first aid cs mini cases Flashcards
1
Q
Behavioral problems in child hood (6)
A
ADHD Oppositional defiant disorder Manic episode conduct disorder substance intoxication substance abuse substance dependence adjustment disorder
2
Q
Behavioral problems in childhood
Key history
A
Onset severity duration triggers physical violence or use of weapons substance-abuse developmental history changes in environment school performance
3
Q
Behavioral problems in childhood
key physical exam
A
Vital signs, neurologic exam
4
Q
Child with short stature (5)
A
Familial short stature growth hormone deficiency hypothyroidism chronic renal insufficiency genetic causes
5
Q
child with Short stature.
key history
A
Prenatal and birth historyGrowth historyPast medical history Family historymedicationsAssociated symptoms like G.I. cardiac pulmonary renal pelvic
6
Q
Child with short stature
key physical exam
A
Vital signs height weight HEENT examHeart and lung examsAbdominal examNeurologic exam
7
Q
Child with a redeye (5)
A
Bacterial conjunctivitis Viral conjunctivitis Keratitis Seasonal allergies Uveitis
8
Q
Child with a redeye
key history
A
On setLocationDurationExacerbating and alleviating factorseye dischargeMedicationsSick contactsImmunizationsAssociated symptoms like G.I. cardiac pulmonary renal pelvic history of similar symptoms
9
Q
Child redeye
key physical exam
A
HEENT examVital signs
10
Q
Child with G.I. symptoms (27)
A
Pyloric stenosis Partial duodenal atresia Gerd Gastroenteritis Hepatitis UTI Hirschsprung disease Low fiber diet Anal stenosis Hypothyroidism Lead poisoning Intussusception Appendicitis Meckel diverticulum Volvulus Blunt abdominal trauma Somatoform disorder Malingering Irritable bowel syndrome Lactose intolerance Child abuse Colic Formula allergy Strangulated hernia Testicular torsion sepsis Aseptic meningitis
11
Q
Child with G.I. symptoms
key history
A
OnsetsLocationQualityIntensityDurationRadiationTiming(relation to meals)Associated symptoms like G.I. cardiac pulmonary Renal pelvicExacerbating and alleviating factorsHistory of similar symptomsHistory of abdominal surgeriesMedicationsSick contactsDaycareImmunizations changes and weight
12
Q
Child with G.I. symptoms
key physical exam
A
Vital signsHeart and lung examsAbdominal examWreck till exam pelvic exam in women
13
Q
Child with fever (4)
A
Neonatal sepsis
Meningitis
Pneumonia
UTI
14
Q
Child with fever key history
A
SeverityDurationAssociated localizing symptomsAppetiteRashSick contactsDaycareImmunizationsPast history
15
Q
Child with fever
key physical exam
A
Vital signsHEENT neckHeartLungAbdominalSkin exam
16
Q
Low back pain (10)
A
Disc herniation Lumbar muscle strain Tumor in the vertebral Canal Abdominal aortic aneurysm Vertebral compression fracture Lumbar spinal stenosis Peripheral vascular disease Knee or leg fracture Ankylosing spondylitis Malingering
17
Q
Low back pain
The physical exam
A
Vital signs The neurologic exam especially L4-S1 nerve roots Back palpation and range of motion Hip exam Consider rectal exam
18
Q
Low back pain
key history
A
LocationQualityIntensity RadiationContext (moving furniture, bending, twisting, trauma) Timing(disturbs sleep) Associated symptoms(especially constitutional, incontinence) exacerbating and alleviating factors History of cancer Recent UTI Diabetes Real stonesIV drug use Smoking
19
Q
Joint/ limb pain (45)
A
Domestic violence Factitious disorder Substance abuse Carpal tunnel syndrome Median nerve compression in forearm or arm Ridiculopathy of nerve roots C6 and C7 in cervical spine SLER heumatoid arthritis Psoriatic arthritis Parvovirus B19 infection Disseminated gonorrhea Arthritis associated with inflammatory bowel disease Osteoarthritis Hip fracture Hip dislocation Pelvic fracture traumatic dislocation Pseudogout Gout Meniscal or ligament damage Septic arthritis Lyme arthritis Reiter arthritis Stress fracture Plantar fasciitis Foot sprain or strain Heal fracture Splinter/ foreign body Tennis elbow(lateral epicondylitis), intermittent claudication, aorta iliac occlusive disease, lumbar spinal stenosis(pseudoclaudication), ruptured Baker's cyst, DVT, myositis/inclusion body myositis, cellulitis, superficial venous thrombosis, angina/MI, tendonitis, shoulder dislocation, humeral fracture, rotator cuff injury, rhabdomyolysis (i.e simvastatin), thyroid disease, polymyositis.
