FA CS - MiniCases Flashcards
47 yo M presents with impotence that started three months ago. He has hypertension and was started on atenolol four months ago. He also has diabetes and is on insulin.
Drug-related ED ED caused by hypertension ED caused by diabetes mellitus Psychogenic ED Peyronie's disease
W/U: Genital exam Rectal exam Glucose CBC
19 yo M c/o receiving messages from his television set. He reports that he did not have many friends in high school. In college, he started to suspect his roommate of bugging the phone. In the same time frame, he stopped going to classes because he felt that his professors were saying horrible things about him that no one else noticed. He rarely showered or left his room and has recently been hearing a voice from his television set telling him to 'guard against the evil empire.'
Schizophrenia Schizoid or schizotypal personality disorder Schizophreniform disorder Psychotic disorder due to a general medical condition Substance-induced psychosis Depression with psychotic features
W/U: Mental status exam Urine toxicology TSH CBC Electrolytes
40 yo F presents with occasional double
vision and droopy eyelids at night with
normalization by morning.
Myasthenia gravis Horner's syndrome Multiple sclerosis Intracranial tumor compressing CN III, IV, or VI Amyotrophic lateral sclerosis
W/U: Tensilon test ACh receptor antibodies (in serum) CXR CT—chest MRI—brain EMG
25 yo F presents with two weeks of a
nonproductive cough. Three weeks ago
she had a sore throat and a runny nose.
Atypical pneumonia
Reactive airway disease
URI-associated ('postinfectious')
Postnasal drip
GERD
W/U: CBC Induced sputum Gram stain and culture CXR IgM detection for Mycoplasma pneumoniae Urine Legionella antigen
65 yo M presents with right foot pain. He has been training for a marathon.
Stress fracture
Plantar fasciitis
Foot sprain or strain
W/U:
XR—foot
Bone scan—foot
MRI—foot
28 yo F c/o seeing bugs crawling on her bed over the past two days and reports hearing loud voices when she is alone in her room. She has never experienced symptoms such as these in the past. She recently ingested an unknown substance.
Substance-induced psychosis Brief psychotic disorder Schizophreniform disorder Schizophrenia Psychotic disorder due to a general medical condition
W/U: Urine toxicology Mental status exam TSH CBC Electrolytes, BUN/Cr, AST/ ALT
18 yo M boxer presents with severe LUQ
abdominal pain that radiates to the left
scapula. He had infectious
mononucleosis three weeks ago.
Splenic rupture Kidney stone Rib fracture Pneumonia Perforated peptic ulcer Splenic infarct
W/U: Rectal exam CBC, electrolytes CXR CT—abdomen U/S—abdomen
30 yo F presents with alternating constipation and diarrhea and abdominal pain that is relieved by defecation. She has no nausea, vomiting, weight loss, or blood in her stool.
Irritable bowel syndrome Infl ammatory bowel disease Celiac disease Chronic pancreatitis GI parasitic infection (ascariasis, giardiasis) Lactose intolerance
W/U: Rectal exam, stool for occult blood CBC Electrolytes Stool for ova and parasitology AXR CT—abdomen/pelvis
30 yo F presents with a thick, white,
cottage cheese-like, odorless Vaginal discharge and vaginal itching.
Vaginitis—candidal
Bacterial vaginosis
Vaginitis—trichomonal
W/U:
Pelvic exam
KOH prep ('whiff test')
Wet mount
Cervical cultures
pH of vaginal fl uid
46 yo F presents with fever and sore
throat.
Pharyngitis (bacterial or viral) Mycoplasma pneumonia Acute HIV infection Infectious mononucleosis
W/U: Throat swab for culture and rapid streptococcal antigen Monospot test CBC HIV antibody and viral load
20 yo African-American F presents with acute onset of severe chest pain. She has a history of sickle cell disease and multiple previous hospitalizations for pain and anemia management.
