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Minicases Flashcards

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1
Q

What are the key physical exam items for headache?

A
  1. vitals
  2. inspection and palpation of entire head
  3. neuro exam WITH fundoscopic exam
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2
Q

Top 5 differential:

21 yo F presents with several episodes of
throbbing left temporal pain that lasts
for 2–3 hours. Prior to its onset, she sees
flashes of light in her right visual field
and feels weakness and numbness on the
right side of her body for a few minutes.
Headaches are often associated with
nausea and vomiting. She has a family
history of migraine.

A
  1. Migraine (complicated)
  2. Tension headache
  3. Cluster headache
  4. Pseudotumor cerebri
  5. Trigeminal neuralgia

longshots: trigeminal neuralgia, CNS vasculitis, partial seizure, intracranial neoplasm

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3
Q

Top 5 workup:

21 yo F presents with several episodes of
throbbing left temporal pain that lasts
for 2–3 hours. Prior to its onset, she sees
flashes of light in her right visual field and feels weakness and numbness on the right side of her body for a few minutes.
Headaches are often associated with nausea and vomiting. She has a family history of migraine.

A
  1. CBC
  2. ESR
  3. CT - head
  4. MRI - brain
  5. LP
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4
Q

Top 5 most important Hx items:

21 yo F presents with several episodes of
throbbing left temporal pain that lasts for 2–3 hours. Prior to its onset, she sees flashes of light in her right visual field and feels weakness and numbness on the
right side of her body for a few minutes. Headaches are often associated with nausea and vomiting. She has a family history of migraine.

A
  1. THROBBING
  2. UNILATERAL
  3. ASSOCIATED NEURO (FLASHES OF LIGHT/WEAKNESS/NUMBNESS)
  4. NAUSEA/VOMITING
  5. FAMILY HX
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5
Q

top 5 differential:

26 yo M presents with severe right
temporal headaches associated with
ipsilateral rhinorrhea, eye tearing, and
redness. Episodes have occurred at the same time every night for the past week and last for 45 minutes.

A
  1. Cluster headache
  2. migraine
  3. tension headache
  4. sinusitis
  5. pseudotumor cerebri
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6
Q

top 5 workup:

26 yo M presents with severe right
temporal headaches associated with
ipsilateral rhinorrhea, eye tearing, and
redness. Episodes have occurred at the
same time every night for the past week
and last for 45 minutes.
A
  1. CBC
  2. ESR
  3. CT - head
  4. MRI - brain
  5. LP
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7
Q

top 5 differential:

65 yo F presents with severe, intermittent
right temporal headache, fever, blurred
vision in her right eye, and pain in her
jaw when chewing.

A
  1. temporal arteritis
  2. migraine
  3. cluster headache
  4. tension headache
  5. meningitis
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8
Q

top 5 workup:

65 yo F presents with severe, intermittent
right temporal headache, fever, blurred
vision in her right eye, and pain in her
jaw when chewing.

A
  1. CBC
  2. ESR
  3. CRP
  4. temporal artery biopsy
  5. carotid doppler
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9
Q

top 5 differential:

30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis.

A
  1. sinusitis
  2. migraine
  3. tension headache
  4. meningitis
  5. intracranial neoplasm
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10
Q

top 5 workup:

30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis.

A
  1. CBC
  2. Xray - sinus
  3. CT - sinus
  4. LP
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11
Q

top 5 workup:

25 yo M presents with high fever, severe
headache, confusion, photophobia, and
nuchal rigidity. Kernig’s and Brudzinski’s
signs are positive.

A
  1. CBC
  2. CT - head
  3. MRI - brain
  4. LP - CSF analysis including cell count, protein, glucose, gram stain, PCR for antigens and Cx)
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12
Q

Diagnosis and top 5 workup:

18 yo obese F presents with a pulsatile
headache, vomiting, and blurred vision
for the past 2–3 weeks. She is taking
OCPs.

A

Pseudotumor cerebri

  1. Urine hCG
  2. CBC
  3. CT - head
  4. LP - opening pressure and CSF analysis
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13
Q

top 5 differential:

57 yo M c/o daily pain in the right cheek
over the past month. The pain is electric
and stabbing in character and occurs
while he is shaving. Each episode lasts
2–4 minutes.

A
  1. trigeminal neuralgia
  2. tension headache
  3. migraine
  4. cluster headache
  5. TMJ dysfunction
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14
Q

top 3 workup:

57 yo M c/o daily pain in the right cheek
over the past month. The pain is electric
and stabbing in character and occurs
while he is shaving. Each episode lasts
2–4 minutes.

A
  1. CBC
  2. ESR
  3. MRI - brain
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15
Q

Top 10 key Hx items for CC of confusion/memory loss? What else is important about Hx gathering in this patient?

A
  • Must include Hx from family members/caregivers
    1. time course of cognitive deficits (acute vs chronic)
    2. associated symptoms (constitutional, incontinence, ataxia, hypothyroid, depression)
    3. waxing/waning nature (delirium)
    4. recent falls
    5. meds and recent med changes
    6. hx of stroke or other vascular dx
    7. STDs (syphilis)
    8. HIV risk factors
    9. EtOH use and nutritional status (B12)
    10. FHx of cognitive deficits (Alzheimers)
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16
Q

top 9 key physical exam items for confusion/memory loss?

A
  1. vitals
  2. complete neuro exam
  3. mini-mental status
  4. gait
  5. ENT
  6. cardiac
  7. pulmonary
  8. abdominal
  9. extremities
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17
Q

top 5 ddx:

81 yo M presents with progressive
confusion over the past several
years together with forgetfulness
and clumsiness. He has a history of
hypertension, diabetes mellitus, and two
strokes with residual left hemiparesis. His
mental status has clearly worsened after
each stroke (stepwise decline in cognitive
function).
A
  1. vascular dementia (multi-infarct)
  2. alzheimers
  3. NPH
  4. chronic subdural
  5. intracranial tumor

Ones w/ very specific hx items: B12 deficiency (nutrition), depression (SIGECAPS), neurosyphilis (promiscuity), hypothyroid (younger, cold intolerance, etc)

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18
Q

top 5 workup:

81 yo M presents with progressive
confusion over the past several
years together with forgetfulness
and clumsiness. He has a history of
hypertension, diabetes mellitus, and two
strokes with residual left hemiparesis. His
mental status has clearly worsened after
each stroke (stepwise decline in cognitive
function).
A
  1. CBC
  2. VDRL/RPR
  3. serum B12
  4. TSH
  5. MRI - brain
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19
Q

top 5 ddx:

84 yo F brought by her son c/o
forgetfulness (e.g., forgets phone
numbers, loses her way back home) along
with diffi culty performing some of her
daily activities (e.g., bathing, dressing,
managing money, using the phone). The
problem has gradually progressed over
the past few years.
A
  1. alzheimers
  2. vascular dementia
  3. depression
  4. hypothyroidism
  5. chronic subdural
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20
Q

top 5 workup:

84 yo F brought by her son c/o
forgetfulness (e.g., forgets phone
numbers, loses her way back home) along
with diffi culty performing some of her
daily activities (e.g., bathing, dressing,
managing money, using the phone). The
problem has gradually progressed over
the past few years.
A
  1. CBC
  2. VDRL/RPR
  3. serum B12
  4. TSH
  5. MRI - brain
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21
Q

top 5 ddx:

72 yo M presents with memory loss, gait
disturbance, and urinary incontinence for
the past six months.

A
  1. NPH
  2. alzheimers
  3. vascular dementia
  4. chronic subdural
  5. intracranial neoplasm
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22
Q

top 5 workup:

72 yo M presents with memory loss, gait
disturbance, and urinary incontinence for
the past six months.