20
Q
Joint/ limb pain
key history
A
Location, Quality, intensity, Duration, pattern(small versus large joints; number involved; swelling, redness, warmth), associated symptoms(Redeye, oral or genital ulceration, diarrhea, dysuria, rash, Focal numbness/ weakness), exacerbating and alleviating symptoms; trauma(including vigorous exercise); medications; DVT risk factors; I’ll call and drug use; Family history of rheumatic disease.
21
Q
Joint/ limb pain
key physical exam
A
Vital signs; HEENT and musculoskeletal exam; relevant neurovascular exam.
22
Q
abuse (5)
A
Domestic violence Osteogenesis imperfecta Substance-abuse Consensual violence sexual behavior Rape
23
Q
Abuse
key history
A
Establish confidentiality; directly question about physical, sexual, or emotional abuse and about fear, safety, Backup plan; history of frequent accidents/Injuries, mental illness, drug use; firearms in the home.
24
Q
Abuse
key physical exam
A
Vital signs; complete exam +/- pelvic
25
Dyspareunia (8)
```
Atrophic vaginitis
Endometriosis
Cervicitis
Depression
Domestic abuse
Vaginismus
vulvodynia
P I D
```
26
Dyspareunia
| key history
Duration, timing, Associated symptoms(vaginal discharge rash, painful menses, G.I. symptoms, hot flashes) , adequacy of lubrication; libido; sexual history; history of sexual trauma or domestic violence; history of endometriosis, pelvic inflammatory disease, or prior abdominal/pelvic surgeries.
27
Dyspareunia
| key physical exam
Vital signs; Abdominal exam; complete pelvic exam
28
Vaginal discharge (3)
Bacterial vaginosis
Vaginitis–candidal vagintis–trichomonal
Cervicitis(chlamydia, gonorrhea)
29
Vaginal discharge
| key history
Amounts, Color, consistency, odor, Duration; Associated vaginal burning, Pain, or pruritus; recent sexual activity; onset of last menstrual period; use of contraceptives, tampons, And douches; History of similar symptoms; history of STDs
30
vaginal discharge
| key physical exam
Vital signs; abdominal exam; complete pelvic exam
31
vaginal bleeding (19)
```
Dysfunctional uterine bleeding
coagulation disorders(example von Willebrand disease, hemophilia)
Cervical cancer
Molar pregnancy
Hypothyroidism
Diabetes mellitus
endometrial cancer
Atrophic endometrium
Endometrial hyperplasia
Endometrial polyps
Atrophic vaginitis
Cervical polyp
Cervicitis
Trauma(example, cervical laceration)
Spontaneous abortion
ectopic pregnancy
Ruptured ovarian
cyst Ovarian torsion
Pelvic inflammatory disease
```
32
vaginal bleeding
| key history
Pre-vs. postmenopausal, duration, and mount; menstrual history and relation to last menstrual period; associated discharge, Pelvic or abdominal pain, Or urinary symptoms; trauma; medications(especially warfarin, contraceptives); history of easy bleeding or bruising; History of abnormal Pap smears
33
Vaginal bleeding
| key physical
vital signs; abdominal exam; complete pelvic exam
34
Amenorrhea (15)
```
Pregnancy
Anovulatory cycle
Hyperprolactinemia
UTI
Thyroid disease
Polycystic ovary syndrome
Ovarian or adrenal malignancy
Premature ovarian failure
Amenorrhea secondary to prolactinoma
Pituitary tumor
Menopause
Sheehan syndrome
Asherman syndrome
Anorexia nervosa
Anxiety induced amenorrhea
```
35
Amenorrhea
| key history
Primary VS. Secondary, duration, possible pregnancy, associated symptoms(headache, decreased peripheral vision, Galactorrhea, hirsutism, virilization, hot flashes, vaginal dryness, symptoms of thyroid disease); history of anorexia nervosa, Excessive dieting, Vigorous exercise, pregnancies, D&Cs, uterine infections; drug use; medications.
