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Minicases Flashcards

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1
Q

Headache key history

A

OPQRSTAA neuro sx N/V jaw claudication trauma dental sinusitis pmh/fhx

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2
Q

headache PEx

A

vitals HEENT fundoscopic neuro

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3
Q
A
  • migraine (complicated)
  • tension
  • cluster
  • pseudotumor cerebri
  • CNS vaxulitis
  • partial seizure
  • intracanial neoplasm
  • CBC
  • ESR
  • CT-head
  • MRI-brain
  • LP-CSF analysis
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4
Q
A
  • cluster
  • migraine
  • tension
  • intracranial tumor
  • pseudotumor cerebri

​​

  • CBC
  • CT-head
  • MRI-brain
  • LP-CSF
  • ESR
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5
Q
A
  • temporal arteritis
  • migraine
  • cluster
  • tension
  • meningitis
  • carotic artery dissection
  • pseudotumor cerebri
  • trigeminal neuraglia
  • intracranial neoplasm
  • TMJ
  • ESR
  • CBC
  • CRP
  • temporal artery biopsy
  • Doppler US-carotids
  • MRI-brain
  • LP-CSF
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6
Q
A
  • sinusitis
  • migraine
  • tension
  • meningitis
  • IC tumor​
  • CBC
  • XR-sinus
  • CT-sinus
  • LP-CSF
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7
Q
A
  • tension
  • migraine
  • depression
  • caffeine or analgesi withdrawal
  • HTN
  • cluster
  • pseudotumor cerebri
  • IC tumor

​​

  • CBC
  • electrolytes
  • ESR
  • CT-head
  • LP-CSF analysis
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8
Q
A
  • subarachnoid hemorrhage
  • migraine
  • meningitis/encephalitis
  • IC hemorrhage
  • Vertebral artery dissection
  • IC venous thrombosis
  • acute HTN
  • IC tumor
  • noncontrast CT-head
  • LP-CSF
  • CBC
  • PT/PTT/INT
  • Urine toxicology
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9
Q
A
  • meningitis
  • migraine
  • SAH
  • sinusitis/encephalitis
  • IC or epidural abscess

​​

  • CBC
  • CT-head
  • MRI-brain
  • LP-CSF
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10
Q
A
  • pseudotumor cerebri
  • tension
  • migraine
  • cluster
  • meningitis
  • IC venous thrombosis
  • IC tumor
  • Urine BhCG
  • CBC
  • CT-head
  • LP-opening pressure and CSF analysis
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11
Q
A
  • trigeminal neuralgia
  • tension
  • migraine
  • cluster
  • TMJ
  • IC tumor
  • CBC
  • ESR
  • MRI-brain
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12
Q

confusion/memory loss key history

A
  • must include hx from family members/caregivers when available
  • time course
  • assoc sx
  • delirium
  • falls
  • meds
  • hx stroke
  • hx ASCVD, spyhilis, HIV, EtOH, B12 def
  • FHX
  • other neuro dz
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13
Q

confusion/memory loss PEx

A
  • vitals
  • neuro
  • MMSE
  • gait
  • general
    • ENT
    • Heart
    • Lungs
    • ABD
    • Ext
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14
Q
A
  • vascular dementia
  • alzheimer dz
  • NPH
  • chronic SHD
  • IC tumor
  • depression
  • B12 def
  • neurosyphilis
  • hypoTHY
  • CBC
  • VDRL/RPR
  • SerumB12
  • TSH
  • MRI-brain
  • CT-head
  • LP-CSF
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15
Q
A
  • alzheimer’s dz
  • vascular dementia
  • depression
  • hypoTHY
  • cSDH
  • NPH
  • IC tumor
  • B12 def
  • Neurosyphilis
  • CBC
  • VDRL/RPR
  • sB12
  • TSH
  • MRI-brain
  • CT-head
  • LP-CSF
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16
Q
A
  • NPH
  • Alz dz
  • vascular dementia
  • cSDH
  • IC tumor
  • Depression
  • B12 def
  • neurosyphilis
  • hypoTHY
  • CT-head
  • BRI-brain
  • LP-opening P and CSF
  • sB12
  • VDRL/RPR
  • TSH
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17
Q
A
  • CJD
  • vascular
  • lewy body dementia
  • Wernicke’s encephalopathy
  • NPH
  • cSDH
  • IC tumor
  • depression
  • delirium
  • B12 def
  • neurosyphilis
  • CBC
  • electrolyties, calcium
  • sB12
  • BDRL/RPR
  • MRI-brain (preferred)
  • CT-head
  • EEG
  • LP-CSF
  • brain biopsy
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18
Q
A
  • hypoglycemia
  • TIA
  • arrhythmia
  • delirium
  • angina
  • glucose
  • CBC
  • electrolyties
  • CPK-MB, troponin
  • ECHO
  • ECG
  • MRI-brain
  • Doppler US-carotid
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19
Q
A
  • SDH
  • SIADH
  • CJD
  • IC tumor
  • CT-head
  • CBC
  • electrolytes
  • MRI-brain
  • LP-CSF
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20
Q

