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Step 2 CS > CS DDX and W/U > Flashcards

CS DDX and W/U Flashcards

1
Q

Key History to get in Behavioral Problems in Childhood

A
  • Onset, severity, duration, triggers
  • Physical violence or use of weapons
  • Developmental history
  • Changes in environment or school performance
  • Change in personality
  • Anhedonia
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2
Q

9 yo M presents with a 2-year history of angry outbursts both in school and at home. His mother complains that runs around “as if driven by a motor” His teacher reports that he cannot sit still in class, regularly interrupts his classmates, and has trouble making friends.

A

ddx:

  • ADHD
  • Oppositional defiant
  • Manic episode
  • Conduct disorder
  • Hyperthyroidism

w/u:

  • PE
  • Mental status exam
  • TSH, FT4
  • EEG
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3
Q

12 yo F presents with a 2-month history of fighting in school, truancy, and breaking curfew. Her parents recently divorced, and she just started school in a new district. before her parents divorced, she was an average student with no behavioral problems.

A

ddx:

  • Adjustment disorder
  • Substance abuse
  • Manic episode
  • Oppositional defiant
  • Conduct disorder

w/u:

  • PE
  • Mental status exam
  • Urine toxicology
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4
Q

15 yo M presents with a 1-year history of failing grades, school abstenteeism, and legal problems, including shoplifting. His parents reports that he spends most of his time alone in his room, adding that when he does go out, it is with a new set of friends.

A

ddx:

  • Substance abuse
  • Conduct disorder
  • Oppositional defiant disorder
  • Adjustment disorder

w/u:

  • PE
  • Mental status exam
  • Urine toxicology
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5
Q

5 yo M presents with a -month history of temper tantrums that last 5-10 minutes and immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite and does not display these behaviors when he is at day care.

A

ddx:

  • Age-appropriate behavior
  • Oppositional defiant disorder
  • ADHD

w/u:

  • PE
  • Mental status exam
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6
Q

14 yo M presentswith short stature and lack of sexual development. His birth weight and length were normal, but he is the shortest child in his class. His father and ucles had the same problems when they were young, but they are now of normal stature

A

ddx:

  • Constitutional disorder
  • Hypothyroidism
  • Genetic disorder
  • GH deficiency/pitutary deficiency
  • Cystic fibrosis
  • Chronic renal insufficiency

w/u:

  • PE
  • CBC
  • CMP
  • GH stimulation/IGF-1
  • TSH, FT4
  • XR - hands
  • U/S - kidney
  • Karotype
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7
Q

3 yo F presents with 3-day history of “pink eye.” It began in the right eye but now involves both eyes. She has mucoid discharge, itching, and difficulty opening her eyes in the morning. Her mother had the flu last week. She has a history of asthma and atopic dermatitis.

A

ddx:

  • Bacterial conjuctivitis
  • Viral conjuctivitis
  • Keratitis
  • Seasonal allergies
  • Uveitis

w/u:

  • PE
  • CBC
  • CMP
  • Mucoid discharge culture
  • Slit lamp exam
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8
Q

2-month-old M presents with persistent crying for 2 weeks. The episode subside after passing flatus or eructation. There is no chnage in appetite, weight, or growth. There is no vomiting, constipation, or fever.

A

ddx:

  • Colic
  • Formula allergy
  • GERD
  • Lactose intolerance
  • Strangulated hernia
  • Testicular torsion/hernia
  • Gastroenteritis

w/u:

  • PE
  • Rectal exam
  • U/S - abdomen
  • U/S - testicular
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9
Q

7 yo M presents with abdominal pain that is generalized, crampy, worse in the mroning, and seemingly less prominent during weekends and holidays. He has missed many school days because of the pain. Growth and development are normal. His parents recently divorced

A

ddx:

  • Somatoform disorder
  • Malingering
  • IBS
  • Lactose intolerance
  • Child abuse

w/u:

  • PE
  • Rectal exam
  • U/S - abdomen
  • CT - abdomen
  • Amylase, lipase
  • Stool exam
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10
Q

8-month-old F presents with sudden-onset colicky abdominal pain with vomitting. The episode are 20 minutes apart, and the child is completely well between episodes. She had loose stools several hours before the pain, but her stools are now bloody.

