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เอา Long Case ไห้ได้ก่อน > Approach General > Flashcards

Approach General Flashcards

1
Q

Fever

A

Acute <2 wk
Chronic >3wk

Local

  • head meningitis encep
  • Ear otitis media
  • node sinusitis
  • throat Tonsilitis
  • Lung bronchitis pneumonia
  • Abdomen Biliarry AGE
  • Urinary pyelonephritis
  • joint Arthritis
  • Skin Abscess cellulitis
  • Gyne PID
Systemic
Bacteria- rickettsial(ลุยสวน ลุยน้ำ)
Enteric typhoid (ผื่น ไข้ตอนเช้า rosespot)
Lepto
Melioidosis

Virus
Dengue
EBV

Parasite
Malaria

Chronic >3wk
- abscess diverticulitis TOA osteomyelitis Endocarditis Aspergilosis Histoplasmosis
####- HIV SLE RA Lymphoma Hyperthyroid
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2
Q

Fatigue

A

Psy
Physiologic

Organic

  1. Infection- TB HIV
  2. inflammation- HF, Cirrhosis, CKD, COPD, DM
  3. Autoimmune- SLE, RA
  4. Tumor- Hemato …
  5. Endocrine- Anemia, Hyper/hypothyroid, Aldosterone insuff
  6. Drug- Antithyroid, Diuretic, Chemo
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3
Q

Wt loss
5% 6 mo
10% 3 mo

A

กินได้- DM, Thyroid, Pheochromocytoma

กินไม่ได้ เหมือน อ่อนแรงอะ

  1. infection - TB HIV
  2. Inflammation - HF Cirrhosis CKD
  3. Auto immune- SLE RA
  4. Tumor Solid Hemato
  5. Endocrine - Aldosterone
  6. Malabsorption- Colectomy
  7. Drug -Amphet, Thyroid, Chemo, Laxative, Diuretic
  8. Psy- Depression, Anorexia, Bulimia
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4
Q

Wt gain

A

กินเยอะ

Endocrine- Cushing, Hypothyroid, PCOS
Thyroid enlarge, Brady, Hoarse, Slow relaxation $$$

Drug- Steroid, NSAID, Antithyroid, Antiepileptic, Antipsychotic

Water retention- HF, cirrhosis, CKD, Nephrotic, nephritis

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5
Q

Bleeding

A

Local- epistaxis, Hemoptysis, Hematemesis, Melena, Hatatochezia, Hematuria, Vaginal bleeding

Systemic
Primary- Skin mucosa Membrane–> vWF, Platelet - dengue, platelet dys, Aspirin, NSAID./ Fibrinogen
Secondary-
Intrinsic , Extrinsic

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6
Q

Epistaxis

A

which site how long until stop
Trauma, ตอนกลางคือเปิดแอร แคะแกะสั่ง
Infection fever face pain
warfarin hepatin painmed

Secondary
family hx
food green veg

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7
Q

Hemoptysis
200ml/day 1 episode
600 ml/ day massive

A

Airway

  1. Bronchitis
  2. Bronchiectasis
  3. Bronchogenic CA

Parenchymal

  1. TB
  2. Pneumonia
  3. ABscess
  4. SLE
  5. CA
  6. CHF

Vascular
1. Emboli ( sudden, asymm expansion, Dec breathsound)

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8
Q

Hematemesis

A

Local

  1. Esophagus - esophagitis, Ca, Mallory weiss, Varices
  2. Stomach- Ca, ulcer, Varies, Dieularoy lesion
  3. Duodenal- Ulcar, Ca, Dieulafoy
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9
Q

Hematochezia

A

Local

  1. Diverticulitis
  2. Ca
  3. INtussuseotion

Colon

  1. Infection
  2. Radiation
  3. Crohn, UC
  4. Ischemic emboli Afib
  5. Fiverticular hemorrhage
  6. Polyp CA

Anorectal

  1. Ext hemorrhoid
  2. Int Hemorrhoid
  3. Anal fissure
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10
Q

Hematuria

A

Local
1. Renal
Glomerular - Nephritis ( PSGN,IgA, SLE), Nephrotic
Non-Glomerular- ATN, Interstitial

  1. Ureter stone, CA
  2. Bladder cystitis, Stone, CA, Chemo
  3. Urethra- Urethritis, BPH, Ca
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11
Q

Vaginal Bleeding

A
  1. r/o pregnancy
  2. think ectopic, abortion, molar
  3. Local
    > ovary - DUB (excercise, wt loss, stress), Axis, Ca, Endometriosis, Endometrioma
    > Uterus - PID, Polyps, Fibroid, Adenomyosis, Endometrial Ca
    > Cervix- Polyps Ca( pap?)
    > Vaginal atrophy
  4. Systemic
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12
Q

