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1
Q

myocardial infarction

A

hx:
pressure like substernal chest pain
pain radiates to left arm, upper back, neck
pain awakens pt at night

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2
Q

cocaine induced MI

A

hx:
pressure like substernal chest pain
h/o cocaine
last used cocaine yesterday

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3
Q

GERD

A

pain in mid chest
previous pain relieved by antacids
previous pain occured after heavy meals

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4
Q

aortic dissection

A

sudden tearing chest pain radiates to back
PHYS:
peripheral pulses/blood pressure diminished or unequal
aortic regurgitation murmur

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5
Q

bladder cancer

A 
hematuria
straining on urination
weak urinary stream and dribbling
painter
h/o smoking
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6
Q

urolithiasis\

A 
hx:
hematuria
straining on urination
physical:
CVAT
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7
Q

BPH

A

polyuria, nocturia
weak urinary stream and dribbling
straining on urination

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8
Q

disk herniation

A

low back pain
s/p lifting heavy boxes
radiated to left thigh and foot
worsens with movement, better when lying still

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9
Q

lumbar spinal stenosis

A

h/o intermittent LBP and leg pain with ambulation
pain resolves with sitting
PHYS
walks with back slightly bent forward

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10
Q

metastatic prostate cancer

A

difficulty urinating
incomplete emptying of bladder
low back pain

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11
Q

pneumothorax

A 
HX:
left sided chest pain s/p MVA
pain exacerbated by movement and deep breaths
dyspnea
PHYSICAL
decr breath sounds over left lung field 
RR = 22 br/min
bruising and tenderness over left chest
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12
Q

hemothorax

A 
HX:
left sided chest pain s/p MVA
dyspnea
cough
PHYS:
decr breath sounds over left lung field
RR 22 br/min
bruising and tenderness over left chest
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13
Q

pneumonia

A 
HX
unilateral chest pain
productive cough
low grade fever
PHYSICAL
temp 100F
RR 22 br/min
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14
Q

T1DM

A

polyuria
polydipsia
recent weight loss
hyperglycemia

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15
Q

T2DM

A

polyuria
polydypsia
obesity
hyperglycemia

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16
Q

insulin induced hypoglycemia

A

episodes of palpitations and diaphoresis that resolves with orange juice
tight glycemic control

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17
Q

diabetic peripheral neuropathy

A 
HX:
h/o DM
constant numbness and tingling in feet
PHYSICAL:
absent ankle jerk
diminished pinprick sensation on plantar surfaces bilaterally
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18
Q

organic ED

A

loss of erection x 2 years with absence of early morning erection
h/o DM
h/o etoh
lovastatin and atenolol

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19
Q

DVT

A 
HX
recent 15 hour airplane flight
gained 15 lbs over 3 years
OCPs x 2 years
FH DVT
PHYSICAL
homan's sign
pitting edema
swollen, tender, red warm right calf
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20
Q

cellulitis

A 
HX
cute to leg 2/2 fall
low grade fever
PHYSICAL
swollen, tender, red, warm right calf
temp 99.9 F
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21
Q

baker cyst rupture

A

HX
spasmodic calf pain
PHYS
swollen, tender, warm right calf

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22
Q

laryngeal cancer

A 
HX
cervical lymphadenopathy
worsenign hoarseness x3 months
weight loss, decr appetiti, low grade fever
h/o cigarrette smoking and alcohol use
advanced age
PHYSICAL
temp 99.9
right cervical lymphadenopathy
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23
Q

laryngitis

A 
HX
h/o flu in recent past
low grade fever
GERD
h/o cigarette smoking
PHYSICAL
temp 99.9
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24
Q

