Illness Scripts Flashcards

Question

67 yo woman c/o significant SOB

Answer 1

Middle-aged man c/o acute SOB and agitation Dx Cor pulmonale ``` HPI Chronic SOB SOB on exertion Exertional syncope Exertional angina B/l swelling of LE in past several weeks ``` PMHx Long standing h/o lung disease h/o smoking PE findings S3/S4 Split S2 ``` W/u CXR ECG Pulse oximetry ABG PFTs Echo ```

Answer 2

Dx COPD HPI Chronic h/o SOB Chronic h/o productive cough Morning white sputum PMHx Long standing h/o smoking Chronic h/o lung disease ``` PE findings Tachypnea Prolonged expirations Distant breath sounds Barrel chest ``` ``` W/u CXR ABG Pulse oximetry PFTs ```

Answer 3

Dx TB ``` HPI Chronic h/o SOB Chronic h/o of productive purulent cough h/o hemoptysis night sweats weight loss fatigue ``` ``` PMHx HIV Immunocompromised Foreign born/travel h/o smoking Exposure to TB (Health care worker) ``` PE findings Fever Tachypnea Cachexia ``` W/u CXR PFTs ABG Pulse oximetry TB sputum gram stain and culture Quantiferon test CBC w/ diff Blood culture ```

Answer 4

Dx Asthma HPI h/o SOB early in life Worse at night/early morning PMHx Hx of allergies Hx of smoking Exposure to second hand smoke ``` PE findings Tachypnea Prolonged expirations Diffuse wheezing Increased vocal fremitus Intercostal retractions ``` W/u CXR PFTs ABG

Answer 5

Dx Bronchogenic carcinoma (Central airway obstruction) ``` HPI Cough w/ purulent sputum Slowly progressive dyspnea Purulent sputum Unintended weight loss Hemoptysis ``` PMHx h/o smoking PE findings Tachypnea Prolonged expirations Wheezing W/u CXR PFTs Bronchoscopy

Answer 6

Dx Lung cancer ``` HPI Hemoptysis Dyspnea Unintended weight loss Fatigue Productive cough ``` PMHx h/o smoking FHx of cancer PE findings Wheezing on lung exam W/u CXR Sputum gram stain and culture Chest CT

Answer 7

Dx Pneumonia ``` HPI Chest pain Cough SOB Purulent Sputum ``` PMHx Recent viral prodrome ``` PE findings Febrile Mild respiratory distress Tachypnea Crackles Areas of lung consolidation ``` ``` W/u CXR Blood cultures Sputum gram stain & culture CBC w/ diff ```

Answer 8

Increased vibration to palpation with 99

Answer 9

Increased clarity of 99 with Auscultation (+ loud and clear) (- soft and muffled) If positive Perform whispered pectoriloquy Whisper 123 and auscultate (+ if clear) (-if faint and muffled)

Answer 10

Say "EEE" | - soft muffled eeee (+ "aaa" heard)

Answer 11

Dx Pleural Effusion HPI Pleuritic chest pain worse with deep inspiration or motion Cough SOB PMHx Recent viral prodrome ``` PE findings Febrile Mild respiratory distress Dullness Egophony ``` ``` W/u CXR Chest U/S Pleurocentesis Pleural fluid cell count/cytology, histology/culture LDH/pH Sputum culture ```

