Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

STEP 2 CS > Illness Scripts > Flashcards

Illness Scripts Flashcards

1
Q

Middle aged man with chest pain of several hours.

List D/Dx +/- Fever

A

+ Fever: PNA, Pleuritis, MI, Costochondritis

-Fever: ACS- MI, ACS- US, PNA, GERD, Costochondritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Young man with abrupt SOB

List D/Dx

A 
Pneumothorax
Allergic Reaction
Panic Attack
PE
PNA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Importance of pertinent positives and negatives

A

Positives- Support primary Dx

Negatives- R/o or placed lower on D/Dx list

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Woman feeling fatigue

Begin to think possibly anemia
Questions to ask e.g. include…

A

Menses
Diet- Red meat

No evidence of anemia- Do not include in D/Dx list

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

D/Dx for depression

A

Major Depressive d/o
Generalized Anxiety d/o
Hypothyroidism
Somatization d/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

D/Dx for anxiety

A

Generalized Anxiety d/o
Major depressive d/o
Hyperthyroidism
Somatization d/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diagnostic plan for depression and Anxiety

A

Screening tests for common chronic diseases

e.g. anemia CBC with diff, renal failure, DM, hypothyroidism, chronic liver disease, chronic infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Basic metabolic panel includes (8)

A
  1. Glucose
  2. Calcium

Electrolytes

  1. Sodium
  2. Potassium
  3. Chloride
  4. CO2 (Bicarb)

Kidney Tests

  1. Blood urea nitrogen
  2. Creatinine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Complete metabolic panel includes (14)

A

BMP (8) + Additional Test markers (6) = CMP

Liver Tests
1. AST (Function)
2. ALT (Function)
3. Albumin (Synthetic)
4* Alkaline Phosphatase
  1. Total protein
  2. Total bilirubin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

40 yo man c/o dizziness and hearing loss

Dx

HPI

PMHx

PE findings

W/u

Meniere dz

A

Dx Meniere dz

HPI 
Episodic spells of vertigo
Fluctuating unilateral hearing loss
Aura & ear fullness
Nausea & vomiting
Tinnitus

PMHx
Hyperlipidemia/MI/DM
FHx hearing problems

PE findings
Sensorineural hearing loss
Normal hearing between attacks

Rinne Test- AC > BC on affected ear
Weber Test- Lateralize to unaffected ear

Gait Problem

W/u
Audiometry Vestibular testing
Electrocochleography
VDRL/RPR/FTA-ab
Brain MRI
Dix-Hallpike maneuver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

40 yo man c/o dizziness and hearing loss

Dx

HPI

PMHx

PE findings

W/u

Otitis Media

A

Dx Otitis Media

HPI 
Otalgia
Pain behind ear
Otorrhea
Decreased hearing m/c unilateral

PMHx
Preceding URI
h/o seasonal allergic rhinitis
recurrent otitis media

PE findings
Conductive hearing loss 
Rinne- BC > AC Affected ear 
Webber- Lateralize to affected ear
Erythematous or opacified TM
Bulging or perforated TM
Fever of facial palsy

W/u

CBC w/ diff
Otomicroscopy
Fiberoptic nasopharyngoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

40 yo man c/o dizziness, nausea, and vomiting

Dx

HPI

PMHx

PE findings

W/u

Vestibular neuronitis

A

Dx Vestibular neuronitis

HPI
Vertigo
Nausea > with head movements
Lasts for days
Vomiting
Gait problems

PMHx
h/o hearing impairment
h/o vertigo
h/o URI

PE findings
Gait instability
Hearing impairment
Webber and Rinne

W/u
MRI/MRA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

35 yo man c/o dizziness

Dx

HPI

PMHx

PE findings

W/u

Labyrinthitis

A

Dx Labyrinthitis

HPI
Vertigo
Tinnitus
Nausea/vomiting

PMHx
Recent URI

PE findings
Examine ear with otoscope
Check for nystagmus

W/u
Audiometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Middle-aged c/o pink eye

