Big Case Scenarios Flashcards
Tests to ALWAYS do to a young woman with abdominal pain.
- Urine B-hCG
- UA (could be PID, UTI, Pyelo, etc…)
- Pelvic Exam (STD, cervical motion tenderness)
- Rectal Exam (endometriosis)
- GC cervical swab (PID)
- Ultrasound pelvis (Ovarian cysts, Ectopic prego, torsion)
- CBC for infection
DDX: 70 y/o man with a shoulder injury after a fall.
- Humeral fracture (very common in elderly. look for loss of sensation over lateral shoulder where the axillary nerve runs)
- Osteoporosis - Always check and put on ddx in elderly with potential fractures.
- Shoulder dislocation
- Elder abuse (depending on living situation)
- Rotator cuff tear
This same 70 y/o man was delayed in seeking care for 3d. What questions do you ask?
Why were you delayed?
What are your living conditions like?
Do you feel safe at home?
What 2 tests do you ALWAYS need when you are assessing a joint injury?
XRAY - looks at bones
MRI - Soft tissues, ligaments
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?
- CBC w/ Diff - to differentiate viral/bacterial
- Peripheral smear - atypical lymphocytes
- Monospot test - Mono +/-
- Rapid Strep antigen
- Throat culture
- Flu test
When testing for HIV, what 2 types of tests do you order and why?
HIV viral load –> active infection
HIV antibody –> Previous infection
What questions do you always ask in a patient with diarrhea?
- Onset
- Daily frequency
- Blood/mucus?
- Recent abx use?
- Travel?
- Sick contacts?
- Eat anything odd?
List the components of the social history:
- Occupation
- EtOH - CAGE. Wanna quit?
- Tobacco - amount, duration, wanna quit?
- Illicits, drugs not rx’d to you?
- SEX!
- Exercise
- Diet
What are the CAGE questions?
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?
In a person with HTN and CP, why do you ALWAYS check BP in both arms?
Aortic dissection –> will show unequal BPs.
Febrile infant (
- Viral URI
- Meningitis
- PNA
- AOM
- UTI
Febrile Infant workup:
- Pneumatic Autoscopy
- CBC w/ Diff
- LP for CSF analysis (must specify)
- CXR
- Cath UA
- Others: BCx, UCx,
ROS for kid
RASH? Cough? Trouble swallowing (pharyngitis)? Runny nose? EAR PULLING? N/V? SOB, using their chest muscles to breathe?
What to ask in a history for a
- HPI
- ROS
- Eating - trouble swallowing, breast/bottle
- Sleeping habits
- Peeing - changes in color, frequency
- Pooping - Changes in consistency, color, etc…
- Day care, sick contacts
- Vaccinations UTD?
- Birth Hx + Prego history
- Last checkup –> “At that point were there any developmental concerns?”
- Medical Hx
- Surgical Hx
- Medications
- Allergies
The patient has pain. What are the extra questions other than OLDCARTS you need to ask?
- Constant or does it come and go?
- Is it getting worse, better, or staying the same?
- Any inciting incident? What were you doing when the pain started?
- Ever felt pain like this before?
Physical Exam for Back pain:
CV, Pulm (always)
Back - inspection, palpation, ROM
Extremities - pulses, hip exam
Neuro - Gait, strength, sensation, STRAIGHT LEG RAISE TEST, DTRs.
Workup for back pain:
- XRAY - lumbar spine
- Rectal (if any urinary or fecal incontinence or straining)
- MRI - lumbar spine
- PSA
- HLA-B27
DDX back pain:
- Disc herniation - radiating pain to foot
- Lumbar spinal stenosis - pain resolves with sitting
- Lumbar muscle strain
- Metastatic prostate cancer - if urinary symptoms and old
Urinary Symptom questions to ask:
- Change in urinary habits?
- Pain or burning with urination?
- Change in color? Blood?
- How often do you urinate a day?
- How many times do you wake up at night?
- Ever feel like you can’t fully empty your bladder?
- Ever experience any dribbling?
- Urgency? … you have to go really fast and maybe can’t make it to the bathroom?
What PE do you do on a Prego woman?
HEENT + THYROID, conjunctiva (for anemia) CV- listen Pulm - Listen Abd - inspect, auscultate, palpate Ext - edema Skin - pigmentation and pallor
What tests do you order in a new onset prego woman?
- Urine B- hCG
- UA
- UCx
- Pap Smear
- Pelvic USG
- Blood type and Rh antibody screen
- HIV
- Cervical swab culture
- BREAST AND PELVIC EXAMS
- RPR, Rubella, HepB antigen, and HIV antibody
In an adult diabetes followup what do you need to specifically ask?
- Eye appt?
- Loss of sensation anywhere?
- Foot infections, foot checks?
- Lipid checks? Cholesterol levels?
- History of heart problems or CAD?
- Glucose levels, last checked, last A1c.
What does a hypoglycemic episode look like in a diabetic?
Sweating Palpitations Heart racing HA 2/2 HTN Lightheaded, Dizzy Adrenaline rush essentially --> Epi and NEpi released and they make you sympathetically overloaded.
DDX and symptoms associated with each in a 35 y/o woman with new onset Amenorrhea.
- PREGNANCY - sexual history
- Hypothyroidism - dry skin, thinning hair, edema, lethargy, depression
- Prolactinoma - vision changes, loss of peripheral views, breast discharge
- PCOS - hair growing anywhere, weight gain,
- Premature Ovarian Failure - date mom started menopause, vaginal dryness, hot flashes.