Answer 12

``` Fever cough chills malaise myalgias fatigue SOB ```

Answer 13

Dx MI ``` HPI Diaphorsis Crushing retrosternal pain > 20 min Chest, neck, mandible, down left arm FHx of heart dz SOB ``` PMHx smoker h/o of angina or MI PE findings Pale and diaphoretic Tachycardia Hemodynamic instability ``` W/u ECG CXR Cardiac troponins CK-MB Echo ```

Answer 14

Dx Angina pectoris/stable angina ``` HPI Pain <20 min Gradual onset Discomfort center or left of chest Worse with exertion Better with rest No change with respiration of position ``` PMHx h/o high cholesterol h/o HTN PE findings Levine sign (clenched fist on chest) High BP S3 or S4 W/u ECG Troponins Stress Test Angina pectoris/stable angina

Answer 15

Dx Aortic dissection HPI Tearing chest pain Back pain Acute onset PMHx h/o HTN h/o Cocaine use Congenital factors- Marfan, Turner, Noonan Syndrome ``` PE findings HTN UE BP Assymetry UE Pulselessness Hemodynamic instability ``` ``` W/u CXR TEE CT scan Urine toxicology ```

Answer 16

Dx Cocaine-induced ACS HPI Chest pain Agitation PMHx Cocaine myocarditis Vasculitis PE findings HTN Arrhythmia Nasal Septum perforation ``` W/u EKG Troponins I/T CK-MB Urine toxicology ```

Answer 17

Dx CHF/Pulmonary edema ``` HPI SOB paroxysmal nocturnal dyspnea orthopnea Pink Frothy sputum cough Noncompliant w/ medication LE pitting edema x several weeks ``` PMHx HTN MI ``` PE findings JVD LE Edema Rales S3 gallop ``` ``` W/u ECG Echo BNP Troponins CXR ```

Answer 18

Dx Myocarditis HPI Chest pain Fatigue LE edema x several weeks PMHx h/o URI PE findings Tachypnea Gallop Peripheral edema ``` W/u CBC w/ diff ESR/CPR ECG CXR Echo ```

Answer 19

Dx Atrial Fibrillation HPI Palpitations Light headed Anxiety PMHx Cardiomyopathy HTN ``` PE findings Pallor Diaphoresis Irregular heart rate Dyspnea ``` W/u ECG Holter monitor Event recorder

Answer 20

Dx Pericarditis HPI Sharp pleuritic chest pain Better when leaning forward Persistent fever PMHx Recent viral prodrome ``` PE findings Febrile Mild respiratory distress Pericardial friction rub Rash on skin ``` ``` W/u ECG ECHO CXR Blood cultures ```

Answer 21

Dx mitral valve prolapse ``` HPI chest pain palpitation dyspnea chest pressure exertion intolerance Dizziness Anxiety d/o ``` PMHx HTN Arrhythmia Pulmonary edema PE findings Systolic murmur and non-ejection click Narrow AP chest diameter Scoliosis and loss of kyphosis of spine ``` W/u ECG/CK-MB Troponin I/T TTE ECHO CV magenetic resonance ```

Answer 22

Dx Drug induced orthostatic hypotension HPI Dizziness Syncope Sx onset after standing or eating PMHx angina, stroke supine HTN HTN medications ``` PE findings Pallor Diaphoresis Hypotension Tachycardia ``` W/u Monitor orthostatic/supine/and sitting BP Tilt Table

Answer 23

Dx Orthostatic hypotension from dehydration ``` HPI Fatigue Palpitations Profuse seating Nausea ``` PMHx Diarrhea Excessive exercise decreased fluid intake PE findings Orthostatic hypotension pale W/u BUN and Creatinine CBC Electrolytes

Answer 24

Dx Insulinoma ``` HPI Severe episodes of fasting or postprandial hypoglycemia Palpitations, diaphoresis, tremulousness Weight gain Confusion Visual changes Unusual behavior ``` PMHx FHx of MEN 1 PE findings Peripheral tremor W/u Blood glucose Plasma GLP-1 level and insulin Abd CT/MRI/US

Answer 25

Dx Hypoglycemia ``` HPI Tremor palpitations anxiety seating hunger paraesthesia ``` ``` PMHx similar episodes during fasts Insulin or other DM Tx alcohol use hormone deficiency (cortisol, glucagon, epinephrine) insulinoma ``` PE findings peripheral tremor ``` W/u Blood glucose level Insulin level C-peptide level Beta-hydroxyurate level Secretatogue screen ```

Answer 26

Dx Bacterial vaginosis HPI grayish-white watery discharge malodorous Post-menstrual onset ``` PMHx IUD Douching Recent antibiotics menopause multiple sex partners unprotected sex ``` PE findings - ``` W/u pelvic exam Wet prep Vaginal pH Whiff test ```

Answer 27

Dx Trichomonal vaginitis ``` HPI Copious green/yellow frothy discharge Malordorous Pruritic Dysparenuia Dysuria Post-coital bleeding ``` PMHx Unprotected sex Multiple partners IUD/smoking PE findings - W/u Pelvic exam Wet prep Vaginal pH

Answer 28

Dx Candida vaginitis ``` HPI White, thick, cheesy, discharge Odorless Pruritic Dyspareunia Dysuria ``` ``` PMHx Previous episodes of Abx DM Pregnant HIV OCP ``` PE findings - W/u Pelvic exam KOH prep Vaginal pH

Answer 29

Dx Atrophic vaginitis ``` HPI Vaginal dryness dysuria/urgency/frequency hot flashes post-coital bleeding ``` ``` PMHx sleep disturbance osteoporosis pelvic organ prolapse tamoxifen/lupron menopause ``` PE findings --- ``` W/u pelvic exam FSH Estradiol Vaginal smear ```

Answer 30

Dx Abnormal uterine bleeding ``` HPI AUB > 6months (frequency/regularity/duration/volume) brown-stain bleeding color dysmenorrhea reproductive age not pregnant fatigue ``` ``` PMHx AUB > 6months thyroid disease not on local or systemic gonadosteroids not on any medication OCP Systemic disorders of hemostasis Ovulatory disorders primary disorders of endometrium ``` PE findings Tachycardia Pallor ``` W/u Pelvic exam CBC Extraction of HB (alkaline hematin method) Pictorial blood loss assessment chart ```

Answer 31

Dx Endometriosis ``` HPI Abn bleeing pelvic pain infertility urinary urgency/frequency dypareunia dysmenorrhea dyschezia ``` PMHx FHx endometriosis FHx infertility PE findings --- ``` W/u Pelvic exam Abd U/S Transvaginal U/S Abd CT ```

Answer 32

Dx Spontaneous abortion ``` HPI Confirmed pregnancy Suddent onset of vaginal bleeding Abd pain and contractions NSAID use ``` ``` PMHx Advanced maternal age smoking cacaine Previous abortion prolonged time to conceive maternal infection ``` PE findings fever ``` W/u pelvic exam abd U/S Beta hCG Folate level RhD level CBC w diff ```

Answer 33

Dx Cervical Cancer ``` HPI Pelvic pain Dyspareunia Bleeding after sex weight loss anorexia ``` ``` PMHx HPV infection smoker multiple partners occ condom use OC{ use over 10 years ``` PE findings --- W/u Pelvic exam Pap smear

Answer 34

Dx Stressed induced amenorrhea HPI no menses for 3 months Started college 3 months ago PMHx mother also with stress PE findings --- W/u bhCG Testosterone and estrogen levels Abd U/S

