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GPA mini case > GPA - Headache, confusion, depress, dizzi, LOC Numbness > Flashcards

GPA - Headache, confusion, depress, dizzi, LOC Numbness Flashcards

1
Q 
DDX:  HA
throbbing, unilateral temporal pain
2-3 hours
aura
weakness/numbness ipsolateral side
n/v
A 
Migraine
tension HA
Cluster HA
Inter-cranial neoplasm
trigeminal neuralgia 
Seizure
CNS vasculitis
Pseudotumor cebrei
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2
Q 
WOrkup:  HA
throbbing, unilateral temporal pain
2-3 hours
aura
weakness/numbness ipsolateral side
n/v
A

CBC - Miningitis, infx,
ESR - Temporal arteritis, vasculitis
CT, MRI- stroke, neoplasm
LP - Atherclerosis, stroke

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3
Q 
DDX- HA
unilateral
Ipsilateral rhinorrhea, tearing, redness
nighlty at same time
45 min
A 
Cluster ha
Migraine
tension HA
sinusitis
Trigeminal neuralgia
neoplasm
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4
Q 
Workup - HA
DDX- HA
unilateral
Ipsilateral rhinorrhea, tearing, redness
nighlty at same time
45 min
A

CBC - Miningitis, infx,
ESR - Temporal arteritis, vasculitis
CT, MRI- stroke, neoplasm
LP - Atherclerosis, stroke

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5
Q 
DDX - HA
Intermttent right temporal HA
Fever
Blurred vison, same side
jaw pain with chewing
A 
Temporal arteritis
migraine, cluster, tension
Meningitis (fever)
TMJ ( jaw pain)
neoplasm (blurred vision)
Carotid artery dissection
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6
Q 
workup - HA
Intermittent right temporal HA
Fever
Blurred visson, same side
jaw pain with chewing
A

*ESR - Temporal arteritis, vasculitis
*Temporal artery biopsy -
* Ultrasoun - carotid artery
CBC - Miningitis, infx,
CRP - inflammation
MRI- stroke, neoplasm
LP - meningitis

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7
Q 
DDX - HA
frontal
fever
nasal discharge
pain with palpation
A

sinusitis
Migraine, tension,
meningitis (fever)
intercranial neoplasm

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8
Q 
workup - HA
frontal
fever
nasal discharge
pain with palpation
A

CBC - infection (miningitis, sinusitis)
XR - sinus
CT - Sinus
LP - Lumbar puncture

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9
Q

DDX - HA
recurrent bilateral squeezing ha
3-4x weekly
end of day, stressful life

A 
Tension*
migraine, Cluster 
depression
caffeine withdrawl
HTN
neoplasm
pseudotumor cerebri (LP)
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10
Q 
Workup - HA
frontal
fever
nasal discharge
pain with palpation
A 
CBC - infx
CMP - electrolytes 
ESR - 
CT - neoplasm
LP - pseudo tumor
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11
Q 
DDX ha
sudden severe ha, 
vomit
confussion
unilateral hemiplegia
nuchal rigidity
A 
* subarachnoid hemorrhage
meningitis
migraine
intercranial hemorrhage
acute HTN
neoplasm
vertebral artery dissection
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12
Q 
Workup - HA
sudden severe ha, 
vomit
confussion
unilateral hemiplegia
nuchal rigidity
A

Non contrast CT - Head
LP - meningitis, hemorrhage, meningitis
CBC - infection
PT/PTT/INR

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13
Q 
DDx -HA
high fever
severe HA
confusion
photophobia
nuchal rigidity
\+ brudzinski and kernig sign
A 
Meningitis (bacterial)
Migraine
subarachnoid hemorrhage
sinusitis
intercranial abscess
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14
Q 
workup -HA
high fever
severe HA
confusion
photophobia
nuchal rigidity
\+ brudzinski and kernig sign
A

CBC - infection
CT - head
MRI - brain
LLP - CSF analysis - Gram stain, PCR, Glucose

