CS/OSCE

Question 1

Wacky, wet, wobbly (DDx)

Answer 1

Normal pressure hydro v.s. chronic subdural hematoma vs. alternative dementia vs intracranial neoplasm vs. neurosyphillis

Question 2

Workup for confusion/memory loss?

Answer 2

CBC
CT/MRI
VDRL/RPR
Serum B12
TSH
LP

Question 3

55 yo with rapidlyk progressive change in mental status, difficulty concentrating, memory impairment associated with myojclonus, ataxia, and startle response

Answer 3

Creutfeldt-Jakob vs vascular vs lewy body vs Wernicke - consider adding serum calcium and brain biopsy

Question 4

Old diabetic with confusion, dizziness, palpitations, diaphoresis, and weakness

Answer 4

Hypoglycemia vs. TIA vs. arrhythmia vs delirium vs angina vs. meds - add trops,, ECG, and glucose levels as well as doppler and urine tox

Question 5

55 yo F gradual altered mental status and headache after being knocked unconscious

Answer 5

Subdural hematoma vs. SIADH (hyponatremia) vs. Creutzfeldt Jokob vs. Intracranial neoplasm vs CNS infecition - standard workup plus BMP

Question 6

Important questions for vision loss?

Answer 6

How recent? What progression? Can you see light? Eye pain, discharge, itching, tearing, photophobia, redness, headache, weakness, numbness, floaters, sparks? Jaw claudication? Trauma?

Question 7

PE for vision loss

Answer 7

Vitals, HEENT, fundoscopic, neuro, and cardio

Question 8

Old dude with acute loss of vision in left eye with palpitations and SOB, hx of afib and right eye cataracts

Answer 8

Retinal artery occlusion vs. vein occlusion vs. acute angle closure glaucoma vs. rentinal detachment vs. temporal arteritis.

Question 9

Workup for vision loss

Answer 9

Fluorescein angioogram, Echo, Doppler U/S, Intraocular tonometry, ESR,CRP

Question 10

Depressed mood key questions?

Answer 10

Onset, duration, SIGECAPS - suicidaility, decreased interest, guilt, energy levels, concentration, activity, lack of pleasure, sleep, family hx of mood disorder, prior episodes, meds

Question 11

Depressed mood PE?

Answer 11

Head and neck, neurologic exam, mental status exam, psych exam: (Appearance, behavior, speech, mood, affect, thought process, thought content, cognition, insight, and judgement

Question 12

Psych workup

Answer 12

PHQ-9, TSH, CBC, urine tox, beck depression inventory, QIDS-SR16

Question 13

DIGFAST pneumonic

Answer 13

Distractability, irritability, grandiosity, flight of ideas, activity increase, sleep decrease,talkativeness

Question 14

Important questions for psychosis

Answer 14

Positive: delusions, hallucinations, disorganized thoughts
neg: blunted affect, social withdrawal, decreased motivation, decreased speech/thought
Cognitive: disorganized speech patterns, thoughts, paranoia
Self reference symptoms: People watching you, messages from media

Question 15

Physical exam for psychosis

Answer 15

Vital signs, mental status, pay attention to appearanc

Question 16

Workup for psychosis

Answer 16

Mental status exam, urine tox, TSH, CBC, electrolytes