Answer 35

Dx Prolactinoma ``` HPI Galactorrhea Oligo/Amenorrhea Loss of axillary and pubic hair Headache ``` PMHx -- PE findings Loss of peripheral vision W/u Prolactin level Brain MRI

Answer 36

Dx Menopause ``` HPI Amenorrhea for 12 mos Hot flashes Vaginal dryness Sleep disturbances Mood imbalance New onset depression Decline in cognitive function Dyspareunia joint pain Breast pain/tenderness ``` PMHx irregular cycles > 4 years before final prd >12mo ago Progressive course of decreased of very heavy bleeding FHx of early menopause hysterectomy with ovarian conservation menstrual migraine PE findings increased age and wrinkling of skin ``` W/u Pelvic exam inhibin B FSH and LH Estradiol level AMH level AFC (ovarian antral follicular count) Transvaginal and pelvic U/S TSH ```

Answer 37

Dx Pregnancy HPI amenorrhea, N w/wo V, breast enlargement/tenderness, increased frequency w/o dysuria, fatigue, mild uterine cramping/discomfort without bleeding constipation, heart burn, nasal congestion, sexually active, reproductive age, physiologic pruritus, hirsutism, androgenic alopecia, increased salivation, food craving or aversion, mood changes PMHx new onset GERD Hx of previous pregnancy ``` PE findings increased pigmentation (face, linea alba, areola), nevi, melasma, striae gravidarum ``` Vascular- spider angiomata, palmar erythema, varicositis, vascular tumors, hemorrhoids Enlarged uterus on abd palpation gigivitis W/u urine and blood bhCG serum ALT/AST, bilirubin Abd, pelvic, transvaginal U/S Pelvic exam Fetal HR with Doppler CBC

Answer 38

Dx Polycystic ovary syndrome HPI Dysmenorrhea Unintentional weight loss Hirsutism ``` PMHx Pelvic pain DM II OSA Ovarian cysts Similar Sx with female family members G0P0 excessive acne ``` ``` PE findings facial acne patches of thin, darker, velvety skin Obese abdomen Hirsutism ``` ``` W/u Pelvic exam serum hCG pelvic U/S Androgen levels Serum insulin Homocysteine level ```

Answer 39

Dx Urethritis ``` HPI Urinary urgency, frequency, starting itching pain, burning, and discomfort in urination and genitalia dysmenorrhea vaginal d/c ``` PMHx active with multiple partners occ condom use PID PE findings --- W/u pelvic exam U/A

Answer 40

Dx urge incontinence HPI Sudden uncontrolled urine loss associate with strong desire to void ``` PMHx UTI DM BPH (man) C-section, prostate surgeries Pregnancy/delivery ``` PE findings No abd tenderness No CVA tenderness ``` W/u Genital and pelvic exam U/A cystometry Post void residual volume Pelvic of abd U/S ```

Answer 41

Dx stress incontinence HPI involuntary urine loss while coughing, laughing, lifting, sneezing ``` PMHx constipation, urinary incontinence multiple gestations smoking prostatectomy ``` PE findings No abd tenderness No CVA tenderness ``` W/u genital and pelvic exams U/A Cystometry Post-void residual volume Pelvic or abd U/S ```

Answer 42

Dx Benign prostatic hyperplasia HPI urgency, hesitancy, frequency, incontinence, weak urine stream, straining to void, sense of incomplete emptying, terminal dribbling PMHx family hx PE findings abd exam WNL W/u Prostate exam PSA Transrectal U/S

Answer 43

Dx Prostate cancer HPI back pain, fatigue, weight loss, urinary frequency and urgency, difficulty starting and maintaining stream of urine, nocturia, dysuria PMHx diet high in processed meat father with prostate cancer PE findings obese abd exam WNL W/u Prostate exam PSA Transrectal U/A

Answer 44

Dx Bladder cancer HPI dysuria, increased frequency, urgency PMHx smoker (many years) hair dresser PE findings WNL abd exam W/u U/A urine cytology cystoscopy

Answer 45

Dx renal cell carcinoma HPI flank pain unintentional weight loss fatigue PMHx smoker, FHx of kidney cancer, x.s. acetaminophen use occupational exposure- asbestos HTN PE findings Obesity Abd mass W/u U/A Abd CT

Answer 46

Dx Testicular torsion ``` HPI young man sudden onset unilateral radiates to lower back N/V ``` PMHx onset during physical exertion PE findings fever CVA tenderness W/u genital exam Doppler U/S of scrotum

Answer 47

Dx nephrolithiasis ``` HPI sudden back/flank pain restlessnes (colicky pain) radiation to groin or abdomen N/V Anorexia Dysuria ``` ``` PMHx kidney stone dehydration high protein and sodium diet overweight ``` PE findings fever CVA tenderness W/u Helical renal CT U/A for Ca2+, oxalate, uric acid renal U/S

Answer 48

Dx Pyelonephritis HPI dysuria, FEVER, N/V, polyuria, urgency, hematuria, chills PMHx recurrent UTO BPH (man) PE findings Fever CVA Tenderness W/u U/A urine culture renal U/S

Answer 49

Dx acute cholecystitis (biliary colic) ``` HPI acute, persistent RUQ pain Pain related to fatty foods Radiation to RIGHT scapula N/V Fever ``` ``` PMHx OCP use Fat DM FHx gb dz multiparity ``` ``` PE findings uncomfortable overweight fever RUQ tenderness Murphy sign Tachycardic ``` ``` W/u CBC w/ diff Abd U/S AST/ALT/ALP, bilirubin ERCP HIDA ```

Answer 50

Dx Pancreatitis ``` HPI persistent epigastric pain radiates to back alleviated by sitting up or bending forward N/V ``` PMHx binge alcohol gallstones ``` PE findings appears ill and uncomfortable epigastric tenderness rebound guarding cullen/gray turner sign febrile tachycardia ``` ``` W/u serum lipase/ amylase CRP/ALT/AST Abd xray Abd U/S Abd CT trypsinogen activation peptide ```

Answer 51

Dx GERD HPI postprandial discomfort, worse supine, heartburn, regurgitation, dysphagia, chest pain, nausea PMHx obesity smoking PE findings wheezing W/u EGD Esophageal pH

Answer 52

Dx Peptic Ulcer Disease ``` HPI epigastric pain and fullness Persistent N/V Hematemesis Melena ``` PMHx NSAIDs H. pylori PE findings uncomfortable, epigastric tenderness W/u EGD FOBT

Answer 53

Dx Gastritis ``` HPI Epigastric pain worse with food better with ant-acids N/V ``` PMHx H. pylori infections and AI dz PE findings epigastric tenderness ``` W/u GUI endoscopy H. pylori testing Serum pepsinogen Antibodies to IF, parietal cells, and H. pylori ```

Answer 54

Dx Gastroenteritis ``` HPI nonbloody diarrhea V/N crampy abd pain onset in winter season malaise ``` PMHx sick contacts ``` PE findings appears frail and uncomfortable fever diffuse abd tenderness dehydration ``` ``` W/u blood culture FOBT fecal leukocyte fecal lactoferrin ```

