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1
Q

Abdominal pain, nausea, vomiting

A

fundoscopic, neuro sx, ENT

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2
Q

RUQ pain

A

Gallbladder, liver (fitz-hugh curtis), gastric, subhepatic appendicitis

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3
Q

Concern for gall stones

A

MRCP, ERCP

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4
Q

Acute hepatitis

A

RUQ pain, fever, anorexia, n/v, dark urine, clay colored stool

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5
Q

Acute glomerulonephritis

A

facial edema, dark urine, decreased urine, pulmonary edema, HTN

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6
Q

Abdominal pain after eating

A

GERD, chronic pancreatitis, mesenteric ischemia

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7
Q

If fever

A

BCx

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8
Q

Any abdominal pain

A

Get LFTs, consider lactate

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9
Q

LUQ pain

A

splenic rupture/infarct, renal stone, PNA, perfed PUD, rib fx

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10
Q

Abdominal pain with h/o abd surgery

A

SBO, ileus, hernia, volvulus, bowel CA

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11
Q

Bloody stool

A

Mesenteric ischemia, PUD, diverticulitis, fissure, angiodysplasia, IBD

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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

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13
Q

Woman with lower abdominal pain

A

Pelvic, Chlamydia, Gonorrhea, VDRL/RPR

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14
Q

Periumbilical Abdominal Pain

A

Celiac, IBS, IBD, chronic pancreatitis, endometriosis, GI parasitic infection

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15
Q

Plan

A

Other exams, labs, imaging

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16
Q

Pelvic pain in female plan

A

Get US pelvis

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17
Q

Flank pain and hematuria ddx

A

renal stone, RCC (flank mass)

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18
Q

Abdominal pain in older patient with CV risk factors

A

AAA, mesenteric ischemia

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19
Q

Suspect Abuse

A

Establish confidential, h/o accidents/injuries, direct questions - physical, sexual, emotional; safety, plan, fear, firearms, mental illness, SA

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20
Q

Woman with recurrent injury

A

DV, SA, consensual violent sexual activity, OI. Get Utox, skeletal survey

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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

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22
Q

ED hx

A

Nocturnal erections, libido, incontinence, gynecomastia, decreased body hair, vascular dz, DM, HTN, prostate sx, social hx, meds (new)

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23
Q

Amenorrhea hx

A

Pregnancy, eating d/o, infections, D&Cs, pregnancies, thyroid, hirsutism, galactorrhea, HA and descreased vision, hot flashes, vaginal dryness

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24
Q

Amenorrhea DDx

A

Pregnancy, anovulatory cycle, hyperprolactinemia/prolactinoma, hypothyroid, anorexia, PCOS, premature ovarian failure, menopause, ovarian malignancy, Sheehan syndrome, anxiety-induced amenorrhea

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25
Q

Test for PCOS

A

Testosterone, DHEAs, LH/FSH

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26
Q

Amenorrhea testing

A

hCG, pelvic US, TSH, ACTH, LH/FSH, BMP, CBC, prolactin, MRI brain, hysteroscopy, testosterone, DHEAs, progesterone challenge test (2ndary)

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27
Q

Back pain hx beyond obvious

A

H/o cancer and DM, UTIs, renal stones, drug use, disturbs sleep

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28
Q

Back pain PE

A

L4-S1 nerve roots, rectal, back palpation ROM and hip, strength/sensation

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29
Q

Pain in back and legs with standing/walking, better at rest and leaning forward

A

Lumbar spinal stenosis, lumbar muscle strain, peripheral vascular dz (ABI), tumor of vertebral canal

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30
Q

L4-S1 exam

A

L4: medial (patellar reflex) (dorsiflexion)
L5: top (great toe dorsiflexion)
S1: lateral (ankle reflex) (plantarflexion)

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31
Q

Child with behavior problems hx

A

Violence/weapons, depression, SA, developmental hx, change in env/grades/personality, legal trouble

