1 Upload Step 2 CS Flashcards
1
Q
Abdominal pain, nausea, vomiting
A
fundoscopic, neuro sx, ENT
2
Q
RUQ pain
A
Gallbladder, liver (fitz-hugh curtis), gastric, subhepatic appendicitis
3
Q
Concern for gall stones
A
MRCP, ERCP
4
Q
Acute hepatitis
A
RUQ pain, fever, anorexia, n/v, dark urine, clay colored stool
5
Q
Acute glomerulonephritis
A
facial edema, dark urine, decreased urine, pulmonary edema, HTN
6
Q
Abdominal pain after eating
A
GERD, chronic pancreatitis, mesenteric ischemia
7
Q
If fever
A
BCx
8
Q
Any abdominal pain
A
Get LFTs, consider lactate
9
Q
LUQ pain
A
splenic rupture/infarct, renal stone, PNA, perfed PUD, rib fx
10
Q
Abdominal pain with h/o abd surgery
A
SBO, ileus, hernia, volvulus, bowel CA
11
Q
Bloody stool
A
Mesenteric ischemia, PUD, diverticulitis, fissure, angiodysplasia, IBD
12
Q
Lower quadrent Pain
A
Anatomic: Appendicitis (RLQ), diverticulitis, nephrolithiasis, bowel perforation
Infectious: UTI, gastroenteritis
GYN: ovarian torsion, PID, cyst rupture, ectopic pregnancy, SAB, endometriosis
CV: Bowel infarct
Immune: IBD, celiac
13
Q
Woman with lower abdominal pain
A
Pelvic, Chlamydia, Gonorrhea, VDRL/RPR
14
Q
Periumbilical Abdominal Pain
A
Celiac, IBS, IBD, chronic pancreatitis, endometriosis, GI parasitic infection
15
Q
Plan
A
Other exams, labs, imaging
16
Q
Pelvic pain in female plan
A
Get US pelvis
17
Q
Flank pain and hematuria ddx
A
renal stone, RCC (flank mass)
18
Q
Abdominal pain in older patient with CV risk factors
A
AAA, mesenteric ischemia
19
Q
Suspect Abuse
A
Establish confidential, h/o accidents/injuries, direct questions - physical, sexual, emotional; safety, plan, fear, firearms, mental illness, SA
20
Q
Woman with recurrent injury
A
DV, SA, consensual violent sexual activity, OI. Get Utox, skeletal survey
21
Q
Plan for rape victim
A
Forensic exam, pelvic, hCG, wet mount, KOH prep, cervical cx, C/G, HIV, viral hepatitis, XR skeletal survey
22
Q
ED hx
A
Nocturnal erections, libido, incontinence, gynecomastia, decreased body hair, vascular dz, DM, HTN, prostate sx, social hx, meds (new)
23
Q
Amenorrhea hx
A
Pregnancy, eating d/o, infections, D&Cs, pregnancies, thyroid, hirsutism, galactorrhea, HA and descreased vision, hot flashes, vaginal dryness
24
Q
Amenorrhea DDx
A
Pregnancy, anovulatory cycle, hyperprolactinemia/prolactinoma, hypothyroid, anorexia, PCOS, premature ovarian failure, menopause, ovarian malignancy, Sheehan syndrome, anxiety-induced amenorrhea
25
Test for PCOS
Testosterone, DHEAs, LH/FSH
26
Amenorrhea testing
hCG, pelvic US, TSH, ACTH, LH/FSH, BMP, CBC, prolactin, MRI brain, hysteroscopy, testosterone, DHEAs, progesterone challenge test (2ndary)
27
Back pain hx beyond obvious
H/o cancer and DM, UTIs, renal stones, drug use, disturbs sleep
28
Back pain PE
L4-S1 nerve roots, rectal, back palpation ROM and hip, strength/sensation
29
Pain in back and legs with standing/walking, better at rest and leaning forward
Lumbar spinal stenosis, lumbar muscle strain, peripheral vascular dz (ABI), tumor of vertebral canal
30
L4-S1 exam
L4: medial (patellar reflex) (dorsiflexion)
L5: top (great toe dorsiflexion)
S1: lateral (ankle reflex) (plantarflexion)
31
Child with behavior problems hx
Violence/weapons, depression, SA, developmental hx, change in env/grades/personality, legal trouble
32
DDx of child with behavior problems
ADHD, ODD, conduct d/o, mania, hyperthyroid, SA, adjustment d/o, age appropriate behavior
33
Plan for child with behavior problems
PE, mental status exam, TSH, EEG, Utox
34
Confusion and memory loss hx