Answer 55

Dx Hepatitis A ``` HPI fatigue malaise anorexia N/V gradual onset ``` PMHx sick contacts travel to endemic areas ``` PE findings low grade fever RUQ pain HSM jaundice LAD ``` ``` W/u AST/ALT Bilirubin AlkP/GGT LDH Serum IgM/IgG Anti-HAV ```

Answer 56

Dx acute cholangitis HPI abd pain jaundice N/V PMHx choledocholithiasis ``` PE findings uncomfortable FEVER RUQ pain jaundice ``` ``` W/u CBC w/ diff CRP ALT/AST/GGT AlkP Blood cultures Transabd U/S ```

Answer 57

Dx pancreatic cancer ``` HPI upper abd pain unintentional weight loss light colored stool dark urine loss of apetite ``` PMHx smoker DM heavy alcohol use PE findings jaundice FHx cancer W/u Abdominal CT CA 19-9 LFT

Answer 58

Dx Diverticulitis ``` HPI LLQ abd pain several days duration gradually increasing diarrhea and constipation ``` PMHx ---- ``` PE findings restless LLQ tenderness guarding rebound ``` W/u CT scan Abd x-ray CBC w/ diff

Answer 59

Dx Diverticulosis ``` HPI painless rectal bleeding constipation weak and fatigue dizziness ``` ``` PMHx no fiber supplements HTN IBS FHx diverticulosis no FHx of colon cancer ``` PE findings --- ``` W/u rectal exam with FOBT CBC w/diff CT abdomen Colonoscopy ```

Answer 60

Dx Colon cancer ``` HPI painless rectal bleeding change in bowel habits weak and fatigue unintentional weight loss ``` ``` PMHx no screening colonoscopy anemia FHx colon cancer smoking ``` PE findings abdominal tenderness abdominal mass ``` W/u rectal exam with FOBT CBC w/ diff CT abd Colonoscopy ```

Answer 61

Dx Angiodysplasia ``` HPI painless rectal bleeding stool black and tarry fatigue no weight loss no hx of bruising ``` PMHx anemia no FHx of colon cancer PE findings --- ``` W/u rectal exam w/ FOBT CBC w/ diff PT/PTT/INR CT abdomen Colonoscopy EGD ```

Answer 62

Dx mesenteric ischemia ``` HPI acute abd pain pain with meals pain out of proportion to exam weight loss N/V blood in stool ``` PMHx arrhythmia, cardiac valvular disease, infective endocarditis, recent MI, ventricular aneurysm, aortic aneurysm, aortic athersclerosis h/o metabolic acidosis PE findings diffuse abd pain on palpation abd guarding Rovsing sign/rebound ``` W/u abd xray CBC ABG Lactate Abd CT angiography ```

Answer 63

Dx large bowel obstruction ``` HPI severe cramping and pain diffuse and poorly localized abdominal distention constipation vomiting unable to pass flatulus ``` PMHx prior abdominal surgery PE findings restless, fever, abd distention, bowel sounds, normal or quiet, hyperresonance on abd percussion, tenderness on palpation ``` W/u CBC w/ diff Electrolytes/anion gap Barium enema Abd xray colonoscopy abd CT ```

Answer 64

Dx lactose intolerance HPI bloating, diarrhea, nausea, flatulence, borborygmi, Sx start 2 hrs after ingestion of lactose, abdominal cramps PMHx stomach problems PE findings ---- ``` W/u hydrogen breath test stool acidity test fecal lactoferrin levels calprotectin levels ```

Answer 65

Dx Traveler's Diarrhea ``` HPI abd cramps nausea bloating malaise anorexia ``` PMHx recent trip overseas use of antacids for heartburn PE findings fever W/u FOB Stool culture Stool ova for parasites

Answer 66

Dx Chron disease ``` HPI Prolonged diarrhea w/or w/o gross bleeding Crampy abdominal pain Steatorrhea Aphthous ulcers or pain in mouth or gums Odynophagia Dysphagia Weight loss Fatigue fever ``` ``` PMHx Fhx IBD PMHx eye problems (uveitis, irits, episcleritis), joint problems (sacroiliitis or ankylosing spondylitis), erythema nodosum and pyoderma gangrenosum Recurrent UTI Primary sclerosing cholangitis Pulmonary manifestations ``` PE Febrile Abd tender to palpation Abd mass ``` W/u Abd x-ray Rectal exam w/ FOBT CBC ESR and CRP PANCA and ASCA Electrolytes Colonoscopy Capsule endoscopy UGI Series MRE ```

Answer 67

Dx IBS HPI Diarrhea w/ alternating constipation Abd cramps better with defecation Diffuse abdominal pain ``` PMHx Anxiety Excessive stress FHx Child abuse ``` PE Generalized abd tenderness W/u ----

Answer 68

Dx Psuedomembranous colitis HPI Watery diarrhea Abd pain and cramps No blood in stool PMHx Allergies Abx therapy Hospitalization PE Diffuse abdominal tenderness to palpation ``` W/u CBC w/ diff Stool assay for C. difficile Rectal exam and FOBT Stool for ova and parasites ```

Answer 69

Dx Appendicitis ``` HPI Periumbilical/sharo Progressive to RLQ Anorexia/fever N/V Diarrhea Malaise Indigestion/flatulence ``` PMHx IBD ``` PE Fever Psoas/obturator sign Rovsing sign McBurney point tenderness ``` W/u CBC w/ diff Abd U/S; if negative or inconclusive then abd CT

Answer 70

Dx Polycystic kidney disease HPI Headache Hematuria Polyuria PMHx FHx of kidney disease HTN UTI PE HTN W/u Abd U/S Abd CT Bun and Creatinine

Answer 71

Dx Ectopic pregnancy ``` HPI Sudden LLQ/RLQ pain Severe, progressive Unilateral Amenorrhea Vaginal bleeding/spotting N/V Breast fullness Weakness ``` ``` PMHx Previous ectopic Fallopian tube pathology and surgery Abdominal surgery In-utero DES exposure PID/ infertility Uterine anomalies Smoker Progesterone contraception/IUD ``` PE Tenderness Gaurding W/u Pelvic exam Serum quantitative bhCG Transvaginal U/S

Answer 72

Dx PID ``` HPI Lower abd pain Gradual or sudden Dull and achy b/l Progressive Fever Purulent vaginal discharge N/V Anorexia/malaise Onset following menses ``` ``` PMHx Multiple partners Unprotected sex Bacterial vaginosis Recent gyn procedure HIV PE Abd- Tenderness, Guarding ``` ``` W/u Pelvic exam NAAT/cultures for chlamydia and gonorrhea Vaginal secretions KOH Transvaginal U/S ```

Answer 73

Dx Ovarian torsion ``` HPI Sharp, intermittent, unilateral, worsening lower abd pain Precipitated by exercise Radiates to flank, back, and/or groin Fever N/V ``` PMHx Previously resolved episodes Pelvic surgery Ovulation induction PE --- W/u Pelvic exam Pelvic U/S Doppler

Answer 74

Dx ovarian cyst rupture ``` HPI Unilateral onset Diffuse Exercise precipitated Vaginal bleeding N/V Shoulder pain ``` PMHx LMP 2 wks ago (midcycle) PE Cullen sign W/u Pelvic exam Pelvic U/S Abd CT

Answer 75