Dx

HPI

PMHx

PE findings

W/u

Conjunctivitis

A

Dx Conjunctivitis

HPI
Redness and swelling of conjunctiva
Sensation of foreign body in eye
Skin itching and watery discharge from both eyes
Normal visual acuity 
No photophobia
PMHx
h/o seasonal or specific allergies
h/o URI
h/o STDs
h/o Sjogren Syndrome
h/o contact lenses
h/o swimming
PE findings
Purulent discharge from one or both eyes
Watery discharge from one or both eyes
Diffuse redness of conjunctiva
Normal vision and no other eye findings
Normal fundoscopic exam

W/u
Rapid test for Adenoviral conjunctivitis
PCR and culture of swabbed specimens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

25 yo man c/o facial pain

Dx

HPI

PMHx

PE findings

W/u

Sinusitis

A

Dx Sinusitis

HPI 
Thick, green nasal discharge
Cough worse at night
Dull, constant headache
Pain worse when head tilts forward

PMHx
h/o asthma

PE findings
Fever
Tenderness on palpation of sinuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

67 yo man c/o difficulty swallowing

Dx

HPI

PMHx

PE findings

W/u

Esophagitis (Medication induced)

A

Dx Esophagitis (Medication induced)

HPI
Retrosternal pain or heartburn
h/o dysphagia
h/o odynophagia
h/o hematemesis
PMHx
h/o GERD
h/o H. Pylori
Obesity
Pregnancy or exogenous estrogen
h/o NSAIDs, antibiotics, bisphophonates

W/u
UGI endoscopy
Barium esophagram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

67 yo man with difficulty swallowing

Dx

HPI

PMHx

PE findings

W/u

Esophageal cancer

A

Dx Esophageal cancer

HPI
dysphagia: solids > liquids
sensation of food stuck in throat
Weight loss

PMHx
h/o smoking and alcoholism
h/o GERD
obesity

PE findings
Lymphadenopathy (LAD)

W/u
Barium esophagram
UGI endoscopy and biopsy
CT of chest and upper abdomen
PET scan for metastasis
CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

57 yo woman c/o difficulty swallowing

Dx

HPI

PMHx

PE findings

W/u

Plummer-Vinson syndrome

A

Dx Plummer Vinson syndrome

HPI
Glossitis
Angular Chelitis
Odynophagia

PMHx
h/o Iron deficiency anemia
Post-menopausal
Vegan diet

PE findings
Cheilosis
Pallor

W/u
CBC
Upper endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

18 yo woman c/o sore throat

Dx

HPI

PMHx

PE findings

W/u

Pharyngitis

A

Dx Pharyngitis

HPI
Rhinorrhea
Cough
Headache
Hoarse voice

PMHx
Recent viral infection

PE findings
Fever

W/u
Throat swab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

17 yo girl c/o sore throat

Dx

HPI

PMHx

PE findings

W/u

Infectious mononucleosis

A

Dx Infectious mononucleosis

HPI
Sore throat
Fatigue
Odynophagia

PMHx
LAD
sick contacts

PE findings
Fever
Pharyngitis
HSM
LAD

W/u
CBC w/ diff
ESR
Monospot test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

35 yo woman c/o palpitations

Dx

HPI

PMHx

PE findings

W/u

Hyperthyroidism

A

Dx Hyperthyroidism

HPI
Heat intolerance
Unintentional weight loss
Irritability
Brittle Hair
Diarrhea

PMHx
FHx thyroid disease

PE findings
Hand tremor
Tachycardia
Hyperventilation
Increased DTR

W/u
TSH, T3, Free T4
Radioactive iodine Uptake Test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Middle-aged man c/o severe chest pain and SOB

Dx

HPI

PMHx

PE findings

W/u

Pulmonary embolism

A

Dx Pulmonary Embolism

HPI
Sudden dyspnea
Orthopnea
Dyspnea at rest
Cough
Hemoptysis
Sudden pleuritic pain
Calf or thigh pain or swelling

PMHx
h/o smoking
h/o of immoblization or recent long flight
Occupation with prolonged sitting

PE findings
HTN/HypoTN
Tachypnea
Tachycardia
Wheezing
Calf or thigh swelling
W/u
CXR
EKG
ABG
Spiral CT
V/Q scan
D-dimer (only when it's a low probability)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Middle-aged man c/o acute SOB and agitation

Dx

HPI

PMHx

PE findings

W/u

COPD Exacerbation

A

Dx COPD Exacerbation

HPI
Acute exacerbation of dyspnea
Chronic h/o dyspnea
Chronic h/o productive cough

