DDX 1 Final v3

Question 1

The patient has a non-productive cough that occurs after being in a cold, dry environment.

Answer 1

Cough-variant asthma

Question 2

The patient has a non-productive cough that occurs at night and appears relieved by sitting up or propping his head with several pillows

Answer 2

Post-nasal drip

Question 3

The patient has a productive cough sometimes and a non-productive cough at other times. The cough has occurred for a couple of months in a row for two years. The patient IS a smoker.

Answer 3

Chronic bronchitis

Question 4

The patient notices that the cough is worse after lying down, especially after eating a large meal. The patient IS overweight.

Answer 4

Esophageal reflux

Question 5

The problem is that taking in a deep breath hurts significantly

Answer 5

Muscle strain or trauma

Question 6

The problem is that at night he can’t breathe and has to prop himself up on pillow. The breathing difficulty then improves slowly. He also notices that even minimal activity leaves him breathless. The patient is NOT a smoker

Answer 6

CHF

Question 7

The patient says that he feels a chest-squeezing pain sensation that affects him all of the time. There is no pain in the arm or jaw and cardiac exam is normal.

Answer 7

Depression/ Stress

Question 8

He says that the only time he has trouble is after long, intensive sporting activities when he finds it difficult to breath. The patient IS in good physical shape

Answer 8

Bronchospasm

Question 9

The patient is a chronic smoker and appears to have a broad chest. He breathes through pursed lips and uses his secondary muscles of respiration to assist. He seems to lean forward on his elbows while breathing

Answer 9

Emphysema

COPD: Pink Puffer

Question 10

A 27-year-old female complains of chest pain that is felt to the left of her heart. The pain does NOT radiate. It is felts as a sharp stabbing pain lasting for several seconds. The pain occurs every month for the last few months. What category would you place this in (cardiac or non-cardiac)?

Answer 10

Non-cardiac: brief, continuous, localized, radiation uncommon, reproducible

Question 11

A 22-year old female complains of abrupt onset of racing heart. Her pulse is 180 bpm during the attack. The attacks just as suddenly abate after about 15 minutes. The patient feels no chest pain. The attacks occur without warning a few times a year. She has noticed that taking in a deep breath and holding it has aborted an attack. What is the name of this type of tachycardia?

Answer 11

paroxysmal SVT tachycardia – all ages, abrupt start/stop of regular palpitations

Question 12

Her medical doctor as prescribed sumatriptin (what headache is likely?)

Answer 12

Migraine

Question 13

The patient is male and complains of orbital pain and a drooping eyelid during the headache. The headache last approximately 45 minutes and return daily for a couple of weeks

Answer 13

Cluster

Question 14

The patient is 65 years old and complains of a new headache that is unilateral and pulses on the side of their head. He also complains of vision loss and generalized aching over the upper trunk area

Answer 14

Temporal arteritis

Question 15

The patient’s neck is stiff and he has a fever. Kernig’s and Brudzinski’s tests are positives

Answer 15

Meningitis

Question 16

The patient also has radiation of pain from the back down the outside of the leg to the knee and has NO objective neurological deficits upon examination

Answer 16

Referred pain and weakness

Question 17

The patient also has radiation of pain from the back down the back of the leg and had a decrease in DTRs, dermatome sensation, and myotome weakness

Answer 17

N root irritation

Question 18

The patient has no back pain and no radiation of pain, however, he does have weakness of specific muscles

Answer 18

Peripheral nerve entrapment

Question 19

The patient also has weakness of the opposite leg associated with numbness and tingling in the feet

Answer 19

Diabetes

Question 20

The RBC count is elevated; the RDW is normal, the MCV is decreased, and there are 2+ microcytes

Answer 20

Thalassemia minor

Question 21

The RBC count and hemoglobin are low; the RDW is elevated, the MCV is decreased, and there are 2+ microcytes, total iron is borderline low

Answer 21

Fe deficiency anemia

Question 22

The RBC count is low; the RDW is elevated, the MCV elevated above 100 Fl, there are 2+ macrocytes, and an increase in methylmalonic acid

Answer 22

B12 deficiency

Question 23

The RBC count is low; the RDW is borderline high, the MCV is normal, the total iron is low, and the ESR is significantly elevated

Answer 23

Anemia of a chronic disease

Question 24

The patient is 60 years old. You determine it’s NOT from atrophic vaginitis (related to aging)

Answer 24

Cancer

Question 25

The patient is 5 years old

Answer 25

Sexual abuse/ trauma

Question 26

The patient is 16 years old and the bleeding is painless and irregular

Answer 26

Physiological

Question 27

The patient is 25 years old, is married and has spotty bleeding instead of a regular period and has abdominal pain

Answer 27

Ectopic pregnancy

Question 28

Most sensitive diagnostic procedure for CHOLELITHIASIS?

