Common Chief Complaints Flashcards
Chest Pain
Diff: PE, ACS, pneumothorax, pericarditis, pneumonia, GERD, MSK, zoster, aortic dissection, PUD, esophageal spasm, pancreatitis, anxiety
Hx:
- quality (pressure, shooting, pleuritic, radiation)
- prior cardiac hx, studies ?
- family hx ACS
- fever / cough/ sputum prod
- tightness, palp, SOB?
- relation to exertion, relation to meals
- PE risks - recent surg, hx PE, OCPs, hemopytsis, unilat leg pain, recently treated cancer
Exam:
- breath sounds
- palpate chest wall, look for rash
- ab exam
- BPs in both arms
Studies:
- EKG
- CXR
- Troponin (maybe not in young)
- PERC / Well’s –> D dimer
SOB
DIFF: CHF exacerbation, pneumonia, asthma, ACS, COPD exacerbation, PE, vasculitis, anxiety, neuromuscular weakness, a fib
Hx:
- relieving / worsening factors (orthopnea?)
- Hx lung disease
- ECHO in past?
Studies:
- CXR
- EKG
- BNP
Syncope
DIFF: arrhythmia, CHF, valvular disease, orthostatic hypotension, vert-basilar stroke, vasovagal, seizure
Hx:
- LOC, urinary incontinence, tongue biting, tonic clonic movements, post-ictal state
- witness?
- hx heart disease
- diuretic use, dehydration, check med list
- dizziness, LH ?
- exertion beforehand
Exam:
- orthostatic vitals
- cardiac exam - crackles, murmurs
Studies:
- EKG
- glucose
- seizure work-up if suspect (CMP, med levels)
Abdominal Pain
DIFF: GERD, PUD, esophagitis or spasm, hepatitis, biliary colic or GB stones, ischemic bowel, IBD, IBS, diverticulitis, ectopic, ovarian torsion, appendicitis, testicular torsion, UTI, pyelonephritis
Hx:
- quality, location, timing of pain
- relation to food
- urinary sx / vaginal sx (discharge)
- ab surgeries in past
- nausea, vomiting, BMS
Exam:
- CVA tenderness
- Note rebound or guarding
- Obturator, psoas, rovsing signs
Studies:
- UA
- CMP + amylase + lipase
- Consider RUQ US if concern for hepatobiliary
- CT abdomen if concern
Back Pain
DIFF: DJD, bony mets, epidural abscess, spinal stenosis, spondyloarthritis
Hx:
- saddle anesthesia
- history of cancer
- recent spinal procedures
- weakness, numbness, tingling in extremities
PE:
- Neuro exam
- palpate whole spine
- straight leg test
Seizure
DIFF: primary sz disorder, hypo/hypercalcemia, hypo/hypernatremia, hypoglycemia, hypoxia, hypercapnia, alcohol withdrawal, meningitis/encephalitis
Hx:
- sz history? witness?
- pro-drome? post-ictal? LOC / incontinence / tongue lac
- DM / insulin use
- Alcohol hx
- Infectious sx? nuchal rigidity
Exam: full neuro, check for nuchal rigidity
Studies:
- CMP
- tox screen
- sz med levels if applicable
- LP if suspect meningitis
- MRI if focal neuro deficits
Altered Mental Status
DIFF: stroke, seizure, SAH, meningitis/encephalitis, abscess in brain, herniation, CHF, hypertensive encephalopathy, hypoxia/hypercapnia, ammonia, uremia, hypoglycemia, DKA, sepsis, hypothermia, sedative meds, CO, tox
Hx:
- Hx liver or kidney disease
- Hx lung disease / COPD or sleep apnea
- dementia, epilepsy, cancer hx
- infectious sx
- Tox / drug and alcohol use
- Head trauma
- Med rec
Exam:
- neuro exam (focal deficits, blown pupils)
- nuchal rigidity
- raccoon eyes or battle’s sign or CSF leak
- signs chronic liver disease
- needle tracks
Studies:
- CBC, CMP, tox screen, UA
- Consider ammonia, TSH, blood cx, ESR based on hx
- Non- contrast head CT
- LP if concern for meningitis, SAH
- EEG
Sore Throat
DIFF: strep pharyngitis, EBV, post-nasal drip, epiglossitis, tracheitis, peri-tonsillar abscess, retro-pharyngeal abscess, Ludwig’s angina, Lemierre syndrome
Hx/Exam:
- Centor (cough, fever, lymph nodes, exudate)
- pain / inability to move neck
- voice changes, drooling, tripod, trismus, stridor, resp distress
Studies:
- If 2-3 Centor get throat swab (if 4 treat empirically)
- Consider imaging (lateral neck x-ray or CT) for deep neck space infections
Vomiting
DIFF: Gastroenteritis, alcoholic gastritis, obstruction, hepatitis, appendicitis, cholecystitis, pancreatitis, diabetic gastroparesis, meningitis, DKA, hypercalcemia, hydrocephalus/inc ICP, migraine, pregnancy, vestibular disorders, ovarian or testicular torsion, digoxin toxicity, renal stones
Hx:
- Relation to meals
- Relieving/ worsening factors
- Sick contacts
- BMs, pain, fevers, jaundice, headaches, vertigo?
- LMP / possibility of pregnancy
- Meds or drugs
Studies:
- BMP if concern over dehydration
- Preg test