Sickle cell disease—pulmonary infarction Pneumonia Pulmonary embolism MI Pneumothorax Aortic dissection
W/U: CBC, reticulocyte count, LDH, peripheral smear ABG CXR CPK-MB, troponin ECG CT—chest with IV contrast
44 yo F presents with a weight gain of > 11 kg over the past two months. She quit smoking three months ago and is on amitriptyline for depression. She also reports cold intolerance and constipation.
Smoking cessation Drug side effect Hypothyroidism Cushing's syndrome Polycystic ovary syndrome Diabetes mellitus Atypical depression
W/U: CBC, electrolytes, glucose TSH 24-hour urine free cortisol Dexamethasone suppression test
28 yo F who is eight weeks pregnant
presents with lower abdominal pain and vaginal bleeding.
Spontaneous abortion
Ectopic pregnancy
Molar pregnancy
W/U: Pelvic exam Urine hCG U/S—pelvis CBC, PT/PTT Quantitative serum hCG
34 yo F presents with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI one week ago.
Pericarditis Aortic dissection MI Costochondritis GERD Esophageal rupture
W/U: ECG CPK-MB, troponin CXR Echocardiography CBC Upper endoscopy
65 yo F presents with inability to use
her left leg and bear weight on it after tripping on a carpet. Onset of menopause was 20 years ago, and she did not receive HRT or calcium supplements. Her left leg is externally rotated, shortened, and
adducted, and there is tenderness in her left groin.
Hip fracture
Hip dislocation
Pelvic fracture
W/U: XR—hip/pelvis CT or MRI—hip CBC Serum calcium and vitamin D Bone density scan (DEXA)
56 yo obese F presents with right knee stiffness and pain that increases with movement. Her symptoms have gradually worsened over the past 10 years. She noticed swelling and deformity of the
joint and is having diffi culty walking.
Osteoarthritis
Pseudogout
Gout
Meniscal or ligament damage
W/U: XR—knee CBC ESR Knee arthrocentesis and synovial fl uid analysis (cell count, Gram stain, culture, crystals) MRI—knee
56 yo F presents with shortness of breath
as well as with a productive cough that
has occurred over the past two years for
at least three months each year. She is a
heavy smoker.
COPD—chronic bronchitis
Bronchiectasis
Lung cancer
Tuberculosis
W/U: CBC Sputum Gram stain and culture CXR PFTs CT—chest PPD
12 yo F presents with a two-month
history of fi ghting 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.
Adjustment disorder Substance intoxication/abuse/ dependence Manic episode Oppositional defi ant disorder Conduct disorder
W/U:
Physical exam
Mental status exam
Urine toxicology
44 yo M presents with fatigue, insomnia, and nightmares about a murder that he witnessed in a mall one year ago. Since then, he has avoided that mall and has not gone out at night.
Post-traumatic stress disorder (PTSD) Depression Generalized anxiety disorder Psychotic or delusional disorder Hypothyroidism
W/U: CBC TSH Calcium Urine toxicology
35 yo F presents with intermittent
episodes of vertigo, tinnitus, nausea, and
hearing loss over the past week.
Ménière's disease Vestibular neuronitis Labyrinthitis Benign positional vertigo Acoustic neuroma
W/U: CBC VDRL/RPR (syphilis is a cause of Ménière's disease) MRI—brain
45 yo G5P5 F presents with postcoital bleeding. She is a cigarette smoker and takes OCPs.
Cervical cancer Cervical polyp Cervicitis Trauma (e.g., cervical laceration)
W/U:
Pelvic exam
Pap smear
Colposcopy and biopsy
29 yo F presents with amenorrhea for the
past six months. She has a history of
occasional palpitations and dizziness. She
lost her fi ancé in a car accident.
Anxiety-induced amenorrhea
W/U: CBC TSH FT4 ACTH Urine cortisol level Progesterone challenge test FSH/LH/estradiol levels
40 yo F presents with fatigue, weight
gain, sleepiness, cold intolerance,
constipation, and dry skin.