loss of vision key history

A
  • acute/chronic
  • progression
  • ability to see light
  • assoc sx
    • eye pain, discharge, itching, tearing, photophobia, redness, HA, weakness, numbness, floaters, sparks
  • hx cardiac/rheum/thromb/ai/neuro dz
  • jaw claudication
  • rx
  • trauma
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21
Q

loss of vision PEx

A
  • vitals
  • CV
  • HEENT
  • fundoscopic
  • neuro
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22
Q
A
  • retinal artery occlusion
  • retinal vein occlusion
  • acute angle-closure glaucoma
  • retinal detachment
  • temporal arteritis
  • fluorescein angiogram
  • ECHO
  • doppler US-carotids
  • intraocular tonometry
  • ESR
  • temporal artery biopsy
  • CBC
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23
Q

depressed mood key history

A
  • onset
  • duration
  • Sleep
  • Interest change
  • Guilt
  • Energy level change
  • Concentration change
  • Appetite change
  • Psychomotor agitation or retardation
  • Suicidal ideation
  • life stress
  • social function
  • excessive etoh /drug use
  • fhx
  • prior epidosdes
  • Rx
    *
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24
Q

depressed mood PEx

A
  • vitals
  • head/neck
  • neuro
  • MSE
    • appearance
    • behavior
    • speech
    • mood
    • affect
    • thought process
    • thought content
    • cognition (30pt MMSE)
    • insight
    • judgment
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25
* Normal bereavement * djustement disorder with depressed mood * MDD with psychotic featuers * schizoaffective disorder * depressive disorder not otherwise specified * PEx * TSH * CBC * Utox * Beck Depression Inventory
26
* MDD * substance-induced mood disorder * dysthymic disorder * PEx * MSE * Beck Depression Inventory * blood EtOH level * TSH * CBC * Utox
27
* bipolar I disorder * bipolar II disorder * cyclothymic disorder * MDD * schizoaffective disorder * PEx * MSE * Utox
28
* schizophrenia * schizoid or schizotypal personality disorder * schizophreniform disorder * psychotic disorder due to genearl medical condition * subtance-induced psychosis * depression with psychotic features * MSE * Utox * TSH * CBC * electrolytes
29
psychosis key history
* positive sx * delusions, hallucinations, disorganized thoughts, disorganized catatonic behavior * negative sx * blunted affect, social w/d, dec motivation, dec speech/thought poverty/blocking * cognitive sx * disorganized speech, paranoia * age first sx * hospitalizations * hx psych meds * alcohol and drug use
30
psychosis key PEx
* vitals * MSE * general appearance
31
* substance-induced psychosis * brief psychotic disorder * schizophreniform disorder * schizophrenia * psychotic disorder to general medication condition * Utox * MSE * TSH * CBC * electrolytes, BUN/Cr * AST/ALT
32
* schizoaffective disorder * mood disorder with psychotic features * schizophrenia * schizophreniform disorder * psychotic disorder from gen med condition * MSE * PHQ9 * TSH * CBC * electrolytes
33
dizziness key history
* lightheadedness vs. vertigo * auditory sx * tinnitus, hearing loss * duration * context * occurs with positioning, following head trauma * assoc sx * visual changes, URI, nausea * neck pain * trauma * meds * hx ASCVD
34
dizziness key PEx
* vitals * neuro * Romberg * gait * nystagmus * tilt test (Dix-Hallpike maneuver) * hearing * Weber and Rinne * ENT * CV
35
* Meniere's disease * vestibular neuronitis * labyrinthitis * BPPV * acoustic neuroma * CBC * VDRL/RPR (syphilis is a cause of Meniere dz) * MRI-brain * Dix-Hallpike maneuver
36
* orthostatic hypotension due to dehydration (diarrhea, diuretic use) * vesituvar neuronitis * labyrinthitis * BPPV * vertebrobasilar insufficiency * orthostatic vital signs * CBC * electrolytes * rectal exam, stool for occult blood * stool leukocytes
37
* drug-induced orthostatic hypotension * vesitbular neuronitis * labyrinthitis * BPPV * brain stem or cerebellar tumor * ARF * orthostatic vitals * CBC * electrolytes * ECHO * MRI-brain
