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Step 2 CS > Differential / Work-Up by CC > Flashcards

Differential / Work-Up by CC Flashcards

1
Q

Headache

A
  • Migraine
  • Tension
  • Cluster
  • SAH (non-contrast head CT, +/- LP, coags)
  • Intracranial neoplasm, abscess (MRI)
  • Inc ICP / pseudotumor cerebri (LP - opening pressure)
  • Meningitis / encephalitis (CBC, LP)
  • CNS vasculitis (ESR, CRP)
  • Temporal arteritis (ESR, CRP, biopsy)
  • TMJ
  • Trigeminal neuralgia
  • Carotid or Vertebral dissection (doppler, CT-angio)
  • Sinusitis (CBC, sinus CT)
  • HTN
  • Intracranial hemorrhage (non-contrast head CT)
  • Intracranial venous thrombosis
  • Caffeine withdrawal
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2
Q

Confusion / Memory Loss

A
  • Az
  • Lewy body dementia
  • Vascular dementia
  • Depression
  • Normal pressure hydrocephalus
  • Frontotemporal dementia
  • Intracranial hemorrhage
  • CJD (brain biopsy)
  • Neuro-syphilis or HIV dementia
  • Hypothyroid, B12 def
  • TIA (ECHO, ECG, head imaging)
  • Hypoglycemia

Work-Up: CBC, BMP, VLDR/RPR, B12, TSH, CT head +/- MRI, depression screen, LP with opening pressure if normal pressure hydrocephalus

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3
Q

Vision Loss

A
  • Retinal artery occlusion
  • Acute angle-closure Glaucoma
  • Retinal vein occlusion
  • Retinal detachment
  • Temporal arteritis

Work - Up: fluorescein angiogram, tonometry, ECHO, carotid doppler, ESR, CRP, temporal artery biopsy

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4
Q

Depression

A
  • MDD
  • Bipolar disorder I and II
  • Normal bereavement
  • Adjustment disorder
  • PTSD
  • MDD w/ psychotic features
  • Schizoaffective
  • Dysthymic
  • Cyclothymic
  • Substance induced depressive disorder

Work-Up: Beck’s Depression Inventory, CBC, TSH, urine tox screen

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5
Q

Psychosis

A
  • Brief psychotic disorder
  • Schizophreniform
  • Schizophrenia
  • Schizoaffective
  • MDD w/ psychotic features
  • Substance induced
  • 2/2 medical condition
  • Schizotypal personality disorder

Work-Up: CBC, BMP, LFTs, BUN/Cr, alcohol level, urine drug screen, TSH, Dep Inventory

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6
Q

Dizziness

A
  • Meniere’s (VDLR/RPR)
  • Vestibular neuronitis (CBC, audiogram)
  • Labyrinthitis (CBC, audiogram)
  • BPV (dix hallpike)
  • Acoustic neuroma
  • Orthostatic hypotension (orthostatic vitals, rectal, CBC, electrolytes)
  • Vertebrobasilar stroke (MRI/MRA)
  • Brainstem or cerebellar tumor
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7
Q

LOC

A
  • Syncope / orthostatics
  • Seizure
  • Stroke
  • Hypoglycemia
  • Sub Use
  • MI
  • PE
  • Arrhythmia or aortic stenosis

Work-Up: EKG, maybe ECHO or Holter monitor, CBC, electrolytes, GLUCOSE, AED levels, drug screen, MI/PE work-up if high suspicion, +/- head imaging

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8
Q

Numbness/Weakness

A
  • Stroke /TIA (CBC, elec, CT head, lipids, EKG, ECHO, carotid dopplers, MRI)
  • GBS (LP, nerve conduction studies)
  • Polymyositis (CPK)
  • Myasthenia gravis (acetylcholine receptor antibodies)
  • MS (VDLR/RPR, ESR, MRI)
  • ALS
  • Todd’s Paralysis (MRI)
  • Peripheral neuropathy (Ca, Vit B12, HgbA1c)
  • Mult Myeloma (SPEP, UPEP)
  • CNS vasculitis (CRP, ESR)
  • Syringomyelia (MRI)
  • Conversion disorder
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9
Q

Fatigue / Sleepiness

A
  • Sleep apnea
  • Insomnia
  • Depression
  • Hypothyroid
  • Anemia
  • Shift Work Sleep Disorder