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32
Q

DDx of child with behavior problems

A

ADHD, ODD, conduct d/o, mania, hyperthyroid, SA, adjustment d/o, age appropriate behavior

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33
Q

Plan for child with behavior problems

A

PE, mental status exam, TSH, EEG, Utox

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34
Q

Confusion and memory loss hx

A

Constitutional sx, gait, incontinence, hypothyroid, depression, meds and changes, EtOH use, HIV/syphilis, B12 deficiency, ask to call family and caregivers

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35
Q

Confusion and memory loss PE

A

MMSE, neuro, gait, vitals, all systems (ext, CV, pulm, abd, ENT)

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36
Q

DDx for confusion and memory loss

A

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

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37
Q

Plan for confusion and memory loss

A

MRI/CT, TSH, B12, CBC, VDRL/RPR, LP

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38
Q

Normal pressure hydrocephalus

A

Do LP for opening pressure

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39
Q

Creutzfeldt-Jakob Dz

A

Rapidly progressive change in mental status, poor concentration, impaired memory, myoclonus, ataxia, startle response

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40
Q

Intermittent confusion and not feeling well

A

Consider cardiac and metabolic: EKG, trop, carotid US, echo, glucose

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41
Q

Gradual AMS and HA after head trauma

A

Subdural, SIADH leading to hypoNa, Creutz-feldt-Jakob Dz, neoplasm

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42
Q

Lucid interval after TBI

A

Epidural hemorrhage

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43
Q

Constipation and diarrhea hx beyond obvious

A

Mucus, float, thyroid sx, diet, abx, travel, HIV risks, h/o surgery

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44
Q

Constipation and diarrhea exam

A

don’t forget thyroid

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45
Q

DDx of constipation and diarrhea

A

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

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46
Q

Types of gastroenteritis

A

Bacterial, viral, protazoal, parasitic. Don’t forget tests for them (stool cx, shigella, c diff, o&p, giardia, entamoeba, cryptosporidosis)

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47
Q

Chest pain hx beyond obvious

A

DVT risks/hx, cocaine, fever, palpitiations, chest tenderness

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48
Q

CP physical exam

A

Sounds, pulses, edema, TTP chest, PMI, JVD. Pulm, abd, extrem (DVT)

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49
Q

CP DDx

A

MI, angina, GERD, costochondritis, dissection, PE, pericarditis, pneumothorax, esophagitis, esophageal spasm, PUD, PNA, esophageal rupture, muscle strain

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50
Q

Sickle cell acute chest syndrome plan

A

CBC, peripheral smear, reticulocyte count, LDH, EKG, CXR, ABG, d-dimer

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51
Q

GERD plan

A

Esophageal pH monitoring, EGD

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52
Q

Depressed mood DDx

A

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

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53
Q

Depression Plan

A

Physical exam, Beck depressioninventory, TSH, Utox, CBC, mental status exam

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54
Q

Dizziness hx beyond obvious

A

Hearing/vision change, positional, recent URI, neck injury, h/o vascular dz, meds

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55
Q

Diziness PE

A

ENT, CV, neuro: romberg, nystagmus, tilt test, gait, hearing, Webber/Rinne

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56
Q

Menieres dz

A

Intermittent vertigo, tinnitus, nausea, hearing loss

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57
Q

Dizziness DDx

A

Meniere’s dz, vestibular neuronitis, labrynthitis (hearing loss), BPV, accoustic neuroma, med induced, dehydration, vertebrobasilar insufficiency, brainstem/cerebellar CA

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58
Q

Dizziness plan

A

Dix-Hallpike maneuver, MRI brain, VRDL/RPR, orthostatic vitals, audiogram, electronystagmography

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59
Q

Dyspareunia hx beyond the obvious

A

Discharge/burning, painful menses, hot flashes, lubrication, menopausal status, libido, sexual hx/abuse, surgery, PID, endometriosis