Constitutional sx, gait, incontinence, hypothyroid, depression, meds and changes, EtOH use, HIV/syphilis, B12 deficiency, ask to call family and caregivers
35
Confusion and memory loss PE
MMSE, neuro, gait, vitals, all systems (ext, CV, pulm, abd, ENT)
36
DDx for confusion and memory loss
Dementia: Vascular, Alzheimers, Lewy body
Anatomic: Parkinsons, normal pressure hydrocephalus, chronic subdural, neoplasm, Wenicke's
Systemic: depression, B12, hypothyroid, hypoglycemia
Infectious: Neurosyphilis, Creutzfeldt-Jakobs Dz
CV: TIA, CVA, arrhythmia
37
Plan for confusion and memory loss
MRI/CT, TSH, B12, CBC, VDRL/RPR, LP
38
Normal pressure hydrocephalus
Do LP for opening pressure
39
Creutzfeldt-Jakob Dz
Rapidly progressive change in mental status, poor concentration, impaired memory, myoclonus, ataxia, startle response
40
Intermittent confusion and not feeling well
Consider cardiac and metabolic: EKG, trop, carotid US, echo, glucose
41
Gradual AMS and HA after head trauma
Subdural, SIADH leading to hypoNa, Creutz-feldt-Jakob Dz, neoplasm
42
Lucid interval after TBI
Epidural hemorrhage
43
Constipation and diarrhea hx beyond obvious
Mucus, float, thyroid sx, diet, abx, travel, HIV risks, h/o surgery
44
Constipation and diarrhea exam
don't forget thyroid
45
DDx of constipation and diarrhea
Infectious: gastroenteritis (bacterial, viral, amoeba, parasitic), c diff, hep A
Cancer: colon, small bowel lymphoma, cardinoid syndrome
Anatomic: Diverticulosis, IBS, diet, chronic pancreatitis
Immune: IBD, celiac
Systemic: SA, hyper/hypothyroid, depression
46
Types of gastroenteritis
Bacterial, viral, protazoal, parasitic. Don't forget tests for them (stool cx, shigella, c diff, o&p, giardia, entamoeba, cryptosporidosis)
47
Chest pain hx beyond obvious
DVT risks/hx, cocaine, fever, palpitiations, chest tenderness
48
CP physical exam
Sounds, pulses, edema, TTP chest, PMI, JVD. Pulm, abd, extrem (DVT)
49
CP DDx
MI, angina, GERD, costochondritis, dissection, PE, pericarditis, pneumothorax, esophagitis, esophageal spasm, PUD, PNA, esophageal rupture, muscle strain
50
Sickle cell acute chest syndrome plan
CBC, peripheral smear, reticulocyte count, LDH, EKG, CXR, ABG, d-dimer
51
GERD plan
Esophageal pH monitoring, EGD
52
Depressed mood DDx
Normal bereavement, MDD, adjustment d/o with depressed mood, depressive d/o NOS, substance induced mood d/o, dysthymic d/o, cyclothymic d/o, bipolar d/o
53
Depression Plan
Physical exam, Beck depressioninventory, TSH, Utox, CBC, mental status exam
54
Dizziness hx beyond obvious
Hearing/vision change, positional, recent URI, neck injury, h/o vascular dz, meds
55
Diziness PE
ENT, CV, neuro: romberg, nystagmus, tilt test, gait, hearing, Webber/Rinne
56
Menieres dz
Intermittent vertigo, tinnitus, nausea, hearing loss
57
Dizziness DDx
Meniere's dz, vestibular neuronitis, labrynthitis (hearing loss), BPV, accoustic neuroma, med induced, dehydration, vertebrobasilar insufficiency, brainstem/cerebellar CA
58
Dizziness plan
Dix-Hallpike maneuver, MRI brain, VRDL/RPR, orthostatic vitals, audiogram, electronystagmography
59
Dyspareunia hx beyond the obvious
Discharge/burning, painful menses, hot flashes, lubrication, menopausal status, libido, sexual hx/abuse, surgery, PID, endometriosis
60
Dyspareunia DDx
Atrophic vaginitis, endometriosis, depression, abuse, cervicitis, PID, vulvodynia, vaginismus
61
Dysphagia hx
Solids v liquids, voice change, drooling, HIV risks, anxiety, Raynaud's, regurgitation
62
Dysphagia PE
HEENT, skin (CREST, scleroderma),CV, pulm, abd
63
Dysphagia DDx
