N/V URI 2 days ago Negative for hearing loss ```

Vestibular neuronitis Labrynthitis Menieres disease BPV

``` DDX - Dizziness dizziness this morning N/V URI 2 days ago Negative for hearing loss ```

CBC Electrolytes- dehydration MRI electronystagmography

``` DDX - LOC fell and LOC at worse Rhythemic limb movements bit tongue lost bladder control confused when woke ```

Seizure: Complex-tonic clonic Convulsive syncope substance abuse/overdose hypoglycemia

``` Workup - LOC fell and LOC at worse Rhythemic limb movements bit tongue lost bladder control confused when woke ```

``` CBC/CMP/GLUCOSE Urine toxicology EEG- Brain function MRI/CT LP ECG - heart ```

DDX - LOC Fell after feeling dizzi Transient LOC HTN + anti-HTN drugs

``` Drug induced orthostatic HTN Cardiac arrhythmia Syncope stoke MI P ```

Workup - LOC Fell after feeling dizzi Transient LOC HTN + anti-HTN drugs

``` Orthostatic vitals signs CBC/CMP CT ECG CTA ```

``` DDX - LOC 65yo, fell and LOC for 3 sec No warning Recent palpitations hx of CABG, coronary artery bypass graft ```

``` Cardiac arrhythmia severe aortic stenosis syncope seizure pulmonary embolism ```

``` DDX - LOC 65yo, fell and LOC for 3 sec No warning Recent palpitations hx of CABG, coronary artery bypass graft ```

``` ECG - heart Holter monitoring - CBC/CMP Glucose Echo CT ```

Key physical exam for HA

``` inspect and palpate entire head ENT inspection Complete Neuro exam Fundoscopic exam Vitals ```

Key PE for confusion

``` Complete nuro mini-mental status gait test General: ENT, Ht, LUng, abd, extremities Vitals ```

Key PE for dizziness

``` Complete Neuro Rhomberg nystagmus Dixhalpike gait hearing Weber Rinne ENT CVD vitals ```

Key exam for LOC

``` orthostatic Complete neuro carotid and cardiac exam lung lower extremities Vitals ```

Key PE for numbness/weakness

Neurologic musculoskeletal relevant vascular exam

``` DDX - Numbness/weakness 68yo - 20 min episode slurred speech unilateral numbness, face droop and hand weakness hx htn, dm and heavy smokeing ```

``` Transient ischemic attack hypoglycemia seizure stroke facial nerve palsey ```

``` Weakness - Numbness/weakness 68yo - 20 min episode slurred speech unilateral numbness, face droop and hand weakness hx htn, dm and heavy smokeing ```

``` CBC/CMP Blood glucose ECG -ht CT/MRI Carodid ultrasound Echo - heart EEG - brain function ```

``` DDX - Numbness/weakness Slurred speach unilateral facial drooping, numbness weakness, + babinski sign hx htn, dm and heavy smokeing ```

``` Stroke TIA intercranial neoplasm seizure subdural or epidural neoplasm ```

``` Workup - Numbness/weakness Slurred speach unilateral facial drooping, numbness weakness, + babinski sign hx htn, dm and heavy smokeing ```

``` CBC/Electrolytes PT/PTT/INR: stroke risk, bleeding disorder CT/MRI Carotid U/S Echo ```

DDX - Numbness/weakness 33yo ascending loss of strength x 2 weeks Recent URI

``` Guillainn barre syndrome Multiple sclerosis Polymyositis-idiopathic inflammatory myasthemia gravis peripheral neuropathy Tumor-vertebral canal ```

WOrkup - Numbness/weakness 33yo ascending loss of strength x 2 weeks Recent URI

``` CBC, CMP CPK - measure muscle damage, LP-CSF analysis MRI - spine Tensilon test - myasthenia gravis B12 ```

``` DDX - Numbness/weakness 30yo - acute onset weakness, numbness, tingling left leg Right eye pain, decreased/double vision electric shocks down spine when flexing head ```

``` Multiple sclerosis stroke CNS tumor Neurosyphilis CNS vasculitis myasthenia gravis ```

``` Workup - Numbness/weakness 30yo - acute onset weakness, numbness, tingling left leg Right eye pain, decreased/double vision electric shocks down spine when flexing head ```

CBC/ESR VDLR/RPR - syphilis MRI LP - CSF analysis

DDX - Numbness/weakness Glove and stocking parestheisa x 2 months HX: dm, HTN, alcholism Decreased: soft touch, vibraiton positon

``` Diabetic peripheral nepropathy Alocholic peripheral neuropathy B12 deficiency Hypocalcemia Hypocalcemia ```

Workup - Numbness/weakness Glove and stocking parestheisa x 2 months HX: dm, HTN, alcholism Decreased: soft touch, vibraiton positon

``` HbA1c Calcium serum B12 UA Serum and urine protein electroparesis ESR - inflammation ```

``` DDX - Numbness/weakness 40yo Occasional double vision droopy eyelids at night normalization by morning ```

``` Myasthenia gravis Horner syndrome:mieosis, ptosis, anhydrosis MS Eye strain fatigue Intercranial tumor ```

``` Workup - Numbness/weakness 40yo Occasional double vision droopy eyelids at night normalization by morning ```

Tensilon test Ach receptor antibody test -Myasthenia gravis CXR CT -chest RO lambert eaton, lung tumor MRI - brain (better for still, brain) ro thymoma

GPA - Headache, confusion, depress, dizzi, LOC Numbness Flashcards

(63 cards)