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60
Q

Dyspareunia DDx

A

Atrophic vaginitis, endometriosis, depression, abuse, cervicitis, PID, vulvodynia, vaginismus

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61
Q

Dysphagia hx

A

Solids v liquids, voice change, drooling, HIV risks, anxiety, Raynaud’s, regurgitation

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62
Q

Dysphagia PE

A

HEENT, skin (CREST, scleroderma),CV, pulm, abd

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63
Q

Dysphagia DDx

A

Esophageal CA, achalasia, systemic sclerosis, esophageal stricture, ALS, esophagitis, Plummer-Vinson syndrome, mitral valve stenosis, Zenker’s diverticulum

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64
Q

Dysphagia plan

A

Barium swallow, upper endoscopy with bx

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65
Q

Achalasia presentation

A

Dysphagia to solids and liquids progressing, hard to belch, regurgitating undigested food, weight loss. Plan - esophageal manometry

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66
Q

Esophagitis plan

A

Always get HIV and CD 4

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67
Q

Fatigue and Sleepiness Hx

A

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

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68
Q

Fatigue and Sleepiness PE

A

ENT (thyroid, LAD, pharynx, conjunct pallor), CV, pulm, abd, neuro, extr (cool, pallor), +/- rectal with FOBT

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69
Q

Fatigue and Sleepiness DDx

A

OSA, hypothyroid, depression, cancer, chronic fatigue syndrome, narcolepsy, anemia, renal failure, PTSD, anxiety, DM, shift work sleep d/o

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70
Q

OSA and sleep difficulty plan

A

Polysomnography, nocturnal pulse oximetry

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71
Q

DM plan

A

Glucose tolerance test, HbA1C

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72
Q

Child with fever hx beyond obvious

A

Daycare, immunizations, lethargy, birth hx. Full PE as plan.

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73
Q

Child with fever DDx

A

Neonatal sepsis, meningitis, PNA, pyelo, otitis, URI, measels/rubella, varicella, scarlet fever

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74
Q

Child with fever plan

A

PE, CXR, UA, Ucx, LP, CBC, BMP, BCx, pneumatic otoscopy

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75
Q

Child with GI Sx hx beyond obvious

A

Constitutional sx (weight), rash, h/o similar sx or surgery, immunizations, meds, daycare

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76
Q

Child with GI Sx DDx

A

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

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77
Q

Pyloric stenosis sx

A

Spitting up with increasing forcefullness and frequency, nonbilious, occurs after feeding, stopped gaining weight

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78
Q

Intussusception Sx

A

Sudden onset colicky abdominal pain with vomiting x20mins, well between; had several loose stools hours before now bloody

79
Q

Child with GI Sx Plan

A

PE, rectal, FOBT, CBC, BMP, US v CT abdomen, contrast enema, serum lead, barium enema, TSH, endoscopy

80
Q

Colic in child sx

A

Persistent crying, improves after passing flatus or belching. No change in weight or appetite, no vomiting or fever or contipation

81
Q

HA hx beyond obvious

A

Neuro sx (parasthesias, vision change, weak, ataxia, photophobia, dizzy, aura, neck stiff); jaw claudication, dental surgery, trauma, worse with LMP/stress/exercise/fatigue)

82
Q

HA PE

A

Inspect and palpate entire head, ENT inspection, complete neuro, fundoscopic exam

83
Q

HA DDx

A

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
Q

Cluster HA sx

A

Severe HA, ipsilateral rhinorrhea and eye tearing/redness occur at same time of day x45mins

85
Q

HA plan

A

MRI/CT head, LP, ESR, doppler US carotid

86
Q

Subarachnoid hemorrhage sx

A

Sudden onset severe HA, vomiting, confusion, hemiplegia, nuchal rigidity. Plan: noncon head CT, PT/INR, CBC

87
Q

Pseudotumor cerebri sx

A

Pulsatile HA, vomiting, blurred vision for weeks. Plan: LP, opening pressure

88
Q

Trigeminal neuralgia sx

A

Unilateral cheek pain, electric and stabbing, occurs while shaving/touching face, lasts 2-4 mins.