Esophageal CA, achalasia, systemic sclerosis, esophageal stricture, ALS, esophagitis, Plummer-Vinson syndrome, mitral valve stenosis, Zenker's diverticulum
64
Dysphagia plan
Barium swallow, upper endoscopy with bx
65
Achalasia presentation
Dysphagia to solids and liquids progressing, hard to belch, regurgitating undigested food, weight loss. Plan - esophageal manometry
66
Esophagitis plan
Always get HIV and CD 4
67
Fatigue and Sleepiness Hx
sleep hygiene, stress, change in shift/lifestyle/diet, thyroid sx, h/o bleeding/anemia, meds, drugs, constitutional sx, family hx, swelling and urine (acute renal failure), DM symptoms
68
Fatigue and Sleepiness PE
ENT (thyroid, LAD, pharynx, conjunct pallor), CV, pulm, abd, neuro, extr (cool, pallor), +/- rectal with FOBT
69
Fatigue and Sleepiness DDx
OSA, hypothyroid, depression, cancer, chronic fatigue syndrome, narcolepsy, anemia, renal failure, PTSD, anxiety, DM, shift work sleep d/o
70
OSA and sleep difficulty plan
Polysomnography, nocturnal pulse oximetry
71
DM plan
Glucose tolerance test, HbA1C
72
Child with fever hx beyond obvious
Daycare, immunizations, lethargy, birth hx. Full PE as plan.
73
Child with fever DDx
Neonatal sepsis, meningitis, PNA, pyelo, otitis, URI, measels/rubella, varicella, scarlet fever
74
Child with fever plan
PE, CXR, UA, Ucx, LP, CBC, BMP, BCx, pneumatic otoscopy
75
Child with GI Sx hx beyond obvious
Constitutional sx (weight), rash, h/o similar sx or surgery, immunizations, meds, daycare
76
Child with GI Sx DDx
Pyloric stenosis, GERD, duodenal atresia, gastroenteritis, hepatitis, UTI, otitis, Hurschprung's, low fiber diet, anal stenosis, hypothyroid, lead poisoning, intussusception, volvulus, appendicitis, Meckel's diverticulum, enterocolitis, blunt abdominal trauma, lactose intolerance, abuse, somatoform d/o, malingering, IBS, hernia, testicular torsion, formula allergy
77
Pyloric stenosis sx
Spitting up with increasing forcefullness and frequency, nonbilious, occurs after feeding, stopped gaining weight
78
Intussusception Sx
Sudden onset colicky abdominal pain with vomiting x20mins, well between; had several loose stools hours before now bloody
79
Child with GI Sx Plan
PE, rectal, FOBT, CBC, BMP, US v CT abdomen, contrast enema, serum lead, barium enema, TSH, endoscopy
80
Colic in child sx
Persistent crying, improves after passing flatus or belching. No change in weight or appetite, no vomiting or fever or contipation
81
HA hx beyond obvious
Neuro sx (parasthesias, vision change, weak, ataxia, photophobia, dizzy, aura, neck stiff); jaw claudication, dental surgery, trauma, worse with LMP/stress/exercise/fatigue)
82
HA PE
Inspect and palpate entire head, ENT inspection, complete neuro, fundoscopic exam
83
HA DDx
Complicated migraine, cluster, tension, pseudotumor cerebri, CNS vasculitis, partial sz, intracranial neoplasm, temporal arteritis, carotid artery dissection, trigeminal neuralgia, Meningitis, sinusitis, caffeine or analgesic withdrawal, intracranial/epidural abscess, intracranial venous thrombosis
84
Cluster HA sx
Severe HA, ipsilateral rhinorrhea and eye tearing/redness occur at same time of day x45mins
85
HA plan
MRI/CT head, LP, ESR, doppler US carotid
86
Subarachnoid hemorrhage sx
Sudden onset severe HA, vomiting, confusion, hemiplegia, nuchal rigidity. Plan: noncon head CT, PT/INR, CBC
87
Pseudotumor cerebri sx
Pulsatile HA, vomiting, blurred vision for weeks. Plan: LP, opening pressure
88
Trigeminal neuralgia sx
Unilateral cheek pain, electric and stabbing, occurs while shaving/touching face, lasts 2-4 mins.