Answer 28

Diagnostic ultrasound

Question 29

Most sensitive diagnostic procedure for ASTHMA?

Answer 29

Spirometry

Question 30

Most sensitive diagnostic procedure for CHF?

Answer 30

Chest x-ray

Question 31

Most sensitive diagnostic procedure for FIRST WEEKS OF ECTOPIC PREGNANCY?

Answer 31

Subunit b-hCG

Question 32

Most sensitive diagnostic procedure for APPENDICITIS?

Answer 32

Diagnostic ultrasound

Question 33

A 35-year-old male patient complains of a constant sense of urgency. He has been seen by a medical doctor who attempted two courses of antibiotic treatment both of which were unsuccessful. The patient notices that eating certain foods such as spicy foods, citrus, alcohol, and caffeine his condition is exacerbated. What does this patient likely have and what’s the prognosis?

Answer 33

prostatosis (non-infectious); self-resolving – non infectious prostatitis

Question 34

A female patient complains of expelling small amounts of urine immediately after she coughs, sneezes, or laughs. She has had two children and noticed the onset of this problem in her early thirties. What is her likely problem?

Answer 34

stress incontinence – pelvic floor laxity, hormone changes, Rx, coughing, obesity

Question 35

A female complains of persistent, extreme vaginal itching and some discharge. She is a diabetic. Which of the following is most likely the cause?

Answer 35

candida – diabetics, extreme pruritis (itching), scant curd-like discharge, OTC

Question 36

The wife of a 65-year-old patient is concerned that her husband has been losing his memory lately. When you test him with a Mini-Mental Status examination, he scores a 27. He is also able to recall items that have been shown to him several minutes before and is able to calculate backwards from 100, and draw a clock figure indicating 11 o’clock. Laboratory testing reveals no abnormalities in thyroid dysfunction, anemia or liver enzymes. There are no indications or past history or motor/sensory complaints/dysfunction. He keeps active with hobbies and has no difficulties with sleep or eating. He is having trouble remembering where his keys are and remembering directions to the grandchildren’s new address. What is the most likely cause based on the information?

Answer 36

age-related memory loss – slow onset, related to learning new events or “tricks”

Question 37

Which of the following would be a promoter of a non-inflammatory response (i.e. T1 helper cells) in relation to asthma? Things that favor Th1 response are presence of younger siblings and exposure to daycare, animals, TB, measles, HAV, rural environments

Answer 37

having TB, varicella, or hepatitis A – favors the inflammatory Th1 response

Question 38

Which of the following is the least common cause of ear pain in the adult patient?
Causes of ear pain: infection from otitis media (MCC), TMJ, teeth, C-spine, ill-fitting glasses

Answer 38

cervical spine problems – 4th on his PPT list of causes of ear pain

Question 39

Which of the following may be helpful in preventing cholelithiasis? (choose 2 answers)
You can ↓ the risk of having cholelithiasis by drinking 3-5 cups of coffee a day and exercising; having diabetes = ↑ risk

Answer 39

Coffee (2-3 cups a day)

Exercise (aerobic)

Question 40

There is a slow painless loss of central vision; red reflex is absent

Answer 40

Cataracts

Question 41

There is a sudden painful loss of vision with nausea and vomiting after being in a dark room

Answer 41

Acute closed-angled glaucoma

acute closed-angle glaucoma – sudden painful peripheral loss, halos, nausea, 10%

Question 42

There is a slow loss of vision that is improved by looking through a pinhole in cardboard

Answer 42

Refractive error

Question 43

The patient is a senior complaining of flashing lights. No eye pain or associated headache.

Answer 43

(Migraines would have flashing lights WITH headaches)

Question 44

The patient says that it appeared as though someone was pulling a shade down over one eye. The vision loss was total, however, vision returned in a few minutes as if the shade was lifted.