89
Q

Hematochezia hx beyond the obvious

A

Amount, rectal pain, trauma, easy bleeding, recent colonoscopy, h/o vascular dz or aortic valve dz, AAA repair, blood thinners

90
Q

Hematochezia DDx

A

Colon ca, anal fissure, diverticulosis, hemorrhoids, ischemic bowel dz, angiodysplasia, UGIB, IBD, proctitis

91
Q

Hematochezia plan

A

INR, FOBT, rectal, colonoscopy, CEA, CT, CBC

92
Q

Hematuria hx beyond the obvious

A

Renal colic, beginning/end/all stream, h/o trauma/vigorous exercise, stones, CA, easy bleeding, smoking, pain, occupational exposures

93
Q

Hematuria PE

A

lymph nodes, abd, GU, rectal, ext

94
Q

Hematuria DDx

A

Bladder CA, RCC, stone, glomerulonephritis, prostate CA, coagulation d/o, polycystic kidney dz, UTI, Pyelo

95
Q

Hematuria Plan

A

GU exam, UA with cytology, cystoscopy, US renal/bladder, PSA, PT/INR, CT, prostate bx, BMP (Cr)

96
Q

RCC presentation

A

Flank pain and mass, painless hematuria, weight loss and fever.

97
Q

Insomnia Hx beyond the obvious

A

Falling v staying asleep, awakening early v multiple, depression, daytime sleepiness, caffeine, work/life change, sleep hygiene, mania sx

98
Q

Insomnia PE

A

Mental status exam, thyroid

99
Q

Insomnia DDx

A

Stress-induced, caffeine-induced, circadian rhythm sleep d/o, MDD, OSA, hypersomnia,

100
Q

Insomnia Plan

A

Polysomnography, mental status exam, TSH, utox

101
Q

OSA plan

A

EKG, polysomnography, CBC, TSH

102
Q

LOC Hx

A

Preceding sx, context, tongue biting or incontinence, tonic clonic movements, confusion, CV dz or arrhythmia, drugs

103
Q

LOC PE

A

Orthostatics, complete neuro, carotids, CV, pulm, lower extr (edema, DVT)

104
Q

LOC DDx

A

Generalized tonic-clonic sz, convulsive syncope, SA/OD, malingering, hypoglycemia, drug-induced HoTN, arrhythmia, vasovagal, stroke, MI, PE, aortic stenosis

105
Q

LOC Plan

A

EEG, MRI/CT head, LP, Utox, EKG, BMP (glucose), CBC, echo, d-dimer, orthostatics

106
Q

Joint and Limb Pain Hx

A

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
Q

MSK exam

A

HEENT, MSK, neurovascular

108
Q

MSK plan, general

A

Identify cause of injury, test for causes, imaging for damage caused by falls, arthrocentesis for joints, bone scan for fx

109
Q

MSK joint pain DDx

A

SLE, RA, psoriatic arthritis, parvo B19, OA, disseminated gonorrhea, arthritis associated with IBD, pseudo/gout, reactive arthritis, Lyme arthritis

110
Q

MSK general DDx

A

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
Q

MSK pain after trauma DDx and plan

A

Fx, dislocation, strain, sprain, meniscal/ligament damage, rotator cuff injury. XR/MRI/CT, Utox, EtOH lvl, PT/INR, CBC

112
Q

Carpal Tunnel Syndrome plan

A

Phalen’s maneuver, Tinel’s sign, Finkelstein’s test, nerve conduction studies, EMG