PMHx
h/o lung disease
h/o smoking

PE findings
Tachypnea
Decreased chest excursion
Decreased breath sounds
Barrel Chest
Hyperresonance
W/u
CXR
Pulse oximetry
ABG
PFTs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Middle-aged man c/o acute SOB and agitation

Dx

HPI

PMHx

PE findings

W/u

Spontaneous Pneumothorax

A

Dx Spontaneous Pnuemothorax

HPI
Suddent SOB
Pleuritic Chest pain

PMHx
Previous episode of spontaneous pneumothorax

PE findings
Tall thin man
Tachypnea
Decreased breath sounds
Decreased chest excursion on affected side
Hyperresonance

W/u
AP and lateral CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

67 yo woman c/o significant SOB

A

Middle-aged man c/o acute SOB and agitation

Dx Cor pulmonale

HPI
Chronic SOB
SOB on exertion
Exertional syncope
Exertional angina
B/l swelling of LE in past several weeks

PMHx
Long standing h/o lung disease
h/o smoking

PE findings
S3/S4
Split S2

W/u
CXR 
ECG
Pulse oximetry
ABG PFTs
Echo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Elderly man c/o worsening dyspnea on exertion

Dx

HPI

PMHx

PE findings

W/u

COPD

A

Dx COPD

HPI
Chronic h/o SOB
Chronic h/o productive cough
Morning white sputum

PMHx
Long standing h/o smoking
Chronic h/o lung disease

PE findings
Tachypnea
Prolonged expirations
Distant breath sounds
Barrel chest
W/u
CXR
ABG
Pulse oximetry
PFTs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Elderly man c/o worsening dyspnea on exertion and productive cough

Dx

HPI

PMHx

PE findings

W/u

TB

A

Dx TB

HPI
Chronic h/o SOB
Chronic h/o of productive purulent cough
h/o hemoptysis
night sweats
weight loss 
fatigue
PMHx
HIV
Immunocompromised
Foreign born/travel
h/o smoking
Exposure to TB (Health care worker)

PE findings
Fever
Tachypnea
Cachexia

W/u
CXR 
PFTs
ABG
Pulse oximetry
TB sputum gram stain and culture
Quantiferon test
CBC w/ diff
Blood culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Elderly man c/o worsening dyspena on exertion and productive cough

Dx

HPI

PMHx

PE findings

W/u

Chronic Asthma

A

Dx Asthma

HPI
h/o SOB early in life
Worse at night/early morning

PMHx
Hx of allergies
Hx of smoking
Exposure to second hand smoke

PE findings
Tachypnea
Prolonged expirations
Diffuse wheezing
Increased vocal fremitus
Intercostal retractions

W/u
CXR
PFTs
ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Elderly man c/o worsening dyspnea on exertion and productive cough

Dx

HPI

PMHx

PE findings

W/u

Bronchogenic carcinoma (Central airway obstruction)

A

Dx Bronchogenic carcinoma (Central airway obstruction)

HPI
Cough w/ purulent sputum
Slowly progressive dyspnea
Purulent sputum
Unintended weight loss
Hemoptysis

PMHx
h/o smoking

PE findings
Tachypnea
Prolonged expirations
Wheezing

W/u
CXR
PFTs
Bronchoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

65 yo man c/o cough

Dx

HPI

PMHx

PE findings

W/u

Lung cancer

A

Dx Lung cancer

HPI
Hemoptysis
Dyspnea
Unintended weight loss
Fatigue
Productive cough

PMHx
h/o smoking
FHx of cancer

PE findings
Wheezing on lung exam

W/u
CXR
Sputum gram stain and culture
Chest CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

60 yo man c/o chest pain and cough

Dx

HPI

PMHx

PE findings

W/u

Pneumonia

A

Dx Pneumonia

HPI
Chest pain
Cough
SOB
Purulent Sputum

PMHx
Recent viral prodrome

PE findings
Febrile 
Mild respiratory distress
Tachypnea
Crackles
Areas of lung consolidation
W/u
CXR
Blood cultures
Sputum gram stain & culture
CBC w/ diff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Tactile Fremitus

A

Increased vibration to palpation with 99

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Bronchophony

If positive…?