36
Amenorrhea
| key physical exam
Vital signs; Breast exam; complete pelvic exam
37
Erectile dysfunction (5)
```
Drug-related ED
ED caused by hypertension
ED caused by Diabetes Mellitus
Psychogenic ED
Peyronie disease
```
38
Erectile dysfunction
| Key history
Duration, severity, +/- nocturnal erections, Libido, stress or depression, trauma, associated incontinence; medications(and recent changes); medical history(hypertension, diabetes, high cholesterol, known astherosclerotic vascular disease, prior prostate surgery); smoking, alcohol, and drug use.
39
Erectile dysfunction
| key physical exam
Vital signs; cardiovascular exam; genital and rectal exams
40
Other urinary symptoms (16)
```
BPH
Prostate cancer
UTI
Bladder stones
Renal cell carcinoma
Urethritis
Cystitis
Prostatitis
Acute pylonephritis
Nephrolithiasis
Stress incontinence
Mixed incontinence
Urge incontinence
Overflow incontinence
Functional incontinence
Diabetes mellitus
```
41
Other urinary symptoms
| key history
Duration, obstructive symptoms (hesitancy, diminished stream, sense of incomplete bladder emptying, straining, post void dribbling), irritative symptoms(urgency, frequency, nocturia), consituational symptoms; bone pain; medications; history of UTIs, urethral stricture, or urinary tract instrumentation; stones, diabetes, alcoholism.
42
Other urinary symptoms
| key physical exam
Vital signs; abdominal exam(including suprapubic percussion to assess for a distended bladder); genital and rectal exams; focused neurologic exam
43
Abdominal pain (38)
```
Nephrolithiasis
Renal cell carcinoma
Pylonephritis
Pancreatic cancer
Acute viral hepatitis
Chronic pancreatitis
cholecystitis/ Choledocholithiasis
Abdominal Aortic aneurysm
Peptic Ulcer diseaseGastritis
Mesenteric ischemia/infarct
Alcoholic hepatitis
Mallory- Weis tear
Ascending cholangitis
Sclerosing cholangitis
Acute glomerulonephritis
GERD
Gastritis
Peptic Ulcer perforation
Splenic rupture
Kidney stone
Rib fracture
Pneumonia
Splenic infarct
Intestinal obstruction
small bowel or colon cancer
volvulus of the bowl
gastroenteritis
food poisoning
Ileus
hernia
Diverticulitis
MI
bowel infarction or perforation
Crohn disease
Ulcerative colitis
abscess
celiac disease
G.I. parasitic infection (amebiasis, Giardiasis).
```
44
Abominal pain (female) (9)
```
Ovarian Torsion
Fitz-Hugh-Curtis syndrome
Ectopic pregnancy
ruptured overian cyst
PID
endometriosis
dysmenorrhea
Vaginitis
spontaneous abortion
```
45
Abdominal pain
| key history
Location, quality, intensity, duration, radiation, timing(relation to meals), associated symptoms(constitutional, G.I., cardiac, pulmonary, renal, pelvic), exacerbating and alleviating factors; history of similar symptoms; history of abdominal surgeries, gallstones, renal stones, atherosclerotic vascular disease; medications; alcohol and drug use; domestic violence.
46
Abdominal pain
| key physical exam
Vital signs; heart and lung exams; abdominal exam, including guarding, rebound, Murphy's sign, Psoas and obturator signs, and CVA palpation; rectal exam; pelvic exam(women).