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15
Q 
DDX HA
obease
pulsatile HA
vomit
blurred vison
2-3 weeks
meds- OCP
A 
Pseudotumor cerebri (OCP)
Tension headache, migraine, cluster
meningitis
intercranial venous thrombosis (Vision)
neoplasm (vision)
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16
Q 
WOrkup -  HA
obease
pulsatile HA
vomit
blurred vison
2-3 weeks
meds- OCP
A

Urine hGC - Pregnancy test (female iwth vomit
CBC - infx
CT - inflammation, bleeding
LP - CFS anlysis (gram stain, pressure)

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17
Q 
DDX - HA
daily pain unilateral cheek x 1month
electric stabbinging
while shaveing
2-4 min
A

Trigeminal neuralgia
Migraine, tension, cluster
TMJ
intercranial neoplasm

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18
Q 
Workup - HA 
daily pain unilateral cheek x 1month
electric stabbinging
while shaveing
2-4 min
A

CBC
ESR
MRI - brain

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19
Q 
DDX - Confusion
progressive confusion x 3 years
memory loss
clumsiness
hx: HTN, DM, strokes, 
stepwise decline in cognitive function
A 
Vascular dementia (strokes)
Alzheimers
Normal pressure hydrocephalus
intercranial tumor
depression
B12 deficiency
neurosyphilis
hypothyroidism
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20
Q 
workup - Confusion
progressive confusion x 3 years
memory loss
clumsiness
hx: HTN, DM, strokes, 
stepwise decline in cognitive function
A 
CBC - infx
VDRL/RPR - syphilis
Serum b12
TSH
MRI/CT - 
LP -
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21
Q 
DDX - Confusion
Forgetfullnes
lost way
difficult performing daily activities
gradual progression
A 
Alzheimers
Vascular demention
depression
hypothyroid
B12
syphillus
neoplasm
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22
Q 
Workup- Confusion
Forgetfullnes
lost way
difficult performing daily activities
gradual progression
A 
CBC
CT/MRI - Head
LP - pressure, and CSF analysis 
Serum B12
VDRL/RPR - syphilis
TSH
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23
Q 
DDX - Confusion
memory loss
gait distubance
urinary incontinence
6 months
A 
Normal pressure hydrocephalus
Alzheimers
Vascular demential
subdural hematoma
neoplasm
depression, B12, syphillus, Hypothyroid
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24
Q 
workup - Confusion
memory loss
gait distubance
urinary incontinence
6 months
A 
CT - Head
LP - pressure, and CSF analysis 
Serum B12
VDRL/RPR - syphilis
TSH
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25
Q 
DDX - Confusion
rapidly progression change in mental status
inability to concentrate
memory impairment
x 2 months
myoclonus
ataxia
A 
Crueztfelt- Jacop
vascular dementia
lewy body dememtia
Normal pressure hydrocephalus
depression
delirium
B12, syphillus,
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26
Q 
workup - Confusion
rapidly progression change in mental status
inability to concentrate
memory impairment
x 2 months
myoclonus
ataxia
A 
CBC, CMP
B12
VDRL/RPR - syphilis
MRI
EEG- brain electroactivity
LP - CSF analysis
27
Q 
DDX - confusion
insulin dependent
confusion
dizziness
palpitation
diaphoresis
weakness
A 
hypoglycemia
TIA - transient ischemic attack
Arrhythemia
Delirium
Angina
28
Q 
Workup - confusion
insulin dependent
confusion
dizziness
palpitation
diaphoresis
weakness
A 
Glucose
CBC, CMP (electrolytes)
Echocardiogram - heart function
ECG - heart function
MRI - TIA
Doppler US - carotid
29
Q