vocal cord polyp/nodule

A

vocal overuse

hoarseness x 3 months

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25
spinal disk herniation
``` HX neck pain increases with movement radiculopathy (left arm pain and numbness) PHYSICAL loss of pinprick sensation neck tenderness, spasm, decr ROM ```
26
cervical fracture
``` HX rapid rotation of neck before painm pain increases with movement osteopenia @ last DEXA PHYSICAL tenderness over spinous process ```
27
neck muscle strain
``` HX rapid rotation of neck before pain PHYSICAL tenderness ober spinous process decreased ROM ```
28
biliary colic/cholecystitis
``` HX pain exacerbated by heavy, fatty foods assoc with N/V FFFF PHYSICAL epigastric tenderness [positive murphy sign ```
29
peptic ulcer disease
HX h/o heavy NSAID use burning epigastic pain 2 to 3 hours after meals pain exacerbated by hunger and fatty foods relieved by antacids PHYSICAL epigastic tenderness
30
gastritis
``` HX h/o heavy NSAID use epigastic pain assoc with food N/V PHYSICAL epigastirc tenderness ```
31
migraine
``` HX unilateral, sharp ha assoc with N/V photophobia PHYSICAL severe pain with lack of neuro findings ```
32
tension headache
``` HX chronic headache assoc with stress at work improve with sleep PHYSICAL severe pain with lack of neuro findings ```
33
intracranial mass lesion
HA assoc with N/V | FH brain tumor
34
hyperprolactinemia
galactorrhea | oligomenorrhea
35
PCOS
weight gain hirsuitism oligomenorrhea
36
pregnancy
change in menstrual cycles regular sexual activity previous successful pregnancy
37
vulvovaginitis
white vaginal discharge fishy odor of discharge vaginal pruritis
38
cervicitis
white vaginal discharge dysparenia sex without protection
39
endometriosis
dysmenorrhea | dysparenia
40
presbycusis
``` HX bilateral, progressive hearing loss advanced age HTN PHYSICAL normal rinne lack of lateralization on weber test ```
41
cochlear nerve damage
``` HX exposure to loud noises bilateral hearing loss PHYSICAL normal rinne lack of lateralization on weber ```
42
otosclerosis
``` HX bilateral, progressive hearing loss advanced age PHYSICAL lack of lateralization on Weber ```
43
physiologic jaundice
HX infant in first WOL no changes in feeding, urination, activity level, BM
44
viral URI
``` fever rhinorrhea sibling with URI day care increased breathing rate ```
45
pneumonia
``` HX persistent cough low grade fever PHYSICAL increased tactile fremitus decr breath sounds temperature ```
46
URI associated cought (postinfectious cough)
``` HX recent URI low grade fecer persistent cough PHYSICAL temperature ```
47
acute bronchitis
``` HX white sputum production PHYSICAL increased tactile fremitus temperature ```
48
extrahepatic biliary obstruction | ex: pancreatic cancer, cholangiocarcinoma, sphincter of oddi dysfunction
``` HX light stools dark urine pruritis father with pancreatic cancer PHYSICAL jaundice sceleral icterus RUQ tenderness ```
49
viral hepatitis
``` HX history of blood transfusion recent travel to mexico PHYSICAL jaundice scleral icterus RUQ tenderness ```
50
acetaminophen toxicity
``` HX recent acetaminophen use concomiant alcohol use PHSYCIAL jaundice scleral icterus RUQ tenderness ```
51
primary biliary cirrhosis
female age 40-60 pruritis other autoimmune disease (i.e hypothyroid)
52
meniere disease
``` HX senseation of spinning room episodic one sided hearing loss PHYSICAL decr hearing one side normal rinne ```
53
benign paroxysmal positional vertigo
sensation of room spinning onset with positional changes duration 20-30 mins
54
orthostatic hypotension causing dizziness
h/o diarrhea | on antihypertensives
55
gout
``` HX monoarticular joint pain and tenderness h/o swollen toe occasional alcohol use PHYSICAL joint tenderness and stiffness swelling at left knee ```
56
rheumatoid arthritis
``` HX morning joint stiffness FH of RA systemic sx - anorexia, weight loss, fatigue, fever) multiple joint involvement duration > 6 weeks PHSYCIAL joint tenderness and stiffness temp 99.9 ```
57
systemic lupus erythematosis
``` HX systemic symptoms (anorexia, wt loss, fatigue) h/o multiple oral ulcers h/o 2 spontaneous abortions raynauds PHYSICAL joint stiffness and tenderness ```
58
plantar fasciitis
``` HX training for marathon gradual pain worse with first few morning stepss PHYSICAL tender medial calcaneal tuberosity pain with toe dorsiflexion ```
59