Dx Mallory-Weiss syndrome HPI Bright red blood w/ gastric content after lots of alcohol Lightheadedness Epigastric abdominal pain PMHx Smoking Heavy alcohol use PE Pallor Diaphoretic Alcohol breath W/u CBC w/ diff EGD

Answer 76

Dx Achalasia ``` HPI Progressive dysphagia both liquid and solid a/w regurgitation of undigested food a/w retrosternal pain a/w coughing when lying flat ``` PMHx --- PE Thin CV exam WNL W/u Esophageal manometry Barium esophagram Endoscopy

Answer 77

Dx Meningitis ``` HPI Severe headache Photophobia Nuchal rigidity Fever ``` PMHx Rash or recent URI recent travel PE Brudzinski sign Kernig sign Nuchal rigidity ``` W/u CBC w/ diff serum glucose electrolytes blood cultures CT head lumbar puncture ```

Answer 78

Dx Subarachnoid hemorrhage ``` HPI Severe headache sudden onset photophobia nuchal rigidity LOC confusion vomiting ``` PMHx recent h/o head injury PE nuchal rigidity MMSE altered W/u Head CT

Answer 79

Dx Migraine ``` HPI Unilateral headache pulsating photophobia visual disturbances associated with food, menses nausea precipitated by stress, hunger, fatigue ``` PMHx OCP use FHx of similar headaches PE --- W/u ----

Answer 80

Dx Tension Headache ``` HPI pain in lower back of head on both sides radiates to neck constant pressure mild to moderate pain ``` PMHx increased stress sleep deprivation recent eye strain PE tense neck and shoulder muscles W/u ---

Answer 81

Dx Cluster headache HPI unilateral orbital pain recurrent w/ periods of spontaneous remission severe associated rhinorrhea and nasal congestion No aura PMHx prior episodes of same headache PE --- W/u ---

Answer 82

Dx Alzheimer Disease ``` HPI progressive memory loss confusion occupational functioning impairment personality and mood changes progressive deterioration falls urinary incontinence fatigue and weakness ``` PMHx Fhx of Alzheimer PE MMSE FND Gait disturbance W/u Brain MRI Brain PET scan

Answer 83

Dx Vascular dementia HPI cognitive deficits and memory social and occupational functioning impairment personality and mood changes, abulia, apathy step-like decline falls urinary incontinence fatigue and weakness PMHx HTN strokes or CVA/dz high cholesterol ``` PE MMSE FND Gait disturbance Hyperreflexia Babinski Pseudobulbar palsy (CN 5,7,9,10,11,12) ``` W/u Brain CT and MRI

Answer 84

Dx Prion Disease HPI rapid progression of psychiatric Sx Depression, agitation, apathy, insomnia, irritability, social withdrawal, psychotic features (delusions and hallucinations) PMHx FHx of prion disease FHx psychiatric ``` PE abnormal sensation gait ataxia involuntary movements immobility paresis of upward gaze cognitive impairment startle response and mutism ``` ``` W/u EEG LP Examination of tonsillar tissue Brain CT and MRI ```

Answer 85

Dx Benign positional vertigo HPI episodic (seconds) with loss of balance N/V Sudden onset with change in head position ``` PMHx --- PE --- W/u Dix-Hallpike test CBC w/diff CT of head Audiogram ```

Answer 86

Dx Cerebrovascular accident HPI FND < 24 hrs sudden ``` PMHx HTN DM high cholesterol A-fib not compliant with Warfarin FHx of early CAD smoking ``` PE FND ``` W/u Head CT Brain MRI ECG CBC w/diff PT/PTT/INR Electrolytes Fasting blood lipids and glucose ```

Answer 87

Dx Subdural hematoma ``` HPI headache confusion somnolence N/V head trauma falls with progressive FNDs Seizures ``` PMHx frequent fall alcoholism h/o anticoagulant medication ``` PE FNDs gait abnormalities nuchal rigidity Brudzinsky/Kernig Babinski Hemiplegia (R or L) Bruises from falls ``` ``` W/u Head CT Brain MRI LP-CSF analysis CBC w/diff PT/PTT/INR Urine toxicology ```

Answer 88

Dx Trigeminal neuralgia HPI Headache Sharp facial pain electric, shock-like, or stabbing repetitive episodes ( at least three) lacrimation, conjunctival injection, and rhinorrhea facial muscle spasm ``` PMHx migraine HTN chronic facial pain dull continuous pain in the jaw ``` PE no FNDs except some sensory loss precipitation of painful attack by tactile stimulation of facial trigger zone W/u Brain CT and MRI

Answer 89

Dx Temporal arteritis ``` HPI right or left temporal headache tongue claudication jaw claudication blurred vision acute tinnitus ``` PMHx recurrently diagnosed with PRP ``` PE Fever Tenderness on scalp over temporal area jaw claudication decreased visual acuity ``` ``` W/u ESR Biopsy of temporal artery LFT CRP Platelet ```

Answer 90

Dx Lumbar muscle strain ``` HPI lower back pain sudden after cleaning house dull and achy b/l no radiation numbness tingling or weakness ``` ``` PMHx similar episode in apst smoking weight gain and sedentary life style during heavy work and strenuous exercise FMHx back pain ``` PE paraspinal tenderness and spasm no sensory deficits and motor impairments in LE W/u L-spine x-ray L-spine MRI

Answer 91

Dx Lumbar spinal stenosis ``` HPI progressive onset back pain and b/l leg pain alleviate by sitting and bending forward aggravated by walking and standing ``` PMHx back pain b/l pain in buttocks and posterior thighs FM hx back pain ``` PE antalgic gait wide based gait abnormal romberg vibration deficits No SLR ``` W/u L-S spine x-ray L-S spine CT L-S spine MRI

Answer 92

Dx Disc herniation HPI severe back pain radiation down to buttock, leg foot, and ankle Associate numbness and paraesthesia worse with cough, sneezing, and prolonged sitting precipitated by heavy lifting bowel and bladder Sx if b/l disc herniation PMHx back pain occupation- labor job sciatica ``` PE loss of sensation in L5-S1 distribution SLR ipsilateral Crossed straight leg test Loss DTRs Impaired ankle reflex ankle dorsireflexion weakness great toe extensor weakness ``` ``` W/u L-S spine x-ray L-S spine CT L-S spine MRI lower extremity EMG ```

Answer 93

Dx Multiple Sclerosis HPI relapsing remiting sensory weakness and visual disturbances pain, light touch, and proprioceptive loss b/l sensory loss in limb and face from certain level down vertigo fatigue urinary incontinence heat sensitivity gait disturbance, incoordination, balance problems headache painful spasms ``` PMHx epilepsy anxiety, depression, cognitive impairment anemia sleep d/o and sleep apnea thyroid d/o and infxns mobility limitations trigeminal neuralgia back pain restless leg syndrome ``` ``` PE weakness associated with spasticity, hyperreflexia, and clonus Lhermitte phenomenon monocular vision/visual field loss (scotoma) and difficulty discerning color Marcus gunn pupils internuclear ophthalmoplegia horizontal nystagmus spastic paraparesis limb ataxia ``` ``` W/u brain MRI spinal MRI CS analysis for oligo-clonal bands visual evoked potential somatosensory evoked potential ```