Hypothyroidism
Depression
Diabetes
Anemia
W/U:
TSH, FT3, FT4
CBC
Glucose, HbA1c
25 yo M presents with hemiparesis (after
a tonic-clonic seizure) that resolves over
a few hours.
Todd's paralysis TIA Stroke Complicated migraine Malingering
W/U: CBC, electrolytes EEG MRI—brain Doppler U/S—carotid
84 yo F brought by her son c/o forgetfulness (e.g., forgets phone numbers, loses her way back home) along with diffi culty performing some of her daily activities (e.g., bathing, dressing, managing money, using the phone). The problem has gradually progressed over the past few years.
Alzheimer's disease Vascular dementia Depression Hypothyroidism Chronic subdural hematoma Normal pressure hydrocephalus Intracranial neoplasm B12 defi ciency Neurosyphilis
W/U: CBC VDRL/RPR Serum B12 TSH MRI—brain (preferred) CT—head LP—CSF analysis (rare)
35 yo M policeman c/o feeling tired and
sleepy during the day. He changed to the
night shift last week.
Sleep deprivation
Sleep apnea
Depression
Anemia
W/U:
CBC
Nocturnal pulse oximetry
Polysomnography
55 yo F presents with gradual altered mental status and headache. Two weeks ago she slipped, hit her head on the ground, and lost consciousness for two minutes.
Subdural hematoma
SIADH (causing hyponatremia)
Creutzfeldt-Jakob disease
Intracranial neoplasm
W/U: Electrolytes CT—head MRI—brain LP
45 yo diabetic F presents with dysuria,
urinary frequency, fever, chills, and
nausea over the past three days. There is
left CVA tenderness on exam.
Acute pyelonephritis
Nephrolithiasis
Renal cell carcinoma
Lower UTI (cystitis, urethritis)
W/U: UA Urine culture and sensitivity CBC, BUN/Cr U/S—renal CT—abdomen
17 yo M presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class. He also describes areas of loss of sensation in his left foot. The pain and sensory loss do not
match any known distribution. He insists on requesting a week off from school because of his injury.
Malingering Lumbar muscle strain Disk herniation Knee or leg fracture Ankylosing spondylitis
W/U:
XR—L-spine/knee
MRI—L-spine
37 yo F presents with dyspareunia,
inability to conceive, and dysmenorrhea.
Endometriosis Cervicitis Vaginismus Vulvodynia PID Depression Domestic violence
W/U: Pelvic exam Wet mount, KOH prep, cervical cultures U/S—pelvis Laparoscopy
28 yo F presents with pain in the
metacarpophalangeal joints of both
hands. Her left knee is also painful and red. She has morning joint stiffness that lasts for an hour. Her mother had rheumatoid arthritis.
Rheumatoid arthritis SLE Disseminated gonorrhea Arthritis associated with infl ammatory bowel disease Osteoarthritis
W/U: ANA, anti-dsDNA, ESR, RF, CBC XR—hands, left knee Cervical culture Arthrocentesis and synovial fl uid analysis
65 yo M presents with postural dizziness
and unsteadiness. He has hypertension
and was started on hydrochlorothiazide
two days ago.
Drug-induced orthostatic hypotension Vestibular neuronitis Labyrinthitis Benign positional vertigo Brain stem or cerebellar tumor Acute renal failure
W/U: Orthostatic vital signs CBC Electrolytes BUN/Cr MRI—brain
25 yo M presents with RUQ pain, fever,
anorexia, nausea, and vomiting. He has
dark urine and clay-colored stool.
Acute hepatitis Acute cholecystitis Ascending cholangitis Choledocholithiasis Pancreatitis Acute glomerulonephritis
W/U: Rectal exam CBC, amylase, lipase AST/ALT/bilirubin/alkaline phosphatase UA Viral hepatitis serologies U/S—abdomen
20 yo F presents with nausea, vomiting (especially in the morning), fatigue, and polyuria. Her last menstrual period was six weeks ago, and her breasts are full and tender. She is sexually active with her boyfriend, and they use condoms for contraception.