Answer 44

(From a TIA of the retinal artery, 2+ days to self-resolve; high in patients with CVD ideals)

Question 45

The patient claims that the loss of vision was preceded by a temporal headache for several weeks, and also a sense of aching and deep pain in the upper trunk/shoulder area.

Answer 45

Temporal arteritis

Question 46

The patient has a slow loss of vision that involves the peripheral field. He complains of seeing halos around lights

Answer 46

Chronic open-angle glaucoma

chronic open-angle glaucoma – slow painless peripheral loss, halos around lights, 90%

Question 47

A female patient complains of sudden abdominal pain. The severe pains lasted several hours and was associated with nausea and vomiting. The pain was unaffected by position. The pain significantly decreased and the patient had little residual pain. The pain was in the epigastric and RUQ. What is most likely?

Answer 47

cholelithiasis – acute RUQ pain, nausea, MC in females and diabetics

Question 48

A patient complains of chronic persistent constipation that seems to alternate with mild diarrhea. This occurs most frequently in the morning and has occurred over the last year. Bowel movement are painful. There are no external lesions such as hemorrhoids or fissures. The patient is not taking medications or iron supplementation. The stool exam is normal with no blood or indications of parasitic infection, however there is mucus in the stool. What does this patient most likely have?

Answer 48

Irritable Bowel Syndrome (IBS) – chronic abdominal pain associated with constipation, diarrhea and mucus in stool; most likely d/t ↓ peristalsis; triggered by stress/food

Question 49

A young male patient with chronic diarrhea complains that every time he has to take a test or when he get gets upset at friends he has bouts of diarrhea that last for several days. There is some blood in the stool that is visible. This has been a problem for several months. There is minimal abdominal pain. He appears in good health. He complains some peripheral joint pain that is associated with diarrhea attacks. He has not traveled to foreign countries or drank water from a stream. What is highest on your list of differentials?

Answer 49

Ulcerative colitis – superficial irritability of colon; heavy diarrhea; HLA-B27+

Question 50

The cause of duodenal ulcers is _____. The standard medical treatment is ____.

Answer 50

H. pylori; triple antibiotic treatment

Question 51

An overweight patient complains of epigastric pain. The pain is worse when lying down after a full meal and seems to be associated with eating meat, orange juice, and coffee. It is also aggravated by his theophylinne for his asthma. Which of the following is most likely?

Answer 51

reflux esophagitis – pain on a full stomach worse with recumbency

Question 52

A 35-year-old male patient complains of difficulty hearing. He says that he has difficulty listening on the phone, however, in a crowded room he hears quite well. There is no associated dizziness or tinnitus. He says that his mom has a similar problem that has gradually become worse. The problem is bilateral. Which of the following is most likely, and what type of hearing loss does this represent?

Answer 52

otosclerosis; conductive – earlier onset (30’s-ish), no assoc. w/ vertigo/dizziness

Question 53

A 60-year-old male complains of severe facial pain that came on without warning and has recurred every time he touches his cheek or attempts to shave. The pain is severe, burning, and stabbing lasting for less than a minute. The pain pattern is from the cheek to corner of the mouth. There are no skin lesions and no abnormalities are seen on the oral exam. What is most likely?

Answer 53

tic douloureux (trigeminal neuralgia) – short, sharp, recurrent pains

Question 54

Pain radiates from the costovertebral angle to the inguinal or testicular areas

Answer 54

Renal pathology

Question 55

Pain begins in the umbilical area and then over 6-12 hours localizes to the RLQ.

Answer 55

Appendicitis

severe pain that starts in the umbilical area and localizes in the RLQ

Question 56

Pain is at the epigastric area and circles around the back in a band-like pattern; pain is somewhat relieved by maintaining fetal position

Answer 56

Acute pancreatitis

severe epigastric pain that radiated to the back

Question 57

In which of the following would reduction of salt be effective? (more than one answer)?

Answer 57

HTN, Meniere’s

Question 58

Which of the following are common features in patients with COPD?

Answer 58

Decrease in FEV & Mucus production

Question 59

A patient claims that he hears a recurrent “fluttering” sounds. What is most likely?

Answer 59

Spasm of the stapedius or tensor tympani muscles

Question 60

A young male patient complains of central abdominal pain that, over 6 hours, migrates to the RLQ. There is associated mild fever and nausea. He reports several hours before having dinner with friends at his home, yet none of them are sick.

Answer 60

appendicitis – central abdominal pain, localizes in RLQ, nausea, fever, ↑ WBCs