A
  1. CT - head
  2. LP - opening pressure and analysis
  3. serum B12
  4. VDRL/RPR
  5. TSH
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23
Q

top 5 ddx:

55 yo M presents with a rapidly
progressive change in mental status,
inability to concentrate, and memory
impairment for the past two months. His
symptoms are associated with myoclonus
and ataxia.
A
  1. CJD
  2. vascular dementia
  3. lewy body dx
  4. wernicke’s encephelopathy
  5. NPH
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24
Q

top 5 workup:

55 yo M presents with a rapidly
progressive change in mental status,
inability to concentrate, and memory
impairment for the past two months. His
symptoms are associated with myoclonus
and ataxia.
A
  1. CBC
  2. BMP (electrolytes and Ca)
  3. serum B12
  4. VDRL/RPR
  5. MRI - brain
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25
top 5 ddx: 70 yo insulin-dependent diabetic M presents with episodes of confusion, dizziness, palpitation, diaphoresis, and weakness.
1. hypoglycemia 2. TIA 3. arrhythmia 4. delirium 5. angina
26
top 5 workup: 70 yo insulin-dependent diabetic M presents with episodes of confusion, dizziness, palpitation, diaphoresis, and weakness.
1. glucose (fingerstick, then serum) 2. CBC 3. BMP (electrolytes) 4. echo 5. ECG
27
top 4 workup: ``` 55 yo F presents with gradual altered mental status and headache. Two weeks ago she slipped, hit her head on the ground, and lost consciousness for two minutes ```
1. non-con CT - head 2. BMP (electrolytes) 3. MRI - brain 4. LP
28
top 7 key Hx items for depressed mood (other than SIGECAPS)?
``` Sleep Interest Guilt Energy Concentration Appetite Psychomotor slowing Suicidality ``` 1. timing (onset and duration) 2. drugs and EtOH 3. life stressors 4. social functioning 5. FHx of mood disorders 6. prior episodes 7. meds
29
key PE and psychological "PE" items for depressed mood?
Traditional PE: 1. vitals 2. HEENT 3. neuro exam 4. mini-mental Psych PE: 1. appearance 2. behavior 3. speech 4. mood 5. affect 6. though process 7. thought content 8. cognition (mini-mental measures this) 9. insight 10. judgement
30
top 5 ddx: ``` 68 yo M presents with a two-month history of crying spells, excessive sleep, poor hygiene, and a 7-kg weight loss, all following his wife’s death. He cannot enjoy time with his grandchildren and reluctantly admits to thinking he has seen his dead wife in line at the supermarket or standing in the kitchen making dinner. ```
*two months is cutoff in time for differentiation b/w bereavement and MDD (might also be diagnosed 2/2 marked impairment, worthlessness, psychosis or suicidal ideation 1. normal bereavement 2. adjustment disorder w/ depressed mood 3. major depressive disorder 4. schizoaffective disorder 5. depressive disorder NOS
31
top 3 workup: ``` 68 yo M presents with a two-month history of crying spells, excessive sleep, poor hygiene, and a 7-kg weight loss, all following his wife’s death. He cannot enjoy time with his grandchildren and reluctantly admits to thinking he has seen his dead wife in line at the supermarket or standing in the kitchen making dinner. ```
1. TSH 2. CBC 3. urine toxicology
32
top 4 ddx: ``` 42 yo F presents with a four-week history of excessive fatigue, insomnia, and anhedonia. She states that she thinks constantly about death. She has suffered fi ve similar episodes in the past, the fi rst in her 20s, and has made two previous suicide attempts. She further admits to increased alcohol use in the past month. ```
1. MDD 2. substance-induced mood disorder 3. dysthmia 4. adjustment disorder
33
top 4 workup: ``` 42 yo F presents with a four-week history of excessive fatigue, insomnia, and anhedonia. She states that she thinks constantly about death. She has suffered fi ve similar episodes in the past, the fi rst in her 20s, and has made two previous suicide attempts. She further admits to increased alcohol use in the past month. ```
1. blood alcohol 2. urine toxicology 3. TSH 4. CBC
34
top 5 ddx: ``` 26 yo F presents with a 3-kg weight loss over the past two months, accompanied by early-morning awakening, excessive guilt, and psychomotor retardation. She does not identify a trigger for the depressive episode but reports several weeks of increased energy, sexual promiscuity, irresponsible spending, and racing thoughts approximately six months before her presentation. ```
1. bipolar I 2. bipolar II 3. cyclothymia 4. MDD 5. schizoaffective disorder
35
1 item for workup: ``` 26 yo F presents with a 3-kg weight loss over the past two months, accompanied by early-morning awakening, excessive guilt, and psychomotor retardation. She does not identify a trigger for the depressive episode but reports several weeks of increased energy, sexual promiscuity, irresponsible spending, and racing thoughts approximately six months before her presentation. ```
urine toxicology
36
top 8 key Hx items for psychosis?
1. positive Sxs: delusions, hallucinations, disorganized thoughts 2. negative Sxs: blunted affect, social withdrawal, decreased motivation, decreased speech/thought 3. cognitive Sxs: disorganized speech/thought 4. paranoia 5. age of first Sx onset 6. previous hospitalizations for similar Sxs 7. previous psych meds 8. EtOH or substance abuse
37
top 5 ddx: ``` 19 yo M c/o receiving messages from his television set. He reports that he did not have many friends in high school. In college, he started to suspect his roommate of bugging the phone. In the same time frame, he stopped going to classes because he felt that his professors were saying horrible things about him that no one else noticed. He rarely showered or left his room and has recently been hearing a voice from his television set telling him to “guard against the evil empire.” ```
1. schizophrenia 2. schizoid or schizotypal personality disorder 3. schizophreniform disorder 4. psychotic disorder 2/2 general medical condition 5. substance-induced psychosis
38
top 4 workup: ``` 19 yo M c/o receiving messages from his television set. He reports that he did not have many friends in high school. In college, he started to suspect his roommate of bugging the phone. In the same time frame, he stopped going to classes because he felt that his professors were saying horrible things about him that no one else noticed. He rarely showered or left his room and has recently been hearing a voice from his television set telling him to “guard against the evil empire.” ```
1. urine toxicology 2. TSH 3. CBC 4. BMP (electrolytes)
39
top 5 ddx: ``` 28 yo F c/o seeing bugs crawling on her bed over the past two days and reports hearing loud voices when she is alone in her room. She has never experienced symptoms such as these in the past. She recently ingested an unknown substance. ```
1. substance-induced psychosis 2. brief psychotic disorder 3. schizophreniform disorder 4. schizophrenia 5. psychotic disorder due to a general medical condition
40
top 5 workup: ``` 28 yo F c/o seeing bugs crawling on her bed over the past two days and reports hearing loud voices when she is alone in her room. She has never experienced symptoms such as these in the past. She recently ingested an unknown substance. ```