Pregnancy Gastritis Hypercalcemia Diabetes mellitus UTI Depression
W/U: Urine hCG Pelvic exam U/S—pelvis CBC, electrolytes, calcium, glucose UA, urine culture Baseline Pap smear, cervical cultures, rubella antibody, HIV antibody, hepatitis B surface antigen, and VDRL/ RPR
32 yo F presents with sudden onset of left lower abdominal pain that radiates to the scapula and back and is associated with vaginal bleeding. Her last menstrual period was fi ve weeks ago. She has a
history of PID and unprotected
intercourse.
Ectopic pregnancy
Ruptured ovarian cyst
Ovarian torsion
PID
W/U: Pelvic exam Urine hCG Cervical cultures U/S—pelvis Quantitative serum hCG
15 yo M presents with a one-year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report 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.
Substance abuse
Conduct disorder
Oppositional defi ant disorder
Adjustment disorder
W/U:
Urine toxicology
Mental status exam
28 yo F presents with pain in the
interphalangeal joints of her hands
together with hair loss and a butterfly
rash on her face.
Systemic lupus erythematosus (SLE) Rheumatoid arthritis Psoriatic arthritis Parvovirus B19 infection
W/U: ANA, anti-dsDNA, ESR, C3, C4, rheumatoid factor (RF), CBC XR—hands UA
12-month-old M presents with fever
for the last two days accompanied by a maculopapular rash on his face and body. He has not yet received the MMR vaccine.
Measles (or other viral exanthem) Rubella Roseola Fifth disease Varicella Scarlet fever Meningitis
W/U: Physical exam CBC Viral antibodies/titers Throat swab for culture LP
28 yo F presents with a thin, grayish white, foul-smelling vaginal discharge.
Bacterial vaginosis Vaginitis—candidal Vaginitis—trichomonal Cervicitis (chlamydia, gonorrhea)
W/U:
Pelvic exam
Wet mount
Cervical cultures
KOH prep ('whiff test')
pH of vaginal fl uid
26 yo M presents with sore throat, fever,
rash, and weight loss. He has a history of
IV drug abuse and sharing needles.
HIV, acute retroviral syndrome Infectious mononucleosis Hepatitis Viral pharyngitis Streptococcal tonsillitis/ scarlet fever Secondary syphilis
W/U: CBC Peripheral smear HIV antibody and viral load CD4 count Monospot test Throat culture VDRL/RPR AST/ALT/bilirubin/alkaline phosphatas
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 fl exing her head.
Multiple sclerosis Stroke Conversion disorder Malingering CNS tumor Neurosyphilis Syringomyelia CNS vasculitis
W/U: CBC, ESR VDRL/RPR MRI—brain LP—CSF analysis Retinal evoked potentials
44 yo F c/o dizziness on moving her
head to the left. She feels that the room
is spinning around her head. Tilt test
results in nystagmus and nausea.
Benign positional vertigo
Vestibular neuronitis
Labyrinthitis
Ménière’s disease
W/U:
MRI—brain
Audiogram
35 yo M presents with shortness of breath and cough. He has had unprotected sex with multiple sexual partners and was recently exposed to a patient with active tuberculosis.
Tuberculosis Pneumonia (including Pneumocystis jiroveci) Bronchitis CHF (cardiomyopathy) Asthma Acute HIV infection
W/U: CBC PPD Sputum Gram stain, acid-fast stain, silver stain, and culture CXR HIV antibody
55 yo M presents with sudden onset of
severe chest pain that radiates to the
back. He has a history of uncontrolled
hypertension.
Aortic dissection MI Pericarditis Esophageal rupture Esophageal spasm GERD Pancreatitis Fat embolism
W/U: ECG, CPK-MB, troponin CXR CBC, amylase, lipase Transesophageal echocardiography (TEE), MRI/MRA—aorta Aortic angiography Upper endoscopy
60 yo M presents with nocturia, urgency, weak stream, and terminal dribbling. He denies any weight loss, fatigue, or bone pain. He has had two episodes of urinary retention that required catheterization.
