Workups for Common Complaints Flashcards
(26 cards)
Migraine
Hx: throbbing, temporal pain 2-3 hrs; flashes of light and weakness before onset; nausea and vomiting
Ddx: tension, cluster, pseudotumor, CNS vasculitis
Workup: CBC, ESR, CT, MRI, LP
Cluster Headache
Hx: ipsilateral, rhinorrhea, eye tearing, redness, same time every night, last for 45 min
Ddx: migraine, tension, intracranial neoplasm
Workup: CBC, CT, MRI, LP, ESR
Temporal Arteritis
Hx: intermittent, temporal, fever, blurred vision, pain in jaw
Ddx: migraine, cluster, tension, meningitis, carotid artery dissection, pseudotumor
Workup: ESR, CRP, CBC, Temporal artery biopsy, Doppler of carotids, MRI, LP
Sinusitis
Hx: headache, fever, nasal discharge, pain on palpation of sinuses
Ddx: migraine, tension, meningitis, intracranial neoplasm
Workup: CBC, XR of sinuses, CT of sinuses, LP
Tension Headache
Hx: bilateral squeezing, 3-4x/week, towards end of work day, associated stress, decreased caffeine
Ddx: migraine, depression, caffeine w/drawal, hypertension, cluster
Workup: CBC, lytes, ESR, CT, LP
Subarachnoid hemorrhage
Hx: sudden onset of severe headache + vomiting, confusion, L hemiplegia, nuchal rigidity
Ddx: migraine, meninigitis, encephalitis, intracranial hemorrhage, vertebral artery dissection, venous thromobosis
Workup: non-con CT, LP, CBC, PT/PTT/INR, Urine toxicology
Meningitis
Hx: high fever, confusion, photophobia, nuchal rigidity
Ddx: migraine, subarachnoid hemorrhage, sinusitis, abscess
Workup: CBC, CT, MRI, LP
Pseudotumor
Hx: pulsatile, vomiting, blurred vision for 2-3 weeks, OCPs
Ddx: tension, migraine, cluster, meningitis, neoplasm
Workup: hCG, CBC, CT, LP for opening pressure
Trigeminal neuralgia
Hx: daily pain in right cheek for month, stabbing, occurs while shaving, episodes last 2-4 minutes
Ddx: tension, migraine, cluster, TMJ, intracranial neoplasm
Workup: CBC, ESR, MRI
Vascular Dementia
Hx: past several years, hx of HTN, diabetes, stroke history with worsening
Ddx: Alzheimers, NPH, chronic subdural, neoplasm, depression, B12
Workup: CBC, VDLR/RPR, Serum B12, TSH, MRI, CT, LP
Alzheimer’s
Hx: forgetfullness (phone numbers, directions), difficulty performing daily activities (bathing, dressing, managing money, using phone), gradual
Ddx: Vascular, depression, hypothyroid, chronic subdural
Workup: CBC, VDRL/RPR, Serum B12, TSH, MRI, CT, LP
Normal Pressure Hydrocephalus
Hx: gait disturbance, urinary incontinence
Ddx: Alzheimer’s, vascular demention, chronic subdural hematoma, depression
Workup: CT, MRI, LP opening pressure, Serum B12, VDRL/RPR, TSH
Creutzfeldt-Jakob
Hx: rapidly progressive change and memory impairment in past 2 months, myoclonus, ataxia, startle response
Ddx: vascular, lewy body, wernicke’s, NPH
Workup: CBC, electrolytes, calcium, serum B12, VDLR/RPR, MRI, EEG, LP, Brain biopsy
Hypoglycemia
Hx: insulin-dep diabetes, episodes of confusion, dizziness, palpitations, diaphoresis
Ddx: TIA, arrhythmia, delirium, angina
Workup: Glucose, CBC, lytes, CPK-MB, troponin, ECG, Echo, MRI, Doppler U/S
Subdural Hematoma
Hx: gradual AMS, slipped two weeks ago and hit head and lost consciousness for 2 min
Ddx: SIADH –> hyponatremia, Creutzfeld-Jakob, intracranial neoplasm
Workup: CT, CBC, electrolytes, MRI, LP
Retinal Artery Occlusion
Hx: sudden loss of vision, palpitations and SOB, hx of afib, no pain, discharge, no headache
Ddx: retinal vein occlusion, acute angle-closure glaucoma, retinal detatchment, temporal arteritis
Workup: fluoresceine angiogram, echo, doppler of carotids, intraocular tonometry, ESR, CBC
Normal bereavement
Hx. 2 month hx of crying, excessive sleep, weight loss, poor hygiene, sees dead wife
Ddx: adjustment disorder, MDD, Schizoaffective
Workup: physical, TSH, CBC, Utox, Beck Depression Inventory
MDD
Hx. month of excessive fatigue, insomnia, anhedonia, preoccupation with death, similar episodes, suicide attempts
Ddx: Substance-induced mood disorder, dysthymic disorder
Workup: physical, mental status, Beck’s inventory, Blood alcohol level, TSH, CBC, UTox
Menieres
Hx: intermittent episodes of vertigo, tinnitus, hearing loss, nausea within past week
Ddx: vestibular neuronitis, labrinthitis, benign position vertigo, acoustic neuroma
Workup: CBC, VDRL/RPR, MRI, Dix Hallpike
Orthostatic Hypotension
Hx. severe diarrhea, furosemide, dizziness for past day
Ddx: vestibular neuronitis, labyrinthitis, BPV, vertebrobasilar insufficiency
Workup: Orthostatics, CBC, Rectal exam with guaiac, stool electrolytes, lytes
Benign Position Vertigo
Hx. dizziness with moving head to left; room spinning around head; tilt test with nystagmus and nausea
Ddx: vestibular neuronitis, labyrinthitis, Menieres
Workup: Dix-hallpike, MRI, audiogram
Labyrinthitis
Hx. dizziness starting this morning and hx of not hearing well, n/v, URI two days ago
Ddx: vestibular neuronitis, Menieres, acoustic neuroma, vertebrobasilar insufficiency
Workup: audiogram, electronystagmography, MRI/MRA
Arrhythmia (causing syncope)
Hx. No warning before passing out; recent palpitations
Ddx: severe aortic stenosis, syncope, seizure, PE
Workup: ECG, holter monitor, CBC, electrolytes (glucose), Echo, CT
Stroke
Hx. slurred speech, right facial droop, right weakness, Babinsky, hx of htn, diabetes, heavy smoking
Ddx: TIA, seizure, intracranial neoplasm, subdural/epidural hematoma
Workup: CT, CBC, electrolytes, PT/PTT/INR, fasting lipid, MRI, Doppler, Echo, ECG