1. urine toxicology 2. TSH 3. CBC 4. CMP (electrolytes + LFTs) 5. BUN/Cr
41
top 5 ddx: 48 yo F presents with a one-week history of auditory hallucinations, stating, “I am worthless” and “I should kill myself.” She also reports a two-week history of weight loss, early-morning awakening, decreased motivation, and overwhelming feelings of guilt.
1. schizoaffective disorder 2. mood disorder w/ psychotic features 3. schizophrenia 4. schizophreniform disorder 5. psychotic disorder due to a general medical condition
42
top 3 workup: 48 yo F presents with a one-week history of auditory hallucinations, stating, “I am worthless” and “I should kill myself.” She also reports a two-week history of weight loss, early-morning awakening, decreased motivation, and overwhelming feelings of guilt.
1. TSH 2. CBC 3. BMP (electrolytes)
43
top 10 key hx items for dizziness?
1. lightheaded vs vertigo 2. auditory Sxs (hearing loss, tinnitus) 3. duration of episodes 4. context (ie, positioning, head trauma, etc) 5. visual Sxs 6. URI 7. nausea 8. neck pain or recent injury 9. meds 10. Hx of atherosclerotic or vascular Dx
44
top 10 key PE items for dizziness?
1. vitals 2. neuro exam 3. romberg 4. nystagmus 5. Dix hallpike (just mention) 6. gait 7. hearing 8. weber and rinne 9. HEENT 10. CV exam
45
top 5 ddx: 35 yo F presents with intermittent episodes of vertigo, tinnitus, nausea, and hearing loss over the past week.
1. Menieres dx 2. vestibular neuronitis 3. labyrinthitis 4. BPV 5. acoustic neuroma
46
top 4 workup: 35 yo F presents with intermittent episodes of vertigo, tinnitus, nausea, and hearing loss over the past week.
1. CBC 2. VDRL/RPR 3. dix hallpike 4. MRI - brain
47
top 5 ddx: 55 yo F c/o dizziness for the past day. She feels faint and has severe diarrhea that started two days ago. She takes furosemide for her hypertension.
1. orthostatic hypotension due to dehydration 2. vestibular neuronitis 3. labyrinthitis 4. BPV 5. vertebrobasilar insufficiency
48
top 5 workup: 55 yo F c/o dizziness for the past day. She feels faint and has severe diarrhea that started two days ago. She takes furosemide for her hypertension.
1. orthostatic vitals 2. CBC 3. BMP (electrolytes) 4. stool exam for blood and fecal leukocytes 5. dix hallpike
49
top 5 ddx: 65 yo M presents with postural dizziness and unsteadiness. He has hypertension and was started on hydrochlorothiazide two days ago.
1. drug induced orthostatic hypotension 2. vestibular neuronitis 3. labyrinthitis 4. BPV 5. brain stem/cerebellar tumor
50
top 5 workup: 65 yo M presents with postural dizziness and unsteadiness. He has hypertension and was started on hydrochlorothiazide two days ago.
1. orthostatic vitals 2. CBC 3. BMP (electrolytes) 4. BUN/Cr 5. MRI - brain
51
top 5 ddx: 44 yo F c/o dizziness on moving her head to the left. She feels that the room is spinning around her head. Tilt test results in nystagmus and nausea.
1. BPV 2. vestibular neuronitis 3. labyrinthitis 4. menieres dx 5. brain neoplasm
52
top 3 workup: 44 yo F c/o dizziness on moving her head to the left. She feels that the room is spinning around her head. Tilt test results in nystagmus and nausea.
1. MRI - brain 2. dix hallpike 3. audiogram
53
top 5 ddx: ``` 55 yo F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI two days ago and has experienced no hearing loss. ```
1. vestibular neuronitis 2. labyrinthitis 3. menieres dx 4. BPV 5. spinal dx/injury
54
top 5 workup: ``` 55 yo F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI two days ago and has experienced no hearing loss. ```
1. dix hallpike 2. CBC 3. BMP 4. electronystagmography 5. MRI/MRA - brain
55
top 5 ddx: 55 yo F c/o dizziness that started this morning and of “not hearing well.” She feels nauseated and has vomited once in the past day. She had a URI two days ago.
1. labyrinthitis 2. vestibular neuronitis 3. menieres dx 4. acoustic neuroma 5. vertebrobasilar insufficiency
56
top 4 workup: 55 yo F c/o dizziness that started this morning and of “not hearing well.” She feels nauseated and has vomited once in the past day. She had a URI two days ago.
1. audiogram 2. electronystagmography 3. MRI/MRA - brain 4. dix hallpike/tilt test
57
top 10 key Hx items for LOC?
* *WITNESSES???** 1. preceding Sxs (nausea, diaphoresis, palpitations, pallor, lightheadedness) 2. context (exertional, postural, traumatic, stress, painful, experience of claustrophobia, dehydration) 3. tongue-biting 4. incontinence 5. movements (tonic-clonic) 6. post-ictal state (confusion) 7. dyspnea 8. personal or FHx of CVD 9. arrhythmia 10. EtOH or drug use
58
top 5 key PE items for LOC?
1. vitals, including orthostatics 2. complete neuro exam 3. CV exam (include carotid auscultation) 4. pulmonary exam 5. LE exam (signs of vascular Dx)
59
top 5 ddx: ``` 26 yo M presents after falling and losing consciousness at work. He had rhythmic movements of the limbs, bit his tongue, and lost control of his bladder. He was subsequently confused (as witnessed by his colleagues). ```
1. seizure (complex tonic-clonic [grand mal]) 2. convulsive syncope 3. substance abuse/OD 4. hypoglycemia 5. malingering
60
top 7 workup: ``` 26 yo M presents after falling and losing consciousness at work. He had rhythmic movements of the limbs, bit his tongue, and lost control of his bladder. He was subsequently confused (as witnessed by his colleagues). ```
1. CBC 2. BMP w/ glucose 3. EEG 4. MRI - brain 5. CT - head (noncon, if hit) 6. ECG (this becomes number one if CV cause suspected) 7. LP - CSF analysis
61
top 9 key Hx items for numbness or weakness?
1. distribution 2. duration 3. progression 4. pain (esp. headache, neck or back pain) 5. consitutional Sxs 6. other neuro Sxs 7. Hx of diabetes 8. EtOH use 9. vascular Dx
62
top 4 key PE items for numbness or weakness?
1. vitals 2. neuro exam 3. MSK exam 4. vascular exam (peripheral pulses)
63
top 5 ddx: ``` 68 yo M presents following a 20-minute episode of slurred speech, right facial drooping and numbness, and right hand weakness. His symptoms had totally resolved by the time he got to the ER. He has a history of hypertension, diabetes mellitus, and heavy smoking. ```
1. TIA 2. hypoglycemia 3. seizure 4. stroke 5. facial nerve palsy
64
top 9 workup: ``` 68 yo M presents following a 20-minute episode of slurred speech, right facial drooping and numbness, and right hand weakness. His symptoms had totally resolved by the time he got to the ER. He has a history of hypertension, diabetes mellitus, and heavy smoking. ```
1. CBC 2. glucose 3. BMP 4. ECG 5. CT - head 6. MRI - brain 7. Doppler - carotids 8. echo 9. EEG
65
top 5 ddx: ``` 68 yo M presents with slurred speech, right facial drooping and numbness, and right hand weakness. Babinski’s sign is present on the right. He has a history of hypertension, diabetes mellitus, and heavy smoking. ```
1. stroke 2. TIA 3. seizure 4. intracranial neoplasm 5. subdural/epidural hematoma
66
top 6 workup: ``` 68 yo M presents with slurred speech, right facial drooping and numbness, and right hand weakness. Babinski’s sign is present on the right. He has a history of hypertension, diabetes mellitus, and heavy smoking. ```