Benign prostatic hyperplasia (BPH) Prostate cancer UTI Bladder stones
W/U: Rectal exam UA CBC, BUN/Cr, PSA U/S—prostate (transrectal)
60 yo M presents with dull epigastric pain that radiates to the back, together with weight loss, dark urine, and clay-colored stool. He is a heavy drinker and smoker.
Pancreatic cancer Acute viral hepatitis Chronic pancreatitis Cholecystitis/choledocholithiasis Abdominal aortic aneurysm Peptic ulcer disease
W/U: Rectal exam CBC, electrolytes Amylase and lipase AST/ALT/bilirubin/alkaline phosphatase U/S—abdomen CT—abdomen
55 yo M presents with pain in the
elbow when he plays tennis. His grip is impaired 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.
Tennis elbow (lateral epicondylitis) Stress fracture W/U: XR—arm Bone scan MRI—elbow
60 yo F c/o left arm pain that started
while she was swimming and was relieved by rest.
Angina/MI
Tendonitis
Osteoarthritis
Shoulder dislocation
W/U: CPK-MB, troponin, ECG CBC ESR XR—shoulder CXR Echocardiography Stress test
55 yo M c/o falling after feeling dizzy
and unsteady. He experienced transient
LOC. He has hypertension and is on
numerous antihypertensive drugs.
Drug-induced orthostatic hypotension (causing syncope) Cardiac arrhythmia Syncope (vasovagal, other causes) Stroke MI Pulmonary embolism
W/U: Orthostatic vital signs CBC Electrolytes CT—head ECG V/Q scan CT—chest with IV contrast
35 yo M presents with burning epigastric
pain that starts 2-3 hours after meals.
The pain is relieved by food and
antacids.
Peptic ulcer disease Gastritis GERD Cholecystitis Chronic pancreatitis Mesenteric ischemia
W/U: Rectal exam Amylase, lipase, lactate AST/ALT/bilirubin/alkaline phosphatase Endoscopy (including H. pylori testing) Upper GI series
21 yo F presents with acute onset of severe RLQ pain, nausea, and vomiting. She has no fever, urinary symptoms, or vaginal bleeding and has never taken OCPs. Her last menstrual period was regular, and she has no history of STDs.
Ovarian torsion Appendicitis Nephrolithiasis Ectopic pregnancy Ruptured ovarian cyst PID Bowel infarction or perforation
W/U: Pelvic exam Rectal exam Urine hCG UA CBC Doppler U/S—pelvis CT—abdomen Laparoscopy
55 yo obese M presents with several
months of poor sleep and daytime
fatigue. His wife reports that he snores
loudly.
Obstructive sleep apnea Daytime fatigue in primary hypersomnia Insomnia with circadian rhythm sleep disorder Insomnia related to major depressive disorder
W/U: CBC TSH Polysomnography ECG
61 yo obese F presents with profuse
vaginal bleeding over the past month. Her last menstrual period was 10 years ago. She has a history of hypertension and diabetes mellitus. She is nulliparous.
Endometrial cancer Cervical cancer Atrophic endometrium Endometrial hyperplasia Endometrial polyps Atrophic vaginitis
W/U: Pelvic exam Pap smear Endometrial biopsy U/S—pelvis Endometrial curettage Colposcopy Hysteroscopy
68 yo M presents with a two-month history of crying spells, excessive sleep, poor hygiene, and a 7-kg weight loss, all following his wife's death. He cannot enjoy time with his grandchildren and reluctantly admits to thinking he has seen his dead wife in line at the supermarket or standing in the kitchen making dinner.
Normal bereavement Adjustment disorder with depressed mood Major depressive disorder with psychotic features Schizoaffective disorder Depressive disorder not otherwise specifi ed (NOS)
W/U: Physical exam Mental status exam TSH CBC Urine toxicology
67 yo M presents with alternating diarrhea and constipation, decreased stool caliber, and blood in the stool for the past eight months. He also reports unintentional weight loss. He is on a low-fi ber diet and has a family history of colon cancer.