A

ddx:

  • Intussusception
  • Appendicitis
  • Meckel’s diverticulum
  • Volvulus
  • Gastroenteritis
  • Enterocolitis
  • Blunt abdominal trauma

w/u:

  • PE
  • U/S - Abdomen
  • CT - Abdomen
  • CBC
  • CMP
  • Contrast enema
  • Rectal exam
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11
Q

3 yo M presents with constipation. The child has had 1 bowel movement per week since birth despite the use of stool softeners. At birth, he did not pass meconium for 48 hours. He has poor weight gain. There is a family history of this problem.

A

ddx:

  • Hirschsprung’s disease
  • Low-fiber diet
  • Anal stenosis
  • Hypothyroidism
  • Lead poisoning

w/u:

  • PE
  • Rectal exam
  • Stool exam
  • Barium enema
  • Suction rectal biopsy
  • Anorectal manometry
  • TSH, FT4
  • CBC
  • CMP
  • Serum lead level
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12
Q

1-month-old F is brought in because she has been spitting up her milk for last 10 days. The vomiting episdoes have increased in frequency and forcefulness. Emesis is nonbloddy and nonbilious. The episdoes usually occur immediately after breastfeeding. She has stopped gaining weight.

A

ddx:

  • Pyloric stenosis
  • Partial duodenal atresia
  • GERD
  • Gastroenteritis
  • Hepatitis

w/u:

  • PE
  • CBC
  • CMP
  • U/S - abdomen
  • Barium swallow
  • pH probe
  • Endoscopy
  • AST/ALT/bilirubin
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13
Q

4 yo M presents with diarrhea, vomiting, lethargy, weakness, and fever. The child attends a day care center where several children have had similar symptoms

A

ddx:

  • Gastroenteritis
  • Food poisoning
  • UTI
  • URI
  • Volvulus
  • Intussception

w/u:

  • PE
  • CBC
  • CMP
  • Stool exam and culture
  • UA
  • AXR
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14
Q

12-month-old M presents with fever for the past 2 days accompanied by a maculopapular rash on his face and body. He has not yet received the MMR vaccine.

A

ddx:

  • Measle
  • Rubella
  • Roseola
  • Fifth disease
  • Varicella
  • Scarlet fever
  • Meningitis

w/u:

  • PE
  • CBC
  • CMP
  • Viral ab/ag
  • Throat swab for culture
  • LP
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15
Q

3 yo M presents with a 2-day history of fever and pulling on his right ear. He is otherwise healthy, and his immunizations are up to date. His older sister recently had a cold. The child attends a day care center.

A

ddx:

  • Otitis media
  • URI
  • Meningitis
  • Pyelonephritis

w/u:

  • PE
  • CBC
  • CMP
  • Blood culture
  • Tympansocentesis culture
  • LP
  • UA
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16
Q

20-day-old M presents with fever, decreased breastfeeding and lethargy. He was born at 36 weeks as a result of premature rupture of membranes.

A

ddx:

  • Neonatal sepsis
  • Meningitis
  • Pneumonia
  • Pyelonephritis

w/u:

  • PE
  • CBC
  • CMP
  • Blood culture
  • LP
  • UA
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17
Q

55 yo M presents with crampy bilateral thigh and calf pain, fatigue, and dark urine. He is on simvastatin and clofibrate for hyperlipidemia.

A

ddx:

  • Rhabdomyolysis
  • Polymyositis
  • Inclusion body myositis

w/u:

  • PE
  • CBC
  • CMP
  • CPK
  • Aldolase
  • UA
  • Urine myoglobin
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18
Q

50 yo M presents with right shoulder pain after falling onto his outstretched hand while skiing. He noticed deformity of his shoulder and had to hld his right arm.

A

ddx:

  • Shoulder dislocation
  • Humerus fracture
  • Rotator cuff injury

w/u:

  • PE
  • CBC
  • CMP
  • XR - hands and shoulder
  • MRI - shoulder
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19
Q

60 yo F c/o left arm pain that started while she was swimming and was relieved by rest.