1. CBC 2. BMP 3. PT/PTT 4. CT - head 5. MRI - brain 6. Doppler - carotids
67
top 5 ddx: 33 yo F presents with ascending loss of strength in her lower legs over the past two weeks. She had a recent URI
1. Guillan barre 2. MS 3. polymyositis 4. myasthenia 5. peripheral neuropathy
68
top 7 workup: 33 yo F presents with ascending loss of strength in her lower legs over the past two weeks. She had a recent URI
1. CBC 2. BMP 3. CPK 4. LP - CSF analysis 5. MRI - spine 6. EMG/nerve conduction study 7. tensilon test
69
top 5 ddx: ``` 30 yo F presents with weakness, loss of sensation, and tingling in her left leg that started this morning. She is also experiencing right eye pain, decreased vision, and double vision. She reports feeling “electric shocks” down her spine upon fl exing her head. ```
1. MS 2. stroke 3. conversion disorder 4. malingering 5. CNS tumor
70
top 5 workup: ``` 30 yo F presents with weakness, loss of sensation, and tingling in her left leg that started this morning. She is also experiencing right eye pain, decreased vision, and double vision. She reports feeling “electric shocks” down her spine upon fl exing her head. ```
1. CBC 2. VDRL/RPR 3. MRI - brain 4. LP - CSF analysis 5. retinal evoked potentials
71
top 5 ddx: 55 yo M presents with tingling and numbness in the hands and feet (gloveand- stocking distribution) over the past two months. He has a history of diabetes mellitus, hypertension, and alcoholism. There is decreased soft touch, vibratory, and position sense in the feet.
1. diabetic peripheral neuropathy 2. alcoholic peripheral neuropathy 3. B12 deficiency 4. hypocalcemia 5. hyperventilation
72
top 5 workup: 55 yo M presents with tingling and numbness in the hands and feet (gloveand- stocking distribution) over the past two months. He has a history of diabetes mellitus, hypertension, and alcoholism. There is decreased soft touch, vibratory, and position sense in the feet.
1. HbA1C 2. ESR 3. Ca (&BMP) 4. serum B12 5. serum and urine protein electrophoresis (for paraprotienemia/myeloma)
73
top 5 ddx: 40 yo F presents with occasional double vision and droopy eyelids at night with normalization by morning.
1. myasthenia gravis 2. horner's syndrome 3. MS 4. intracranial tumor (sp., compressing CN III, IV or VI) 5. ALS
74
top 6 workup: 40 yo F presents with occasional double vision and droopy eyelids at night with normalization by morning.
1. tensilon test 2. ACh receptor Abs 3. CXR 4. CT - chest 5. MRI - brain 6. EMG
75
top 5 ddx: 25 yo M presents with hemiparesis (after a tonic-clonic seizure) that resolves over a few hours.
1. Todd's paralysis 2. TIA 3. stroke 4. complicated migraine 5. malingering
76
top 5 workup: 25 yo M presents with hemiparesis (after a tonic-clonic seizure) that resolves over a few hours.
1. CBC 2. BMP (repeat x3 over several hours) 3. EEG 4. MRI - brain 5. U/S - carotids
77
top 10 unique Hx items for excessive fatigue and sleepiness?
1. sleep hygiene 2. snoring 3. waking up w/ choking/gasping 4. witnessed apnea 5. overexertion 6. stress levels 7. depression/other emotional issues 8. recent lifestyle changes 9. shift changes at work 10. recent weight changes
78
Top 3 ROS areas to focus for excessive fatigue and sleepiness?
1. thyroid 2. blood/bleeding/clotting 3. CV
79
top 7 key PE items for excessive fatigue and sleepiness?
1. vitals 2. head and neck (conjuctival pallor, oropharynx/palate, LAN, thyroid) 3. CV 4. pulmonary 5. abdominal exam 6. neuro exam 7. rectal w/ OBT
80
top 5 ddx: 40 yo F c/o feeling tired, hopeless, and worthless and of having suicidal thoughts. She recently discovered that her husband is homosexual.
1. depression 2. adjustment disorder 3. hypothyroidism 4. anemia
81
top 3 workup: 40 yo F c/o feeling tired, hopeless, and worthless and of having suicidal thoughts. She recently discovered that her husband is homosexual.
1. CBC 2. TSH 3. HIV/STD testing
82
top 5 ddx: ``` 44 yo M presents with fatigue, insomnia, and nightmares about a murder that he witnessed in a mall one year ago. Since then, he has avoided that mall and has not gone out at night. ```
1. PTSD 2. depression 3. generalized anxiety disorder 4. psychotic or delusional disorder 5. hypothyroidism
83
top 4 workup: ``` 44 yo M presents with fatigue, insomnia, and nightmares about a murder that he witnessed in a mall one year ago. Since then, he has avoided that mall and has not gone out at night. ```
1. CBC 2. TSH 3. Ca 4. urine toxicology
84
top 5 ddx: 55 yo M presents with fatigue, weight loss, and constipation. He has a family history of colon cancer.
1. colon cancer 2. hypothyroidism 3. renal failure 4. hypercalcemia 5. depression
85
top 5 workup: 55 yo M presents with fatigue, weight loss, and constipation. He has a family history of colon cancer.
1. rectal w/ OBT 2. CBC 3. CMP (electrolytes, Ca, BUN/Cr, AST/ALT, TSH) 4. colonoscopy 5. barium enema
86
top 5 ddx: 40 yo F presents with fatigue, weight gain, sleepiness, cold intolerance, constipation, and dry skin.
1. hypothyroidism 2. depression 3. diabetes 4. anemia
87
top 4 workup: 40 yo F presents with fatigue, weight gain, sleepiness, cold intolerance, constipation, and dry skin.
1. TFTs (TSH, FT3, FT4) 2. CBC 3. serum glucose 4. HbA1c
88
top 5 ddx: ``` 50 yo obese F presents with fatigue and daytime sleepiness. She snores heavily and naps 3–4 times per day but never feels refreshed. She also has hypertension. ```
1. OSA 2. hypothyroidism 3. chronic fatigue syndrome 4. narcolepsy
89
top 5 workup: ``` 50 yo obese F presents with fatigue and daytime sleepiness. She snores heavily and naps 3–4 times per day but never feels refreshed. She also has hypertension. ```
1. CBC 2. TSH 3. nocturnal pulse ox 4. polysomnography 5. ECG
90
top 5 ddx: 20 yo M presents with fatigue, thirst, increased appetite, and polyuria.
1. DM type 1 2. atypical depression 3. primary polydipsia 4. diabetes insipidus 5. DM type 2
91
top 7 workup: 20 yo M presents with fatigue, thirst, increased appetite, and polyuria.
1. fingerstick glucose 2. GTT 3. HbA1c 4. UA 5. CBC 6. electrolytes w/ glucose 7. BUN/Cr
92
top 4 ddx: 35 yo M policeman c/o feeling tired and sleepy during the day. He changed to the night shift last week.
1. sleep deprivation 2. sleep apnea 3. depression 4. anemia
93
top 3 workup: 35 yo M policeman c/o feeling tired and sleepy during the day. He changed to the night shift last week.
1. CBC 2. nocturnal pulse ox 3. polysomnography
94
top 10 unique Hx items for night sweats?
1. patterns 2. recent URI 3. associated pulmonary Sxs (cough, hemoptysis, pleuritic chest pain) 4. LAN 5. fever 6. rash 7. malaise 8. weight loss 9. pruritis 10. travel hx/exposure to high risk populations
95
top 7 key PE items for night sweats?
1. vitals 2. HEENT (look for LAN) 3. CV 4. pulmonary 5. abdominal (look for HSM) 6. skin exam 7. MSK exam (look for join pain)
96
top 5 ddx: 30 yo M presents with night sweats, cough, and swollen glands of one month’s duration.
1. TB 2. acute HIV 3. lymphoma 4. leukemia 5. hyperthyroidism
97
top 5 workup: 30 yo M presents with night sweats, cough, and swollen glands of one month’s duration.
1. PPD 2. CBC 3. CXR 4. sputum gram stain, AFB and Cx 5. HIV Ab