A

Increased clarity of 99 with Auscultation (+ loud and clear) (- soft and muffled)

If positive

Perform whispered pectoriloquy
Whisper 123 and auscultate (+ if clear) (-if faint and muffled)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Egophony

A

Say “EEE”

- soft muffled eeee
(+ “aaa” heard)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

66 yo man c/o chest pain and cough

Dx

HPI

PMHx

PE findings

W/u

Pleural effussion

A

Dx Pleural Effusion

HPI
Pleuritic chest pain worse with deep inspiration or motion
Cough
SOB

PMHx
Recent viral prodrome

PE findings
Febrile
Mild respiratory distress
Dullness 
Egophony
W/u
CXR
Chest U/S
Pleurocentesis
Pleural fluid cell count/cytology, histology/culture
LDH/pH
Sputum culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Viral prodrome

A 
Fever
cough
chills
malaise
myalgias
fatigue
SOB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

53 yo man c/o recurrent chest pain, dyspnea, anxiety

Dx

HPI

PMHx

PE findings

W/u

Myocardial infarction

A

Dx MI

HPI
Diaphorsis
Crushing retrosternal pain > 20 min
Chest, neck, mandible, down left arm
FHx of heart dz
SOB

PMHx
smoker
h/o of angina or MI

PE findings
Pale and diaphoretic
Tachycardia
Hemodynamic instability

W/u
ECG
CXR
Cardiac troponins
CK-MB
Echo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

53 yo man c/o recurrent chest pain, dyspnea, and anxiety

Dx

HPI

PMHx

PE findings

W/u

Angina pectoris/stable angina

A

Dx Angina pectoris/stable angina

HPI
Pain <20 min
Gradual onset
Discomfort 
center or left of chest
Worse with exertion
Better with rest
No change with respiration of position

PMHx
h/o high cholesterol
h/o HTN

PE findings
Levine sign (clenched fist on chest)
High BP
S3 or S4

W/u
ECG
Troponins
Stress Test

Angina pectoris/stable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Middle age man c/o severe chest pain

Dx

HPI

PMHx

PE findings

W/u

Aortic dissection

A

Dx Aortic dissection

HPI
Tearing chest pain
Back pain
Acute onset

PMHx
h/o HTN
h/o Cocaine use
Congenital factors- Marfan, Turner, Noonan Syndrome

PE findings
HTN
UE BP Assymetry
UE Pulselessness
Hemodynamic instability
W/u
CXR
TEE
CT scan
Urine toxicology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Middle aged man c/o severe chest pain

Dx

HPI

PMHx

PE findings

W/u

Cocaine-induced ACS

A

Dx Cocaine-induced ACS

HPI
Chest pain
Agitation

PMHx
Cocaine myocarditis
Vasculitis

PE findings
HTN
Arrhythmia
Nasal Septum perforation

W/u
EKG
Troponins I/T
CK-MB
Urine toxicology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

67 yo woman c/o significant dyspnea

Dx

HPI

PMHx

PE findings

W/u

CHF/Pulmonary edema

A

Dx CHF/Pulmonary edema

HPI
SOB
paroxysmal nocturnal dyspnea
orthopnea
Pink Frothy sputum cough
Noncompliant w/ medication
LE pitting edema x several weeks

PMHx
HTN
MI

PE findings
JVD
LE Edema
Rales
S3 gallop
W/u
ECG
Echo
BNP
Troponins
CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

67 yo woman c/o significant dyspnea

Dx

HPI

PMHx

PE findings

W/u

Myocarditis

A

Dx Myocarditis

HPI
Chest pain
Fatigue
LE edema x several weeks

PMHx
h/o URI

PE findings
Tachypnea
Gallop
Peripheral edema

W/u
CBC w/ diff
ESR/CPR
ECG
CXR Echo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

67 yo woman c/o significant dyspnea

Dx

HPI

PMHx

PE findings

W/u

Atrial Fibrillation

A

Dx Atrial Fibrillation

HPI
Palpitations
Light headed
Anxiety

PMHx
Cardiomyopathy
HTN

PE findings
Pallor
Diaphoresis
Irregular heart rate
Dyspnea

W/u
ECG
Holter monitor
Event recorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