89
Hematochezia hx beyond the obvious
Amount, rectal pain, trauma, easy bleeding, recent colonoscopy, h/o vascular dz or aortic valve dz, AAA repair, blood thinners
90
Hematochezia DDx
Colon ca, anal fissure, diverticulosis, hemorrhoids, ischemic bowel dz, angiodysplasia, UGIB, IBD, proctitis
91
Hematochezia plan
INR, FOBT, rectal, colonoscopy, CEA, CT, CBC
92
Hematuria hx beyond the obvious
Renal colic, beginning/end/all stream, h/o trauma/vigorous exercise, stones, CA, easy bleeding, smoking, pain, occupational exposures
93
Hematuria PE
lymph nodes, abd, GU, rectal, ext
94
Hematuria DDx
Bladder CA, RCC, stone, glomerulonephritis, prostate CA, coagulation d/o, polycystic kidney dz, UTI, Pyelo
95
Hematuria Plan
GU exam, UA with cytology, cystoscopy, US renal/bladder, PSA, PT/INR, CT, prostate bx, BMP (Cr)
96
RCC presentation
Flank pain and mass, painless hematuria, weight loss and fever.
97
Insomnia Hx beyond the obvious
Falling v staying asleep, awakening early v multiple, depression, daytime sleepiness, caffeine, work/life change, sleep hygiene, mania sx
98
Insomnia PE
Mental status exam, thyroid
99
Insomnia DDx
Stress-induced, caffeine-induced, circadian rhythm sleep d/o, MDD, OSA, hypersomnia,
100
Insomnia Plan
Polysomnography, mental status exam, TSH, utox
101
OSA plan
EKG, polysomnography, CBC, TSH
102
LOC Hx
Preceding sx, context, tongue biting or incontinence, tonic clonic movements, confusion, CV dz or arrhythmia, drugs
103
LOC PE
Orthostatics, complete neuro, carotids, CV, pulm, lower extr (edema, DVT)
104
LOC DDx
Generalized tonic-clonic sz, convulsive syncope, SA/OD, malingering, hypoglycemia, drug-induced HoTN, arrhythmia, vasovagal, stroke, MI, PE, aortic stenosis
105
LOC Plan
EEG, MRI/CT head, LP, Utox, EKG, BMP (glucose), CBC, echo, d-dimer, orthostatics
106
Joint and Limb Pain Hx
Many v few joints, large v small joints, red eye or rash, oral/GU ulcers, trauma/exercise, meds, DVT risk, FHx rheumatic dz, diarrhea, dysuria
107
MSK exam
HEENT, MSK, neurovascular
108
MSK plan, general
Identify cause of injury, test for causes, imaging for damage caused by falls, arthrocentesis for joints, bone scan for fx
109
MSK joint pain DDx
SLE, RA, psoriatic arthritis, parvo B19, OA, disseminated gonorrhea, arthritis associated with IBD, pseudo/gout, reactive arthritis, Lyme arthritis
110
MSK general DDx
LE: meniscal/ligament damage, stress fx, Baker's cyst rupture, DVT, plantar fasciitis, superficial venous thrombosis
UE: carpal tunnel, Dequervain's, lateral epicondylitis
Chest: rotator cuff injury, OA, angina/MI
General: DV, SA, sprain, strain, foreign body, myositis, rhabdomyolysis (statins)
111
MSK pain after trauma DDx and plan
Fx, dislocation, strain, sprain, meniscal/ligament damage, rotator cuff injury. XR/MRI/CT, Utox, EtOH lvl, PT/INR, CBC
112
Carpal Tunnel Syndrome plan
Phalen's maneuver, Tinel's sign, Finkelstein's test, nerve conduction studies, EMG
113
MSK pain rheumatalogic cause plan
ANA, anti-ds DNA, C3 C4, RF, CCP, ESR, UA, CBC, Xray joints. Maybe lyme titers
114
OA v. RA v. psoriatic hand joint involvement
OA: DIP, PIP, 1st CMC
RA: PIP, MCP, wrist
Psoriatic: DIP, PIP
115
Pain after fall in menopausal woman hx, plan
Time since menopause, HRT, Ca supplement. DEXA scan, MRI/XR/CT, serum Ca and vitamin D
116
Presentation of hip fx v. dislocation
Fx: external rotation, adducted, groin pain