Colorectal cancer Irritable bowel syndrome Diverticulosis GI parasitic infection (ascariasis, giardiasis) Infl ammatory bowel disease Angiodysplasia
W/U: Rectal exam CBC AST/ALT/bilirubin/alkaline phosphatase Colonoscopy Barium enema CT—abdomen/pelvis
65 yo M presents with painless
hematuria. He is a heavy smoker and
works as a painter.
Bladder cancer Renal cell carcinoma Nephrolithiasis Acute glomerulonephritis Prostate cancer Coagulation disorder (i.e., factor VIII antibodies) Polycystic kidney disease Genitourinary exam
W/U: UA, urine cytology BUN/Cr, PSA, CBC, PT/PTT Cystoscopy U/S—renal/bladder CT—abdomen/pelvis IVP
48 yo F presents with dysphagia for both solid and liquid foods that has slowly progressed in severity over the past year. It is associated with regurgitation of undigested food, especially at night.
Achalasia Plummer-Vinson syndrome Esophageal cancer Esophagitis Systemic sclerosis Mitral valve stenosis Esophageal stricture Zenker's diverticulum
W/U: CXR Endoscopy Barium swallow Esophageal manometry
37 yo M presents with severe epigastric pain, nausea, vomiting, and mild fever. He appears toxic. He has a history of intermittent epigastric pain that is relieved by food and antacids. He also smokes heavily and takes aspirin on a regular basis.
Peptic ulcer perforation Acute pancreatitis Hepatitis Cholecystitis Choledocholithiasis Mesenteric ischemia
W/U: Rectal exam CBC, electrolytes, amylase, lipase, lactate AST/ALT/bilirubin/alkaline phosphatase AXR Upright CXR Endoscopy (including H. pylori testing)
65 yo M presents after falling and losing
consciousness for a few seconds. He
had no warning prior to passing out but
recently had palpitations. His past history
includes coronary artery bypass grafting
(CABG).
Cardiac arrhythmia (causing syncope) Severe aortic stenosis Syncope (other causes) Seizure Pulmonary embolism
W/U: ECG Holter monitoring CBC, electrolytes Glucose Echocardiography CT—head
30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis.
Sinusitis Migraine Tension headache Meningitis Intracranial neoplasm
CBC
XR—sinus
CT—sinus
LP
25 yo M presents with high fever, severe
headache, confusion, photophobia, and
nuchal rigidity. Kernig’s and Brudzinski’s
signs are positive.
Meningitis Migraine Subarachnoid hemorrhage Sinusitis/encephalitis Intracranial or epidural abscess
W/U: CBC CT—head MRI—brain LP—CSF analysis (cell count, protein, glucose, Gram stain, PCR for antigens, culture)
20 yo M presents with severe RLQ abdominal 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 the RLQ. McBurney's and psoas signs are positive.
Acute appendicitis Gastroenteritis Diverticulitis Crohn's disease Nephrolithiasis Volvulus or other intestinal obstruction/perforation
W/U: Rectal exam CBC, electrolytes AXR CT—abdomen U/S—abdomen
55 yo F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI two days ago and has experienced no hearing loss.
Vestibular neuronitis Labyrinthitis Ménière's disease Benign positional vertigo Vertigo associated with cervical spine disease/injury Vertebrobasilar insufficiency
W/U: CBC Electrolytes Electronystagmography MRI/MRA—brain
50 yo F presents with recurrent episodes of bilateral squeezing headaches that occur 3-4 times a week, typically toward the end of her work day. She is experiencing signifi cant stress in her life.
Tension headache Migraine Depression Caffeine or analgesic withdrawal Hypertension Cluster headache Pseudotumor cerebri Intracranial neoplasm
CBC Electrolytes ESR CT—head LP