60 yo man c/o chest pain and cough

Dx

HPI

PMHx

PE findings

W/u

Pericarditis

A

Dx Pericarditis

HPI
Sharp pleuritic chest pain
Better when leaning forward
Persistent fever

PMHx
Recent viral prodrome

PE findings
Febrile 
Mild respiratory distress
Pericardial friction rub
Rash on skin
W/u
ECG
ECHO
CXR 
Blood cultures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Middle aged man c/o palpitation and chest pain

Dx

HPI

PMHx

PE findings

W/u

Mitral valve prolapse

A

Dx mitral valve prolapse

HPI
chest pain
palpitation
dyspnea
chest pressure
exertion intolerance
Dizziness
Anxiety d/o

PMHx
HTN
Arrhythmia
Pulmonary edema

PE findings
Systolic murmur and non-ejection click
Narrow AP chest diameter
Scoliosis and loss of kyphosis of spine

W/u
ECG/CK-MB
Troponin I/T
TTE
ECHO
CV magenetic resonance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Middle age man c/o dizziness

Dx

HPI

PMHx

PE findings

W/u

Drug induced orthostatic hypotension

A

Dx Drug induced orthostatic hypotension

HPI
Dizziness
Syncope
Sx onset after standing or eating

PMHx
angina, stroke
supine HTN
HTN medications

PE findings
Pallor
Diaphoresis
Hypotension
Tachycardia

W/u
Monitor orthostatic/supine/and sitting BP
Tilt Table

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

69 yo man c/o lightheadedness

Dx

HPI

PMHx

PE findings

W/u

Orthostatic hypotension from dehydration

A

Dx Orthostatic hypotension from dehydration

HPI
Fatigue 
Palpitations
Profuse seating
Nausea

PMHx
Diarrhea
Excessive exercise
decreased fluid intake

PE findings
Orthostatic hypotension
pale

W/u
BUN and Creatinine
CBC
Electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

patient c/o palpitation and anxiety

Dx

HPI

PMHx

PE findings

W/u

Insulinoma

A

Dx Insulinoma

HPI
Severe episodes of fasting or postprandial hypoglycemia
Palpitations, diaphoresis, tremulousness
Weight gain
Confusion
Visual changes
Unusual behavior

PMHx
FHx of MEN 1

PE findings
Peripheral tremor

W/u
Blood glucose
Plasma GLP-1 level and insulin
Abd CT/MRI/US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Patient c/o palpitations and anxiety

Dx

HPI

PMHx

PE findings

W/u

Hypoglycemia

A

Dx Hypoglycemia

HPI
Tremor
palpitations
anxiety
seating
hunger
paraesthesia
PMHx
similar episodes during fasts
Insulin or other DM Tx
alcohol use
hormone deficiency (cortisol, glucagon, epinephrine)
insulinoma

PE findings
peripheral tremor

W/u
Blood glucose level 
Insulin level
C-peptide level
Beta-hydroxyurate level
Secretatogue screen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

38 yo c/o vaginal discharge

Dx

HPI

PMHx

PE findings

W/u

Bacterial vaginosis

A

Dx Bacterial vaginosis

HPI
grayish-white watery discharge
malodorous
Post-menstrual onset

PMHx
IUD
Douching
Recent antibiotics
menopause
multiple sex partners
unprotected sex
W/u
pelvic exam
Wet prep
Vaginal pH
Whiff test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

38 yo woman c/o vaginal discharge

Dx

HPI

PMHx

PE findings

W/u

Trichomonal vaginitis

A

Dx Trichomonal vaginitis

HPI
Copious green/yellow frothy discharge
Malordorous
Pruritic
Dysparenuia
Dysuria
Post-coital bleeding

PMHx
Unprotected sex
Multiple partners
IUD/smoking

W/u
Pelvic exam
Wet prep
Vaginal pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

38 yo woman c/o vaginal discharge

Dx

HPI

PMHx

PE findings

W/u

Candida vaginitis

A

Dx Candida vaginitis

HPI
White, thick, cheesy, discharge
Odorless
Pruritic
Dyspareunia
Dysuria
PMHx
Previous episodes of Abx
DM
Pregnant
HIV
OCP

W/u
Pelvic exam
KOH prep
Vaginal pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