Work Up: CBC, TSH, polysomnography, Beck’s Dep Inventory

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10
Q

Night Sweats

A
  • Tuberculosis (PPD, quantiferon gold, CXR, CBC, sputum gram stain and acid fast stain)
  • Leukemia/ lymphoma
  • Acute HIV (HIV antibody)
  • Hyperthyroid (TSH, free T4)
  • Pheochromocytoma (urine catecholamines )
  • Carcinoid (5-HIAA)
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11
Q

Sore Throat

A
  • Strep pharyngitis
  • Viral pharyngitis
  • Epiglossitis
  • Retropharyngeal abscess or peritonsillar abscess
  • EBV
  • Acute HIV
  • Postnasal drip 2/2 allergies
  • Secondary syphilis

Work Up: pharyngeal cx, CBC w/ peripheral smear, Monospot, HIV antibodies, VLDR/RPR

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12
Q

Cough/ SOB

A
  • COPD exacerbation (sputum cx, CXR)
  • Asthma exacerbation (peak expiratory flow measure, pulse ox, CBC, CXR)
  • PNA (CBC, CXR)
  • Atypical pneumonia (legionella, mycoplasma IgM)
  • CHF / pulmonary edema (CXR, ECHO, BNP)
  • PE (ct angio?)
  • Pneumothorax (CXR)
  • MI (ECG, troponin, CXR)
  • Viral URI
  • Lung cx
  • GERD
  • Pulmonary vasculitis (ANCA)
  • Pneumonitis
  • Foreign body in airway (lateral decubitus films or insp/exp films)
  • Bronchitis
  • Tb / lymphoma / mets/ HIV / sarcoidosis (PPD, CXR, sputum x with acid fast stain, HIV antibody)
  • Mitral stenosis, valve disease
  • Arrhythmia, A fib (ECG)
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13
Q

CP

A
  • PE
  • PTX
  • PNA
  • Cardiac tamponade
  • MI
  • Aortic dissection
  • GERD
  • CHF exacerbation
  • Pericarditis, myocarditis
  • Pancreatitis/ esophagitis/ PUD
  • Esophageal spasm
  • MSK / ribs
  • Herpes zoster
  • Sickle cell acute chest

Work Up: ECG, CXR, trop, d-dimer or CT-angio, CBC (reticulocyte count and smear), electrolytes, possible ECHO, stress test if angina, barium swallow, manometry, EGD w/ H pylori

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14
Q

Palpitations

A
  • A fib, dysrhythmia
  • Hypoglycemia
  • Panic attack
  • Hyperthyroidism
  • Pheochromocytoma
  • Carcinoid syndrome
  • MV prolapse
  • Sub use

Work-Up: EKG, CBC, elec, glucose, TSH, +/- urine catecholamines and 5-HIAA, ECHO and holter if poss MV prolapse, urine tox

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15
Q

Wt Loss

A
  • anorexia
  • depression
  • chron’s / UC / malabsorption
  • cx
  • HIV, Tb
  • Hyperthyroid

Work-Up: CBC, TSH, elec, HIV antibodies, quant gold, dep screen, urine tox,

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16
Q

Wt Gain

A
  • Depression
  • Hypothyroid
  • Cushing’s
  • DM
  • Smoking cessation
  • PCOS
  • Insulinoma

Work-Up: CBC, electrolytes, glucose, 24 hr urine free cortisol, TSH, HgBA1c, insulin level, if suspect PCOS … vaginal US and testosterone level

17
Q

Dysphagia

A
  • achalasia (barium swallow)
  • esophagitis (candida, CMV, herpes, pills) - HIV antibody
  • esophageal dysmotility (manometry)
  • GERD
  • gastric carcinoma or esophageal carcinoma (CXR, upper endoscopy with biopsy)
  • MSK (ALS, MG)
  • CREST
  • Stricture
  • Plummer Vinson Syndrome (iron, ferritin, TIBC)
  • Mitral valve stenosis
  • Zenker’s diverticulum
18
Q