47
Weight gain (7)
```
Smoking cessation
Drug side effect
Hypothyroidism
Cushing syndrome
Polycystic ovary syndrome
Diabetes mellitus
Atypical depression
```
48
Weight gain
| key history
Amount, duration, timing(relation to medication changes, smoking cessation, depression); diet history; hypothyroid symptoms(fatigue, constipation, skin/hair/nail changes); menstrual irregularity; medical history; alcohol and drug use.
49
Weight gain
| key physical exam
Vital signs; complete exam, including signs of Cushing's syndrome(hypertension, central obesity, moon face, Buffalo hump, supraclavicular fat pads, purple abdominal striae).
50
Hematuria (9)
```
Bladder cancer
renal cell carcinoma
nephrolithiasis
Acute glomerulonephritis
prostate cancer
coagulation disorder(example, factor eight Anti-bodies)
Polycystic kidney disease
UTI
pylonephritis
```
51
Hematuria
| key history
Amount, duration, +/-clots, associated symptoms(constitutional, renal colic, dysuria, irritative voiding symptoms); medications; history of vigorous exercise, Trauma, smoking, stones, cancer, or easy bleeding.
52
Hematuria
| key physical exam
Vital signs; lymph nodes; abdominal exam; genitourinary and rectal exams; extremities.
53
Blood in stool (10)
```
ColoRectal cancer
Anal Fissure
Hemorrhoids
Diverticulosis
ischemic bowel disease
Angiodysplasia
Upper GI bleeding
Inflammatory bowel disease(Ulcerative colitis, Crohn disease)
Proctitis
Dysentery
```
54
Blood in stool
| key history
Melena vs. bright blood; amount, duration, associated symptoms(constitutional, abdominal or rectal pain, tenesmus, constipation/diarrhea); trauma; history of similar symptoms; prior colonoscopy; medications(especially WARFARIN); history of easy bleeding or atherosclerotic vascular disease.
55
Blood in stool
| key physical exam
Vital signs +/- orthostatics; abdominal and rectal exams.
56
Upper G.I. Bleeding (6)
```
Bleeding peptic ulcer
Gastritis
Gastric cancer
Esophageal varices
Mallory-Weiss tear
boerhaave syndrome
```
57
Upper G.I. bleeding
| key history
Amount, duration, context(after severe vomiting, alcohol ingestion, nosebleed), associated symptoms (constituational, nausea, abdominal pain, dyspepsia); medications(especially WARFARIN, NSAIDs); history of peptic ulcer disease, liver disease, abdominal aortic aneurysm repair, easy bleeding.
58
upper G.I. bleeding
| key physical exam
Vital signs, including orthostatic's; ENT, Heart, lung, Abdominal, and rectal exams.
59
Constipation/diarrhea (21)
```
coloRectal cancer
IBS
Diverticulosis
Infectious diarrhea(gastroenteritis)–bacterial, viral, protozoal(cryptosporidiosis, isosporabeli), GI parasitic infection(ascariasis, giardiasis, amebiasis);
IBD
Angiodysplasia
low fiber diet
Substance-abuse(Example, heroin)
Depression
Hypothyroidism/ hyperthyroidism
Celiac disease
Chronic pancreatitis
Lactose intolerance
Food poisoning
pseudomembranous colitis
Travelers diarrhea
Hepatitis A
Small Bowl lymphoma
Carcinoid syndrome
```
60
Constipation/diarrhea
| key history
Frequency and volume of stools, duration of change in bowel habits, associated symptoms(constitutional, abdominal pain, bloating, sense of incomplete evacuation, melena or hematochezia); thyroid disease symptoms; diets (especially fiber and fluid intake); medications(including recent antibiotics); Sick contacts, travel, camping, HIV risk factors; history of abdominal surgeries, diabetes, pancreatitis; Alcohol and drug use; family history of colon cancer.