Amenorrhea

6 month or 3 consecutive mon

A
  1. Preg, lactation, Menopause
    2.Primative - uterus
  2. Secondary
    Pituitary- stress, excercise, prolactin, sheehan, anorexia, hyperthyroid
    Ovary- PCOS, Ovarian failure, OCP
    UTerus - Asherman
    Cervix-
    Vagina- Imperforated hymen
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13
Q

Anemia

A

find source trauma, hematuria, melena

Vitamin def- eat less meat, iron b12 def
Chronic HF,CKD,COPD
Genetic- Family History , Drug G6PD

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14
Q

Hemolysis

A

Intravascular- hemoglobinuria cocacola++
G6PD, PNH, MAHA»>DIC, HUS, TTP, Eclap, HELLP, Malignant HT, Prosthetic valve

Extravascular- concentrated Urine
AIHA, Hereditary Spherocytosis, Thalassemia

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15
Q

Dysphagia

A

Oropharyngeal
Mechanical- Tumor CA
Functional- CNS,PNS(GBS,MS), NMJ(MG,Botulinum), Muscle (Polyomyositis)

Esophageal
Mechanical- Stricture, Ca(Progressive)
Functional- Achalasia, Scleroderma, Diffuse esophageal spasm
Sensational- GERD( globus)

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16
Q

Chest pain

A

Skin - herpes
MSK- chosto, fracture
Lung- Pneumothorax, empyema, Pneumonia, Embolism
GI- Esophagitis, GERD, Mallory Weiss, Dyspepsia, Ca
Vascular- Dissection

Heart
Ischemic- ACS, Angina, Prinzmetal
non-ischemic- Pericarditis, Myositis, Hypertrophy, AS

17
Q

Palpitation

A

Cardiac
Arrhythmia- tachy (SVT,VT), Brady (Av block), Irregular
Non arrhythmia- ASD,VSD, AR, AS, CHF

Metabolic- Physiologic(stress, excercise, volume depletion)
Pathologic (Fever, Hypogly, Thryotoxicosis, Pheochromocytoma)

Drug- coffee, alcohol, smoking, amphetamine

Psy- Anxiety, panic, hyperven

18
Q

Syncope

Dx Seizure, TIA, Hypogly

A

Cardiac

  • Vascular-Pulmo embolism, Aortic dissection
  • Cardiac -Arrhythmia - block
  • Cardiac structural- Tamponade, Hypertrophy, MI, AS

Orthostatic

  • Hypovolemic- vomit, Diarrhea, Bleeding, Diuretic, Vasodilator
  • ANS- Aging, DM, URemia, Cord injury

Reflex

  • Emotional
  • Situational- sneeze defecation, urination
  • Carotid sinus- Massage, Tight shirt
19
Q

Cough

A

Lung

  • Upper - Sinusitis, Common cold, Post infection, FB
  • Lower- Bronchitis, Bronchiolitis, Pneumonia, TB, Asthma, COPD, Irritant, Cancer

Heart
- LV failure

GI
- GERD

Drug
- ACEi

20
Q

Dyspnea

A

Respi

  • Airway- FB, CROUP, Bronchiolitis, Anaphylaxis, Asthma, COPD
  • Parenchymal- Pneumonia, Intersitial lung(fibrosis, COPD, Occupational), Tumor CA
  • Vascular - embolism
  • Pleural - pneumothorax, hemothroax, chylothorax, pleural effusion

Neuromascular
Upper - Brain stem c spine
Lower- GBS, MG, Kyphosis

Heart
CHF

Metabolic
Anemia, Acidosis, DKA, Uremia, Thyrotoxicosis

Psychiatric
Anxiety, panic, Hyperventilation

21
Q

Edema

A

Localized
infection- cellulitis, erysipelas, parasite
Venous obstruction- DVT
Lymph obstruction- Radiation, Surgery, Dissection, Tumor Ca

Generalized
Heart - CHF
Liver - Cirrhosis
Kidney- Nephrotic, Glomerulonephritis, AKI/CKD
Hypoalbumin- malnutrition
Metabolic- hypothyroid
Drug- amlo, NSAID, Estrogen
22
Q

Jaundice

A

Hemolysis

23
Q

NV

A

Head

  • Brain - hydroceph, EDH, SDH, ICH, Menintitis, Enceph, Tumor Ca
  • Eye- glaucoma
  • Ear- Labyrinitis, Motion sickness