38
* BPPV * vestibular neuronitis * labyrinthitis * Meniere's dz * Dix-Hallpike maneuver * MRI-brian * audiogram
39
* vestibular neuronitis * labyrinthitis * Meniere's dz * BPPV * vertigo associated with cervical spine dz or injury * vertebrobasilar insufficiency * CBC * electrolytes * electronystagmography * MRI/MRA-brain
40
* labyrinthitis * vestibular neuronitis * Meniere's dz * acoustic neuroma * vertebrobasilar insufficiency * audiogram * electronystagmography * MRI/MRA-brain
41
loss of consciousness key history
* prodrome * nausea, diaphoresis, palpitations, pallor, lightheadedness * context * exertional, postural, traumatic, stressful/painful, claustrophobic, dehydration * tongue biting/incontinence/tonic/clonic movements/prolonged confusion * SOB/PE risk factors * hx heart disease, arrhyth, HTN, DM * drug and alcohol use
42
loss of consciousness key PEx
* vitals * orthostatic vitals * neuro * carotid and CV exam * Resp * LE
43
* GTC seizure * convulsive episode * substance abuse/OD * malingering * hypoglycemia * CBC * electrolytes, glucose * Utox * EEG * MRI-brain * CT-head * LP-CSF * ECG
44
* drug-induced orthostatic hypotension (causing syncope) * hypoglycemia * cardiac arrhythmia * syncope (vasovagal, other) * stroke * MI * PE * orthostatic vitals * CBC * electrolytes, glucose * ECHO * Ct-head * ECG * V/Q scan * CTA-chest w/ IV contrast * D-dimer
45
* cardiac arrhythmia (causing syncope) * severe aortic stenosis * syncope (other causes) * seizures * PE * ECG * holter monitor * CBC * electrolytes, glucose * ECHO * CT-head
46
numbness and tingling key history
* distribution * unilaterlal, bilateral, prox/distal * duration * progression * pain * esp. HA, neck, back pain * constitutional sx * other neuro sx * hx DM, EtOH, ASCVD
47
numbness and tingling key PEx
* vitals * neuro * MSK * relevant vascular exam
48
* TIA * hypoglycemia * seizures * stroke * facial nerve palsy * CT-head * CBC * electrolytes, glucose * fasting lipid panel * ECG * MRI-brain * Doppler US-carotid * ECHO * EEG
49
* stroke * TIA * seizure * IC tumor * SDH/EDH * CT-head * CBC * electrolytes * PT/PTT/INF * fasting lipid panel * MRI-brain * Doppler US-carotid * ECHO * ECG
50
* GBS * MS * polymyositis * MG * peripheral neuropathy * tumor of vertebral canal * CBC * electrolytes * CPK * LP-CSF * MRI-spine * EMG * nerve conduction studies * Tensilon (edrophonium) test * sB12
51
* MS * stroke * conversion disorder * malingering * CNS tumor * neurosyphilis * syringomyelia * CNS vasculitis * CBC * ESR * BDRL/RPR * MRI-brain, spine * LP-CSF and oligoclonal bands * retinal evoked potentials
52
* diabetic peripheral neuropathy * alcoholic peripheral neuropathy * B12 def * hypocalcemia * hyperventilation * paraproteinemia/myeloma * HbA1c * ESR * calcium * sB12 * UA * SPEP and UPEP
53
* MG * Horner's syndrome * MS * IC tumor compressing CN II, IV, VI * amyotrophic lateral sclerosis * Tensilon (edrophonium) test * serum anti-AChR antibodies * CXR * CT-chest * MRI-brain * EMG
54
* Todd's paralysis * TIA * stroke * complicated migraine * malingering * CBC * electrolytes * EEG * MRI-brain * Doppler US-carotid
55
* carpal tunnel 2/2 hypothyroidism * overuse injury of median nerve * medial epicondylitis * Phalen's maneuver * Tinel's sign * nerve conduction studies * TSH * CBC
56
fatigue and sleepiness key history
* duration * sleep hygiene * snoring, witnessed apnea, waking up choking/gasping * overexertion * stress, depression, emotional problems * lifestyles changes, shift changes * diet, weight changes * sx other * thyroid, bleeding, anemia * meds * alcohol * drugs * caffeine
57
fatigue and sleepiness key PEx
* vitals * ENT * conjunctival pallor, oropharynx/palate, lymphadenopathy, thyroid) * CV * pulm * ABD * neuro * LE * consider rectal exam and occult blood testing
58
* depression * adjustment disorder * hypothyroidism * anemia * CBC * TSH * HIV/STD testing * PHQ9
59