98
top 10 unique Hx items for insomnia?
1. description (trouble falling asleep vs multiple awakenings vs early morning awakening) 2. daytime sleepiness 3. other, significant PMHx (pain from arthritis, etc) 4. snoring 5. nightmares 6. depression 7. caffiene use 8. EtOH and drug use 9. work/lifestyle (constant travel w/ jet lag, shift work, etc) 10. stress levels and general sleep hygeine
99
BIG two PE items for insomnia?
1. vitals | 2. MMSE
100
top 4 ddx: 25 yo F presents with a three-week history of difficulty falling asleep. She sleeps seven hours per night without nightmares or snoring. She recently began college and is having trouble with her boyfriend. She drinks 3–4 cups of coffee a day.
1. stress-induced insomnia 2. caffeine-induced insomnia 3. circadian rhythm disorder 4. insomnia related to major depressive disorder
101
top 5 workup: 25 yo F presents with a three-week history of diffi culty falling asleep. She sleeps seven hours per night without nightmares or snoring. She recently began college and is having trouble with her boyfriend. She drinks 3–4 cups of coffee a day.
1. polysomnography 2. mental status exam 3. urine toxicology 4. CBC 5. TSH
102
top 4 ddx: 55 yo obese M presents with several months of poor sleep and daytime fatigue. His wife reports that he snores loudly.
1. OSA 2. daytime fatigue in primary hypersomnia 3. circadian rhythm disorder 4. insomnia related to major depressive disorder
103
top 4 workup: 55 yo obese M presents with several months of poor sleep and daytime fatigue. His wife reports that he snores loudly.
1. CBC 2. TSH 3. polysomnography 4. ECG
104
top 3 ddx: ``` 33 yo F c/o three weeks of fatigue and trouble sleeping. She states that she falls asleep easily but wakes up at 3 A.M. and cannot return to sleep. She also reports an unintentional weight loss of 3.5 kg along with an inability to enjoy the things she once liked to do. ```
1. insomnia related to major depressive disorder 2. primary hypersomnia 3. circadian rhythm disorder
105
top 4 workup: ``` 33 yo F c/o three weeks of fatigue and trouble sleeping. She states that she falls asleep easily but wakes up at 3 A.M. and cannot return to sleep. She also reports an unintentional weight loss of 3.5 kg along with an inability to enjoy the things she once liked to do. ```
1. mental status exam 2. TSH 3. CBC 4. polysomnography
106
top 9 unique Hx items for sore throat?
1. fever 2. ear pain 3. recent/current URI 4. odynophagia 5. swollen glands 6. cough 7. rash 8. sick contacts 9. HIV risk factors
107
top 5 PE items for sore throat?
1. vitals 2. ENT exam (look for thrush, exudates, erythema, and LAN) 3. pulmonary 4. abdominal 5. skin exam
108
top 5 ddx: 26 yo F presents with sore throat, fever, severe fatigue, and loss of appetite for the past week. She also reports epigastric and LUQ discomfort. She has cervical lymphadenopathy and a rash. Her boyfriend recently experienced similar symptoms.
1. infectious mononucleosis 2. hepatitis 3. viral/bacterial pharyngitis 4. acute HIV infection 5. secondary syphillis
109
top 5 workup: 26 yo F presents with sore throat, fever, severe fatigue, and loss of appetite for the past week. She also reports epigastric and LUQ discomfort. She has cervical lymphadenopathy and a rash. Her boyfriend recently experienced similar symptoms.
1. CBC w/ peripheral smear 2. monospot (heterophile nuclear Ab test) 3. throat swab and Cx 4. LFTs (AST/ALT/bilirubin/alk phos) 5. HIV ELISA/p24 Ab test
110
top 5 ddx: 26 yo M presents with sore throat, fever, rash, and weight loss. He has a history of IV drug abuse and sharing needles.
1. HIV, acute retroviral syndrome 2. infectious mononucleosis 3. hepatitis 4. viral pharyngitis 5. endocarditis
111
top 5 workup: 26 yo M presents with sore throat, fever, rash, and weight loss. He has a history of IV drug abuse and sharing needles.
1. CBC w/ peripheral smear 2. HIV ELISA/p24 Ab test 3. CD4 count 4. monospot (heterophile nuclear Ab test) 5. throat swab and Cx
112
top 4 ddx: 46 yo F presents with fever and sore throat.
1. pharyngitis (bacterial vs viral) 2. mycoplasma pneumonia 3. acute HIV infection 4. infectious mononucleosis
113
top 4 workup: 46 yo F presents with fever and sore throat.
1. throat swab for Cx and RST 2. monospot (HNAb test) 3. CBC 4. HIV Ab and viral load
114
top 10 unique Hx items for cough/SOB?
1. acute vs chronic 2. presence & description of sputum 3. postnasal drip 4. dyspnea (or cough) 5. wheezing 6. chest pain 7. recent exposures 8. hx of lung disease 9. allergies 10. meds (ACEi, esp.)
115
top 8 key PE items for cough/shortness of breath?
1. vitals 2. pulse ox 3. nasal mucosa exam 4. oropharynx 5. CV 6. pulmonary 7. lymph nodes (neck, axillary and inguinal) 8. extremity exam (clubbing, cyanosis, edema)
116
top 5 ddx: 30 yo M presents with shortness of breath, cough, and wheezing that worsen in cold air. He has had several such episodes over the past four months
1. asthma 2. GERD 3. bronchitis 4. penumonia 5. foreign body
117
top 5 workup: 30 yo M presents with shortness of breath, cough, and wheezing that worsen in cold air. He has had several such episodes over the past four months
1. CBC 2. CXR 3. peak flow measurement 4. PFTs 5. methacholine challenge test
118
top 5 ddx: 56 yo F presents with shortness of breath as well as with a productive cough that has occurred over the past two years for at least three months each year. She is a heavy smoker.
1. COPD 2. bronchiectasis 3. lung cancer 4. tuberculosis
119
top 5 workup: 56 yo F presents with shortness of breath as well as with a productive cough that has occurred over the past two years for at least three months each year. She is a heavy smoker.
1. CBC 2. CXR 3. sputum gram stain and Cx 4. PFTs 5. CT - chest
120
top 5 ddx: 58 yo M presents with pleuritic chest pain, fever, chills, and cough with purulent yellow sputum. He is a heavy smoker with COPD.
1. pneumonia 2. bronchitis 3. lung abscess 4. lung cancer 5. tuberculosis
121
top 5 workup: 58 yo M presents with pleuritic chest pain, fever, chills, and cough with purulent yellow sputum. He is a heavy smoker with COPD.
1. CBC 2. sputum gram stain and Cx 3. CXR 4. CT - chest 5. ECG
122
top 5 ddx: 25 yo F presents with two weeks of a nonproductive cough. Three weeks ago she had a sore throat and a runny nose.
1. atypical pneumonia 2. reactive airway dx 3. URI-associated 4. postnasal drip 5. GERD
123
top 5 workup: 25 yo F presents with two weeks of a nonproductive cough. Three weeks ago she had a sore throat and a runny nose.
1. CBC 2. induced sputum gram stain and Cx 3. CXR 4. IgM detection for Mycoplasma pneumoniae 5. urine legionella antigen
124
top 5 ddx: 65 yo M presents with worsening cough over the past six months together with hemoptysis, dyspnea, weakness, and weight loss. He is a heavy smoker.
1. lung cancer 2. tuberculosis 3. lung absces 4. COPD 5. vasculitis
125
top 5 workup: 65 yo M presents with worsening cough over the past six months together with hemoptysis, dyspnea, weakness, and weight loss. He is a heavy smoker.
1. CBC 2. sputum gram stain, Cx and cytology 3. CXR 4. CT - chest 5. PPD
126