48 yo woman c/o vaginal discharge

Dx

HPI

PMHx

PE findings

W/u

Atrophic vaginitis

A

Dx Atrophic vaginitis

HPI
Vaginal dryness
dysuria/urgency/frequency
hot flashes
post-coital bleeding
PMHx
sleep disturbance
osteoporosis
pelvic organ prolapse
tamoxifen/lupron
menopause
W/u
pelvic exam
FSH
Estradiol
Vaginal smear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

38 yo woman c/o heavy vaginal bleeding

Dx

HPI

PMHx

PE findings

W/u

abnormal uterine bleeding

A

Dx Abnormal uterine bleeding

HPI
AUB > 6months (frequency/regularity/duration/volume)
brown-stain bleeding color
dysmenorrhea
reproductive age
not pregnant
fatigue
PMHx
AUB > 6months
thyroid disease
not on local or systemic gonadosteroids
not on any medication
OCP
Systemic disorders of hemostasis
Ovulatory disorders
primary disorders of endometrium

PE findings
Tachycardia
Pallor

W/u
Pelvic exam
CBC
Extraction of HB (alkaline hematin method)
Pictorial blood loss assessment chart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

38 yo woman c/o heavy vaginal bleeding

Dx

HPI

PMHx

PE findings

W/u

Endometriosis

A

Dx Endometriosis

HPI
Abn bleeing pelvic pain
infertility
urinary urgency/frequency
dypareunia
dysmenorrhea
dyschezia

PMHx
FHx endometriosis
FHx infertility

W/u
Pelvic exam
Abd U/S
Transvaginal U/S
Abd CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

38 yo woman c/o heavy vaginal bleeding

Dx

HPI

PMHx

PE findings

W/u

Spontaneous abortion

A

Dx Spontaneous abortion

HPI
Confirmed pregnancy
Suddent onset of vaginal bleeding
Abd pain and contractions
NSAID use
PMHx
Advanced maternal age
smoking cacaine
Previous abortion
prolonged time to conceive
maternal infection

PE findings
fever

W/u
pelvic exam
abd U/S
Beta hCG
Folate level
RhD level
CBC w diff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

45 yo woman c/o abnormal vaginal bleeding

Dx

HPI

PMHx

PE findings

W/u

Cervical cancer

A

Dx Cervical Cancer

HPI
Pelvic pain
Dyspareunia
Bleeding after sex
weight loss 
anorexia
PMHx
HPV infection
smoker
multiple partners 
occ condom use
OC{ use over 10 years

W/u
Pelvic exam
Pap smear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

18 yo woman c/o irregular menses

Dx

HPI

PMHx

PE findings

W/u

Stress induced amenorrhea

A

Dx Stressed induced amenorrhea

HPI
no menses for 3 months
Started college 3 months ago

PMHx
mother also with stress

W/u
bhCG
Testosterone and estrogen levels
Abd U/S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

30 yo woman c/o amenorrhea

Dx

HPI

PMHx

PE findings

W/u

Prolactinoma

A

Dx Prolactinoma

HPI
Galactorrhea
Oligo/Amenorrhea
Loss of axillary and pubic hair
Headache

PE findings
Loss of peripheral vision

W/u
Prolactin level
Brain MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

48 yo woman c/o amenorrhea for few hours

Dx

HPI

PMHx

PE findings

W/u

Menopause

A

Dx Menopause

HPI
Amenorrhea for 12 mos
Hot flashes
Vaginal dryness
Sleep disturbances
Mood imbalance
New onset depression
Decline in cognitive function
Dyspareunia
joint pain
Breast pain/tenderness

PMHx
irregular cycles > 4 years before final prd >12mo ago
Progressive course of decreased of very heavy bleeding
FHx of early menopause
hysterectomy with ovarian conservation
menstrual migraine

PE findings
increased age and wrinkling of skin

W/u
Pelvic exam 
inhibin B
FSH and LH
Estradiol level
AMH level
AFC (ovarian antral follicular count)
Transvaginal and pelvic U/S
TSH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Middle aged woman c/o amenorrhea for few weeks