Answer 94

Dx Diabetic peripheral neuropathy ``` HPI numbness and tingling in hands and feet for few mos pain in legs >6 mo constipation Impotence vision problems ``` ``` PMHx DM alcoholism HTN otitis media ``` PE decreased soft vibratory and position sense sores on feet ``` W/u Glucose level HbA1c nerve conduction study EMG ```

Answer 95

Dx Parkinson disease ``` HPI feeling slow in processing information and thinking for last few months loss of dexterity (noted when dressing) slight tremor malaise sleep disturbances decreased sense of smell bradykinesia constipation ``` PMHx occupation: e.g. farmer ``` PE soft spoke, slow speech, hypomimia (masked facies) resting tremor bradykinesia rigidity ``` W/u ---

Answer 96

Dx Idiopathic intracranial hypertension ``` HPI throbbing headache headache worse in morning and with coughing/sneezing N/V Pulsatile tinnitus Double vision ``` PMHx Isotretinoin for acne PE CNS examination Fundoscopy Obese W/u Brain CT LP w/ CSF analysis

Answer 97

Dx Carpal tunnel syndrome HPI 1- 3th phalange and wrist Numbness and tingling Pain radiated up forearm PMHx occupation involves repetitive movement hypothyroidism multiple pregnancies ``` PE tenderness to palpation of 1st digits and wrist decreased muscle strength of left hand decreases sensation in first 3 digits Phalen or Tinel sign ``` W/u Left hand x-ray EMG Nerve conduction study

Answer 98

Dx Rhematoid Arthritis ``` HPI Morning stiffness < 1 hr 6 wks improved w/ motion swelling of hands low-grade fever fatigue for several mos ``` PMHx FHx of RA PE rheumatoid nodules decreased ROM on hands and fingers tender joints with ROM W/u anti-CCP ANA, RF Hand/wrist x-ray

Answer 99

Dx SLE ``` HPI photosensitivity oral ulcers alopecia weight loss swelling and redness of affected joints fatigue ``` PMHx FHx of immune disease ``` PE Malar/discoid rash low grade fever petechiae decreased ROM on affected joints tender joints w/ ROM ``` ``` W/u ANA anti-dsDNA Ab Anti-smith Ab Complement level antiphospholipid Ab INR ```

Answer 100

Dx Lyme disease ``` HPI erythema migrans rash arthralgias/myalgias onset: migratory/ polyarticular tick bite lives in northeast, mid atlantic, upper midwest swelling and redness of affected joints fatigue ``` PMHx hx of tick bite or walking in woods ``` PE bell palsy bradycardia heart block target rash not present at this stage low grade fever decreased ROM on affected joints tender joints w/ ROM ``` W/u Lyme titer: ELISA/Western blot

Answer 101

Dx Osteoarthritis ``` HPI Morning stiffness < 30 min monoarticular/polyarticular asymmetric insidious progression worse with exercise relieved by rest ``` ``` PMHx FHx of OA obesity trauma/ repetitive stress previous surgery ``` PE < ROM W/u Hip x-ray

Answer 102

Dx Polymyalgia rheumatica ``` HPI morning stiffness > 30 min Distal extremities Fatigue Anorexia/weight loss Fever Headache Scalp tenderness ``` PMHx carpal tunnel temporal arteritis PE PIP affected nodules W/u ESR CRP MRI or U/S of involved joint

Answer 103

Dx multiple myeloma ``` HPI bone pain: spine, long bones, skull, pelvis, chest severe/intermittent worse with movement relieved by rest fatigue/generalized weakness weight loss ``` PMHx anemia recent bacterial infection PE back pain ``` W/u serum protein electrophoresis U/A bence jones proteins & albumin peripheral smear skeletal survey serum Ca ```

Answer 104

Dx psoriatic arthritis ``` HPI joint pain with polyarthriris oligo arthritis (asymmetrical but at multiple joints) morning stiffness > 30 min worse with prolonged immobility better with physical exercise back pain h/o skin disease ``` ``` PMHx FHx psoriasis FHx RA spondyloarthritis enthesitis and tenosynovitis arthritis mutilans CV diseases or stroke achilles tendinitis and planter fasciitis gout ``` ``` PE stress pain,, joint line tenderness and effusion in affected joint DIP join pain and deformity sausage digits decreased ROM in affected joints dactylitis skin lesions over joint pressure points nail pitting, onycholysis hyperkeratosis splinter hemorrhages pitting edema conjunctivitis and uveitis ``` ``` W/u CBC ESR CRP FR ANA anti-CCP HLA B27 xray and MRI of affected joint Arthrocentesis and sinovial fluid analysis BUN/uric acid U/A ```

Answer 105

Dx gout ``` HPI acute swelling of ankle joint monoarticular or oligoarticular asymmetric increased with purines (foods) increased with exercise low-grade fever ``` ``` PMHx prior episode trauma/diuretics alcohol nephrolithiasis metabolic syndrome ``` PE podagra erythema W/u joint aspiration with synovial fluid analysis angle x-ray for crystal uric acid level in blood

Answer 106

Dx disseminated gonococcal infection ``` HPI c/o tenosynovitis asymmetric mono or poly-arthralgia dermatitis fever, chills generalized malaise multiple partners unprotected sex ``` PMHx congenital or acquired complement deficiency SLE STI PE purulent arthritis pustular or veiculopustular dermatitis tenosynovitis with redness and warmth around tendon sheath ``` W/u CBC w diff synovial fluid analysis blood culture on tayer-martin media PCR for gonoccocal DNA skin lesions specimens ```

Answer 107

Dx lateral epicondilitis ``` HPI elbow pain,swelling, loss of motion repetitive elbow movement numbness and tingling in the hand cervical neck pain ``` ``` PMHx trauma smoking gout gonorrhea IBS ``` PE local tenderness, swelling, redness at affected jiont impaired ROM sensory loss ``` W/u CXR X-ray and MRI of affected joint arthrocentesis CBC uric acid level ```

Answer 108

Dx hip dislocation HPI fall PMHx long term smoker recent hip replacement surgery PE tenderness to palpation of hip limited ROM W/u hip-x-ray MRI of affected hip

Answer 109

Dx hip fracture HPI fall hip pain PMHx osteoporosis PE tenderness on palpation of hip W/u hip-x-ray MRI of affected hip