A

ddx:

  • Angina
  • Tendinitis
  • OA

w/u:

  • PE
  • CBC
  • CMP
  • ECG
  • XR - shoulder
  • CXR
  • Echocardiography
  • Stress test
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20
Q

45 yo F presents with right calf pain. Her calf is tender, warm, red, and swollen compared to the left side. She was started on OCPs 2 months ago for dysfunctional uterine bleeding.

A

ddx:

  • DVT
  • Baker’s cyst rupture
  • Myositis

w/u:

  • U/S - right leg
  • CBC
  • d-Dimer
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21
Q

60 yo F presents with pain in both legs that is induced by walking and is relieved by rest. She had cardiac bypass surgery 6 months ago and continues to smoke heavily.

A

ddx:

  • Peripheral vascular disease
  • Leriche syndrome
  • Lumbar spinal stenosis

w/u:

  • ABI
  • Angiogrpahy
  • MRI - L-spine
  • U/S
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22
Q

27 yo F presents with painful wrists and elows, a swollen and hot knee joint that is painful on flexion, a rash on her limbs, and vaginal discharge. She is sexualy active with multiple partners and occasionally uses condoms.

A

ddx:

  • Disseminate gonnorhea
  • SLE
  • Reactive arthritis

w/u:

  • CBC
  • CMP
  • Knee arthrocentesis
  • ANA, anti-dsDNA
  • Blood culture
  • XR - Knee
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23
Q

55 yo M presents with pain in the elebow when he plays tennis. His grip is imparied as a result of the pain. There is tenderness over the lateral epicondyle as well as pain on resisted wrist dorsiflexion (Cozen’s test) with the elbow in extension.

A

ddx:

  • Tennis Elbow
  • Stress fracture
  • OA

w/u:

  • XR - arm
  • Bone scan
  • MRI - elbow
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24
Q

65 yo M preents with pain i the heel of the right foot that is most notable with his first few steps and then improves as he continues walking. He has no known trauma.

A

ddx:

  • Plantar fasciitis
  • Heel fracture
  • Splinter/foreign body

w/u:

  • XR - heel
  • Bone scan - foot
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25
Q

45 yo M presents with fevers and right knee pain wiht swelling and redness.

A

ddx:

  • Septic arthritis
  • Gout
  • RA
  • Lyme arthritis

w/u:

  • CBC
  • Knee arthrocentesis
  • Blood, urethra CX
  • XR - knee
  • Uric acid
  • Lyme titier
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26
Q

65 yo F presents with inability to use her left leg or bear eight on it after tripping on a carpet. Onset of menopause was 20 years ago, and she did not receive HRT or calcium suppllements. Her left leg is externally rotated, shortend, and adducted, and there is tenderness in her left groin.

A

ddx:

  • Hip fracture
  • Hip dislocation
  • Pelvic fracture

w/u:

  • XR- hip/pelvis
  • CT or MRI - hip
  • Calcium and vitamin D
  • DEXA
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27
Q

28 yo F presents with pain in the interphalangeal joints of her hands accompained by hair loss and a rash on her face.

A

ddx:

  • SLE
  • Psoriatic arthritis
  • RA

w/u:

  • ANA, anti-dsDNA, ESR, C3, C4
  • CBC
  • XR - hands
  • UA
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28
Q

30 yo F secretary presents with wrist pain and a sensation of numbness and burning in her palm and the first, second, and third fingers of her right hand. The pain worsens at night and is relieved by loose shaking of the hand. There is sensory loss in the same fingers. Exam reveals a positive Tinel’s sign.

A

ddx:

  • Carpal tunnel syndrome
  • Median nerve compression
  • De Quervain’s syndrome

w/u:

  • Phalen’s maneuver and Tinel’s sign
  • Finkelstein’s test
  • Nerve conduction studies
  • EMG
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29
Q

30 yo F presents with wrist pain and a black eye after tripping, falling, and hitting her head on the edege of a table. She looks anxious and gives an inconsistent story.