DDX - Confusion
altered mental status
hit head 2 weeks ago
LOC of 2 minutes

A

subdural hematoma
SIADH - cause hyponatremia
Intracranial neoplasm

30
Q

Workup - Confusion
altered mental status
hit head 2 weeks ago
LOC of 2 minutes

A

Electrolytes
CT/MRI
LP

31
Q 
DDX - Dizziness
intermittent vertigo
tinnitis
nausea
hearing loss
x 1 week
A 
Menieres
vestibular neuronitisitis
Labrynthitis
Benign positional vertigo
acoustic neroma
32
Q 
Workup- Dizziness
intermittent vertigo
tinnitis
nausea
hearing loss
x 1 week
A

CBC
VLDR/RPR - syphilis is cause of mineres
MRI- neuroma

33
Q 
DDX - Dizziness
Dizziness x 1 day
fain
severe diarrhea x 32 days
furosemide for HTN
A 
Dehydration
orthostatic HTN 
Vestibular neuronitis
Labyrinthitis - Hearing loss/vertigo
Benign positional vertigo
Vertebrobasilar insufficency
34
Q 
workup - Dizziness
Dizziness x 1 day
fain
severe diarrhea x 32 days
furosemide for HTN
A

Orthostatic vital signs
CBC
Electrolytes- dehydration
Stool - fecal leukocytes, occult blood

35
Q

DDX - Dizziness
postural dizziness/unsteadiness
HTN
new medications

A 
Drug induced orthostatic hypotension
vestibular neuronitis
labrynthitis
BPV
cerebellar tumor
Acute renal failure
36
Q

workukup - Dizziness
postural dizziness/unsteadiness
HTN
new medications

A

Orthostatic vital signs
CBC
Electrolytes- dehydration
MRI

37
Q

DDX - Dizziness
dizziness upon moving head to left
room is spinning
Tilt test = nystagmus + Nausea

A

Benign positional vertigo
Vestibular neuronitis
Labrynthisit
meneres disease

38
Q

Workup - Dizziness
dizziness upon moving head to left
room is spinning
Tilt test = nystagmus + Nausea

A

MRI
AUdiogram
Dix-Halpike test

39
Q 
DDX - Dizziness
dizziness this morning
N/V
URI 2 days ago
Negative for hearing loss
A

Vestibular neuronitis
Labrynthitis
Menieres disease
BPV

40
Q 
DDX - Dizziness
dizziness this morning
N/V
URI 2 days ago
Negative for hearing loss
A

CBC
Electrolytes- dehydration
MRI
electronystagmography

41
Q 
DDX - LOC
fell and  LOC at worse
Rhythemic limb movements
bit tongue
lost bladder control
confused when woke
A

Seizure: Complex-tonic clonic
Convulsive syncope
substance abuse/overdose
hypoglycemia

42
Q 
Workup - LOC
fell and  LOC at worse
Rhythemic limb movements
bit tongue
lost bladder control
confused when woke
A 
CBC/CMP/GLUCOSE
Urine toxicology
EEG- Brain function
MRI/CT
LP
ECG - heart
43
Q

DDX - LOC
Fell after feeling dizzi
Transient LOC
HTN + anti-HTN drugs

A 
Drug induced orthostatic HTN
Cardiac arrhythmia
Syncope
stoke
MI
P
44
Q

Workup - LOC
Fell after feeling dizzi
Transient LOC
HTN + anti-HTN drugs

A 
Orthostatic vitals signs
CBC/CMP
CT
ECG
CTA
45
Q 
DDX - LOC
65yo, fell and LOC for 3 sec
No warning
Recent palpitations
hx of CABG, coronary artery bypass graft
A 
Cardiac arrhythmia
severe aortic stenosis
syncope
seizure
pulmonary embolism
46
Q 
DDX - LOC
65yo, fell and LOC for 3 sec
No warning
Recent palpitations
hx of CABG, coronary artery bypass graft
A 
ECG - heart
Holter monitoring - 
CBC/CMP
Glucose
Echo
CT
47
Q

Key physical exam for HA

A 
inspect and palpate entire head
ENT inspection
Complete Neuro exam
Fundoscopic exam
Vitals
48
Q

Key PE for confusion

A 
Complete nuro
mini-mental status
gait test
General: ENT, Ht, LUng, abd, extremities
Vitals
49
Q