113
Q

MSK pain rheumatalogic cause plan

A

ANA, anti-ds DNA, C3 C4, RF, CCP, ESR, UA, CBC, Xray joints. Maybe lyme titers

114
Q

OA v. RA v. psoriatic hand joint involvement

A

OA: DIP, PIP, 1st CMC
RA: PIP, MCP, wrist
Psoriatic: DIP, PIP

115
Q

Pain after fall in menopausal woman hx, plan

A

Time since menopause, HRT, Ca supplement. DEXA scan, MRI/XR/CT, serum Ca and vitamin D

116
Q

Presentation of hip fx v. dislocation

A

Fx: external rotation, adducted, groin pain
Dislocation: internally rotated, adducted, flexed at hip

117
Q

Suspect gout v septic joint plan

A

Arthrocentesis and analysis: gram stain, crystals, cx, cell count; uric acid, ESR, XR/MRI

118
Q

Lateral epicondylitis PE and presentation

A

Elbow pain with TTP lateral eipcondyle, grip impaired, pain on resisted wrist dorsiflexion with elbow extended

119
Q

Disseminated gonorrhea presentation

A

Swelling/redness/pain of large joints, rash on limbs, vaginal discharge. Several partners, no protection. Arthrocentesis, cervical cx

120
Q

Peripheral vascular dz presentation and plan

A

Intermittent claudication (pain with use, better with rest), h/o CV risks and dz. Ankle Brachial Index, angiography, doppler US BLE.

121
Q

Intermittent claudication of BLE DDx

A

Periphersal vascular dz, Leriche syndrome (aortoiliac occusive dz), lumbar spine stenosis, OA

122
Q

Chest and shoulder MSK pain with activity

A

Think Angina/MI v. tendinitis v. OA

123
Q

Statin induced rhabdomyolysis presentation

A

Crampy b/l leg pain, fatigue, dark urine. H/o HLD, statins. Plan: CPK, UA with urine myoglobin, BMP, Ca, uric acid, aldolase

124
Q

Nausea and vomiting hx

A

CP, abdominal sx, neuro sx (HA, vertigo, stiff neck), urinary sx, pregnancy

125
Q

Nausea and vomiting PE

A

ENT, complete abd, +/- fundoscopic/CV/pulm/rectal

126
Q

Hypercalcemia presentation

A

Polyuria and thirst, n/v, constipation, bone pain, muscle weakness, confusion, lethargy/fatigue

127
Q

Neck mass hx and PE

A

Mobility, pain, moves with swallow, dysphagia or SOB, constitutional or other sx. PE: HEENT, lymph nodes, spleen, tonsils, CV, pulm, abd

128
Q

Neck mass DDx

A

Non/Hodgkin’s Lymphoma, gastric carcinoma, thyroid nodule, TB

129
Q

Night sweats hx

A

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
Q

Night sweats PE

A

HEENT, LAD, skin, CV, msk (joint pain), pulm, abd (hepatosplenomegaly)

131
Q

Night sweats DDx

A

TB, acute HIV, lymphoma, leukemia, hyperthyroidism, carcinoid syndrome, pheochromocytoma

132
Q

Carcinoid Tumor presentation

A

Night sweats, abdominal pain, facial flushing, diarrhea, rash, melena, BRBPR, asthma, pellagra. Plan: 5-HIAA

133
Q

Palpitations hx

A

Gradual v. sudden on/offset, caffeine, anxiety, associated sx (LH, SOB, diarrhea, LOC), thyroid sx, h/o anemia, CV dz, DM/insulin

134
Q

Palpitations PE

A

Endocrine, tremor, complete CV, thyroid (exophthalmos, lid retraction/lag, bruit)

135
Q

Palpitations DDx

A

Hypoglycemia, arrhythmia, hyperthyroid, panic attack, hyperventilation, pheochromocytoma, carcinoid syndrome, angina, SA, mitral valve prolapse, acute stress d/o

