Adult CC, and Ddx.

Question 1

Chief Complaint: Altered Mental Status

Answer 1

AEIOU TIPS

1. Alcohol.
2. Electrolytes, encephalopathy
3. infection
4. overdose, oxygen deprivation
5. uremia
6. trauma
7. insulin
8. psychogenic
9. stroke/seizure/subarachnoids hemorrhage/Space occupying lesion

Elderly: hypoglycemia, sepsis, stroke.
Other ages: alcohol, drugs, hypoglycemia

Question 2

Chief Complaint: Headache

Answer 2

1. Infectious: meningitis, encephalitis, sinusitis, brain abscess.
2. Vascular: subarachnoid hemorrhage, hemorrhagic stroke, venous sinus thrombosis, cervical artery dissection
3. Others: idiopathic intracranial HTN, CO poisoning, giant cell arteritis.
4. More: migraine, tension, cluster, trigeminal neuralgia, TMJ, Post-LP, post trauma.

Question 3

Chief Complaint: Head Injury

Answer 3

1. Intracranial:
   
   1. subarachnoid hem
   2. subdural hematoma
   3. epidural hematoma
   4. intraparenchymal hemorrhage.
2. Cervical artery dissection, TBI, Diffuse axonal injury.

Question 4

Chief Complaint: Syncope

Answer 4

1. Cardiac:
   
   1. long QT, WPW, brugada syndrome, 2nd/3rd heart block, SA node dysfuntion. Aortic stenosis, HoCM, ACS
2. Vascular:
   
   1. pulmonary embolism, carotid stenosis, AAA, orthostatic HoTN.
3. Metabolic:
   
   1. hypoglycemia, hyperkalemia, anemia
4. Neuro:
   
   1. seizure, bleed, vasovagal, hyperventilation, carotid sinus sensitivity.
5. Pulm:
   
   1. pneumothorax.

Question 5

Chief Complaint: Dizziness

Answer 5

1. Central vertigo:
   
   1. cerebellar stroke, tumor, abscess, MS, subclavian steal.
2. Peripheral vertigo:
   
   1. vestibular neuritis, BPPV, labyrinthitis, migraine.
3. Lightheaded:
   
   1. anemia, low Cardiac output, bradycardia, dehydration, orthostatic HoTN, hyperviscosity syndrome.
4. Ataxia:
   
   1. ethanol, hyponatremia, Normal pressure hydrocephalus, benzos, antiepileptics, aminoglycosides, neurosyphilis.

Question 6

Chief Complaint: Weakness/Fatigue

Answer 6

1. Infection: sepsis, epidural abscess, encephalitis, meningitis, botulism
2. Cardiac: arrhythmia, ACS, bradycardia, CHF.
3. Metabolic: hypoglycemia, hyperkalemia, hyponatremia, hypothyroidism.
4. Neuro: stroke, subdural, myasthenia gravis, GBS, MS, polymyalgia rheumatica.
5. MSK: muscular dystrophy, poly/dermatomyositis.
6. Heme: anemia, leukemia.
7. Toxins: organophosphate poison, CCB, Bblock
8. GBS-CSF findings= high protein, normal WBC.

Question 7

Chief Complaint: Seizure

Answer 7

1. Metabolic: glucose, Na, hypocalcemia, uremia, thyrotoxicosis, hepatic encephalopathy.
2. Medications: antispasmodics, anticholingergics, antipsychotics, TCA, bupropion, lithium, clozapine, lidocaine.
3. EtOH withdrawal, stimulants
4. Infection: encephalitis, meningitis, neurocysticercosis
5. Structure: intracranial hem, subarachnoid hem, hydrocephalus. Epilepsy, eclampsia, hypoxia.
6. Cardiac dysrhythm, tetanus, malingering, cataplexy.