top 5 ddx: ``` 55 yo M presents with increased dyspnea and sputum production over the past three days. He has COPD and stopped using his inhalers last week. He also stopped smoking two days ago. ```
1. acute COPD exacerbation (bronchitis) 2. lung cancer 3. pneumonia 4. URI 5. CHF
127
top 5 workup: ``` 55 yo M presents with increased dyspnea and sputum production over the past three days. He has COPD and stopped using his inhalers last week. He also stopped smoking two days ago. ```
1. CBC 2. CXR 3. PFTs 4. sputum gram stain and Cx 5. CT - chest
128
top 5 ddx: ``` 34 yo F nurse presents with worsening cough of six weeks’ duration together with weight loss, fatigue, night sweats, and fever. She has a history of contact with tuberculosis patients at work. ```
1. tuberculosis 2. pneumonia 3. lung abscess 4. lymphoma 5. HIV/AIDS
129
top 5 workup: ``` 34 yo F nurse presents with worsening cough of six weeks’ duration together with weight loss, fatigue, night sweats, and fever. She has a history of contact with tuberculosis patients at work. ```
1. CBC 2. PPD 3. sputum gram stain, AFB and Cx 4. CXR 5. CT - chest
130
top 5 ddx: 35 yo M presents with shortness of breath and cough. He has had unprotected sex with multiple sexual partners and was recently exposed to a patient with active tuberculosis.
1. TB 2. pneumonia (including PCP) 3. bronchitis 4. CHF 5. asthma
131
top 5 workup: 35 yo M presents with shortness of breath and cough. He has had unprotected sex with multiple sexual partners and was recently exposed to a patient with active tuberculosis.
1. CBC 2. PPD 3. sputum gram stain, AFB, GMS 4. CXR 5. HIV ELISA
132
top 5 ddx: ``` 50 yo M presents with a cough that is exacerbated by lying down at night and improved by propping up on three pillows. He also reports exertional dyspnea. ```
1. CHF 2. cardiac valvular dx 3. GERD 4. pulmonary fibrosis 5. COPD
133
top 5 workup: ``` 50 yo M presents with a cough that is exacerbated by lying down at night and improved by propping up on three pillows. He also reports exertional dyspnea. ```
1. CBC 2. CXR 3. ECG 4. echocardiography 5. PFTs
134
What are the top 6 unique Hx items for chest pain?
1. context (exertional, postprandial, positional) 2. associated symptoms (sweating, nausea, dyspnea, palpitations, sense of doom) 3. cardiac risk factors (hypertension, hyperlipidemia, smoking, FHx) 4. Hx of heart dx or diagnostic testing 5. prior hx of similar symptoms 6. PE risk factors (hx of DVT, coagulopathy, malignancy, recent immobilization)
135
What are the top 8 key PE items for chest pain?
1. vitals (including BP in both arms) 2. heart auscultation 3. JVD 4. PMI and chest wall tenderness 5. peripheral pulses 6. edema 7. pulmonary exam 8. abdominal exam
136
top 5 ddx: ``` 60 yo M presents with sudden onset of substernal heavy chest pain that has lasted for 30 minutes and radiates to the left arm. The pain is accompanied by dyspnea, diaphoresis, and nausea. He has a history of hypertension, hyperlipidemia, and smoking. ```
1. Myocardial infarction (MI) 2. GERD 3. angina 4. costochondritis 5. aortic dissection
137
top 5 workup: ``` 60 yo M presents with sudden onset of substernal heavy chest pain that has lasted for 30 minutes and radiates to the left arm. The pain is accompanied by dyspnea, diaphoresis, and nausea. He has a history of hypertension, hyperlipidemia, and smoking. ```
1. ECG 2. CPK-MD and Troponins I and T 3. CXR 4. CBC w/ electrolytes 5. echocardiography/cardiac cath
138
top 5 ddx: ``` 20 yo African-American F presents with acute onset of severe chest pain. She has a history of sickle cell disease and multiple previous hospitalizations for pain and anemia management. ```
1. sickle cell - pulmonary infarction 2. pneumonia 3. PE 4. MI 5. pneumothorax
139
top 5 workup: ``` 20 yo African-American F presents with acute onset of severe chest pain. She has a history of sickle cell disease and multiple previous hospitalizations for pain and anemia management. ```
1. CBC w/ retics, LDH and peripheral smear 2. ABG 3. CXR 4. CPK-MD and troponins I and T 5. ECG
140
top 5 ddx: 45 yo F presents with a retrosternal burning sensation that occurs after heavy meals and when lying down. Her symptoms are relieved by antacids.
1. GERD 2. esophagitis 3. peptic ulcer disease 4. esophageal spasm 5. MI
141
top 5 workup: 45 yo F presents with a retrosternal burning sensation that occurs after heavy meals and when lying down. Her symptoms are relieved by antacids.
1. ECG 2. barium swallow 3. upper endoscopy 4. esophageal pH monitoring 5. urea breath test
142
top 3 ddx: 55 yo M presents with retrosternal squeezing pain that lasts for two minutes and occurs with exercise. It is relieved by rest and is not related to food intake.
1. stable angina 2. esophageal spasm 3. esophagitis
143
top 5 workup: 55 yo M presents with retrosternal squeezing pain that lasts for two minutes and occurs with exercise. It is relieved by rest and is not related to food intake.
1. ECG 2. CPK-MB and troponins 3. CXR 4. CXR 5. echocardiography
144
top 5 ddx: ``` 34 yo F presents with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI one week ago. ```
1. pericarditis 2. aortic dissection 3. MI 4. costochondritis 5. GERD
145
top 4 workup: ``` 34 yo F presents with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI one week ago. ```
1. ECG 2. CPK-MB and troponins 3. CXR 4. CBC
146
top 5 ddx: 34 yo F presents with stabbing chest pain that worsens with deep inspiration and is relieved by aspirin. She had a URI one week ago. Chest wall tenderness is noted.
1. costochondritis 2. pneumonia 3. MI 4. PE 5. pericarditis
147
top 5 workup: 34 yo F presents with stabbing chest pain that worsens with deep inspiration and is relieved by aspirin. She had a URI one week ago. Chest wall tenderness is noted.
1. ECG 2. CPK-MB 3. CXR 4. CBC
148
top 5 ddx: ``` 70 yo F presents with acute onset of shortness of breath at rest and pleuritic chest pain. She also presents with tachycardia, hypotension, tachypnea, and mild fever. She is recovering from hip replacement surgery. ```
1. PE 2. pneumonia 3. costochondritis 4. MI 5. CHF
149
top 6 workup: ``` 70 yo F presents with acute onset of shortness of breath at rest and pleuritic chest pain. She also presents with tachycardia, hypotension, tachypnea, and mild fever. She is recovering from hip replacement surgery. ```
1. ECG 2. CXR 3. ABG 4. CPK-MB and troponins 5. CBC and electrolytes 6. CTPA vs D-dimer
150
top 5 ddx: 55 yo M presents with sudden onset of severe chest pain that radiates to the back. He has a history of uncontrolled hypertension.
1. aortic dissection 2. MI 3. pericarditis 4. esophageal rupture 5. esophageal spasm
151
top 5 workup: 55 yo M presents with sudden onset of severe chest pain that radiates to the back. He has a history of uncontrolled hypertension.
1. ECG, CPK-MB and tropoonins 2. CXR 3. CBC, amylase and lipase 4. TEE 5. MRI/MRA - aorta
152
What are the top 6 unique Hx items for palpitations?
1. gradual vs acute onset/offset 2. context (exertion, caffeine, anxiety) 3. associated Sxs (lightheadedness, chest pain, dyspnea) 4. hyperthyroid Sxs 5. Hx of bleeding or anemia 6. Hx of heart disease
153