Dislocation: internally rotated, adducted, flexed at hip
117
Suspect gout v septic joint plan
Arthrocentesis and analysis: gram stain, crystals, cx, cell count; uric acid, ESR, XR/MRI
118
Lateral epicondylitis PE and presentation
Elbow pain with TTP lateral eipcondyle, grip impaired, pain on resisted wrist dorsiflexion with elbow extended
119
Disseminated gonorrhea presentation
Swelling/redness/pain of large joints, rash on limbs, vaginal discharge. Several partners, no protection. Arthrocentesis, cervical cx
120
Peripheral vascular dz presentation and plan
Intermittent claudication (pain with use, better with rest), h/o CV risks and dz. Ankle Brachial Index, angiography, doppler US BLE.
121
Intermittent claudication of BLE DDx
Periphersal vascular dz, Leriche syndrome (aortoiliac occusive dz), lumbar spine stenosis, OA
122
Chest and shoulder MSK pain with activity
Think Angina/MI v. tendinitis v. OA
123
Statin induced rhabdomyolysis presentation
Crampy b/l leg pain, fatigue, dark urine. H/o HLD, statins. Plan: CPK, UA with urine myoglobin, BMP, Ca, uric acid, aldolase
124
Nausea and vomiting hx
CP, abdominal sx, neuro sx (HA, vertigo, stiff neck), urinary sx, pregnancy
125
Nausea and vomiting PE
ENT, complete abd, +/- fundoscopic/CV/pulm/rectal
126
Hypercalcemia presentation
Polyuria and thirst, n/v, constipation, bone pain, muscle weakness, confusion, lethargy/fatigue
127
Neck mass hx and PE
Mobility, pain, moves with swallow, dysphagia or SOB, constitutional or other sx. PE: HEENT, lymph nodes, spleen, tonsils, CV, pulm, abd
128
Neck mass DDx
Non/Hodgkin's Lymphoma, gastric carcinoma, thyroid nodule, TB
129
Night sweats hx
Recent illness, waxing/waning, pleuritic CP, B symptoms, LAD, early satiety, social hx, high risk population exposure, travel hx, menstrual hx, n/v/d
130
Night sweats PE
HEENT, LAD, skin, CV, msk (joint pain), pulm, abd (hepatosplenomegaly)
131
Night sweats DDx
TB, acute HIV, lymphoma, leukemia, hyperthyroidism, carcinoid syndrome, pheochromocytoma
132
Carcinoid Tumor presentation
Night sweats, abdominal pain, facial flushing, diarrhea, rash, melena, BRBPR, asthma, pellagra. Plan: 5-HIAA
133
Palpitations hx
Gradual v. sudden on/offset, caffeine, anxiety, associated sx (LH, SOB, diarrhea, LOC), thyroid sx, h/o anemia, CV dz, DM/insulin
134
Palpitations PE
Endocrine, tremor, complete CV, thyroid (exophthalmos, lid retraction/lag, bruit)
135
Palpitations DDx
Hypoglycemia, arrhythmia, hyperthyroid, panic attack, hyperventilation, pheochromocytoma, carcinoid syndrome, angina, SA, mitral valve prolapse, acute stress d/o
136
Mitral Valve Prolapse presentation
Young person with episodic palpitations, lightheadedness, and sharp CP
137
Psychosis hx
Positive sx (disorganized, hallucinations, delusions), negative sx (blunted, withdrawn, slowed speech/thought), age onset, hospitalizations, previous psych meds, SA
138
Psychosis PE and plan
Mental status exam, general appearance, utox, TSH, Beck depression inventory
139
Psychosis DDx
Schizophrenia, schizotypal personality d/o, schizophreniform d/o, mood d/o with psychotic features, psychotic d/o 2/2 meds/substances/medical condition, brief psychotic d/o, schizoaffective d/o
140
Schizoaffective d/o presentation
Auditory hallucinations, weight loss, early wakening, decreased motivation, feelings of guilt
141
Child with Red Eye hx
