PD1 Block 2 materials Flashcards by isabelle courtney

Patient complains of RLQ pain, frequent Diarrhea, & crampy pain:

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: Crohn’s disease

Differentials:
1. UC
2. Carcinoid tumor
3. Colorectal cancer

Tests:
Colon biopsy
Colonoscopy
Guaiac stool test

Rx:
Steroids & immunosuppressants
Surgery (if not effective)

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Patient complains of LLQ pain & frequent diarrhea that is sometimes bloody:

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: Ulcerative colitis

Differentials:
1. Crohn’s
2. Carcinoid syndrome
3. Colorectal cancer

Tests:
Colon biopsy
Colonoscopy
Guaiac stool test

Rx:
NSAIDS, Antibiotics, & Immunosuppressants

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Patient complains of Abdominal pain, bouts of diarrhea & constipation, change in bowel habits, inability to empty the bowels, nausea, flatulence, & an urgent need to defecate:

What is your diagnosis?

What are your differentials?

What is the treatment?

Diagnosis: Irritable Bowel Syndrome (usually young women)

Differentials:
1. Ulcerative colitis
2. Crohn’s
3. Carcinoid syndrome
4. Colorectal cancer

Rx:
High fiber diet, reduce stress, & antidiarrheals

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Patient complains of Crampy abdominal pain that comes & goes, Loss of appetite, & Constipation:

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: Bowel obstruction (adhesions from inflammation or poor cleaning post surgery)

Differentials:
1. Intussception
2. Hirschsprung disease
3. IBS

Tests:
Abdominal CT

Rx:
Remove obstruction & any ischemic/necrotic bowel

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Patient complains of Abdominal pain, stomach cramps, nausea/vomiting, gagging, indigestion, fever, chills, malaise/sweating, dehydration, dizziness, headache & weakness:

What is your diagnosis?

What are your differentials?

What is the treatment?

Diagnosis: Food poisoning

Differentials:
1. Flu
2. Norovirus
3. Rotavirus
3. Adenovirus

Rx: It should resolve on its own

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Patient complains of Abdominal pain, Watery diarrhea, vomiting, stomach cramps, excessive flatulence, & weight loss:

What is your diagnosis?

What are your differentials?

What is the treatment?

Diagnosis: Rotavirus

Differentials:
1. Food poisoning
2. Norovirus
3. Adenovirus

Rx:
Fluid replacement if it’s needed, otherwise it should resolve on its own in 3-7 days

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Patient complains of Swollen legs (edema) & belly (ascites), yellow skin/eyes (jaundice), red palms if it’s a man they will also complain of easy bruising, abnormal bleeding, impotence, shrunken testes, & enlarged breasts (gynecomastia):

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis:
Alcoholic Liver Disease (history of alcohol abuse)

Differentials:
1. Non-alcoholic Fatty Liver Disease
2. Hep A,B,C
3. Fatty liver Disease

Tests:
Liver enzyme panel/liver function test

Rx: Stop drinking (long term!)

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Patient complains of Abdominal pain, feeling of fullness in the right upper abdomen, nausea, loss of appetite/weight loss, yellow skin/eyes (jaundice), swollen legs (edema) & belly (ascites), extreme tiredness/mental confusion, & weakness:

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: Fatty liver disease

Differentials:
1. Alcoholic liver disease
2. Non-alcoholic liver disease
3. Hep A, B, C

Tests:
Liver enzyme panel/function test
Serum cholesterol & blood work

Rx: Change in diet, exercise, & weight loss

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Patient complains of Belching, heart burn, nausea, regurgitation, bitter taste in the mouth, discomfort in the upper abdomen, dry cough, & difficulty swallowing:

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: GERD

Differentials:
1. Esophageal cancer
2. MS
3. Stroke
4. Plummer-Vinson syndrome

Tests:
Blood work (iron levels)
Esophageal endoscopy

Rx:
Antacids, Proton pump inhibitors (Omeprazole), & H2 inhibitors (Cimetidine)

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Patient complains of Severe iron deficiency, spooning nails (koilonychia), post cricoid dysphagia, upper esophageal webs, pallor, difficulty breathing, dyspnea, weakness, & tachycardia:

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: Plummer Vinson syndrome

Differentials:
1. Esophageal cancer
2. GERD

Tests:
Blood work (iron levels)
Esophageal endoscopy

Rx:
Iron supplements & mechanical dilation

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Patient complains of fever, fatigue, loss of appetite, nausea/vomiting, abdominal pain, dark urine, clay-colored bowel poop:

What is your diagnosis?

What are your differentials?

