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Step 2 CS > Big Case Scenarios > Flashcards

Big Case Scenarios Flashcards

1
Q

Tests to ALWAYS do to a young woman with abdominal pain.

A
  1. Urine B-hCG
  2. UA (could be PID, UTI, Pyelo, etc…)
  3. Pelvic Exam (STD, cervical motion tenderness)
  4. Rectal Exam (endometriosis)
  5. GC cervical swab (PID)
  6. Ultrasound pelvis (Ovarian cysts, Ectopic prego, torsion)
  7. CBC for infection
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2
Q

DDX: 70 y/o man with a shoulder injury after a fall.

A
  1. Humeral fracture (very common in elderly. look for loss of sensation over lateral shoulder where the axillary nerve runs)
  2. Osteoporosis - Always check and put on ddx in elderly with potential fractures.
  3. Shoulder dislocation
  4. Elder abuse (depending on living situation)
  5. Rotator cuff tear
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3
Q

This same 70 y/o man was delayed in seeking care for 3d. What questions do you ask?

A

Why were you delayed?
What are your living conditions like?
Do you feel safe at home?

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4
Q

What 2 tests do you ALWAYS need when you are assessing a joint injury?

A

XRAY - looks at bones

MRI - Soft tissues, ligaments

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5
Q

21 y/o comes in with URI symptoms suspicious for mono. (Cervical LAD, abdominal pain, fever, fatigue, recent sick contact girlfriend had it a month ago). What is your ddx and what tests do you run?

A
  1. CBC w/ Diff - to differentiate viral/bacterial
  2. Peripheral smear - atypical lymphocytes
  3. Monospot test - Mono +/-
  4. Rapid Strep antigen
  5. Throat culture
  6. Flu test
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6
Q

When testing for HIV, what 2 types of tests do you order and why?

A

HIV viral load –> active infection

HIV antibody –> Previous infection

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7
Q

What questions do you always ask in a patient with diarrhea?

A
  1. Onset
  2. Daily frequency
  3. Blood/mucus?
  4. Recent abx use?
  5. Travel?
  6. Sick contacts?
  7. Eat anything odd?
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8
Q

List the components of the social history:

A
  1. Occupation
  2. EtOH - CAGE. Wanna quit?
  3. Tobacco - amount, duration, wanna quit?
  4. Illicits, drugs not rx’d to you?
  5. SEX!
  6. Exercise
  7. Diet
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9
Q

What are the CAGE questions?

A

Cut back?
Annoyed you by asking about your drinking habits?
Guilty feelings?
Eye opener –> ever needed a drink in the AM to help a hangover or to get your day started?

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10
Q

In a person with HTN and CP, why do you ALWAYS check BP in both arms?

A

Aortic dissection –> will show unequal BPs.

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11
Q

Febrile infant (

A
  1. Viral URI
  2. Meningitis
  3. PNA
  4. AOM
  5. UTI
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12
Q

Febrile Infant workup:

A
  • Pneumatic Autoscopy
  • CBC w/ Diff
  • LP for CSF analysis (must specify)
  • CXR
  • Cath UA
  • Others: BCx, UCx,
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13
Q

ROS for kid

A 
RASH?
Cough? 
Trouble swallowing (pharyngitis)?
Runny nose? 
EAR PULLING? 
N/V?
SOB, using their chest muscles to breathe?
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14
Q

What to ask in a history for a

A
  1. HPI
  2. ROS
  3. Eating - trouble swallowing, breast/bottle
  4. Sleeping habits
  5. Peeing - changes in color, frequency
  6. Pooping - Changes in consistency, color, etc…
  7. Day care, sick contacts
  8. Vaccinations UTD?
  9. Birth Hx + Prego history
  10. Last checkup –> “At that point were there any developmental concerns?”
  11. Medical Hx
  12. Surgical Hx
  13. Medications
  14. Allergies
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15
Q

The patient has pain. What are the extra questions other than OLDCARTS you need to ask?

A
  1. Constant or does it come and go?
  2. Is it getting worse, better, or staying the same?
  3. Any inciting incident? What were you doing when the pain started?
  4. Ever felt pain like this before?
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16
Q

Physical Exam for Back pain:

A

CV, Pulm (always)
Back - inspection, palpation, ROM
Extremities - pulses, hip exam
Neuro - Gait, strength, sensation, STRAIGHT LEG RAISE TEST, DTRs.

17
Q

Workup for back pain:

A
  1. XRAY - lumbar spine
  2. Rectal (if any urinary or fecal incontinence or straining)
  3. MRI - lumbar spine
  4. PSA
  5. HLA-B27
18
Q

DDX back pain:

A
  1. Disc herniation - radiating pain to foot
  2. Lumbar spinal stenosis - pain resolves with sitting
  3. Lumbar muscle strain
  4. Metastatic prostate cancer - if urinary symptoms and old
19
Q

Urinary Symptom questions to ask:

A
  1. Change in urinary habits?
  2. Pain or burning with urination?
  3. Change in color? Blood?
  4. How often do you urinate a day?
  5. How many times do you wake up at night?
  6. Ever feel like you can’t fully empty your bladder?
  7. Ever experience any dribbling?
  8. Urgency? … you have to go really fast and maybe can’t make it to the bathroom?
20
Q

What PE do you do on a Prego woman?