A

ddx:

  • Domestic violence
  • Factititious disorder
  • Substance abuse

w/u:

  • XR - wrist
  • CT - head
  • Urine toxicology
30
Q

37 yo F presents with dyspareunia, inability to conceive, and dysmenorrhea.

A

ddx:

  • Endometriosis
  • Cervicitis
  • Domestic violence

w/u:

  • Pelvic exam
  • Wet mount
  • Discharge CX
  • U/S - pelvis
  • Laparoscopy
  • Endometrial biopsy
31
Q

54 yo F c/o painful intercourse. Her last menstrual period was 9 months agao. She ahs hot flashes.

A

ddx:

  • Atrophic vaginitis
  • Endometriosis
  • Cervicitis

w/u:

  • Pelvic exam
  • LH/FSH
  • Wet mount, KOH prep
  • Cervical cultures
32
Q

28 yo F who is 8 weeks pregnant presents with lower abdominal pain and vaginal bleeding.

A

ddx:

  • Spontaneous abortion
  • Ectopic pregnancy
  • Molar pregnancy

w/u:

  • BhCG
  • Quant hCG
  • U/S - abdomen/pelvis
  • Pelvic exam
  • CBC
  • PT/PTT
33
Q

45 yo G5P5 F preents with postcoital beeding. SHe is a cigarrette smoker and takes OCPs.

A

ddx:

  • Cervical cancer
  • Endometrial cancer
  • Cervical polyp

w/u:

  • Pelvic exam
  • Pap smear
  • Colposcopy and biopsy
  • HPV testing
  • Endometrial biopsy
34
Q

61 yo obese F presents with profuse vaginal bleeding for the past month. Her alst menstrual period was 10 years ago. She has a history of hypertension and diabetes millitus. HSe is nulliparous.

A

ddx:

  • Endometrial cancer
  • Cervical cancer
  • Endometrial hyperplasia

w/u:

  • Pelvic exam
  • Pap smear
  • Endometrial biopsy
  • Endometrial curettage
  • U/S - pelvis
  • Colposcopy
  • Hysteroscopy
35
Q

35 yo F presents with amenorrhea, cold intolerance, coarse hair, wieght loss, and fatigue. She has a history of abruptio placentae followed by hypovolemic shock and failure of lactation 2 years ago.

A

ddx:

  • Sheehan’s syndrome
  • Premature ovarian failure
  • Thyroid disease

w/u:

  • Urine hCG
  • LH/FSH, prolactin
  • CBC
  • Pelvic exam
  • TSH, FT4
  • ACTH
  • MRI - brain
  • Hysteroscopy
36
Q

35 yo F presents with amenorrhea, galactorrhea, visual field defets, and headaches for the past 6 months.

A

ddx:

  • Prolactinoma
  • Pitutary tumor
  • Pregnancy

w/u:

  • Urine hCG
  • LH/FSH, prolactin
  • CBC
  • Pelvic and breast exam
  • MRI - brain
37
Q

40 yo F presents with amenorrhea, morning nausea and vomitting, fatigue, and polyuria. Her last menstrual period was 6 weeks ago, and her breasts are full and tender. She uses the rhythm method for contraception.

A

ddx:

  • Pregnancy
  • Anovulatory cycle
  • Hyperprolactinemia

w/u:

  • Urine hCG
  • U/S - abdomen/pelvis
  • Pelvic exam
  • CBC
  • UA
  • Prolactin, TSH
  • Baseline pap smear, cervical cultures, TORCHES test
38
Q

Key history for amenorrhea

A
  • Headache
  • Decreased peripheral vision
  • Galactorrhea
  • Hirsutism
  • Virilization
  • Hot flashes
  • Vaginal dryness
  • Sxs of thyroid disease
39
Q

73 yo M presents with acute loss of vision in his left eye, palpitations, and shortness of breath. he has a hisotry of artial fibrillation and cataracts in his right eye. He has no eye pain, discharge, redness, or photophobia, he has not experienced headache, weakness, or numbness.

