Midterm2 Flashcards by Omer Yusuf

Diagnosis?

15 month male presents to ED with sudden onset GTC seizure. Seizure lasted 3 minutes. Child has had a mild cough for the last 24hrs. Immunization complete. Fever of 39.8C (rectal).

Simple febrile seizure

Fever > 39, lasting less than 5 minutes.

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Diagnosis?

15 month male presents to ED with sudden onset GTC seizure. Seizure lasted 3 minutes. Child has had a mild cough for the last 24hrs. Immunization complete. Fever of 39.8C (rectal).

a) Meningitis
b) UTI
c) Bacteremia
d) Simple febrile seizure
e) Complex febrile seizure

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Diagnosis?

2y/o F presents with seizure after 2 day history of photophobia and neck pain. Not fully vaccinated. CBC is significant for WBC of 24.

Meningitis

WBC>20 + photophobia + seizure + neck pain.

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Diagnosis?

2y/o F presents with seizure after 2 day history of photophobia and neck pain. Not fully vaccinated. CBC is significant for WBC of 24.

a) UTI
b) Meningitis
c) Simple Febrile Seizure
d) Epilepsy
e) AOM

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Next step?

2y/o F presents with seizure after 2 day history of photophobia and neck pain. Not fully vaccinated. CBC is significant for WBC of 24.

a) LP
b) Repeat CBC
c) Oxygen nasal prongs
d) Reassurance
e) Report family to CFS

LP is 1st line test for meningitis per readings.

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Diagnosis?

10 month old M presents with 24hr hx of fever (38.9C oral). Parents report son has been more irritable than normal. Urine is foul smelling. Urinalysis is leukocyte esterase +ve. Urine culture confirmed most likely diagnosis.

UTI

In this age group, urine culture needed to confirm dx.

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Diagnosis?

a) Meningitis
b) AOM
c) UTI
d) Occult Bacteremia
e) Kidney stones

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Next step?

10 month old M presents with 24hr hx of fever (38.9C oral). Parents report son has been more irritable than normal. Urine is foul smelling. Urinalysis is leukocyte esterase +ve.

a) Urine culture
b) CXR
c) LP
d) Antibiotics
e) Steroids

Per reading, in this age group need urine culture for diagnosis.

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Diagnosis?

2 month old F presents with fever (39.8C oral). Crying more than usual, eating less, and refusing several feedings. Immunization incomplete. ROS is -ve. CBC shows WBC of 32. CXR, LP, and UA are normal. Blood cultures pending.

Bacteremia (occult)

ROS and tests rule out most foci of infection.

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Diagnosis?

2 month old F presents with a 24 hour history of fever (39.8C oral). Crying more than usual, eating less, and refusing several feedings. Immunization incomplete. ROS is -ve. CBC shows WBC of 32. CXR, LP, and UA are normal. Blood cultures pending.

a) Pyelonephritis
b) Viral encephalitis
c) Kawasaki disease
d) Occult Bacteremia
e) UTI

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Next step?

a) Antibiotics
b) Steroids
c) Repeat CXR
d) Topical Naproxen
e) Anti-pyeretics

Very sick kid here, need to treat abx empirically.

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Diagnosis?

9 month old M presents with 1 day history of ear pain, difficulty sleeping, and fever (38.7C oral). Patient has had a runny nose for the last 3 days. On exam, TM is bulging.

AOM

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Diagnosis?

9 month old M presents with 1 day history of ear pain, difficulty sleeping, and fever (38.7C oral). Patient has had a runny nose for the last 3 days. On exam, TM is bulging.

a) Pneumonia
b) TM perforation
c) AOM
d) Bacteremia
e) Child abuse

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Next step?

9 month old M presents with 1 day history of ear pain, difficulty sleeping, and fever (38.7C oral). Patient has had a runny nose for the last 3 days. On exam, TM is bulging.

a) Prednisone
b) Reassurance
c) CXR
d) Rapid strep
e) CBC

Per reading, in mild/moderate patients >6mo age, watch and wait.

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Diagnosis?

28M presents after episode of dizzyness. Occured after turning over in bed. Episode lasted about 20sec. Patient described “it felt like the room was spinning”. Patient has had two other episodes like this in the past week. Dix-Hallpike test is +ve.

BPPV

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Next step?

a) CT head
b) EKG
c) Dix-Hallpike test
d) Epley Maneuvre
e) Reassurance

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Next step?

a) Epley maneuvre
b) Lorazapam
c) Neurology referral
d) CBT + SSRI
e) 24hr Holter monitor

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Next step?