Answer 110

Dx myasthenia gravis ``` HPI worse at night/exertion- weakness weakness better with rest diplopia dysphagia and difficulty chewing slurred speech droopy eyelids progressive fatigue jaw weakness w/ chewing difficulty walking up stairs no muscle pain ``` PMHx FHx of hypothyroidism and RA ``` PE slurred speech drooping eyelids decreased muscle strength decreased flexes in UE and LE b/l ``` ``` W/u ACH receptor Abs muscle specific tyrosine kinase Abs anti-striated muscle Abs EMG nerve conduction study ```

Answer 111

Dx Guillaine-Barre syndrome ``` HPI ascending symmetrical weakness numbness and tingling progressive fatigue diplopia slurred speech ``` PMHx recent URI ``` PE low BP and high HR ptosis loss of DTR in LE b/l decreased muscle strenth in LE b/l ``` W/u EMG, nerve conduction study PFTs (FVC, negative inspiratory force)

Answer 112

Dx cellulits ``` HPI ankle area extending up LLE +/- puncture wound welling/erythema/unilateral fever/chills/malaise no drainage ``` ``` PMHx trauma few days ago skin disorder at site DM or HIV Surgery ``` PE Lymph nodes Erythema W/u CBC w/ diff

Answer 113

Dx Peripheral arterial disease ``` HPI worse with ambulation worse when climbing stairs better with rest intermittent/cramping/claudication ``` ``` PMHx hyperlipidemia DM MI HTN smoker Fhx ``` ``` PE diminished/absent pulses shiny skin/absent hair cold feet thickened toe nails impaired sensation ``` W/u ankle/brachial arterial pressure

Answer 114

Dx deep vein thrombosis HPI pain w/ leg swelling (difference of 3 cm circumference) OCPs and smoking sedentary lifestyle dyspnea of sudden onset, chest pain, fatigue if complicated with PE ``` PMHx malignancy prior DVT immobilization >3days surgery > 30 min pregnancy estrogen Tx smoking obestiy h/o venous thromboembolism ``` ``` PE localized tenderness entire leg swollen pitting edema collateral superficial veins increased warmth at affected side tachypnea ``` ``` W/u doppler U/S of LE D-Dimer CTA ant-phospholipid ABs Factor V leiden Protein C S INR, PT, PTT Homocysteine level antithrombin III Factor VIII CXR ABG ECG ```

Answer 115

Dx plantar fascitis HPI sharp unilateral pain worse at period of rest and in morning PMHx smoking runner PE Obese pain reproduced by bending foot and toes up toward shin W/u ----

Answer 116

Dx costochondritis ``` HPI region pain syndrome stinging pain pain reproducible multiple areas of chest tenderness absence of cough ``` PMHx --- PE tenderness at upper costal cartilage of costochondral or costosternal junctions localized muscle tension no heat erythema or localized swelling W/u CXR

Answer 117

Dx panic disorder HPI unexpected episodes of palpitations, SOB, dizziness associated w/ sweating, trembling, chest pain, palpitiations, and circumoral numbness persistent concern about future attacks PMHx anxiety no substance use d/o caffeine use PE ---- W/u ---

Answer 118

Dx acute alcohol intoxication ``` HPI dizziness euphoria ataxia slurred speech vomiting confusion ``` PMHx alcohol abuse alcoholism stressful job ``` PE alcohol scent on breath unstable gait slurred speech MMSE ``` W/u serum ethanol level urine tox serum glucose level

Answer 119

Dx substance-induced psychosis HPI disorientation acute intoxication of alcohol PMHx alcoholic cannabis use PE --- W/u urine tox

Answer 120

Dx Schizophrenia HPI > 6 mo delusions, hallucinations (auditory), social dysfxn, disorganized speech interferes with normal functioning PMHx FHx PE MMSE impaired judgement blunt affect ``` W/u urine tox head CT brain MRI brain PET scan ```

Answer 121

Dx Schizoaffective disorder ``` HPI delusions hallucinations alogia avolition anhedonia irritable mood excessive agitation ``` PMHx anxiety risk taking behavior PE disorganized speech blunt affect ``` W/u CBC w/ diff electrolytes serum glucose cortisol urine tox serum alcohol TSH ```

Answer 122

Dx Bipolar disorder DIG FAST ``` HPI sad mood > 2wks early morning wakefulness anhedonia loss of concentration decreased appetite suicidal ideation associated with periods of increased energy, excessive spending, and increased promiscuous sexual activity ``` PMHx FHx similar Sx PE affect depressed mood c/w affect ``` W/u CBC w/ diff electrolytes serum glucose cortisol urine tox serum alcohol level TSH ```

Answer 123

Dx Adjustment disorder ``` HPI loss of interest feeling of hopelessness better with removal of stressors sadness anhedonia difficulty concentration ``` PMHx loss of job 1mo ago PE depressed affect affect c/w mood ``` W/u CBC w/ diff electrolytes serum glucose cortisol urine tox serum alcohol level TSH ```

Answer 124

Dx Major depressive disorder HPI (5/9) SIGECAPS + depressed mood or anhedonia PMHx Fhx psych conditions ``` PE decreased concentration of MMSE depressed affect mood c/w affect lack of eye contact ``` ``` W/u CBC w/ diff electrolytes serum glucose cortisol urine tox serum alcohol level TSH ```

Answer 125

Dx Normal bereavement ``` HPI anhedonia anorexia trouble concentrating trouble sleeping ``` PMHx loss of husband 6 mo ago PE --- W/u ---

Answer 126

Dx social anxiety disorder HPI persistent fear of one or more social or performance situations diaphoresis, tremors, palpitations, nausea in public places avoidance of public spaces PMHx anxiety PE anxious affect mood c/w affect ``` W/u CBC w/ diff electrolytes serum glucose cortisol urine tox serum alcohol level TSH ```

Answer 127

Dx lead poisoning ``` HPI anorexia abd pain/constipation poor attention span distractability impulsiveness/hyperactivity pica/lethargy vomiting headache ``` PMHx old building low socioeconomic status ``` PE --- W/u physical exam blood lead level CBC ```

Answer 128

Dx Iron deficiency anemia ``` HPI anorexia lethargy fatigue pallor irritability poor feeding pica mainly milk ``` PMHx low birth weight blood loss systolic murmur ``` PE --- W/u Physical exam peripheral smear serum iron/ferritin TIBC/FEP reticulocyte count FOBT CBC/MCV/RDW ```

Answer 129

Dx ADHD ``` HPI inattention/hyperactive impulsive multiple settings <12 yo > 6 mo distracted/disorganized forgetful constant fidgeting short attention span tasks not completed ``` PMHx FHx psychiatric d/o PE --- W/u physical exam psychiatric mental status evaluation