calcaneal stress fracture
``` HX training for marathon diffuse pain over heel refractory to conservative management PHYSICAL tenderness over plantar heel and arch ```
60
achilles tendiniities
HX training for marathon PHSYCIAL pain with toe dorsiflexion
61
acute otitis media
``` HX fever pulling at right ear fatigued, not playing with toys h/o otitis media ```
62
meningococal meningitis
maculopapular facial rash spread to chest, back, abdomen fever difficulty sleeping x 2 days recent episode of vomitting`
63
scarlet fever
maculopapular facial rash fever difficult swallowing x 2 days
64
pulmonary TB
``` HX fever and night sweats with fatigue worsening cough x 1 month close contact with active TB decr appetitie unintentional weight loss - down 6 lbs over 2 months PHYSICAL productive cough with blood tinged sputum ```
65
malignant lung neoplasm
``` HX fever and night sweats with fatigue decr appetitie h/o heavy smoking and chronic broncitis PHYSICAL blood tinged sputum ```
66
typical pneumonia
``` HX fever mucus production h/o heavy smoking and chronic bronchitis PHSYCIAL sputum production ```
67
pancreatic cancer
``` HX h/o smoking h/o eating fatty foods unintentional weight loss foul smelling, greasy stools PHYSICAL mild epigastic pain ```
68
chronic pancreatitis
``` HX h/p alcohol use worseing epigastic discomfort that radiates to back foul smelling, greasy looking stools PHYSICAL mild epigastric tenderness ```
69
ED 2/2 vascular disease
h/o htn h/o hld no early morning or nocturnal tumescence
70
general anxiety disorder
``` HX imparied concentration, irritabilty, difficulty sleeping, muscle tension, sweating, palpitations anxiety over academics no h/o substance use PHYSICAL tachy: HR 102/min ```
71
hyperthyroidism
``` HX anxiety unintentional weight loss, fatigue, sweating, palpitations, incr B< PHYSICAL tachy: HR 102 brisk DTR ```
72
foreign body aspiration
sudden onset while playing with toys noisy breathing muffled cough
73
croup
noisy breathing difficulty breathing fever x 1 week
74
epiglottitis
HX occasional voice hoarseness occasional muffling
75
appendicitis
``` HX RLQ abd pain worse with movement N/V low grade fever PHYSICAL RLQ direct and rebound tenderness RLQ guarding temp 100.5 positive rovsing positive psoas ```
76
pelvic inflammatory disease
``` HX std 6 months ago with untreated partner N/V spotting unprotected sex with multiple partners low grade fever PHYSICAL RLQ tenderness temp 100.5 ```
77
ruptured ectopic pregnancy
``` HX LMP 5 weeks ago and spotting crampy lower abdominal pain pain worse with movement N/V pain recent PHYSICAL RLQ rebound tenderness RLQ guarding ```
78
alzheimers
``` HX steady cognitive decline memory impairment imparied EF decline in ADLs PHYSICAL failed 3 item recall ```
79
vasucular (multi-infarct) dementia
``` HX previous stroke h/o coronary artery disease (MI) HTN impaired EF PHYSICAL decreased strength in LUE DTR 3+ in LUE and LLE positive babinki bilaterally failed 3 item recall ```
80
hypothyroidism
``` fatigue x 3 months cold intolerance hair loss weight gain chronic dry skin oligomenorrhea ```
81
COPD/chronic bronchitis
``` HX chronic cough sputum production smoking history coal miner ```
82
pneumoconiosis
coal miner | chronic cough
83
colorectal cancer
bloody stool x 1 month FH unintentional weight loss
84
hemorrhoids
history of hemorrhoids | hematochezia
85
parkinson's
``` HX resting tremor PHYSICAL low frequency resting tremor UE bradykinetic gait UE rigidity ```
86
viral gastroenteritis
HX acute watery diarrhea low grade fever day care
87
simple febrile seizure
<15 mins no prior history fever
88
meningitis
tonic clonic seizure fever decr appt decr urine output
89
infectious mononucleosis
``` HX sore throat x 2 weeks LUQ pain recent ill contacts PHYSICAL LUQ tenderness lymphadenopathy ```
90
acute HIV infection
sore throat x 2 weeks two sexual partners over past year, male and female treated for gonorrhea recently
91
streptococcal pharyngitis
``` HX sore throat x 2 weeks low grade fever h/o cigarette smoking PHYSICAL lymphadenopathy ```
92
convulsive syncope
LOC x several minutes arms and legs shaking x 30 secons no subsequent confusion or weakness
93
cardiac arrhythmia
LOC after palpatiations and lightheadedness taking beta blocker (atenolol) no confusion or weakness after history of MI

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