A

ddx:

  • Renal arterial occlusion
  • Renal vein occlusion
  • Acute angle-closure glaucoma

w/u:

  • Fluorescein angiogram
  • Echocardiography
  • U/S - carotid
  • Intraocular tonometry
  • ESR
  • Temporal artery biopsy
  • CBC
40
Q

68 yo M presents with a 2-month history of crying spells, excessive sleep, poor hygiene, and a 15-lb weight loss, all following his wife’s death. He cannot enoy time with his grandchildren and admits to thinking he has seen his dead wife in line at the super market or standing in the kitchen making dinner.

A

ddx:

  • Normal bereavement
  • Adjument disorder
  • MDD

w/u:

  • PE
  • TSH
  • CBC
  • Urine toxicology
  • Beck Depression Inventory
41
Q

68 yo M presents with a 2-month history of crying spells, excessive sleep, poor hygiene, and a 15-lb weight loss, all following his wife’s death. He cannot enoy time with his grandchildren and admits to thinking he has seen his dead wife in line at the super market or standing in the kitchen making dinner.

A

ddx:

  • Normal bereavement
  • Adjument disorder
  • MDD

w/u:

  • PE
  • TSH
  • CBC
  • Urine toxicology
  • Beck Depression Inventory
42
Q

35 yo F presents with intermittent episodes of vertigo, tinnitus, nausea, and hearing loss within the past week.

A

ddx:

  • Meniere’s disease
  • Vestibular neuronitis
  • Labyrinthitis

w/u:

  • CBC
  • VDRL/RPR
  • MRI - brain
  • Dix-Hallpike maneuver
43
Q

55 yo F c/o dizziness for the past day. She feels faint and has severe diarrhea that started 2 days ago. She takes furosemide for hypertension.

A

ddx:

  • Orthostatic hypotension due to dehydration
  • Vesticular neuronitis
  • Labyrinthitis

w/u:

  • Orthostatic vital signs
  • CBC
  • CMP
  • Rectal exam
  • Stool leukocytes and culture
44
Q

55 yo F c/o dizziness that started this morning. She is nauseated and has vomitted once in the past day. She had a URI 2 days ago and has experienced no hearing loss.

A

ddx:

  • Vesticular neuronitis
  • Labyrinthitis
  • Meniere’s disease

w/u:

  • CBC
  • CMP
  • Electronystagmography
  • MRI - brain
45
Q

55 yo M c/o falling after feeling dizzy and unsteady. He experienced transient loss of consciousness. His past medical history is significant for hypertension and diabetes mellitus.

A

ddx:

  • Drug-induced orthostatic hypotension
  • Hypoglycemia
  • Cardiac arrhythmia

w/u:

  • Orthostatic vital signs
  • CBC
  • Electrolyte, glucose
  • Echocardiography
  • CT - head
  • ECG
  • V/Q scan
  • CTA - chest with IV contrast
  • d-Dimer
46
Q

Key history for numbness/weakness

A
  • Distribution
  • History of diabetes
  • Alcoholism
  • Atherosclerotic vascular
47
Q

30 yo F presents with weakness, loss of sensation, and tingling in her left leg that started this morning. She is also experiencing right eye pain, decreased vision, and double vision. She reports feeling “electric shocks” down her spine upon flexing her head.

A

ddx:

  • MS
  • Stroke
  • CNS tumor

w/u:

  • CBC
  • ESR
  • VDRL/RPR
  • MRI - brain, spine
  • LP - CSF analysis
  • Retinal evoke potentials
48
Q

20 yo M presents with fatigue, thirst, increase appetite, and polyuria.

A

ddx:

  • DM
  • Atypical depression
  • Primary polydipsia

w/u:

  • HbA1c
  • Glucose tolerance test
  • UA
  • CBC
  • CMP
49
Q

35 yo M policeman c/o feeling tired and sleepy during the day. He changed to the night shift last week.

A

ddx:

  • Shift work sleep disorder
  • Sleep apnea
  • Depression

w/u:

  • CBC
  • Nocturnal pulse oximetry
  • Polysomnogrpahy
50
Q

45 yo F presents with excessive sweating, unintentional weight loss, palpitations, diarrhea, and shortness of breath.

