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PD1 Block 2 materials Flashcards

1
Q

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?

A

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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2
Q

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?

A

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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3
Q

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?

A

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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4
Q

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?

A

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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5
Q

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?

A

Diagnosis: Food poisoning

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

Rx: It should resolve on its own

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6
Q

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?

A

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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7
Q

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?

A

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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8
Q

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?

A

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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9
Q

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?

A

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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10
Q

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?

A

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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11
Q

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?

A

Diagnostic: Hep B

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

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12
Q

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?

A

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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13
Q

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?

A

Diagnosis: Yeast infection

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

Rx: Fluconazole

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14
Q

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?

A

Diagnosis: Trichomoniasis (STI)

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

Rx: Both partners take a single dose of metronidazole

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15
Q

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?

A

Diagnosis: UTI OR pyelonephritis

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

Rx: Fluoroquinolone

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16
Q

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?

A

Diagnosis: BPH

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

Rx. Tamsulosin

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17
Q

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?

A

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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18
Q

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?

A

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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19
Q

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?

A

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

20
Q

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?

A

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

21
Q

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?

A

Diagnosis: Gonorrhea

Differentials:
1. Trichomonas
2. Chlamydia

Rx: Ceftriaxone

22
Q

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?

A

Diagnosis: Trichomoniasis

Differentials:
1. Gonorrhea
2. Chlamydia

Rx: Metronidazole

23
Q

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?

A

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)

24
Q

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?

A

Diagnosis: Menopause

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

Test:
pregnancy test

Rx:
Hormone therapy & diet supplementation

25
Q

The Breast cyst .Mastolgia

A

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

26
Q

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

A

The Breast cyst .Mastolgia

27
Q

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?

A

Diagnosis: Splenomegaly caused by liver cirrhosis

Differential Diagnosis: Infection, Cystic Fibrosis, juvenile rheumatoid
arthritis

Treatment: surgery to remove your spleen (splenectomy)

28
Q

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

A

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

29
Q

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

A

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

30
Q

Pt complains of menorrhagia

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

A

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

31
Q

Pt complains of Jaundice

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

A

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

32
Q

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

A

Differentials: Intestinal obstruction, drug induced- anticholinergics

Tests:
-Thyroid function
- Ultrasound
-barium enema
-colonoscopy

Tx:
L-thyoxine, replacement of follow up monitoring routinely

Diagnosis:
Hypothyroidism

33
Q

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.

A

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

34
Q

Pt complains of abdo Left Lower Quadrant pain

Cc: N/V/F, Abdo tenderness, constipation, chills

A

Differentials:
Ovarian cysts, colon obstruction

Tests:
- Blood work – WBC, CT,
- Ultrasound
- colonoscopy

Tx: diet changes, antibiotics pain management with drugs

Diagnosis:
Diverticulitis

35
Q

Pt complains of foul diarrhea

Cc: Abdo pain and cramping, weight loss, lethargy, F/N, dehydrated

A

Differentials: E. coli, un’s, Ulcerative colitis

Tests:
-Vitals
-blood tests -wbc
-colonoscopy
-fecal sample

Tx: Vancomycin and Probiotics

Diagnosis:
C.Dliff

36
Q

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

A

Differentials: Splenomegaly, Splenic cyst

Tests:
-Blood work-cbc
-fecal
-occult blood test
-ultrasound
-colonoscopy with biopsy

Tx: Surgical resection, chemoradiation

Diagnosis:
Cholelithiasis/ gallstones

37
Q

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.

A

Differentials:
Alcoholic or viral hepatitis, hepatic flexure obstruction

Tests:
- Bloodwork WBC
- Liver function
- Ultrasound biopsy

Tx: cholecystostomy drug- Ursodiol

Diagnosis:
Cholelithiasis/ gallstones

38
Q

Pt comes in with wight loss over month

Cc:
Pain epigastric
Jaundice
Radiating Pain in the lower back

A

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

39
Q

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

A

Differentials: H. Pylori, food poisoning

Tests:
Blood count CBC
GI endoscopy
H. Pylori test

Tx:
Blood transfusion
Colonoscopy

Diagnosis:
Dyspepsia and Peptic Ulcer Disease

40
Q

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

A

Differentials:
Crohns, Colorectal cancer, Celiacs

Tests:
Blood count CBC
Hemoccult test
Initial screening

Tx: High fiber diet, reduce stress,

Diagnosis:
Irritable Bowel syndrome

41
Q

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.

A

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

42
Q

Pt young comes in after Binge drinking with N/V. Abdo pain radiating to back

Cc: fever, leukocytosis, hemoconcentration

A

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

43
Q

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

A

Test: Angio, ultrasound.

Diagnosis: Abdominal Aortic aneurysm

44
Q

-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

A

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

45
Q

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.

A

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

46
Q

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.

A

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

47
Q

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.

A

➤ 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

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