55F presents to ED w/ episodes of nausea, vomiting, and feeling that the room is spinning. Each episode is <1min, and the most recent one started 1hr ago when she bent over to tie her shoes. Neuro exam is significant for horizontal nystagmus. PMHx is significant for HTN and DLD.

a) CT head
b) Dix-Hallpike test
c) EKG
d) Reassurance
e) Epley maneuvre

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Which of the following would also be seen in this patient?

60M presents to his FM due to episodes of dizziness. Patient describes a sensation that the room is spinning. Each episode lasts less than 15 seconds, and is triggered when he looks up.

a) Xanthrochromia on LP
b) Hyponatremia on CMP
c) Bidirectional nystagmus on HINTS exam
d) JVD on cardiac exam
e) +ve Dix-Hallpike maneuvre

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Diagnosis?

64F presents with episodes of dizziness. Each episodes lasts about 30sec, and she describes it that the world is spinning. Episodes usually occur immediately after lying down or sitting up.

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BPPV

Diagnosis?

68F presents with sudden onset, persistent dizziness which started 4hrs ago. She states “it feels like the room is spinning!”. She also reports nausea and vomitting. PMHx is significant for HTN, DM2, DLD, and AF. Neuro exam is significant for dysmetria and ataxic gait.

a) Stroke
b) Acute Vestibular Neuritis
c) PE
d) Valvular Heart Disease
e) Psychogenic dizziness

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She’s got all the vascular risk factors.

Diagnosis?

72M presents with 2hr history of dizziness. Sudden onset, associated with diplopia and dysarthria. Patient says that it feels like the room is tilting and swaying. PMHx is significant for HTN, AF, and OSA. Physical exam is significant for bidirectional nystagmus and skew deviation.

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Stroke (posterior circulation)

Diagnosis?

34F presents with 8mo hx of persistent dizziness. Describes as “wooziness” and “lightheadedness”. Exacerbated by crowds and deadlines. Began after a particularly difficult breakup. She has seen multiple specialists and had many different tests, all of which came back normal. PMHx is significant for GAD and IBS. Physical exam is unremarkable.

a) Stroke
b) Acute Vestibular Neuritis
c) Arrhythmia
d) Hypoglycemia
e) Somatic symptom disorder

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Somatic symptom disorder (i.e. psychogenic dizziness).

Does this patient have any headache red flags?

48M presents with acute headache while playing ultimate frisbee. Temperature is 37.2C. PMHx is significant for HTN controlled on amlodipine. Vitals are normal otherwise.

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Yes

Per background readings, associated with exertion.

# Does this patient have any headache red flags? 32F presents to walk-in clinic with acute headache that started 2hrs ago. Throbbing/pounding pain in the left temple with photophobia. Has occured in the past. No visual disturbances and vitals are normal. PMHx is only significant for pregnancy delivered vaginally two weeks ago.

Yes | Per background reading, postpartum is RF.

# Next step? 35F presents with acute R-sided headache. Describes headache as "pounding". Before the headache, she describes seeing a zigzag line of light flickering across her visual field. Associated symptoms include nausea, vomitting, and photophobia. Patient denies phonophobia. a) Diclofenac b) CT head c) LP d) CRP e) ABG

A | Mild-moderate migraine 1st line = NSAIDs.

# Next step? 72M presents with temporal headache that has been worsening over the last 3 weeks. Associated symptoms include jaw pain and vision changes which he has described as a "curtain falling down". The headache is affecting his day to day life, as he now has difficulty chewing lingonberries. a) Prednisone b) Ketorolac c) LP d) CT head e) Referral to psychiatry

A | Lingonberries are a swedish thing, and GCA is common in northern europe.

# Next step? 80M presents with a dull, constant headache over the last 3 months. The headache is worse with valsalva and has been waking him up from sleep. PMHx is significant for HTN, DM2, and lung cancer. Physical exam is significant for papilledema on fundoscopy. a) Aspirin b) LP c) Reassurance d) MRI head e) Dexamethasone

D | Headache waking up from sleep is concerning for some type of neoplasm.

# Diagnosis? 25F presents with 24hrs of headache that started while she was studying for her OSCEs. Describes a dull aching behind her eyes. Associated symptoms include myalgias, nasal discharge, and sore throat. Physical exam is significant for fever.

Influenza (/influenza-like illness)

# Next step? 55M presents to ED with sudden, severe occipital headache that started 4hrs ago. Patient reports nausea and has vomitted once. Wife states that patient briefly lost conciousness at the beginning of the headache. FamHx is significant for sister with Ehlers-Danlos syndrome. a) Reassurance b) Sumatriptan c) CT head d) Ceftriaxone + Vancomycin e) Genetics referral

C | Ehlers-Danlos can be associated with aneurysms, which can cause SAH.