61
Constipation/diarrhea
| key physical exam
Vital signs; relevant thyroid/endocrine exam; abdominal and rectal exams; +/- female Pelvic exam
62
Nausea/vomiting (6)
```
Pregnancy
Gastritis
Hypercalcemia
Diabetes mellitus
UTI
Depression
```
63
Nausea/vomiting
| key history
acuity of onset, +/- abdominal pain, relation to meals, sick contacts, possible food poisoning, possible pregnancy; neurologic symptoms (Headache, stiff neck, vertigo, focal numbness or weakness), other associated symptoms(G.I., chest pain), Exacerbating and alleviating factors; medications.
64
Nausea/vomiting
| key physical exam
Vital signs; ENT; consider funduscopic exam(increased intracranial pressure); Complete abdominal exam; consider heart, lung, and rectal exams.
65
Dysphagia (10)
```
Esophageal cancer
Achalasia
Esophagitis(CMV. HSV, Pill induced)
Systemic sclerosis
esophageal stricture
Amyotrophic lateral sclerosis
Plummer Vinson syndrome
Mitral valve stenosis
Zinker diverticulum
GERD
```
66
Dysphasia
| key history
Solids or liquids versus both solids and liquids, +/- progression, constitutional symptoms(especially weight-loss), drooling, regurgitation, odynophagia, GERD symptoms; medications; HIV risk factors, History of smoking, History of Raynaud phenomenon.
67
Weight loss (6)
```
Hyperthyroidism
Cancer
HIV infection
Dieting/ diet drugs
anorexia nervosa
Malabsorption
```
68
Weight loss
| key history
Amounts, duration, +/- intention, Diet history, body image, anxiety or depression; other constitutional symptoms; palpitations, tremor, Diarrhea; Family history of thyroid disease; HIV risk factors; tobacco, alcohol, and drug use; medications; history of cancer; blood in urine or stool
69
Palpitations (16)
```
Hypoglycemia
Cardiac arrhythmias
angina
Hyperthyroidism
Hyperventilation episodes
Panic attacks
Pheochromocytoma
Carcinoid syndrome
Generalized anxiety disorder
Acute stress disorder
Specific phobia
Agoraphobia
Substance-abuse/ dependence
Mitral valve prolapse
Social phobia
avoidant personality disorder
```
70
Palpitations
| key history
Gradual versus acute onset/ offsets, Context (surgeon, caffeine, anxiety), associated symptoms(lightheadedness, chest pain, dyspnea); hyperthyroid symptoms; history of bleeding or anemia; history of heart disease
71
Chest pain (18)
```
Myocardial infarction
Gerd
Angina
Costochondritis
Aortic dissection
Pericarditis
Pulmonary embolism
Pneumothorax
Sickle cell disease– pulmonary infarction
Pneumonia
Esophagitis
Peptic ulcer disease
Esophageal spasm
Esophageal rupture
Muscle strain
CHF
Pancreatitis
Fat embolism
```
72
Chest pain
| key history
j
73
Cough/ shortness of breath (27)
```
Asthma
GERD
Bronchitis
Pneumonitis
Foreign body
COPD– chronic bronchitis
Bronchiectasis
Long cancer
Tuberculosis
Pneumonia (PCP)
Long abscess
Pericarditis
Atypical pneumonia
Reactive airway disease
URI – associated cough (post infectious)
Postnatal drip
Vasculitis(i.e. Wegner)
Interstitial lung disease
CHF (cardiomyopathy)
URI
Lymphoma
Metastatic cancer
HIV/AIDS (may be acute infection)
Sarcoidosis
Cardiac valvular disease
pulmonary fibrosis
```
74
Cough/ shortness of breath
| key history
j
75
Sore throat (7)
```
Infectious mono
Hepatitis
Viral or bacterial pharyngitis
Acute HIV infection
Secondary syphilis
Streptococcal tonsillitis/ Scarlet fever
Mycoplasma pneumonia
```
76
Sore throat
| key history
j
77
Insomnia (7)
Stress-induced insomnia
Caffeine induced insomnia
Insomnia with circadian rhythms the disorder
Insomnia related to major depressive disorder
Obstructive sleep apnea
Daytime fatigue in primary hypersomnia
Primary hypersomnia
78
Insomnia
| key history
j
79
Night sweats (5)
```
Tuberculosis
Acute HIV infection
lymphoma
Leukemia
Hyperthyroidism
```
80
night sweats
| key history
j
81
Fatigue and sleepiness (18)
```
Depression
Adjustment disorder
Hypothyroidism
Anemia
Post traumatic stress disorder
Generalized anxiety disorder
Psychotic or delusional disorder
colon cancer
Renal failure
Hypercalcemia
Diabetes
obstructive sleep apnea
Chronic fatigue syndrome
Narcolepsy
Atypical depression
Primary polydipsia
Diabetes insipidus
Sleep deprivation
```
82
fatigue and sleepiness
| key history
j
83
Numbness/weakness (24)
```
Transient ischemic attack
Hypoglycemia
Seizure
Stroke
Facial nerve palsy
Intracranial neoplasm or intracranial neoplams compressing CN3 4 6.