Dx

HPI

PMHx

PE findings

W/u

Pregnancy

A

Dx Pregnancy

HPI
amenorrhea, N w/wo V, breast enlargement/tenderness, increased frequency w/o dysuria, fatigue, mild uterine cramping/discomfort without bleeding

constipation, heart burn, nasal congestion, sexually active, reproductive age, physiologic pruritus, hirsutism, androgenic alopecia, increased salivation, food craving or aversion, mood changes

PMHx
new onset GERD
Hx of previous pregnancy

PE findings
increased pigmentation (face, linea alba, areola), nevi, melasma, striae gravidarum

Vascular- spider angiomata, palmar erythema, varicositis, vascular tumors, hemorrhoids

Enlarged uterus on abd palpation
gigivitis

W/u
urine and blood bhCG
serum ALT/AST, bilirubin
Abd, pelvic, transvaginal U/S

Pelvic exam
Fetal HR with Doppler
CBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

26 yo woman c/o difficulty getting pregnant

Dx

HPI

PMHx

PE findings

W/u

Polycystic ovary syndrome

A

Dx Polycystic ovary syndrome

HPI
Dysmenorrhea
Unintentional weight loss
Hirsutism

PMHx
Pelvic pain
DM II
OSA
Ovarian cysts
Similar Sx with female family members
G0P0
excessive acne
PE findings
facial acne
patches of thin, darker, velvety skin
Obese abdomen
Hirsutism
W/u
Pelvic exam
serum hCG
pelvic U/S
Androgen levels
Serum insulin
Homocysteine level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

30 yo c/o dysuria

Dx

HPI

PMHx

PE findings

W/u

Urethritis

A

Dx Urethritis

HPI
Urinary urgency, frequency, starting
itching pain, burning, and discomfort in urination and genitalia
dysmenorrhea
vaginal d/c

PMHx
active with multiple partners
occ condom use
PID

W/u
pelvic exam
U/A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

55 yo woman c/o urinary incontinence

Dx

HPI

PMHx

PE findings

W/u

urge incontinence

A

Dx urge incontinence

HPI
Sudden uncontrolled urine loss associate with strong desire to void

PMHx
UTI
DM
BPH (man)
C-section, prostate surgeries
Pregnancy/delivery

PE findings
No abd tenderness
No CVA tenderness

W/u
Genital and pelvic exam
U/A
cystometry
Post void residual volume
Pelvic of abd U/S
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

55 yo woman c/o urinary incontinence

Dx

HPI

PMHx

PE findings

W/u

Stress Incontinence

A

Dx stress incontinence

HPI
involuntary urine loss while coughing, laughing, lifting, sneezing

PMHx
constipation, urinary incontinence
multiple gestations
smoking
prostatectomy

PE findings
No abd tenderness
No CVA tenderness

W/u
genital and pelvic exams
U/A
Cystometry
Post-void residual volume
Pelvic or abd U/S
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

70 yo man c/o nocturia

Dx

HPI

PMHx

PE findings

W/u

Benign prostatic hyperplasia

A

Dx Benign prostatic hyperplasia

HPI
urgency, hesitancy, frequency, incontinence, weak urine stream, straining to void, sense of incomplete emptying, terminal dribbling

PMHx
family hx

PE findings
abd exam WNL

W/u
Prostate exam
PSA
Transrectal U/S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

70 yo man c/o hematuria

Dx

HPI

PMHx

PE findings

W/u

Prostate Cancer

A

Dx Prostate cancer

HPI
back pain, fatigue, weight loss, urinary frequency and urgency, difficulty starting and maintaining stream of urine, nocturia, dysuria

PMHx
diet high in processed meat
father with prostate cancer

PE findings
obese
abd exam WNL

W/u
Prostate exam
PSA
Transrectal U/A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

60 yo man c/o hematuria

Dx

HPI

PMHx

PE findings

W/u

Bladder cancer

A

Dx Bladder cancer

HPI
dysuria, increased frequency, urgency

PMHx
smoker (many years)
hair dresser

PE findings
WNL abd exam

W/u
U/A
urine cytology
cystoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

60 yo man c/o hematuria

Dx

HPI

PMHx

PE findings

W/u

renal cell carcinoma

A

Dx renal cell carcinoma

HPI
flank pain
unintentional weight loss
fatigue

PMHx
smoker, FHx of kidney cancer, x.s. acetaminophen use
occupational exposure- asbestos
HTN

