Block 4 practical Flashcards
35 yr old man
CC:
RUQ abdominal pain/cramping
Other:
Skin/eye color change (yellow)
Fever, N/V, loss of appetite, & fatigue
Note:
Patient is a heavy drinker *years long
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Viral hepatitis
Bile stones
Cholecystitis
Cirrhosis
Alcoholic hepatitis
Tests:
Blood work for liver enzymes (AST»ALT)
Ultrasound & CT
HIDA scan
Liver biopsy
Diagnosis:
Alcoholic hepatitis
Treatment:
Abstain from alcohol
Naltrexone (reduce cravings)
Benzodiazepines (Lorazepam for withdrawal)
Vitamin K
55 yr old man
CC:
Chest pain with exertion (better with rest)
Other:
Dyspnea, Dizziness, & Palpitations, Diaphoresis
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
MI
Anxiety
Stable Angina
Arrythmia
Tests:
ECG
Cardiac enzymes/troponin
Lipid profile
Cardiac stress test
Diagnosis:
Stable Angina
Treatment:
Life-style changes
B-blockers
Nitroglycerin
27 yr old
CC:
Weight-loss, Restlessness, & Smooth neck swelling
Other:
Diarrhea, Palpations, Hypertension
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Arrythmias
Pheochromocytoma
Anorexia
Hyperthyroidism
Tests:
ECG
Thyroid function & Ultrasound
Urine metaneprhine
Holter monitor
Diagnosis:
Hyperthyroidism
Treatment:
Antithyroid drugs like Methimazole or Propylthiouracil
24 yr old
CC:
Green-Gray Vaginal discharge that stinks
Other:
Mild pruritis, Dysuria, Dyspareunia, & Strawberry cervix
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Candida albicans
Bacterial vaginalis
Trichomonas
Tests:
Saline wet mount
KOH test
Blood culture
Diagnosis:
Trichomonas
Treatment:
Metronidazole (partner to)
40 yr old
CC:
Productive cough (with blood) for over 3 wks
Other:
Fever, Weight-loss, Night sweats, & Lymphadenopathy
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Pulmonary embolism
SCLC
Pneumonia
TB
Tests:
CXR
Sputum culture & acid fast stain
Diagnosis:
TB
Treatment:
Isolation
RIPE:
(Rifampin, Isoniazid, Pyrazinamide, & Ethambutol)
23 yr old
CC:
Painless scrotal mass
Other:
Swollen testicle
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Spermatocele
Testicular cancer
Hydrocele
Tests:
Ultrasound
Transillumination
Diagnosis:
Hydrocele
Treatment:
Surgical resection or aspiration
30 yr old woman
CC:
Vision loss & foot weakness
Other:
Lateral gaze nystagmus, intention tremor, memory & concentration difficulties/issues, a shooting shock-like pain when flexing the neck
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
ALS
Pituitary adenoma (pushing against the optic chiasm)
Stroke
MS
Tests:
MRI
Electromyography
Diagnosis:
MS
Treatment:
Supportive care
Glucocorticoids for acute attacks
INF-B & Monoclonal Abs (Alemtuzumab or Natalizumab) to prevent flare ups
33 yr old woman
CC:
Sudden vision loss
Other:
Severe eye pain with movement & vision loss in the left eye
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Corneal ulcer
Papilledema
Giant cell temporal arteritis
Optic neuritis
Tests:
Gadolinium-enhanced MRI
Ophthalmoscope
Diagnosis:
Optic neuritis
Treatment:
High dose IV corticosteroids
Young boy
CC:
Weakness
Other:
Slower & less coordinated, family history of uncle dying very young
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
FAS
Duchene Muscular dystrophy
Osteomalacia
MS
Tests:
Muscle biopsy
DNA & blood tests
Diagnosis:
Duchene Muscular dystrophy
Treatment:
No treatment & poor prognosis
80 yr old
CC:
Hearing loss
Other:
Worse in noisy areas & Tinnitus
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Acoustic neuroma (unilateral)
Cerumen impaction
Presbycusis
Tests:
Otoscopy
Audiogram
CT
Rinne & Weber test
(air vs bone conduction & lateral vs uni)
Diagnosis:
Presbycusis
Treatment:
Hearing aids
75 yr old
CC:
Memory loss (short-term)
Other:
Not oriented to person/time/place
Difficulty with daily living activities
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Dementia
Subdural hematoma
Vit B12 deficiency
Alzheimer’s
Tests:
CT
CBC
Diagnosis:
Alzheimer’s
Treatment:
Supportive care
AchE inhibitors
(Donepezil, Rivastigmine, Galantamine)
50 yr old
CC:
Lower back pain
Other:
Bus driver, no neurological or radiation
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Herniated disk
Compression fracture
Muscular back pain
Tests:
Straight leg test
MRI
Diagnosis:
Muscular back pain
Treatment:
Physio therapy & pain meds
40 yr old
CC:
Sore throat & Dysphagia
Other:
Heart burn after eating (worse at night), Halitosis, & Persistent cough
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Esophageal diverticula
Achalasia
GERD
Tests:
Barium swallow
X-ray
Gastroscopy
Diagnosis:
GERD
Treatment:
Life-style & Diet changes
PPI’s & antacids
Surgery for very severe cases
Elderly
CC:
Loss of consciousness/syncope
Other:
Rapid onset & recovery, takes antihypertensives, worse when shifting positions i.e laying down to standing up
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Vasovagal syncope
B-blocker side effects
Hypovolemia
Orthostatic hypotension
Tests:
Electrolyte panel
Blood glucose
Diagnosis:
ECG
Orthostatic hypotension
Treatment:
Glucose & fluid/electrolyte replacement as needed
35 yr old woman
CC:
Headache
Other:
Recurrent unilateral & localized headaches with sensitivity to light/sound
Differentials:
Tests:
Diagnosis:
Treatment:
Differentials:
Cluster headaches
Tension headaches
Migraine without aura
Tests:
ESR & C reactive protein
Determine recurrent headache patterns
Diagnosis:
Migraine without aura
Treatment:
Sumatriptan (acute)
Ibuprofen or Tylenol
Propranolol (severe)