Subdural or epidural hematoma
Guillain–barre syndrome
Multiple sclerosis
Polymyositis
Myasthenia gravis
peripheral neuropathy(alcoholic, diabetic, B12)
Tumor vertebral canal/CNS tumor
Conversion disorder
malingering
Neurosyphilis
Syringomyelia
CNS vasculitis
Hyperventilation
Paraproteinemia/ myeloma
Horner's syndrome
ALS
Todd paralysis
Complicated migraine
```
84
numbness/weakness
| key history
j
85
Loss of consciousness (12)
```
Complex tonic conic seizure
Convulsive syncope
Substance-abuse/overdose
Malingering
Hypoglycemia
Drug-induced orthostatic hypotension(causing syncope)
Cardiac arrhythmia
Vasovagal syncope
Stroke
MI
Pulmonary embolism
Severe aortic stenosis
```
86
Loss of consciousness
| key history
j
87
Dizziness (10)
```
Ménière disease
vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Acoustic neuroma
Orthostatic hypotension due to dehydration (diarrhea diuretic use)
Vertebrobasilar insufficiency
Brainstem or cerebellar tumor
Acute renal failure
Vertigo associated with cervical spine disease or injury
```
88
dizziness
| key history
J
89
Psychosis (8)
```
Schizophrenia
Schizoid or schizotypical personality disorder
Schizophreniform disorder
Psychotic disorder to the general medical condition
Substance induced psychosis
Depression with psychotic features
Brief psychotic disorder
Mood disorder with psychotic features
```
90
Psychosis
| key history
j
91
Depressed mood (10)
```
Normal bereavement
Adjustment disorder with depressed mood
Major depressive disorder with psychotic features
Schizoaffective disorder
Depressive disorder not otherwise specified
Substance induced mood disorder
Dysthymic disorder
Bipolar one bipolar two
Cyclothymic disorder
Atypical depression
```
92
Depressed mood
| key history
j
93
Confusion/memory loss (18)
```
Vascular dementia
alzheimer disease
Normal pressure hydrocephalus
Chronic subdural hematoma
Intracranial tumor
Depression
B12 deficiency
neurosyphilis
Hypothyroidism
Cruetzfeldt-Jakob disease
lewy body dementia
Wernicke encephalopathy
Delirium
Hypoglycemia
Transient ischemic attack
Arrhythmia
Angina
SIADH(causing hyponatremia)
```
94
Confusion/memory loss
| key history
j
95
Headache (20)
```
Migraine
Tension headache
Cluster headache
Pseudotumor cerebri
Trigeminal neuralgia
CNS vasculitis
Partial seizure
Intracranial neoplasm
Sinusitis
Temporal arthritis
Meningitis/ encephalitis (bacterial/HSV)
Carotid artery dissection
Temporomandibular joint disorder
Depression
Caffeine or analgesic withdrawal
Hypertension
Subarachnoid hemorrhage/ intracranial hemorrhage
Vertebral artery dissection
Intracranial venous thrombosis
Intracranial or epidural abscess
```
96
headache
| key history
j