A

ddx:

  • Hyperthyroidism
  • Pheochromocytoma
  • Carcinoid syndrome

w/u:

  • CBC
  • TSH, FT4
  • 24-hr urinary catecholamine
  • 5-HIAA
  • CBC
  • PPD
51
Q

26 yo F presents with sore throat, fever, severe fatigue, and loss of appetite for the past week. She also reports epigastric and LUQ discomfort. She has cervical lymphadenopathy and a rash. Her boyfriend recently experienced similar symptoms.

A

ddx:

  • Infectious mononucleosis
  • Hepatitis
  • Viral pharyngitis

w/u:

  • CBC
  • Monospot test
  • Throat culture
  • AST/ALT/bilirubin
52
Q

26 yo M preents with sore throat, fever, rash and weight loss. He has a history of IV drug abuse and sharing needles.

A

ddx:

  • Acute HIV infection
  • Infectious mononucleosis
  • Viral pharyngitis

w/u:

  • CBC
  • HIV antibody and viral load
  • CD4 count
  • Monospot test
  • Throat culture
  • AST/ALT/bilirubin
53
Q

58 yo M presents with 1 week of pleuritic chest pain, fever, chills, and cough with purulent yellow sputum. He is a heavy smoker with COPD.

A

ddx:

  • Pneumonia
  • COPD exacerbation
  • Lung cancer

w/u:

  • CBC
  • Sputum gram stain and culture
  • CXR
  • CT - chest
  • ECG
  • PPD
54
Q

25 yo F presents with 2 weeks of nonproductive cough. Threee weeks ago she had a sore throat and a runny nose.

A

ddx:

  • Atypical pneumonia
  • Reactive airway disease
  • Posinfectious cough

w/u:

  • CBC
  • Sputum gram stain and culture
  • Cold ab for mycoplasma
  • Legionella antigen test
55
Q

60 yo M presents with worsening dyspnea of 6 hrs duration and a cough that is accompanied by pink, frothy sputum.

A

ddx:

  • Pulmonry edema
  • CHF
  • Asthma

w/u:

  • CBC
  • CXR
  • ECG
  • ABG
  • PFTs
  • BNP
56
Q

20 yo AA F presents wiht acute onset of severe chest pain for a few hours. She has a history of sickle cell disease and multiple hospitalizations for pain and anemia management.

A

ddx:

  • Acute chest syndrome
  • MI
  • Aortic dissection
  • PE

w/u:

  • CBC
  • CXR
  • CPK-MB, troponin
  • CTA
  • ECG
  • d-Dimer
57
Q

55 yo M presents with retrosternal squeezing pain that lasts for 2 minutes and occurs with exercise. it is relieved by rest and is not related to food intake.

A

ddx:

  • Stable angina
  • Esophageal spasm
  • Esophagitis

w/u:

  • CBC
  • CXR
  • CPK-MB, troponin
  • Exercise stress test
  • Upper endoscopy
58
Q

33 yo F presents with stabbing chest pain that worsens with deep inspiration and is relieved by aspirin. She had a URI 1 week ago. Chest wall tenderness is noted.

A

ddx:

  • Costochondritis
  • Pneumonia
  • Muscle strain

w/u:

  • CBC
  • CXR
  • CPK-MB, troponin
  • ECG
59
Q

70 yo F presents with acute onset of shortness of breath at rest and pleuritic chest pain. She aslo presents with tachycardia, hypotension, tachypnea, and mild fever. She is recovering from hip replacement.

A

ddx:

  • PE
  • MI
  • Aortic dissection

w/u:

  • CBC
  • CXR
  • d-Dimer
  • CTA
  • Troponin, CPK-MB
  • U/S - legs
60
Q

35 yo M presents with several episodes of palpitations, sweating, and rapid breathing. Episodes occur unexpectedly, and he does not recall any triggers. he has had 4-5 episodes per month for several months. Each episode lasts 2-3 minutes. He does not have any history of psychiatric illness except for separation anxiety as a child.

A

ddx:

  • Panic attacks
  • GAD
  • Acute stress disorder

w/u:

  • CBC
  • CXR
  • d-Dimer
  • CTA
  • Troponin, CPK-MB
  • U/S - legs
61
Q

34 yo F presents with episodic palpitations accopanied by lightheadedness and sharp, atypical chest pain.