* PTSD * depression * GAD * psychotic or delusional disorder * hypoTHY * CBC * TSH * Utox * PHQ9
60
* colon cancer * hypothyroidism * renal failure * hypercalcemia * depression * rectal exam, stool for occult blood * CBC * electrolytes, BUN/Cr, calcium * AST/ALT * TSH * colonoscopy * barium enema * CT-abd/pelvis
61
* hypothyroidism * depression * diabetes * anemia * TSH, fT4, fT3 * CBC * fasting glucose * HBA1c
62
* OSA * hypothyroidism * chronic fatigue syndrome * narcolepsy * CBC * TSH * nocturnal pulse ox * polysomnography * ECG
63
* diabetes mellitus * atypical depression * primary polydipsia * diabetes insipidus * GTT * HbA1c * UA * CBC * electrolytes, BUN/Cr, glucose
64
* shift work sleep disorder * sleep apnea * depression * anemia * CBC * nocturnal pulse ox * polysomnography
65
night sweats key history
* OPQRSTAA * assoc dz or sx * fever, recent URI, assoc cough, hemoptysis, pleuritic chest pain * lymphadenopathy * rash * malaise * wt loss * itching * diarrhea * n/v * early satiety * presence of sig RF * traveling to areas with endemic infections IVDU * Hx alcohol * sexual exposures * sick contacts * exposure to high-risk populations such as prisoners/homeless * menstrual history/menopausal status * travel history
66
night sweats key PEx
* vitals * HEENT * throat, LNs * CV * pulm * abd * hepatosplenomegaly * skin * MSK * joint pain
67
* tuberculosis * acute HIV infection * lymphoma * leukemia * hyperthyroidism * PPD/Quantiferon gold * CBC * CXR * sputum gram stain, acid-fast stain, cx * HIV antibody * TSH, fT4
68
* hyperthyroidism * pheochromocytoma * carcinoid syndrome * TB * TSH, fT4, fT3 * 24-h urine catecholamines * urine 5-HIAA * CBC * PPD
69
insomnia key history
* primary/secondary * description * daytime sleepiness * other med problems * arthritis (pain) * diabetes (polyuria) * common sleep disorder (sleep apnea, RLS) * nightmares, depression * caffeine, alcohol, drugs, meds * work or lifestyles (jet lag or shift work) * stressors * sleep hygiene * psychiatric sx (mania sx)
70
insomnia key PEx
* vitals * thyroid * MSE
71
* stress-induced insomnia * caffeine-induced insomnia * insomnia with circadian rhythm sleep disorder * insomnia related to MDD * polysomnography * MSE * utox * CBC * TSH
72
* OSA * daytime fatigue in primary hypersomnia * insomnia with circadian rhythm sleep disorder * insomnia related to MDD * CBC * TSH * polysomnography * ECG
73
* insomnia related to MDD * primary hypersomnia * insomnia with circadian rhythm disorder * MSE * TSH * CBC * polysomnography
74
sore throat key history
* duration * fever * other ENT * odynophagia * swollen glands * cough * rash * sick contacts * HIV RF
75
sore throat key PEx
* vitals * HEENT * oral thrush * tonsillar exudate * lymphadenopathy * pulm * abd * splenomegaly * skin
76
* infectious mononucleosis * hepatitis * viral/bacterial pharyngitis * acute HIV infection * secondary syphilis * CBC w/ peripheral smear * monospot test * throat cx * AST/ALT/bili/ALP * HIV ab and viral load * anti-EBV ab * VDRL/RPR
77
* HIV, acute retroviral syndrome * infectious mononucleosis * hepatitis * viral pharyngitis * strep tonsillitis/scarlet fever * secondary syphilis * CBC with peripheral smear * HIV antibody and viral load * CD4 count * monospot test * VDRL/RPR * AST/ALT/bili/ALP
78
* pharyngitis (bact or viral) * mycoplasma PNA * acute HIV if * infectious mononucleosis * throat swab for cx and rapid strep antigen * CBC * monospot test * serologic test (cold agglutinin titer) for mycoplasma * HIV antibody and viral load
79
cough/dyspnea key history
* acute/chronic * freq, timing * sputum/hemoptysis * assoc sx * constitutional, URI, post nasal drip, dyspnea, eheez, chest pain, heartburn * exac/allevi * exposures * smoking? * hx lung disease * posttussive emesis * heart failure * allergies * meds * ACEi
80
cough/shortness of breath key PEx
* vitals * pulse ox * HEENT * nasal mucosa, oropharynx * LNs * pulm * CV * ABD * ext * clubbing, cyanosis, edema
81
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