What are the 5 key PE items for palpitations?
1. vitals/general (tremor) 2. endocrine/thyroid exam 3. HEENT (look for exopthalmos, lid lag, lid retraction, gland size) 4. check for carotid bruits 5. CV exam
154
top 5 ddx: 70 yo diabetic M presents with episodes of palpitations and diaphoresis. He is on insulin.
1. hypoglycemia 2. cardiac arrhythmia 3. angina 4. hyperthyroidism 5. hyperventilation
155
top 5 workup: 70 yo diabetic M presents with episodes of palpitations and diaphoresis. He is on insulin.
1. glucose 2. CBC & electrolytes 3. TSH 4. BUN/Cr 5. ECG/Holter
156
What are the top 10 unique Hx items for weight loss?
1. amount of weight loss 2. how long since first started 3. diet hx 4. psych stuff (body image, anxiety, depression) 5. B Sxs (fever, chills, night sweats) 6. palpitations/tremors 7. GI issues (diarrhea, n/v) 8. FHx of thyroid dx or cancers (big ones: breast, prostate, lung, colon) 9. HIV risk factors 10. EtOH and drug use
157
What PE items should be done for weight loss, minus except MAYBE neuro?
1. vitals | 2. all the rest (everything)
158
top 5 ddx: 42 yo F presents with a 7-kg weight loss over the past two months. She has a fine tremor, and her pulse is 112.
1. hyperthyroidism 2. cancer (carcinoid, pheo) 3. HIV infection 4. exogenous causes (drug use, surreptitious thyroxine use) 5. anorexia nervosa (w/ possible concominant drug use for weight loss)
159
top 5 workup: 42 yo F presents with a 7-kg weight loss over the past two months. She has a fine tremor, and her pulse is 112.
1. TSH w/ FT3 and FT4 2. CBC and electrolytes 3. HIV ELISA 4. urine toxicology 5. urinary/serum free metanephrines/ serum 5-HIAA
160
What are the top 7 unique Hx items for weight gain?
1. amount of weight gain 2. since when 3. associated setting (recent medication changes, smoking changes, depression, other big life changes) 4. diet history 5. hypothyroid Sxs (fatigue, cold intolerance, weight distribution, skin/hair/nail changes, moon face, purple striae) 6. menstrual irregularities 7. GI issues (constipation) 8. EtOH or drug use (marijuana)
161
What PE items should be completed for weight gain, except MAYBE neuro?
1. vitals 2. everything else, with particular emphasis on signs of cushing's (hypertension, central obesity, moon face, buffalo hump, supraclavicular fat pads, purple abdominal striae)
162
top 5 ddx: ``` 44 yo F presents with a weight gain of > 11 kg over the past two months. She quit smoking three months ago and is on amitriptyline for depression. She also reports cold intolerance and constipation. ```
1. smoking cessation 2. dug side effect 3. hypothyroidism 4. cushing's syndrome 5. PCOS
163
top 5 workup: ``` 44 yo F presents with a weight gain of > 11 kg over the past two months. She quit smoking three months ago and is on amitriptyline for depression. She also reports cold intolerance and constipation. ```
1. CBC w/ electrolytes 2. serum glucose 3. TSH 4. 24 hour urinary free cortisol 5. dexamethasone suppression test
164
Top 5 unique Hx items for dysphagia?
1. solids vs liquids vs both (progressive) 2. Associated constitutional Sxs (weight loss, fever) 3. Drooling, regurgitation or pain 4. Hxs of: GERD, HIV/HIV risk factors, smoking or Raynaud's 5. Meds or recent med changes
165
Top 6 key PE items for dysphagia?
1. vitals 2. Head and neck 3. Heart 4. Pulmonary 5. Abdominal 6. Skin (looking for signs of scleroderma/CREST)
166
top 5 ddx: 75 yo M presents with dysphagia that started with solids and progressed to liquids. He is an alcoholic and a heavy smoker. He has had an unintentional weight loss of 7 kg over the past four months.
1. esophageal cancer 2. achalasia 3. esophagitis 4. systemic sclerosis 5. esophageal stricture
167
top 5 workup: ``` 75 yo M presents with dysphagia that started with solids and progressed to liquids. He is an alcoholic and a heavy smoker. He has had an unintentional weight loss of 7 kg over the past four months. ```
1. CBC 2. CXR 3. endoscopy w/ biopsy 4. barium swallow 5. CT - chest
168
top 5 ddx: 45 yo F presents with dysphagia for two weeks together with fatigue and a craving for ice and clay
1. Plummer-vinson syndrome 2. esophageal cancer 3. esophagitis 4. achalasia 5. systemic sclerosis
169
top 4 workup: 45 yo F presents with dysphagia for two weeks together with fatigue and a craving for ice and clay
1. CBC 2. Iron studies: serum iron, ferritin, TIBC 3. barium swallow 4. endoscopy
170
top 5 ddx: ``` 48 yo F presents with dysphagia for both solid and liquid foods that has slowly progressed in severity over the past year. It is associated with regurgitation of undigested food, especially at night. ```
1. achalasia 2. plummer-vinson 3. esophageal cancer 4. esophagitis 5. systemic sclerosis
171
top 4 workup: ``` 48 yo F presents with dysphagia for both solid and liquid foods that has slowly progressed in severity over the past year. It is associated with regurgitation of undigested food, especially at night. ```
1. CXR 2. endoscopy 3. barium swallow 4. esophageal manometry
172
top 5 ddx: 38 yo M presents with dysphagia and pain on swallowing solids more than liquids. Exam reveals oral thrush.
1. esophagitis (CMV, HSV, pill-induced, candida) 2. systemic sclerosis 3. GERD 4. esophageal stricture 5. zenker's diverticulum
173
top 5 unique Hx items for n/v?
1. abdominal pain 2. relation to meals 3. any sick contacts 4. pregnancy features/hx 5. neuro Sxs (headache, stiff neck, vertigo, focal numbness)
174
top 5 key PE items for n/v?
1. vitals 2. ENT 3. fundoscopic (for ICP) 4. complete abdominal exam 5. +/- heart, lung, rectal
175
top 5 ddx: ``` 20 yo F presents with nausea, vomiting (especially in the morning), fatigue, and polyuria. Her last menstrual period was six weeks ago, and her breasts are full and tender. She is sexually active with her boyfriend, and they use condoms for contraception. ```
1. pregnancy 2. gastritis 3. hypercalcemia 4. diabetes mellitus 5. UTI
176
top 5 workup: ``` 20 yo F presents with nausea, vomiting (especially in the morning), fatigue, and polyuria. Her last menstrual period was six weeks ago, and her breasts are full and tender. She is sexually active with her boyfriend, and they use condoms for contraception. ```
1. urine hCG 2. pelvic exam 3. U/S - pelvis 4. standard labs: CBC, electrolytes, Ca, glucose 5. UA & UCx
177
top 5 unique Hx items for abdominal pain?
1. relation to meals 2. associated Sxs: constitutional, GI, cardiac, pulmonary, renal, pelvic 3. Hx of: abdominal surgery, gallstones, renal stones, vascular dx 4. EtOH and drug use 5. domestic violence
178
top 5 key PE items for abdominal pain?
1. vitals 2. heart 3. pulmonary 4. abdominal, including: guarding, rebound, Murphy's, CVA palpation 5. (rectal) 6. (pelvic)
179
top 4 ddx: ``` 45 yo M presents with sudden onset of colicky right-sided fl ank pain that radiates to the testicles, accompanied by nausea, vomiting, hematuria, and CVA tenderness. ```
1. nephrolithiasis 2. renal cell carcinoma 3. pyelonephritis 4. GI etiology (appendicitis)
180
top 5 workup: ``` 45 yo M presents with sudden onset of colicky right-sided fl ank pain that radiates to the testicles, accompanied by nausea, vomiting, hematuria, and CVA tenderness. ```