Non-head
GI- biliary, hep, panc
Stomach colon- AGE, Dyspepsia, Gastricoutlet obstruction, Diverticulitis, obstruction
GU- Pyelonephrotis, PID, Stone, Pregnancy
Metabolic- Uremia, DKA, Hyponat, Adrenal insuff
Drug- Morphine

24
Q

Diarrhea

A

Acute
WATERY
+ vomiting- Vomiting(poisoning)
+Diarrhea dominant- Bacteria ETEC, Vibro, Camphylo, C diff, Rota, Novo virus

BLOODY
Bacteria - EHEC, EIEC, Shiga, samonella, C diff, V parahemolyticus
Virus - CMV
PRotozoa- E Histolytica

Chronic
+ lactose def, Thyroitoxicosis, TB, Amebic, IBD, Radiation, Ca, C Philippinesis, Giardia, Cirrhosis, Bile duct obstruction, LAxative, Colchicine, Amoxyclav

25
Q

Abdominal PAin

A

Biliary - Hepatitis, abscess, Colic, Cholecystitis, Cholangitis, Pancreatitis

Stomach- GERD, Esophagitis, Dyspepsia, CA

Small Bowel- Dyspepsia

Large bowel- AGE, Appendicitis, Diverticulitis, Obstruction, Infraction, Intussusception, Volvulus

Renal- Pyelonephritis, stone

OBGYN- PID, Ovarian Cyst, Ectopic preg, Endometriosis, Eterine fibroid, Cystitis

Aorta- dissection, aneurysm

26
Q

Pelvic Pain

A

OB- ectopic, Abortion, Molar
3rd trim- Placenta previa, arubtion, uterine rupture

GYNE- Ovary- PID, Cyst, Ectopic, Endometriosis
Tube- PID, Ectopic
Uterine- Adenomyosis, Myoma
Cervix- PID

27
Q

Leukorrhea

A

Physiologic

PAthologic
Infection= PID- Gonorrhea, chlamydia
Vaginitis= Gardnerella, Trichomonas, Candida

Non-infection- FB, IUD, Atrophic vaginitis

28
Q

HEad ache

A

Primary

  • Tension
  • Cluster
  • Migraine
  • Trigerminal neuralgia
Secondary
- infection- enceph, meningitis, subdural empyema, abscess
- trauma- concussion, hemorrhage
- Tumor- Ca brain
-Vascular - Stroke, SAH
CSF- Hydrocephalus, post lumbar puncture

Red flag

  • fever, wt loss , HIV, Preg
  • Neuro seizure, weakness, diplopia, vision loss
  • 50 yo plus
  • Progressive
29
Q

Alteration of consciousness

A

Intracranial - infect trauma tumor pressure stroke
Infection- enceph, meningitis, Abscess, Subdual empyema
Trauma- Hemorrhage
Tumor- CA
Vascular- stroke, malformation
Other- Status epilepticus, Hydrocephalus

Extracranial
Infection - sepsis
Endocrine- hypogly, DKA/HHS, Hypo/per thyroid, Adrenal crisis
Metabolic - Uremia encep, hepatic encep, hypoxemia, hypercapnea
Electrolyte- hyperhypo Na hyper Cal
Drug- morphine, Alcohol, Sedative
Other- shock, hypohyperthermia, HTN enceph, Eclampsia

30
Q

Seizure

A 
Intracranial
Infection-Enceph,meningoenceph, abscess,subdural empyema, cysticercosis
Trauma- Brain, hemorrhage
Tumor
Vascular- Stroke , SAH, Malformation
Other- Hydrocephalous
Extracranial
Infection- sepsis, fever
Endocrine- hypogly
Metabolic- uremia
Electrolyte- hyponat, hypocal
Drug/toxin- alcohol intox,withdrawal, BZD withdraw
Medication-
31
Q

Vertigo

A

Central
- Brain stem, cerebellar, Migrain

Peripheral

  • With HL = Meniere, Lybrinthitis, Vesticular shwannoma
  • with out HL= BPPV, Vestibular neuritis, Perilymph fistula
32
Q

Tremor

A

Resting - parkinson, antipsychotic
Intentional- Brain stem, cerebellar

Postural - Essential tremor, Thyrotoxicosis, Alcohol withdrawal, Anxiety, Fear, coffee

33
Q

Weakness

A

Cortex Brainstem- Abscess, Trauma, Stroke
Spinal cord- Abscess, Demyelination, infract, trauma, tumor
Anterior horn- poliomyositis, Trauma
PNS- GBS, DM
NJM- Myasthenia gravis, Botulinum
Muscle- Myositis, muscle dystrophy, Electrolyte

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