One v. b/l, discharge, photophobia, constitutional sx, immunizations, meds
142
Child with Red Eye plan
PE including HEENT, opthalmoscopic eye exam, discharge cx, slit lamp exam
143
Child with Red eye DDx
Bacterial/viral conjunctivitis, allergic rhinitis, keratitis, uveitis
144
Child with short stature hx
Other sx, general hx, prenatal/birth/growth hx, family h/o problem, cognitive/school ability
145
Child with short stature PE and plan
Height, weight, CV, pulm, abd, HEENT, neuro. GH stimulation test, IGF-1 and IGFBP-3 levels, TSH, US renal/cardiac, sweat chloride testing, karypotype, XR hand
146
Child with short stature DDx
Constitutional short stature, GH deficiency, hypothyroid, chronic renal insufficiency, CF, genetic causes (Turner's)
147
Cough and SOB hx
Change, hemoptysis, constitutional sx, URI, CP (pleuritic), improving?, work exposures, smoking hx, meds (ace-i), lung dz, CHF, HIV exposure
148
Cough and SOB PE
Pulse ox, nasal mucosa, oropharynx, LAD, CV, pulm, extr
149
Cough and SOB DDx
Asthma, GERD, bronchitis, pneumonitis, foreign body, PNA, CHF, COPD (exacerbation), lung CA, TB, bronchiectasis, PE, lung abscess, URI, post-nasal drip, RAD, ILD, vasculitis, sarcoidosis, pulmonary edema
150
Cough and SOB Plan
CXR, peak flow meter, methacholine challenge test, PFTs, sputum gram stain, PPD, IgM mycoplasma, urine legionella Ag, bronchoscopy, echo, BNP
151
Atypical PNA presentation
Young person with nonproductive cough a few weeks after URI
152
Pulmonary edema presentation
Worsening dyspnea over hours, cough with frothy pink sputum
153
Sore throat hx
Ear symptoms, LAD, HIV risks
154
Sore throat PE
ENT (oral thrush, exucate, LAD), Abd (splenomegaly), pulm, skin
155
Infectious mononucleosis symptoms
Sore throat, severe fatigue, fever, loss of appetite, epigastric and LUQ discomfort, cervical LAD, rash
156
Sore throat DDx
Mono, viral/bacterial pharyngitis, acute HIV, scarlet fever, syphilis, mycoplasma PNA
157
Sore throat plan
CBC with smear, monospot, throat cx, HIV ab, anti-EBV Ab, rapid strep
158
Acute HIV pharyngitis
Sore throat, fever, rash, weight loss, IV drug use hx
159
UGIB hx
Severe vomiting, nosebleed, EtOH, blood thinners, NSAIDs, h/o liver dz or AAA repair
160
UGIB PE
Orthostatics, ENT, CV, pulm, abd, rectal
161
UGIB DDx
Bleeding peptic ulcer, gastritis, gastric CA, esophageal varices, mallory weiss tear
162
UGIB plan
Rectal, CBC with type and cross, INR, upper endoscopy, H pylori, CMP
163
Urinary Sx Hx
Post void dribbling, stress leak, obstructive sx, meds, bone/back pain, DM, h/o UTIs, instrumentation, stones, EtOH, recent new sexual partner
164
Urinary Sx PE
Abdominal (puprapubic percussion), focused neuro
165
Urinary Sx DDx
BPH, prostate CA, UTI, bladder stones, RCC, urethritis, prostatitis, pyelo, renal stone, stress/mixed/functional/urge/overflow incontinence,
166
Urinary Sx plan
Rectal, GU, PSA, UA, US/bx prostate, alk phos, CT/MRI pelvis/spine/abd, C&G PCR, US renal, urodynamic testing, cystourethroscopy
167
Urge incontinence sx
Unable to suppress urge to urinate, loses large amounts at once without warning
168
Vaginal discharge hx
Pain/pruritis, recent sex, onset of LMP, contraception, tampons, douches, h/o STDs
169
Vaginal discharge PE
Abd, complete pelvic
170
Vaginal discharge DDx
Bacterial vaginosis, vaginitis (candida, trichomonal), cervicitis (chlamydia, gonorrhea)