Diagnostic: Hep B

Differentials:
1. Fatty Liver Disease
2. Alcoholic Liver Disease
3. Hep C

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Patient complains of loss of appetite, tired/weakness, fever, itchy skin, yellow skin/eye (jaundice), bloated belly, swollen legs (edema), & pain in the right upper abdomen:

What is your diagnosis?

What are your differentials?

What is the treatment?

Diagnosis: Metastatic cancer to the liver

Differentials:
1. Hep A,B,C
2. Infects
3. Fatty liver disease

Rx:
Surgical resection, Ablation (heat to kill the tumor), & a hepatic artery infusion (delivers chemo to the liver directly)

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Patient complains of thick white discharge, vaginal itching/inflammation, pain during sex/urination:

What is your diagnosis?

What are your differentials?

What is the treatment?

Diagnosis: Yeast infection

Differentials:
1. Bacterial vaginosis
2. Genital herpes
3. Allergic reaction
4. Trichomoniasis
5. Gonorrhea

Rx: Fluconazole

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Patient complains of abnormal discharge that’s thick/or/thin frothy & yellow/green discharge with a fishy smell and swelling & itching around the vagina

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: Trichomoniasis (STI)

Differential:
1. Gonorrhea
2. Chlamydia
3. Bacterial vaginosis

Rx: Both partners take a single dose of metronidazole

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Patient complains of pain when peeing, urine frequency & urgency, blood in the urine (hematuria), lower abdominal pain:

What is your diagnosis?

What are your differentials?

What is the treatment?

Diagnosis: UTI OR pyelonephritis

Differentials:
1. Pelvic inflammatory disorder
2. Cholecystitis
3. Appendicitis
4. Bladder cancer

Rx: Fluoroquinolone

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Patient complains of Pain when peeing, urinary frequency & urgency, having a hard time starting & stopping urine stream, dribbling urine, & nocturia:

What is your diagnosis?

What are your differentials?

What is the treatment?

Diagnosis: BPH

Differentials:
1. Pyelonephritis
2. Bladder cancer
3. Appendicitis

Rx. Tamsulosin

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Patient complains of dull pain or no pain in the testes, testes feel like a bag of worms & are not light translucent, testes might be different sizes & swollen, & the sperm count will be low:

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: Varicocele

Differentials:
1. Hydrocele
2. Testicular cancer

Tests:
Sperm count
Light translucency

Rx:
If there’s symptoms NSAIDS & surgery
If there’s no symptoms it should resolve on its own

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Patient complains of swollen testes with or without discomfort or painless swelling of one or both testes:

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: Hydrocele

Differentials:
1. Varicocele
2. Testicular cancer

Tests:
Light translucency
Sperm count

Rx:
Monitor it as it should go away on its own

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Patient complains of a red & swollen mass/or/bump in the umbilical region:

What is your diagnosis?

What are your differentials?

What is the treatment?

Diagnosis: Sister Mary Joseph nodule (malignant & metastatic umbilical nodule)

Differentials:
1. Hernia
2. Abdominal cancer
3. Trauma

Rx: Palliative surgery, mild chemo, & giving the best supportive care possible

Patient complains of clammy/sweaty skin, dizziness, fainting, tachycardia, nausea/vomiting, shortness of breath, & sudden severe pain in the belly/lower back/legs (note its a pulsatile abdominal mass)

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: Abdominal aortic aneurysm

Differentials:
1. Umbilical hernia
2. SMJ nodule
3. Abdominal cancer

Test:
Abdominal CT

Rx:
Stent & surgery
Stop smoking (if they do)
Exercise & diet management

Patient complains of abnormal penis discharge that can be white/yellow/or green in color, a burning feeling when peeing, & inflamed/swollen fore skin or tender testes:

What is your diagnosis?

What are your differentials?

What is the treatment?

Diagnosis: Gonorrhea

Differentials:
1. Trichomonas
2. Chlamydia

Rx: Ceftriaxone

Patient complains of pain when peeing or ejaculating, urine frequency, thin white discharge, & a sore/swollen head/fore skin:

What is your diagnosis?

What are your differentials?

What is the treatment?

Diagnosis: Trichomoniasis

Differentials:
1. Gonorrhea
2. Chlamydia

Rx: Metronidazole

Patient complains of urine incontinence, a missed period, tender/swollen breasts, nausea/vomiting, fatigue, & urine frequency:

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: pregnancy

Differentials:
1. Pyelonephritis
2. STD
3. Overactive bladder syndrome
4. Menopause

Tests:
pregnancy test

Rx:
Kegel exercises & Pessary (inserted into the vaginal to support the urethra)

Patient complains of Urine incontinence, irregular periods, vaginal dryness, hot flashes & chills, weight gain, night sweats, & sleep issues:

What is your diagnosis?

What are your differentials?

What is the diagnostic test

What is the treatment?