Answer 130

Dx oppositional defiant disorder ``` HPI patterns of argumentative behavior > 6 mo often loses temper/angry argues with authority annoys classmate blames others for his mistakes ``` ``` PMHx --- PE --- W/u physical exam ```

Answer 131

Dx Measles ``` HPI cough, coryza, and conjunctivitis recent travel or exposure to sick persons transient respiratory Sx Fever Malaise, anorexia diarrhea lethargy ``` PMHx otitis media missed vaccinations ``` PE fever maculopapular rash koplik spots keratitis or corneal ulcerations non-purulent conjunctivitis LAD ``` ``` W/u Physical exam serum measles IgM and IgG Abs RT-PCR for measles virus RNA CBC w/ diff ```

Answer 132

Dx Neonatal sepsis ``` HPI fever lethargy poor feeding poor tone irritability seizures ``` ``` PMHx inherited metabolic disorders hypoxia acidosis GBS infection maternal chorioamnionitis intrapartum-fetal tachycardia APGAR <6 Meconium ileus ``` ``` PE respiratory distress: tachypnea, flaring, grunting, and use of respiratory muscles tachycardia hypotension fever ``` ``` W/u physical exam cbc w/ diff blood cultures LP CXR (if respiratory distress) ```

Answer 133

Dx colic ``` HPI irritability paroxysmal crying (esp. at night) relieved by flatus or bowel movement normal feeding ``` PMHx --- ``` PE face of baby flushed distended and tensed abdomen clenched fingers stiff and extended arms otherwise NL PE ``` W/u bring child for PE

Answer 134

Dx intussesception ``` HPI progressive intermittent cramping sudden every 15-20 min inconsolable cry bilious emesis lethargy alerted consciousness ``` PMHx reactive lymphoid hyperplasia gastroenteritis FHx GI problems: Meckel, Chron, celiac, cystic fibrosis PE drawing legs to abdomen distension palpable sausage-shaped abd mass ``` W/u bring child for PE FOBT for gross blood and currant jelly stool abd U/S abd plain x-ray ```

Answer 135

Dx Hirschsprung disease HPI a/w brown vomit abd swelling flatulence PMHx --- PE --- W/u Physical exam

Answer 136

Dx anorexia nervosa HPI weight loss food restriction excessive exercise ``` PMHx use of laxatives amenorrhea brittle hair fatigue FHx of eating d/o ``` PE thin appearance lanugo HYPOTENSION W/u electrolytes cbc

Answer 137

Dx Hypothyroidism ``` HPI weight gain cold intolerance dry skin brittle hair/puffy face/sleepiness constipation depressed mood muscle weakness decreased mood muscles weakness decreased sweating hoarseness lower extremity edema impaired memory tongue enlargement ``` ``` PMHx potential drug induced- lithium hypothalamic-pituitary axis damage menstrual abnormalities carpal tunnel h/o autoimmune disease FHx of hypothyroidism ``` ``` PE loss of eye brows periorbital edema DTR: delayed relaxation edema ``` W/u TSH Free T3

Answer 138

Dx B12 deficiency ``` HPI weight loss decreased appetite unsteady gait numbness/tingling of feet and hands perception of wearing stockings or gloves constipation or diarrhea sore tongue/weakness psychosis/memory loss pallor palpitations dyspnea on exertion ``` ``` PMHx vegan diet alcoholic pernicious anemia chron disease/celiac GI resection acid suppressing drug metformin bacterial overgrowth ``` PE Romberg sign altered gait ``` W/u cbc peripheral smear serum b12 methylmalonic acid homocysteine ```

Answer 139

Dx iron deficiency anemia ``` HPI angular chelitis pica lethargy/pallor palpitations/dyspnea on exertion poor exercise tolerance lightheadedness leg cramps glossitis/koilonychia ``` ``` PMHx GI bleed menorrhagia celiac sprue recent infections bacterial overgrowth systolic murmur ``` PE pallor tachycardia ``` W/u ferritin serum iron TIBC/CBC peripheral smear ```

Answer 140

Dx Non-Hodgkin Lymphoma ``` HPI fever/night sweats/ weight loss skin rash, pruritis anorexia/weight loss N/V complex regional pain abd fullness early satiety headache lethargy seizure ``` PMHx PMHx or FHx lymphoma or hematopoietic malignancy radiation or chemoTx exposure to agricultural pesticides and hair dyes ``` PE painless, peripheral lymphadenopathy HSM fever FNDs ``` ``` W/u cbc w/diff serum LDH and uric acid serum Ca peripheral smear serum protein electrophoresis CXR CT abd PET/CT brain LN Bx ```

Answer 141

Dx PTSD HPI flashbacks nightmares Sxs > 1 mo PMHx major stressor PE --- W/u ---

Answer 142

Dx drug-related erectile dysfunction HPI h/o ED non compliant with DM or HTN medications PMHx HTN, DM, MI radical prostatectomy ``` PE abn peripheral sensation on LE abn femoral/peripheral pulse alopecia, gynecomastia visual field defects ``` ``` W/u genital examinations nocturnal penile tumescence test MRI brain glucose level and hgbA1c Testosterone and prolactin duplex doppler of penis Lipid profile ```

Answer 143

Dx DM ``` HPI poly- uria/dipsia/phagia h/o hypoglycemia Sx weight gain or loss (DM I) sedentary lifestyle high fat diet h/o claudication ``` ``` PMHx CV dz HTN high cholesterol PAD obesity smoking ``` PE obese diminished LE peripheral pulses decreased LE sensation ``` W/u blood glucose hgbA1c fasting lipid profile urine albumin AST/ALT serum creatinine TSH (if type DM 1) ```

Answer 144

Dx domestic violence ``` HPI h/o abd pain depressed mood difficulty falling asleep pain on bruised area abd pain or other Sx ``` PMHx depression visiting the clinic multiple times w/o a clear dz PE bruises inspection of other skin or body parts with traces of trauma in different stages of healing W/u x-ray skeletal survey Fast U/S for soft tissue damage

Answer 145

Dx stress induced insomnia ``` HPI issue falling asleep and staying asleep anxiety fatigue unreasonable worries and tension impaired daytime function inability to concentrate weight loss or gain memory problems h/o x.s coffee ``` ``` PMHx FHx of bipolar disorder or other psychiatric disorder h/o starting new medication anxiety d/o very stressful situation complex regional pain using recreational drugs and alcohol ``` PE nl thyroid exam DTR intact b/l motor 5/5 b/l W/u cbc TSH, T3, free T4

Answer 146

Dx obstructive sleep apnea HPI snoring morning headaches excessive daytime sleepiness PMHx smoker PE obese hypertensive W/u polysomnography

Illness Scripts Flashcards

(170 cards)