study

Question 1

What should you do when you first enter the room?

Answer 1

1. Confirm that it is the patient
2. introduce yourself
3. Remove the clip board off the seat
4. Drape the patient

Question 2

How should you start the conversation with the patient?

Answer 2

Open ended question like, what brought you in today?

Question 3

What pneumonic should you use to gather information?

Answer 3

FORDPAPP

frequency, onset, relieving factors, duration, precipitating factors, associated symptoms, past episodes, progression

Question 4

What is the differential for a patient complaining of HA?

Answer 4

Migraine, tension, cluster, psuedotumor cerebri, giant cell arteritis, intracranial neoplasm, sinusitis, subarachnoid hemorrhage, trigeminal neuralgia

Question 5

What is the workup for a patient with HA?

Answer 5

CBC, ESR, CT of head, MRI of brain, LP for CSF analysis

Question 6

Patient presents with frontal HA, fever, and nasal discharge. There is pain on palpation of the frontal and maxillary sinuses. History of allergies. What is the differential?

Answer 6

Sinusitis
migraine 
tension HA
meningitis
Intracranial neoplasm

Question 7

What is the workup for a patient suspected of sinusitis?

Answer 7

CBC, XR or CT of sinusis

Question 8

Patient presents daily pain in the right cheek for the past month. The pain is electric and stabbing in nature and occurs while the patient is shaving. Pain last for 2-4min. What is the differential diagnosis?

Answer 8

Trigeminal neuralgia
tension HA
migraine
cluster HA
TMJ disorder
Intracranial neoplasm

Question 9

What is the workup for a patient with trigemial neuralgia?

Answer 9

CBC, ESR, MRI of brain

Question 10

Patient presents with sudden severe HA, vomiting, confusion, left hemiplegia, and nuchal rigidity. What is the differential?

Answer 10

Subarachnoid hemorrhage
migraine
meningitis
intracranial hemorrage
vetebral artery dissection
acute HTN
Intracranial neoplasm

Question 11

What is the workup for a patient with subarachnoid hemorrhage?

Answer 11

Noncontrast CT of head, LP, CBC, PT/PTT/INR, urine toxicology

Question 12

Patient presents with high fever, severe HA, confusion, photophobia, and nuchal rigidity. What is the differential?

Answer 12

Meningitis
Migraine
Subarachnoid hemorrhage
sinusitis
intracranial abscess

Question 13

What is the workup for a patient with meningitis?

Answer 13

LP, CBC, CT head

Question 14

Young patient presents with pulsatile HA, vomiting and blurred vision for the past 2-3 wks. She is also taking OCPs. What is the differential?

Answer 14

Pseudotumor cerebri
TensionHA
Migraine
Cluster HA
Meningitis

Question 15

What is the workup for a patient suspected of pseudotumor cerebri?

Answer 15

CBC, LP for opening pressure, CT of head, urine for hCG

Question 16

Patient presents with severe right temporal HA associated with ipsilateral rhinorrhea, eye tearing, and redness. What is the differential?

Answer 16

Cluster HA
Tension HA
Migraine HA
Intracranial neoplasm

Question 17

Patient presents with progressive confusion for the past several years accompanied by forgetfullness and clumsiness. History of HTN, diabetes and 2 strokes. Mental status has worsened after each stroke. What is the differential diagnosis?

Answer 17

Vascular dementia
Alzheimer disease
Normal pressure hydrocephalus
Intracranial neoplasm
B12 deficiency
Hypothyroidism

Question 18

What is the workup for a patient suspected of dementia?

Answer 18

CBC, serum B12, TSH, MRI of brain, CT of head

Question 19

Patient presents with forgetfullness and difficulty performing some of her daily activities. Problem has progressed gradually of the past years. What is the differential diagnosis?

Answer 19

Alzheimers
vascular dementia
Depression
Hypothyroidism
Chronic subdural hematoma

Question 20

Patient presents memory loss, gait disturbance, and urinary incontinence for the past 6 months. What is the differential diagnosis?

Answer 20

Normal pressure hydrocephalus
Alzheimers disease
Vascular dementia
Chronic subdural hematoma
Intracranial neoplasm

Question 21

Patient presents with a rapid progressive change in mental status, inability to concentrate and memory impairment for the past 2 months. Symptoms associated with myoclunus, ataxia, and a startle response. What is the differential?

Answer 21

Creutzfeldt-Jakob disease
Vascular dementia
Lewy body dementia
Wernicke’s encehalopathy

Question 22

Insulin dependent patient presents with confusion, dizziness, palpitations, diaphoresis and weakness. What is the differential?

Answer 22

Hypoglycemia
TIA
Arrhythmia
Delerium
Angina

Question 23

Patient presents with gradual altered mental status and headache. 2 wks ago they slipped hit their head on the ground and lost consciousness for 2 minutes. What is the differential?