Diagnosis: Menopause

Differentials:
1. Pregnancy
2. Pyelonephritis
3. STD
4. Overactive bladder

Test:
pregnancy test

Rx:
Hormone therapy & diet supplementation

The Breast cyst .Mastolgia

fluid-filled sacs inside the breast that are usually benign, that can be one or multiple. A smooth, easily movable round or oval lump that may have smooth edges (benign) ● Nipple discharge (clear, yellow, straw colored or dark brown) ● Breast pain or tenderness ● An increase lump size and breast tenderness just before your period ● Better after your period

The Breast cyst .Mastolgia

Patient complains of abdominal pain in the upper-right region, tenderness in the right region of the abdomen, nausea and vomiting, swelling of the abdomen, fever, persistent itching, jaundice, indicated by yellow eyes and skin, brown urine.: What is your diagnosis? What are your differentials? What is the diagnostic test What is the treatment?

Diagnosis: Splenomegaly caused by liver cirrhosis Differential Diagnosis: Infection, Cystic Fibrosis, juvenile rheumatoid arthritis Treatment: surgery to remove your spleen (splenectomy)

PT has Abdo mass in Left Flank: PT has Abdo mass in Left Flank

Diagnosis: Renal cell Carcinoma Diff: Cyst, renal infection, kidney stone Tests: -urine sample - blood work (WBC) -X-ray -CT -Biopsy -ultrasound Tx: Surgery, radiation, palliative of terminal

Pt complains of a scrotal mass: Painless palpable mass in the testes Scrotum feels heavy Pain in scrotum Dull ache in groin Lower back pain Breast tenderness

Differentials: Traumatic injury and varicocele Tests: - Digital exam - Ultrasound - Blood work - Tumor markers - Increase in serotonin Tx: surgical removal of a testicle, chemo Diagnosis: Seminoma

Pt complains of menorrhagia Cc: Pain during sex Abdo pain Pain while using the toilet Bloody discharge Pain in the lower back

Differentials: Polyps or fibrinoid in the uterus, ovarian cyst, cervical trauma Tests: - Pap smear - Ultrasound - Endometrium biopsy - Digital vaginal exam Tx: hysterectomy, chemo, and radiation Diagnosis: Uterine cancer

Pt complains of Jaundice Cc: The skin and sclera have yellow hue Excessive drinker Fever fatigue Nausea and vomit Right Upper Quad pain

Differentials: Viral hep and gallstone Tests: -Blood work-AST ALT Bilirubin Ammonina - Ct scan - liver biopsy Tx: Abstinence from alcohol, nutritional support, vitamin K, and routine checkups Diagnosis: Alcoholic Hep

Pt complains of constipation Cc: Abdo pain, fatigue, weight gain, poor appetite, cold

Differentials: Intestinal obstruction, drug induced- anticholinergics Tests: -Thyroid function - Ultrasound -barium enema -colonoscopy Tx: L-thyoxine, replacement of follow up monitoring routinely Diagnosis: Hypothyroidism

Pt complains of Right lower Quadrant pain Cc: Severe sharp, Knife pain, pain radiates to Mc Burney’s point/ umbilicus Rebound tenderness is present, as fever, and nausea.

Differentials: PID, ectopic pregnancy Tests: -blood work- Wbc and Hcg -pelvic exam and swab -urine analysis -ultrasound -ct of abdo Tx: Appendectomy then pain management and supportive care. Diagnosis: Acute Appendicitis

Pt complains of abdo Left Lower Quadrant pain Cc: N/V/F, Abdo tenderness, constipation, chills

Differentials: Ovarian cysts, colon obstruction Tests: - Blood work – WBC, CT, - Ultrasound - colonoscopy Tx: diet changes, antibiotics pain management with drugs Diagnosis: Diverticulitis

Pt complains of foul diarrhea Cc: Abdo pain and cramping, weight loss, lethargy, F/N, dehydrated

Differentials: E. coli, un’s, Ulcerative colitis Tests: -Vitals -blood tests -wbc -colonoscopy -fecal sample Tx: Vancomycin and Probiotics Diagnosis: C.Dliff

Pt complains of Abdo Mass in Left upper Quad Cc: Thin stool with Blood, Abdo pain and cramp, OTC drugs do not relieve pain, weight loss, Fatigue

Differentials: Splenomegaly, Splenic cyst Tests: -Blood work-cbc -fecal -occult blood test -ultrasound -colonoscopy with biopsy Tx: Surgical resection, chemoradiation Diagnosis: Cholelithiasis/ gallstones

Pt complains of abdo Right Upper quad pain Cc: Intense pain that radiates to back, pain in the right shoulder, nausea and vomiting, loss of appetite, and jaundice.