1. rectal 2. UA 3. UCx and sensitivity 4. BUN/Cr 5. CT - abdomen
181
top 5 ddx: ``` 60 yo M presents with dull epigastric pain that radiates to the back, together with weight loss, dark urine, and clay-colored stool. He is a heavy drinker and smoker. ```
1. pancreatic cancer 2. acute viral hepatitis 3. chronic pancreatitis 4. cholecystitis/ choledocholithiasis 5. abdominal aortic aneurysm
182
top 5 workup: ``` 60 yo M presents with dull epigastric pain that radiates to the back, together with weight loss, dark urine, and clay-colored stool. He is a heavy drinker and smoker. ```
1. rectal 2. CBC and electrolytes 3. amylase and lipase 4. LFTs (AST/ALT/bilirubin/alk phos) 5. U/S - abdomen
183
top 5 ddx: ``` 56 yo M presents with severe midepigastric abdominal pain that radiates to the back and improves when he leans forward. He also reports anorexia, nausea, and vomiting. He is an alcoholic and has spent the past three days binge drinking. ```
1. acute pancreatitis 2. peptic ulcer disease 3. cholecystits/choledoco 4. gastritis 5. AAA
184
top 5 workup: ``` 56 yo M presents with severe midepigastric abdominal pain that radiates to the back and improves when he leans forward. He also reports anorexia, nausea, and vomiting. He is an alcoholic and has spent the past three days binge drinking. ```
1. rectal 2. CBC w/ electrolytes 3. BUN/Cr 4. LFTs (AST/ALT/bilirubin/alk phos) 5. U/S - abdomen
185
top 5 ddx: ``` 41 yo obese F presents with RUQ abdominal pain that radiates to the right scapula and is associated with nausea, vomiting, and a fever of 101.5°F. The pain started after she had eaten fatty food. She has had similar but less intense episodes that lasted a few hours. Exam reveals positive Murphy’s sign. ```
1. acute cholecystitis 2. hepatitis 3. choledocolithiasis 4. ascending cholangitis 5. peptic ulcer dx
186
top 5 workup: ``` 41 yo obese F presents with RUQ abdominal pain that radiates to the right scapula and is associated with nausea, vomiting, and a fever of 101.5°F. The pain started after she had eaten fatty food. She has had similar but less intense episodes that lasted a few hours. Exam reveals positive Murphy’s sign. ```
1. rectal 2. CBC 3. LFTs (AST/ALT/bili/AP) 4. U/S abdomen 5. HIPA scan
187
top 5 ddx: 43 yo obese F presents with RUQ abdominal pain, fever, and jaundice. She was diagnosed with asymptomatic gallstones one year ago.
1. ascending cholangitis 2. acute cholecystitis 3. hepatitis 4. choledocolithiasis 5. sclerosing cholangitis
188
top 5 workup: 43 yo obese F presents with RUQ abdominal pain, fever, and jaundice. She was diagnosed with asymptomatic gallstones one year ago.
1. rectal 2. CBC 3. LFTs 4. viral hepatitis serologies 5. U/S - abdomen
189
top 5 ddx: 25 yo M presents with RUQ pain, fever, anorexia, nausea, and vomiting. He has dark urine and clay-colored stool.
1. acute hepatitis 2. acute cholecystitis 3. ascending cholangitis 4. choledocolithiasis 5. pancreatitis
190
top 5 workup: 25 yo M presents with RUQ pain, fever, anorexia, nausea, and vomiting. He has dark urine and clay-colored stool.
1. rectal 2. CBC 3. amlyase and lipase 4. LFTs 5. viral hepatitis serologies
191
top 5 ddx: ``` 21 yo F presents with acute onset of severe RLQ pain, nausea, and vomiting. She has no fever, urinary symptoms, or vaginal bleeding and has never taken OCPs. Her last menstrual period was regular, and she has no history of STDs. ```
1. ovarian torsion 2. appendicitis 3. nephrolithiasis 4. ectopic pregnancy 5. ruptured ovarian cyst
192
top 5 workup: ``` 21 yo F presents with acute onset of severe RLQ pain, nausea, and vomiting. She has no fever, urinary symptoms, or vaginal bleeding and has never taken OCPs. Her last menstrual period was regular, and she has no history of STDs. ```
1. pelvic exam 2. urine hCG 3. rectal 4. U/S - pelvis w/ color flow 5. UA
193
top 5 ddx: 68 yo M presents with LLQ abdominal pain, fever, and chills for the past three days. He also reports recent onset of alternating diarrhea and constipation. He consumes a low-fi ber, high-fat diet.
1. diverticulitis 2. crohn's dx 3. UC 4. gastroenteritis 5. abscess
194
top 5 workup: 68 yo M presents with LLQ abdominal pain, fever, and chills for the past three days. He also reports recent onset of alternating diarrhea and constipation. He consumes a low-fi ber, high-fat diet.
1. rectal 2. CBC w/ electrolytes 3. CXR 4. AbdXR 5. CT - abdomen
195
top 5 ddx: ``` 20 yo M presents with severe RLQ abdominal pain, nausea, and vomiting. His discomfort started yesterday as a vague pain around the umbilicus. As the pain worsened, it became sharp and migrated to the RLQ. McBurney’s and psoas signs are positive. ```
1. acute appendicitis 2. gastroenteritis 3. diverticulitis 4. crohn's dx
196
top 5 workup: ``` 20 yo M presents with severe RLQ abdominal pain, nausea, and vomiting. His discomfort started yesterday as a vague pain around the umbilicus. As the pain worsened, it became sharp and migrated to the RLQ. McBurney’s and psoas signs are positive. ```
1. rectal 2. CBC w/ electrolytes 3. AbdXR 4. CT - abdomen 5. U/S - abdomen
197
top 5 ddx: ``` 30 yo F presents with periumbilical pain for six months. The pain never awakens her from sleep. It is relieved by defecation and worsens when she is upset. She has alternating constipation and diarrhea but no nausea, vomiting, weight loss, or anorexia. ```
1. IBS 2. crohn's dx 3. celiac dx 4. chronic pancreatitis 5. GI parasitic infection
198
top 5 workup: ``` 30 yo F presents with periumbilical pain for six months. The pain never awakens her from sleep. It is relieved by defecation and worsens when she is upset. She has alternating constipation and diarrhea but no nausea, vomiting, weight loss, or anorexia. ```
1. rectal 2. stool OBT 3. pelvic 4. urine hCG 5. CBC w/ electrolytes
199
top 5 ddx: ``` 24 yo F presents with bilateral lower abdominal pain that started with the first day of her menstrual period. The pain is associated with fever and a thick, greenish-yellow vaginal discharge. She has had unprotected sex with multiple sexual partners. ```
1. PID 2. endometriosis 3. STD/vaginitis 4. cystitis 5. spontaneous abortion
200
top 5 workup: ``` 24 yo F presents with bilateral lower abdominal pain that started with the fi rst day of her menstrual period. The pain is associated with fever and a thick, greenish-yellow vaginal discharge. She has had unprotected sex with multiple sexual partners. ```
1. pelvic 2. rectal 3. urine hCG 4. cervical Cxs 5. CBC/ESR/UA/UCx
201
What are the top 10 unique Hx items for constipation/diarrhea?
1. frequency and volume of stools 2. associated Sxs (constitutional, abdominal pain, bloating, incomplete evacuation) 3. stool color change (melena/Fe overload) or frank blood 4. thyroid dx Sxs 5. diet (esp. fiber and fluid intake) 6. recent med changes (esp. antibiotics) 7. sick contacts 8. recent travel (esp. camping) 9. HIV risk factors 10. FHx of CC
202
What are the top 5 PE items for constipation/diarrhea?
1. vitals 2. thyroid/endocrine exam 3. abdominal exam 4. rectal exam 5. pelvic exam (if female)

Step 2 CS (3 decks)

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