Key PE for dizziness

A 
Complete Neuro
Rhomberg
nystagmus
Dixhalpike
gait
hearing
Weber Rinne
ENT
CVD
vitals
50
Q

Key exam for LOC

A 
orthostatic
Complete neuro
carotid and cardiac exam
lung
lower extremities
Vitals
51
Q

Key PE for numbness/weakness

A

Neurologic
musculoskeletal
relevant vascular exam

52
Q 
DDX - Numbness/weakness
68yo - 20 min episode
slurred speech
unilateral numbness, face droop and hand weakness
hx htn, dm and heavy smokeing
A 
Transient ischemic attack
hypoglycemia
seizure
stroke
facial nerve palsey
53
Q 
Weakness - Numbness/weakness
68yo - 20 min episode
slurred speech
unilateral numbness, face droop and hand weakness
hx htn, dm and heavy smokeing
A 
CBC/CMP
Blood glucose
ECG -ht
CT/MRI
Carodid ultrasound
Echo - heart
EEG - brain function
54
Q 
DDX - Numbness/weakness
Slurred speach
unilateral facial drooping, numbness weakness,
\+ babinski sign
hx htn, dm and heavy smokeing
A 
Stroke
TIA
intercranial neoplasm
seizure
subdural or epidural neoplasm
55
Q 
Workup - Numbness/weakness
Slurred speach
unilateral facial drooping, numbness weakness,
\+ babinski sign
hx htn, dm and heavy smokeing
A 
CBC/Electrolytes
PT/PTT/INR: stroke risk, bleeding disorder
CT/MRI
Carotid U/S
Echo
56
Q

DDX - Numbness/weakness
33yo
ascending loss of strength x 2 weeks
Recent URI

A 
Guillainn barre syndrome
Multiple sclerosis
Polymyositis-idiopathic inflammatory 
myasthemia gravis
peripheral neuropathy
Tumor-vertebral canal
57
Q

WOrkup - Numbness/weakness
33yo
ascending loss of strength x 2 weeks
Recent URI

A 
CBC, CMP
CPK - measure muscle damage, 
LP-CSF analysis
MRI - spine
Tensilon test - myasthenia gravis
B12
58
Q 
DDX - Numbness/weakness
30yo - acute onset
weakness, numbness, tingling left leg
Right eye pain, decreased/double vision
electric shocks down spine when flexing head
A 
Multiple sclerosis
stroke
CNS tumor
Neurosyphilis
CNS vasculitis
myasthenia gravis
59
Q 
Workup - Numbness/weakness
30yo - acute onset
weakness, numbness, tingling left leg
Right eye pain, decreased/double vision
electric shocks down spine when flexing head
A

CBC/ESR
VDLR/RPR - syphilis
MRI
LP - CSF analysis

60
Q

DDX - Numbness/weakness
Glove and stocking parestheisa x 2 months
HX: dm, HTN, alcholism
Decreased: soft touch, vibraiton positon

A 
Diabetic peripheral nepropathy
Alocholic peripheral neuropathy
B12 deficiency
Hypocalcemia
Hypocalcemia
61
Q

Workup - Numbness/weakness
Glove and stocking parestheisa x 2 months
HX: dm, HTN, alcholism
Decreased: soft touch, vibraiton positon

A 
HbA1c
Calcium 
serum B12
UA
Serum and urine protein electroparesis
ESR - inflammation
62
Q 
DDX - Numbness/weakness
40yo
Occasional double vision
droopy eyelids at night
normalization by morning
A 
Myasthenia gravis
Horner syndrome:mieosis, ptosis, anhydrosis
MS
Eye strain fatigue
Intercranial tumor
63
Q 
Workup - Numbness/weakness
40yo
Occasional double vision
droopy eyelids at night
normalization by morning
A

Tensilon test
Ach receptor antibody test -Myasthenia gravis
CXR
CT -chest RO lambert eaton, lung tumor
MRI - brain (better for still, brain) ro thymoma

GPA mini case (11 decks)

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