Neck Mass

A
  • Thyroid cx or nodule
  • Lymphoma
  • Tb
  • Gastric cx

Work -Up: CBC w/ diff, elect, CXR, US thyroid, upper endoscopy, LN biopsy, PPD

19
Q

N&V

A
  • Gastroenteritis
  • Food poisoning
  • Pregnancy
  • Inc ICP
  • Renal colic
  • Ovarian or testicular torsion
  • Volvulus, pyloric stenosis
  • Appendicits
  • Hepatitis
  • UTI/ pyelonephritis
  • SBO

Work-Up: CBC, elect, urine preg test, pelvic US, UA

20
Q

Ab Pain

A
  • Hepatitis
  • Gastritis
  • PNA
  • GB stones, cholecystitis, cholangitis
  • Pancreatitis
  • SBO
  • Appendicitis
  • Diverticulitis
  • Pyelonephritis / UTI
  • Renal stones
  • PID
  • Mesenteric ischemia (ECG)
  • IBS
  • Chron’ s / UC
  • Torsion
  • Endometriosis, vag infection, ectopic

Work-Up: CBC, electrolytes, UA, hepatitis serologies, amylase, lipase, CT abdomen for stones or diverticulitis, pelvic US (doppler), RUQ US for gallstones, MRCP/ERCP, LFTs, upper endoscopy w/ H pylori testing, colonoscopy, stool studies, urine preg test, cervical cx

21
Q

Constipation / Diarrhea

A
  • SBO (CT abdomen and pelvis)
  • IBS (CBC, electrolytes)
  • Low fiber diet
  • Traveler’s Diarrhea
  • Hepatitis (viral serologies)
  • Diverticulitis (CT abdomen)
  • Colon cx (rectal exam, colonoscopy)
  • Parasitic infection (stool O&P, stool leuks and cx)
  • Hypothyroid (TSH)
  • Depression
  • C diff (stool toxin)
  • Lactose intolerance
22
Q

Upper GI Bleed

A
  • Esophageal varices
  • Boorheaves
  • PUD / bleeding ulcer
  • Mallory Weiss Tear
  • Epistaxis
  • Gastritis
  • Esophageal or gastric cx

Work-Up: CBC, type and screen, FOBT, LFTs, coag, upper endoscopy, H pylori

23
Q

Lower GI Bleed

A
  • Colon cx
  • Diverticulosis
  • Hemorrhoids
  • Fissure
  • Infectious diarrhea
  • Angiodysplasia
  • Chron’s / UC
  • Ischemic bowel

Work-Up: CBC, elec, rectal exam/FOBT, colonscopy, C diff toxin, stool leuks and cx, CT ab and pelvis, coags

24
Q

Hematuria

A
  • Bleeding disorder
  • UTI
  • Renal stones
  • Bladder cx
  • Menses
  • Dietary
  • Polycystic kidney disease
  • Renal cell carcinoma
  • Prostate cx
  • IgA Nephropathy

Work-Up: UA, CBC, coags, renal US, CT abdomen, cystoscopy, rectal & pelevic exam

25
Q

Other Urinary Sx

A
  • BPH / prostate cx (rectal exam, Cr, trans-rectal US)
  • Urge incontinence
  • Stress incontinence
  • Overflow incontinence
  • Stricture
  • Urethritis / cystitis / prostatitis (UA, urethral cx, chlamydia and gonorrhea)

For incontinence … bladder stress test, poss post-void residual, UA + cx

26
Q

Erectile Dysfunction

A
  • Psych related
  • 2/2 HTN or DM
  • Drug induced
  • Peyronies (plaques & curvature)

Work-Up: CBC, elec, glucose, HgBA1c, lipids, genital and rectal exams, testosterone

27
Q

Amenorrhea

A
  • Preg
  • Menopause
  • Anorexia / diet / exercise
  • Anxiety / PTSD / dep
  • Hypopituitary / pituitary tumor
  • Thyroid disease
  • Anovulatory cycles
  • Prolactinoma / hyper-prolactin
  • PCOS
  • Premature ovarian failure
  • Asherman’s
  • Sheehan

Work-Up: CBC, elec, urine preg, TSH, pelvic exam, pelvic US, prolactin, LH/FSH, testosterone (PCOS), MRI brain if suspect mass / Sheehan’s, hysteroscopy for Asherman