136
Q

Mitral Valve Prolapse presentation

A

Young person with episodic palpitations, lightheadedness, and sharp CP

137
Q

Psychosis hx

A

Positive sx (disorganized, hallucinations, delusions), negative sx (blunted, withdrawn, slowed speech/thought), age onset, hospitalizations, previous psych meds, SA

138
Q

Psychosis PE and plan

A

Mental status exam, general appearance, utox, TSH, Beck depression inventory

139
Q

Psychosis DDx

A

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
Q

Schizoaffective d/o presentation

A

Auditory hallucinations, weight loss, early wakening, decreased motivation, feelings of guilt

141
Q

Child with Red Eye hx

A

One v. b/l, discharge, photophobia, constitutional sx, immunizations, meds

142
Q

Child with Red Eye plan

A

PE including HEENT, opthalmoscopic eye exam, discharge cx, slit lamp exam

143
Q

Child with Red eye DDx

A

Bacterial/viral conjunctivitis, allergic rhinitis, keratitis, uveitis

144
Q

Child with short stature hx

A

Other sx, general hx, prenatal/birth/growth hx, family h/o problem, cognitive/school ability

145
Q

Child with short stature PE and plan

A

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
Q

Child with short stature DDx

A

Constitutional short stature, GH deficiency, hypothyroid, chronic renal insufficiency, CF, genetic causes (Turner’s)

147
Q

Cough and SOB hx

A

Change, hemoptysis, constitutional sx, URI, CP (pleuritic), improving?, work exposures, smoking hx, meds (ace-i), lung dz, CHF, HIV exposure

148
Q

Cough and SOB PE

A

Pulse ox, nasal mucosa, oropharynx, LAD, CV, pulm, extr

149
Q

Cough and SOB DDx

A

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
Q

Cough and SOB Plan

A

CXR, peak flow meter, methacholine challenge test, PFTs, sputum gram stain, PPD, IgM mycoplasma, urine legionella Ag, bronchoscopy, echo, BNP

151
Q

Atypical PNA presentation

A

Young person with nonproductive cough a few weeks after URI

152
Q

Pulmonary edema presentation

A

Worsening dyspnea over hours, cough with frothy pink sputum

153
Q

Sore throat hx

A

Ear symptoms, LAD, HIV risks

154
Q

Sore throat PE

A

ENT (oral thrush, exucate, LAD), Abd (splenomegaly), pulm, skin

155
Q

Infectious mononucleosis symptoms

A

Sore throat, severe fatigue, fever, loss of appetite, epigastric and LUQ discomfort, cervical LAD, rash

156
Q

Sore throat DDx

A

Mono, viral/bacterial pharyngitis, acute HIV, scarlet fever, syphilis, mycoplasma PNA

157
Q

Sore throat plan

A

CBC with smear, monospot, throat cx, HIV ab, anti-EBV Ab, rapid strep

158
Q

Acute HIV pharyngitis

A

Sore throat, fever, rash, weight loss, IV drug use hx

159
Q

UGIB hx

A

Severe vomiting, nosebleed, EtOH, blood thinners, NSAIDs, h/o liver dz or AAA repair

160
Q

UGIB PE

A

Orthostatics, ENT, CV, pulm, abd, rectal

161
Q

UGIB DDx

A

Bleeding peptic ulcer, gastritis, gastric CA, esophageal varices, mallory weiss tear

162
Q

UGIB plan

A

Rectal, CBC with type and cross, INR, upper endoscopy, H pylori, CMP

163
Q

Urinary Sx Hx

A

Post void dribbling, stress leak, obstructive sx, meds, bone/back pain, DM, h/o UTIs, instrumentation, stones, EtOH, recent new sexual partner

164
Q

Urinary Sx PE

A

Abdominal (puprapubic percussion), focused neuro

165
Q

Urinary Sx DDx

A

BPH, prostate CA, UTI, bladder stones, RCC, urethritis, prostatitis, pyelo, renal stone, stress/mixed/functional/urge/overflow incontinence,