171
Vaginal discharge Plan
Pelvic, Chlamydia, Gonorrhea, VDRL/RPR, wet prep, KOH prep, pH, cervical cx
172
Vaginal bleeding hx
Menopause satus, LMP, menstrual hx, urinary sx, abd pain, pregnancy, trauma, OCPs, blood thinners, abdnormal paps, context
173
Vaginal bleeding PE
Abdominal, complete pelvic
174
Vaginal bleeding DDx
Dysfunctional uterine bleeding, coagulation d/o, cervical CA, molar pregnancy, hypothyroid, endometrial CA, atrophic endometrium, endometrial hyperplasia/polyps, trauma, pregnancy, SAB, ectopic pregnancy, ruptured ovarian cyst, ovarian torsion, PID
175
Vaginal bleeding Plan
Urine hCG and quant, pelvic, US pelvis, cervical cx, pap, PT/INR, LH/FSH, TSH, prolactin, endometrial bx, colposcopy, hysteroscopy, HPV testing
176
Vision loss hx
Acute v chronic, see light, jaw claudication, trauma, eye sx, weak/numb, floaters, h/o CV/rheum/neuro dz, h/o thrombosis, autoimmune dz
177
Vision loss PE
CV, HEENT, funduscopic, neuro
178
Vision loss DDx
Retinal artery/vein occlusion, acute closed angle glaucoma, retinal detachment, temporal arteritis
179
Acute closed angle glaucoma presentation
Severe eye pain, n/v, HA, blurred vision, tearing, red eye, halo around lights, sudden onset
180
Acute open angle glaucoma presentation
Gradual loss of peripheral vision in both eyes, tunnel vision late
181
Vision loss Plan
Fluorescein angiogram, echo, doppler US carotid, intraocular tonometry, temporal artery bx, ESR
182
Numbness and weakness hx
Unilateral v. b/l, prox v. distal, progression, pain, neuro sx, H/o DM or EtOH, atherosclerosis
183
Numbness and weakness PE
Neuro, MSK, vascular, Babinski's
184
Numbness and weakness DDx
TIA, CVA, seizure, hypoglycemia, facial nerve palsy, subdural/epidural hemorrhage, intracranial neoplasm, Guillain-Barre syndrome, MS, myasthenia gravis, peripheral neuropathy, tumor of spine, polymyositis, conversion d/o, malingering, MS, CNS vasculitis, syringomyelia, neurosyphilis, diabetic/EtOH peripheral neuropathy, B12 deficiency, hypocalcemia, myeloma, Horner's syndrome, ALS, Todd's paralysis (post sz), complicated migraine
185
Numbness and weakness plan
CT, MRI, doppler US carotids, EKG, echo, EEG, PT/INR, Tensilon test, serum B12, CPK, nerve conduction studies, EMG, LP, retinal evoked potentials, Ca, ESR, serum Ach receptor Abs
186
MS presentation
Young woman with weakness and loss of sensation of limb, vision loss, eye pain, double vision, electric shocks down spine when flex neck
187
Weight loss hx
diet and exercise, body image, blood in urine/stool, B sx, hyperthyroud sx, HIV risks, drugs, h/o CA
188
Weight loss PE
Complete
189
Weight loss DDx
Hyperthyroidism, CA, HIV, diet, diet drugs, anorexia, malabsorption
190
Weight gain hx
Smoking cessation, depression, med change, diet, PMHx, hypothyroid sx, drugs, mestrutal irregularity, hirsutism
191
Weight gain PE
Complete, edema (renal dz), Cushings sx
192
Cushings Syndrome presentation
HTN, moon facies, buffalo hump, central obesity, striae, supraclavicular fat (dexamethazone suppression test, 24hr urine free cortisol test)
193
Weight gain DDx
Smoking cessation, drug side effect, Cushings, hypothyroid, PCOS, DM, atypical depression, insulinoma, preactive postprandial hypoglycemia
194
Insulinoma presentation
Weight gain, tremor, palpitations, anxiety, hunger relieved by eating, proximal weakness and easy bruising