Answer 23

Subdural hematoma
SIADH
Intracranial neoplasm

Question 24

Patient presents with acute loss of vision in his left eye, palipitations, and shortness of breath. History of A.Fib and cataracts in his right eye. No eye pain, discharge, redness, or photophobia. No headache, weakness or numbness. What is the differential?

Answer 24

Retinal artery occlusion
Retinal vein occlusion
Acute angle closure glaucoma

Question 25

What is the workup for a patient with retinal artery occlusion?

Answer 25

Fluorescein angiogram Echo Doppler of carotids CBC

Question 26

Patient presents with 2 month history of crying spells, excessive sleep, poor hygiene and a 15lb weight loss following the death of his wife. What is the diffential?

Answer 26

Normal bearevement Major Depression Adjustment disorder with depressed mood

Question 27

What is the workup for a person with mental health issues?

Answer 27

Physical exam, CBC, TSH, urine toxicology, beck depression inventory

Question 28

Patient presents with a 6lb weight loss in the past 2 months, accompanied by early morning awakening, excessive guilt, and psychomotor retardation. Reports several wks of increased energy, sexual promiscuity, irresponsible spending and racing thoughts 6 months ago. What is the differential?

Answer 28

Bipolar 1 disorder Bipolar 2 disorder Cyclothymic disorder

Question 29

Patient presents with complaints of receiving messages from his television, having no friends in high school, rarely showers and thinks his friends buged his phone. What is the differential?

Answer 29

Schizophrenia Schizoid or Schizotypal Schizophreniform disorder

Question 30

Patient presents with intermittent episodes of vertigo, tinnitus, nausea, and hearing loss within the past week. What is the differential diagnosis?

Answer 30

Menieres disease Vestibular neuronitis Labyrinthitis Benign positional vertigo

Question 31

What is the workup for a patient with dizziness?

Answer 31

CBC, VDRL/RPR, MRI of brain, Dix-Hallpike maneuver

Question 32

Patient presents with dizziness for the past day. Patient feels faint and has severe diarrhea that started 2 days ago. Patient takes furosemide for hypertension. What is the differential diagnosis?

Answer 32

Orthostatic hypotension due to dehydration Vestibular neuronitis Labyrinthitis Benign Positional Vertigo

Question 33

Patient presents with postural dizziness and unsteadiness. Patient has HTN and was started on hydrochlorothiazide 2days ago. What is the differential diagnosis?

Answer 33

Drug induced orthostatic hyopotension Vestibular neuronitis Labyrinthitis Benign positional vertigo

Question 34

Patient presents with dizziness on moving their head to the left. Patient feels the room is spinning around their head. Tilt test results in nystagmus and nausea. What is the differential?

Answer 34

Benign positional vertigo Vestibular neuronitis Labyrinthitis Meniere disease

Question 35

Patient presents with dizziness that started this morning. Patient is nauseated and has vomitied once. Patient had a URI 2 days ago and has experienced no hearing loss. What is the differential diagnosis?

Answer 35

Vestibular neuronitis Labyrinthitis Menieres disease Benign positional vertigo

Question 36

Patient presents with dizziness that started this morning and not hearing well. Patient feels nauseated and has vomitied once. Patient had a UTI 2 days ago. What is the differential?

Answer 36

Labyrinthitis Vestibular neuronitis Menieres disease Acoustic neuroma

Question 37

Patient presents after falling and losing consciousness at work. They had rhythmic movements of the limbs, bit their tongue and lost control of their bladder. Subsequently they was confused after regaining consciousness. What is the differential?

Answer 37

``` Tonic clonic seizure convulsive syncope substance abuse malingering hypoglycemia ```

Question 38

Patient complains of feeling dizzy and unsteady and experiencing transient loss of consciousness. Past medical history includes HTN and diabetes. What is the differential?

Answer 38

``` Drug induced orthostatic hypotension hypoglycemia cardiac arrhythmia syncope stroke MI PE ```

Question 39

Patient presents after falling and losing consciousness for a few seconds. There was no warning but there were palpitations. History of coronary artery bypass graft. What is the differential?

Answer 39

``` Cardiac arrhythmia aortic stenosis syncope seizure PE ```

Question 40

Patient presents with slurred speech, right facial drooping and numbness and right hand weakness. Babinski's sign is present on the right. History of HTN, diabetes and heavy smoking. What is the differential?

Answer 40

``` Stroke TIA Seizure Intracranial neoplasm Subdural or epidural hematoma ```

Question 41

Patient presents with ascending loss of strength in the lower legs over the past 2 weeks. History of recent URI. What is the differential?

Answer 41

Guillian-Barre syndrome Multiple sclerosis Polymyositis Myasthenia Gravis