Question 8

Chief Complaint: Vomiting

Answer 8

1. Neuro: intracranial bleed/ tumor.
2. Cardiac: MI
3. GI: gastroenteritis, hepatitis, esophageal obstruction, achalasia, gastroparesis, zenker diverticulum.
4. GU: UTI.
5. Endo: DKA, Adrenal insufficiency, thyroid dz.
6. Drugs: CO, tylenol overdose, aspirin, opioid use/withdrawal, EtOH, digoxin toxicity.
7. Psych: depression, bulemia, anorexia
8. Preg: nausea/vomiting of pregnancy. Molar pregnancy, hyperemesis gravidarum.

Question 9

Chief Complaint: PAINFUL Red eye

Answer 9

1. Ruptured globe
2. Corneal ulcer
3. Corneal abrasion
4. acute angle closure glaucoma
5. iritis
6. HSV keratitis
7. Episcleritis
8. scleritis
9. ultraviolet keratitis
10. Foreign Body
11. Iridodialysis

Question 10

Chief Complaint: Painless red eye

Answer 10

1. Conjunctivitis
2. subconjunctival hemorrhage
3. hyphema
4. epidemic keratoconjunctivitis
5. pingueculum - benign growth on conjunctiva.
6. pterygium - growth covering part of cornea.

Extra-ocular

• blepharitis, hordeolum, orbital/periorbital cellulitis, cavernous sinus thrombosis, cluster HA.

Question 11

Chief Complaint: epistaxis

Answer 11

Etiologies:

• digital trauma, facial trauma, irritant.
• anticoagulants, liver failure,
• dyscrasias
  
  • leukemia, ITP, polycythemia vera, hemophila.

Question 12

Chief Complaint: Hemoptysis

Answer 12

1. Airway
   
   1. bronchitis, neoplasm, trauma, FB.
2. Infection
   
   1. tuberculosis, pneumonia, fungal infection.
3. Vascular dz
   
   1. pulmonary embolism, AVM, pulmonary HTN,
4. Vasculitis
   
   1. goodpasture, SLE, Wegener’s
5. Coagulopathy, valvular heart disease, cocaine.

Question 13

Chief Complaint: dental pain

Answer 13

1. Odontogenic
   
   1. caries, pericoronitis, periradicular periodontitis, post-extraction pain.
2. Periodontal
   
   1. periapical abscess, periodontal abscess, acute necrotizing ulcerative gingivitis, ludwig’s angina.
3. Trauma
   
   1. fracture, subluxation, avulsion.

Question 14

Chief complaint: Sore Throat

Answer 14

1. Infection
   
   1. peritonsilar abscess, retropharyngeal abscess, epiglottitis, strep pharyngitis, mononucleosis,
2. Non-infection
   
   1. caustic ingestion, Foreign body, ACS, lymphoma.

Question 15

Cheif Complaint: Chest pain

Answer 15

• CV:
  
  • ACS, aortic dissection, pericarditis.
• Pulm
  
  • pulm embolism, Pneumothorax, pneumonia
• GI
  
  • Boerhaave’s syndrome, pneumomediastinum, GERD
• Thoracic Wall
  
  • costochondritis, rib contusion/fracture, shingles.
• Panic Attack

Question 16

Chief complaint: palpitation

Answer 16

• Narrow:
  
  • sinus tach, AVRT, A-flutter.
  • A-fib, mutifocal a-tach, A-flutter.
• Wide
  
  • V-tach, accelerated idioventricular rhythm
• Valve
  
  • mitral/aortic insufficiency, mitral valve prolapse.
• Psych
  
  • panic attack, anxiety, depression
• Drugs
  
  • caffein, meth, cocain, ASA OD, EtOH withdrawal
• Other
  
  • thyrotoxicosis, anemia, addison crisis.
  • pheochromocytoma, acute porphyria, carcinoid

Question 17

Chief Complaint: shortness of breath

Answer 17

• Airway
  
  • obstruction, anaphylaxis, paradoxical vocal cord dysfunction, mass.
• Breathing
  
  • asthma, PE, COPD, pleural effusion, noncardiogenic edema, PTX, PNA.
• Cardiac
  
  • CHF, pericardial effusion, pericardial tamponade, ACS, arrhythmia
• Other
  
  • anemia, panic attack, pulmonary contusion, flail chest, DKA, CO poisoning, organophosphate ingestion/poisoning.