Differentials: Alcoholic or viral hepatitis, hepatic flexure obstruction Tests: - Bloodwork WBC - Liver function - Ultrasound biopsy Tx: cholecystostomy drug- Ursodiol Diagnosis: Cholelithiasis/ gallstones

Pt comes in with wight loss over month Cc: Pain epigastric Jaundice Radiating Pain in the lower back

Differentials: stomach cancer, necrotic pancreatitis, Tests: increased amylase, lipase, alkaline phosphatase, CA 19-9, and carcinoembryonic antigen (CEA). Tx: surgical removal, pancreaticoduodenectomy or distal pancreatectomy is preferred to a total pancreatectomy to preserve some of the pancreatic function Diagnosis: pancreatic adenocarcinoma

Pt comes in presents with vague upper abdominal discomfort Cc: nausea, and early satiety. daily NSAID user. pale on examination anemic. mild abdominal tenderness melanotic stool

Differentials: H. Pylori, food poisoning Tests: Blood count CBC GI endoscopy H. Pylori test Tx: Blood transfusion Colonoscopy Diagnosis: Dyspepsia and Peptic Ulcer Disease

Pt several-year history of abdominal pain and constipation. denies any fever, weight loss, heartburn, or bloody stools

Differentials: Crohns, Colorectal cancer, Celiacs Tests: Blood count CBC Hemoccult test Initial screening Tx: High fiber diet, reduce stress, Diagnosis: Irritable Bowel syndrome

Pt come in 4 months of history and daily burning sensation epigastric pain. Get worst after eating and lying down and improves with PPI use. Symptoms of reactive airway disease and hoarseness.

Tests: Endoscopy Barium esophagogram Tx: H2 blockers, PPI, lifestyle changes, diet changes, surgical GE fundoplication Diagnosis: GERD can lead to Barrett esophagus and lead to esophageal adenocarcinoma

Pt young comes in after Binge drinking with N/V. Abdo pain radiating to back Cc: fever, leukocytosis, hemoconcentration

Diagnosis: Acute Pancreatitis can lead to pulmonary and cardiac and renal dysfunction

Pt comes with asymptomatic abdo mass. Non tender mass with prominent aortic pulsation. Femoral pulse and popliteal pulse appear more prominent that usual

Test: Angio, ultrasound. Diagnosis: Abdominal Aortic aneurysm

-old person presents to your office for a routine checkup. He reports having occasional bloody stools and you discover guaiac-positive stools. He is a bit pale, but hemodynamically stable at the moment. You decide that further evaluation of this bleeding is necessary, but most of it can be carried out on an outpatient basis with close follow-up

Most likely diagnosis: Hemorrhoids. Next diagnostic step: Complete blood count (CBC) and colonoscopy. Next step in therapy: Discontinue NSAID use and decrease alcohol consumption. Diagnosis: Lower Gastrointestinal Bleeding

old woman with chronic kidney disease (CKD). She has a history of uncontrolled diabetes and currently has uncontrolled hypertension. She presents with periorbital edema, long-standing lower extremity edema, an S4 and displaced PMI, and central obesity. The urinalysis shows hyaline casts, 3+ proteinuria and glucose, negative ketones, and hemoglobin 10.9 g/dL with an MCV of 82.3 g/dL.

Most likely diagnosis: Acute worsening of chronic kidney disease Next diagnostic step: Measurement of serum electrolytes, blood urea nitrogen (BUN), and creatinine; imaging of the kidneys Next step in therapy: Further history to identify and remove any offending agents (such as nonsteroidal anti-inflammatory drugs [NSAIDs]), and control of blood pressure and diabetes; may require dialysis if she develops complications such as pulmonary edema, severe hyperkalemia, or anuria. Diagnosis: CKD

28-year-old woman presents for evaluation of irregular menstrual cycles for the past year. She is obese and noted to have gained 30 lb. She is found to be hirsute and to have acanthosis nigricans. Her pelvic examination is normal.

Most likely diagnosis: Anovulatory menstrual cycles secondary to polycystic ovarian syndrome (PCOS) ➤ Initial laboratory test: Pregnancy test ➤ Treatment to regulate cycle: Oral contraceptive pills Diagnosis: Menstrual Cycle Irregularity

A 25-year-old woman presents with a foul-smelling vaginal discharge. She has a greenish, frothy discharge and a “strawberry cervix” noted on examination.

➤ Organism most likely to cause this infection: Trichomonas vaginalis ➤ Expected microscopic examination findings: Motile, flagellated trichomonads, and many white blood cells. ➤ Recommended treatment: Metronidazole 2 g by mouth in a single dose for both the patient and her sexual partner. Metronidazole 500 mg twice a day for a week is an alternate regimen. Diagnosis: Vaginitis