# Next step? 55M presents to ED with sudden, severe occipital headache that started 22hrs ago. Patient reports nausea and has vomitted once. Wife states that patient briefly lost conciousness at the beginning of the headache. FamHx is significant for sister with Ehlers-Danlos syndrome. a) CT head b) LP c) Ceftriaxone + Vancomycin d) Sumatriptan e) Psychiatry consult

B | Per readings, CT after 6hrs but before 24hrs is 90% Sn, therefore do LP.

# Diagnosis? 28M presents with 24hr hx of fever (39.5C), confusion, and headache. Associated symptoms include photophobia, nausea, and neck stiffness. Patient denies skin rash.

Meningitis (Bacterial) | Classic triad of meningitis = headache, neck pain, fever

# Next step? 28M presents to ED with headache that has been worsening over the last 24hrs. Started yesterday morning while he was at work in the garage as a mechanic. Patient also reports dizziness and has vomitted once. Patient states that the headache is better when he left work and that his co-workers had also been reporting headaches. His workplace had recently installed a unvented propane heater. a) Sumatriptan b) 100% O2 c) CT head d) Morphine e) CBC + lytes

# We are less likely to expose patients to radiation if... a) They are young b) They are diabetic c) They have increased ICP d) They have a fever e) They have delirium

A | Per reading, less like to CT young patients d/t cancer risk.

# Diagnosis? 78M presents with 24hr history of lethargy. PCH staff reported that patient had a stiff neck. Patient also has fever (38.9C) and has vomitted twice. Physical exam is significant for rash. LP shows low glucose and elevated WBCs, with neutrophil predominance.

Meningitis (Bacterial) | Per BR, elderly bacterial meningitis can present as lethargy.

# What is their GCS? 34M presents to ED via ambulance. Responds to pain, is making incomprehensible sounds, and is in cecorticate posture.

7 | Eyes 2, Verbal 2, Motor 3

# What is their GCS? 22F presents to ED via ambulance after suicide attempt. No eye opening, inappropriate words, and withdraws to pain.

8 | E1, V3, M4.

# What is their GCS? 30M is found on the sidewalk outside a homeless shelter. When you apply painful stimuli, he opens his eyes, tells you to go away, and then pushes your hand away. What is his GCS?

12 | E2, V5, M5

# What is their GCS? 85M in a nursing home is walking around his room and greets you when you enter. He speaks clearly but his answers are confusing and rambling.

14 | E4, V4, M6

# What is their GCS? 45M opens their eyes to verbal stimulation but is unable to follow commands and displays a localization pain response. They grunt when noxious stimuli are provided but do not produce words.

10 | E3, V2, M5

# Diagnosis? 76F presents with sudden onset R sided weakness of the arm and face. PMHx is significant for AF, HTN, and DM2.

Stroke (Ischemic) | Specifically MCA stroke, most common type.

# Next step? 77M presents with severe, "splitting" headache on the L side. Patient was reading when suddenly the headache started and progressively got worse over the next 25mins. Associated symptoms include dizziness and vomitting. PMHx significant for poorly controlled HTN and AF on warfarin. Physical exam is significant for dysarthria and R sided hemiparesis. a) LP b) CT head c) CBC + lytes d) Reassurance e) Diclofenac

B | Need CT to investigate ischemic v. hemorrhagic stroke.

# Next step? 73M brought to ED by son due to decreased LOC. Per son, patient fell 3 weeks ago while walking dog, hitting head on the pavement. Since then, patient has developed a headache and dizziness that has been getting progressively worse. PMHx is significant for AF on warfarin and EtOH use disorder. a) Reassurance b) Morphine c) Antibiotics d) Tox screen e) CT head

E | Subacute trauma with neuro ssx is concerning for SDH, therefore CT.

# Diagnosis? 23F is brought to ED by parents due to 2d hx of lethargy, fever (37.9C), and decreased LOC. Over the last two days, patient has had visual hallucinations and can only be roused by painful stimuli. Per parents, patient had a "mild flu" about two weeks ago. LP shows mildly elevated protein and mildly elevated WBCs with lymphocyte predominance.

Encephalitis (Viral) | Fun fact, rabies encephalitis can be treated via Milwaukee protocol.

# Next step? 58M is brought to ED by paramedics after landlord found him alone in his appartement unresponsive. Has the smell of EtOH. Per collateral from landlord, patient was having troubles with walking and had been struggling with simple tasks. PMHx is significant for EtOH use disorder. Physical exam is significant for hypothermia (35.8C). a) Thiamine b) Glucose c) Naltrexone d) EKG e) Norepinephrine

A | In reality the whole thiamine then glucose thing is BS...

Midterm2 Flashcards

(46 cards)