A 
HEENT + THYROID, conjunctiva (for anemia)
CV- listen
Pulm - Listen
Abd - inspect, auscultate, palpate
Ext - edema
Skin - pigmentation and pallor
21
Q

What tests do you order in a new onset prego woman?

A
  1. Urine B- hCG
  2. UA
  3. UCx
  4. Pap Smear
  5. Pelvic USG
  6. Blood type and Rh antibody screen
  7. HIV
  8. Cervical swab culture
  9. BREAST AND PELVIC EXAMS
  10. RPR, Rubella, HepB antigen, and HIV antibody
22
Q

In an adult diabetes followup what do you need to specifically ask?

A
  1. Eye appt?
  2. Loss of sensation anywhere?
  3. Foot infections, foot checks?
  4. Lipid checks? Cholesterol levels?
  5. History of heart problems or CAD?
  6. Glucose levels, last checked, last A1c.
23
Q

What does a hypoglycemic episode look like in a diabetic?

A 
Sweating 
Palpitations
Heart racing
HA 2/2 HTN
Lightheaded, Dizzy
Adrenaline rush essentially  --> Epi and NEpi released and they make you sympathetically overloaded.
24
Q

DDX and symptoms associated with each in a 35 y/o woman with new onset Amenorrhea.

A
  1. PREGNANCY - sexual history
  2. Hypothyroidism - dry skin, thinning hair, edema, lethargy, depression
  3. Prolactinoma - vision changes, loss of peripheral views, breast discharge
  4. PCOS - hair growing anywhere, weight gain,
  5. Premature Ovarian Failure - date mom started menopause, vaginal dryness, hot flashes.
25
Q

Labs to order with Amenorrhea

A 
B-hCG
Pelvic Exam
Breast Exam
LH, FSH
Prolactin, TSH
MRI-brain
26
Q

Pain with sex questions to ask…

A

Refer to page 278 in book.

  1. HPI
  2. Full Gyn Hx
  3. Safe at home? Problems with boyfriend? Hx of abuse?
  4. Vaginal discharge?
27
Q

Full Gyn Hx Questions

A

LMP?
How often do you get periods?
How long do they last?
Flow heavy/light? How many tampons/pads per day?
Any bleeding in between periods? What color?
Associated with cramping?
Vaginal discharge? - smell, color

Last pap? Normal?
Hx of abnormal paps?
Breast leakage or tenderness?

Sexually active? 
Men/Women/Both?
Contraception? Barrier protection?
How many partners in the last year? Current partners?
STDs? Treated? Partner treated? 
HIV tested?

How many pregnancies?
How many live births? Any miscarriages or abortions?
Method of delivery?
Term? Complications?

28
Q

DDX for pain with Sex?

A
  1. Vulvovaginitis (gardnerella)
  2. Cervicitis (gonococcal, chalmydial)
  3. Endometriosis
  4. PID
  5. Domestic violence
  6. Vaginismus
29
Q

Questions to ask for hearing loss in a 75 y/o man? pg 288

A
  1. Onset, progression, timing
  2. Both ears? Any specific pitches (high vs low)
  3. Do you have trouble hearing speech?
  4. Treatments tried
  5. Ear pain/discharge
  6. Dizziness, room spinning
  7. Feel imbalanced or like you’ll fall?
  8. Tinnitus?
  9. Trauma
  10. Loud noise exposure
  11. Anything weird get stuck in your ear? Lots of wax?
30
Q

What PE to do for hearing loss with no dizziness or vertigo?

A
  1. HEENT with whisper test, Weber, and Rinne
  2. CV/Pulm Auscultation
  3. Neuro - CN II-XII, sensation (light touch, temp), motor, reflexes (biceps, patellar), cerebellar signs (finger to nose), gait, Romberg
31
Q

Name the components of the really quick neuro exam:

A
  1. CN II- XII
  2. Sensation to light touch and temp on 4 extremities
  3. Motor
  4. REFLEXES - biceps and patellar
  5. Cerebellar
32
Q

Full ROS:

A

General: Fatigue, Fevers, Chills. Weight change. Appetite change. Hot/cold intolerance. Recent infections. Sick contacts.
HEENT: Heachache, Vision changes.
Pulm: CP, SOB, COUGH
CV: Palpitations, swelling in your legs.
Abd: Abdominal pain. N/V/C/D?
GI: Changes in bowel habits?
GU: Changes in urinary habits?
Neuro: Weakness, Numbness or tingling in any extremity
Skin: Changes in hair, skin, or nails?

33
Q

Things to test with Thyroid suspicions?

A 
Thyroid size
Palpate heart and auscultate
Extremity edema
TREMOR for hyperthyroid
DEPRESSION with hypothyroid

Step 2 CS (2 decks)

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