28
Q

Vaginal Bleeding

A
  • Cervicitis
  • Endometriosis / polyps / hyperplasia
  • Coagulopathy / VWF
  • PID / Fitz Hugh Curtis
  • Cervical cx
  • Endometrial cx
  • Spont abortion
  • Dysfunctional Uterine Bleeding
  • Ectopic
  • Molar pregnancy
  • Atrophic vaginitis
  • Ruptured ovarian cyst
  • Trauma

Work-Up: pelvic exam, urine preg, CBC, coags, cervical cx, pap smear, colposcopy, HPV testing, LH/FSH/prolactin / TSH, pelvic US, endometrial biopsy

29
Q

Vaginal Discharge

A
  • Candida
  • Bac vaginosis
  • Trich
  • Cervicitis

Work-Up: KOH prep, wet mount, cervical cx, pelvic exam

30
Q

Dyspareunia

A
  • atrophic vaginitis
  • menopause
  • cervicitis
  • endometrial cx / endometriosis
  • IPV
  • vaginismus
  • PID

Work-Up: pelvic exam, cervical cx, LH/FSH, endometrial biopsy, wet mount, KOH prep

31
Q

Abuse

A
  • IPV
  • Consensual
  • Osteogenesis imperfecta
  • Sub abuse
  • Rape

Work-Up: skeletal survey, forensic exam, urine hcg, wet mount, KOH prep, cervical cx, CBC, HIV, hepatitis

32
Q

Joint / Limb Pain

A
  • OA
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Lyme disease
  • Polymyalgia rheumatica
  • SLE
  • Psoriatic arthritis
  • Gout
  • Disseminated gonorrhea
  • Septic arthritis
  • Reactive arthritis
  • Rhabdo
  • Polymyositits
  • Inclusion Body Myositis

Work-Up: CBC, ESR, CRP, ANA, anti-ds DNA, CCP, RF, X-ray of involved joints, synovial fluid analysis, uric acid, cervical cx (if suspect gonorrhea), lyme titers, CPK, elec, urine myoglobin

  • Hip frax
  • Hip dislocation
  • Plantar fasciitis
  • Stress frax
  • Shoulder dislocation v. rotator cuff v. humerus frax

Work-Up: CBC, VitD, Ca, X-ray (joint above and below), DEXA,

  • DVT
  • Claudication

Work-Up: d dimer, lower extremity doppler, ABI’s angiography

33
Q

Lower Back Pain

A
  • Epidural abscess
  • Sciatica
  • Ankylosing spondylitis
  • DJD / disc disease / herniation
  • Vert compression frax (DEXA)
  • Lumbar/sacral strain
  • Spinal stenosis

Work-Up: spinal X-ray, MRI imaging only if neuro deficits, pt tenderness or history of cx

34
Q

Peds Fever

A
  • PNA
  • Viral URI, bronchiolitis
  • Meningitis
  • Bacteremia
  • UTI
  • Neonatal sepsis
  • AOM (otoscope)
  • Measles, mumps, rubella, Fifth’s disease, varicella, scarlet fever, roseola (throat swab?)
  • Gastroenteritis
  • Volvulus / intussusception (US)

Sepsis Work-Up: CBC, elec, blood cx, UA + cx, CXR, LP

35
Q

Peds GI

A
  • Pyloric stenosis
  • Volvulus
  • Intussusception
  • Gastroenteritis
  • Appendicitis
  • Hirschsprung’s / anal stenosis
  • Functional / somatoform
  • GERD
  • Lead poisoning (constipation)
  • Hypothyroidism
  • Lactose intolerance
  • Child abuse
  • IBS
  • Torsion / strangulated hernia
  • Colic

Work-Up: CBC, elec, UA, ab US, TSH, lead, amylase, lipase, contrast enema + rectal full thickness biopsy for Hirschsprung’s

36
Q

Peds Short Stature

A
  • GH def
  • Constitutional
  • CF
  • Hypothyroid
  • Genetic disorder
  • Malabsorption

Work-Up: CBC, elec, IGF-1 levels, TSH, chloride sweat test, karyotype, hand X-ray for bone age determination

37
Q

Peds Behavioral Issues

A
  • ADHD
  • Autism spectrum
  • Oppositional defiant disorder
  • Conduct disorder
  • Hyperthyroid
  • Adjustment disorder
  • Sub use
  • Mania

Work - Up: TSH, tox screen

Step 2 CS (3 decks)

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