166
Q

Urinary Sx plan

A

Rectal, GU, PSA, UA, US/bx prostate, alk phos, CT/MRI pelvis/spine/abd, C&G PCR, US renal, urodynamic testing, cystourethroscopy

167
Q

Urge incontinence sx

A

Unable to suppress urge to urinate, loses large amounts at once without warning

168
Q

Vaginal discharge hx

A

Pain/pruritis, recent sex, onset of LMP, contraception, tampons, douches, h/o STDs

169
Q

Vaginal discharge PE

A

Abd, complete pelvic

170
Q

Vaginal discharge DDx

A

Bacterial vaginosis, vaginitis (candida, trichomonal), cervicitis (chlamydia, gonorrhea)

171
Q

Vaginal discharge Plan

A

Pelvic, Chlamydia, Gonorrhea, VDRL/RPR, wet prep, KOH prep, pH, cervical cx

172
Q

Vaginal bleeding hx

A

Menopause satus, LMP, menstrual hx, urinary sx, abd pain, pregnancy, trauma, OCPs, blood thinners, abdnormal paps, context

173
Q

Vaginal bleeding PE

A

Abdominal, complete pelvic

174
Q

Vaginal bleeding DDx

A

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
Q

Vaginal bleeding Plan

A

Urine hCG and quant, pelvic, US pelvis, cervical cx, pap, PT/INR, LH/FSH, TSH, prolactin, endometrial bx, colposcopy, hysteroscopy, HPV testing

176
Q

Vision loss hx

A

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
Q

Vision loss PE

A

CV, HEENT, funduscopic, neuro

178
Q

Vision loss DDx

A

Retinal artery/vein occlusion, acute closed angle glaucoma, retinal detachment, temporal arteritis

179
Q

Acute closed angle glaucoma presentation

A

Severe eye pain, n/v, HA, blurred vision, tearing, red eye, halo around lights, sudden onset

180
Q

Acute open angle glaucoma presentation

A

Gradual loss of peripheral vision in both eyes, tunnel vision late

181
Q

Vision loss Plan

A

Fluorescein angiogram, echo, doppler US carotid, intraocular tonometry, temporal artery bx, ESR

182
Q

Numbness and weakness hx

A

Unilateral v. b/l, prox v. distal, progression, pain, neuro sx, H/o DM or EtOH, atherosclerosis

183
Q

Numbness and weakness PE

A

Neuro, MSK, vascular, Babinski’s

184
Q

Numbness and weakness DDx

A

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
Q

Numbness and weakness plan

A

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
Q

MS presentation

A

Young woman with weakness and loss of sensation of limb, vision loss, eye pain, double vision, electric shocks down spine when flex neck

187
Q

Weight loss hx

A

diet and exercise, body image, blood in urine/stool, B sx, hyperthyroud sx, HIV risks, drugs, h/o CA

188
Q

Weight loss PE

A

Complete

189
Q

Weight loss DDx

A

Hyperthyroidism, CA, HIV, diet, diet drugs, anorexia, malabsorption

190
Q

Weight gain hx

A

Smoking cessation, depression, med change, diet, PMHx, hypothyroid sx, drugs, mestrutal irregularity, hirsutism

191
Q

Weight gain PE

A

Complete, edema (renal dz), Cushings sx

192
Q

Cushings Syndrome presentation

A

HTN, moon facies, buffalo hump, central obesity, striae, supraclavicular fat (dexamethazone suppression test, 24hr urine free cortisol test)

193
Q

Weight gain DDx

A

Smoking cessation, drug side effect, Cushings, hypothyroid, PCOS, DM, atypical depression, insulinoma, preactive postprandial hypoglycemia

194
Q

Insulinoma presentation

A

Weight gain, tremor, palpitations, anxiety, hunger relieved by eating, proximal weakness and easy bruising

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