A

ddx:

  • MVP
  • Cardiac arrythmia
  • Panic attack

w/u:

  • CBC
  • Echocardiography
  • Holter monitor
62
Q

44 yo F presents with a weight gain for >25 lbs within the past 2 months. She quit smoking 3 months ago and is on amitriptyline for depression. She also reports cold intolerance and constipation.

A

ddx:

  • Smoking cessation
  • Hypothoroidism
  • Cushing’s syndrome

w/u:

  • CBC
  • TSH, FT4
  • Glucose tolerance test
63
Q

45 yo F presents with dysphagia for 2 weeks accompanied by mouth and throat pain, fatigue, and a craving for ice and clay.

A

ddx:

  • Plummer-Vinsone syndrome
  • PUD
  • Esophagitis

w/u:

  • CBC
  • Serum iron, ferritin, TIBC
  • Upper endoscopy
64
Q

25 yo M presents with RUQ pain, fever, anorexia, nausea, and vomitting. He has dark urine and clay colored stoo.

A

ddx:

  • Acute hepatitis
  • Pancreatitis
  • Ascending cholangitis

w/u:

  • CBC
  • U/S - abdomen
  • UA
  • AST/ALT/Bilirubin
  • Viral hepatitis serology
65
Q

20 yo M presents with severe RLQ abdomina pain, nausea, and vomiting. His discomfort started yesterday as a vague pain around the umbilicus. As the pain worsened, it became sharp and migrated to RLQ. McBurney’s and psoas are positive.

A

ddx:

  • Acute appendicitis
  • Gastroenteritis
  • Diverticuitis

w/u:

  • CBC
  • CT - abdomen
  • U/S - abdomen
  • AXR
  • Blood culture
66
Q

24 yo F presents with bilateral lower abdominal pain that started with the first day of her menstrual period. The pain is associated with fever and a thick, greenish-yellow vaginal discharge. She has had unprotected sex with multiple sex partners.

A

ddx:

  • PID
  • Cervicitis
  • Vaginitis

w/u:

  • Pelvic exam
  • Urine hCG
  • Cervical cultures
  • CBC
  • ESR
  • UA
  • U/S - pelvis
67
Q

33 yo M presents with watery diarrhea, vomiting, and diffuse abdominal pain that began yesterday. He also reports feeling hot. Several of his coworkers are also ill.

A

ddx:

  • Viral gastroenteritis
  • Bacteral gastroenteritis
  • Food poisoning

w/u:

  • Rectal exam
  • Stool leukocytes
  • CBC
  • Eletrolytes
  • CT - abdomen/pelvis
68
Q

33 yo M presents with watery diarrhea, diffuse abdominal pain, and weight loss within the past 3 weeks. he has a history of aphthous ulcers. he has not responded to antibiotics.

A

ddx:

  • IBS
  • Crohn’s disease
  • UC

w/u:

  • Rectal exam
  • Stool leukocytes
  • CBC
  • Eletrolytes
  • CT - abdomen/pelvis
  • Colonscopy
69
Q

33 yo F presents with rectal bleeding and diarrhea for the past week. She has had lower abdominal pain and tenesmus for several months.

A

ddx:

  • Crohn’s disease
  • UC
  • Anal fissure

w/u:

  • Rectal exam
  • CBC
  • PT/PTT
  • Colonscopy
  • CT - abdomen
70
Q

35 yo M presents with painless hematauria. he has a family history of kidney disease.

A

ddx:

  • Polycystic kidney disease
  • Nephrolithiasis
  • UTI

w/u:

  • GU exam
  • UA
  • BUN/cr
  • PSA
  • CBC
  • U/S - renal
71
Q

19 yo M presents with a burning sensation during urination and urethral discharge. he recently had unprotected sex with a new partner.

A

ddx:

  • Urethritis
  • Cystitis
  • Prostatitis

w/u:

  • GU exam
  • UA
  • Gram stain and culture of urethral discharge
  • Chlamydia and gonorrhea PCR

Step 2 CS (2 decks)

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