PE findings
Obesity
Abd mass

W/u
U/A
Abd CT

70
Q

37 yo man c/o groin pain

Dx

HPI

PMHx

PE findings

W/u

Testicular torsion

A

Dx Testicular torsion

HPI
young man
sudden onset 
unilateral
radiates to lower back
N/V

PMHx
onset during physical exertion

PE findings
fever
CVA tenderness

W/u
genital exam
Doppler U/S of scrotum

71
Q

37 yo Man/Woman c/0 increasing flank pain

Dx

HPI

PMHx

PE findings

W/u

nephrolithiasis

A

Dx nephrolithiasis

HPI
sudden back/flank pain
restlessnes (colicky pain)
radiation to groin or abdomen
N/V
Anorexia
Dysuria
PMHx
kidney stone
dehydration
high protein and sodium diet
overweight

PE findings
fever
CVA tenderness

W/u
Helical renal CT
U/A for Ca2+, oxalate, uric acid
renal U/S

72
Q

37 yo Man/Woman c/o flank pain and fever

Dx

HPI

PMHx

PE findings

W/u

Pyelonephritis

A

Dx Pyelonephritis

HPI
dysuria, FEVER, N/V, polyuria, urgency, hematuria, chills

PMHx
recurrent UTO
BPH (man)

PE findings
Fever
CVA Tenderness

W/u
U/A
urine culture
renal U/S

73
Q

45 yo womanc/o right sided abdominal pain

Dx

HPI

PMHx

PE findings

W/u

Acute cholecystitis (biliary colic)

A

Dx acute cholecystitis (biliary colic)

HPI
acute, persistent RUQ pain
Pain related to fatty foods
Radiation to RIGHT scapula
N/V
Fever
PMHx
OCP use
Fat
DM
FHx gb dz
multiparity
PE findings
uncomfortable
overweight
fever
RUQ tenderness
Murphy sign
Tachycardic
W/u
CBC w/ diff
Abd U/S
AST/ALT/ALP, bilirubin
ERCP
HIDA
74
Q

41 yo woman c/o acute painful abdominal distress

Dx

HPI

PMHx

PE findings

W/u

Pancreatitis

A

Dx Pancreatitis

HPI
persistent epigastric pain
radiates to back
alleviated by sitting up or bending forward
N/V

PMHx
binge alcohol
gallstones

PE findings
appears ill and uncomfortable
epigastric tenderness
rebound guarding
cullen/gray turner sign
febrile
tachycardia
W/u
serum lipase/ amylase
CRP/ALT/AST
Abd xray
Abd U/S
Abd CT
trypsinogen activation peptide
75
Q

53 yo man c/o recurrent chest pain, dyspnea, anxiety

Dx

HPI

PMHx

PE findings

W/u

GERD

A

Dx GERD

HPI
postprandial discomfort, worse supine, heartburn, regurgitation, dysphagia, chest pain, nausea

PMHx
obesity
smoking

PE findings
wheezing

W/u
EGD
Esophageal pH

76
Q

41 yo woman c/o acute painful abdominal distress

Dx

HPI

PMHx

PE findings

W/u

Peptic ulcer disease

A

Dx Peptic Ulcer Disease

HPI
epigastric pain and fullness
Persistent
N/V
Hematemesis
Melena

PMHx
NSAIDs
H. pylori

PE findings
uncomfortable, epigastric tenderness

W/u
EGD
FOBT

77
Q

46 yo woman c/o abdominal pain and nausea

Dx

HPI

PMHx

PE findings

W/u

Gastritis

A

Dx Gastritis

HPI
Epigastric pain
worse with food
better with ant-acids
N/V

PMHx
H. pylori
infections and AI dz

PE findings
epigastric tenderness

W/u
GUI endoscopy
H. pylori testing
Serum pepsinogen
Antibodies to IF, parietal cells, and H. pylori
78
Q

68 yo woman c/o chills, nausea, and abdominal pain

Dx

HPI

PMHx

PE findings

W/u

Gastroenteritis (Norovirus)

A

Dx Gastroenteritis

HPI
nonbloody diarrhea
V/N
crampy abd pain
onset in winter season
malaise

PMHx
sick contacts

PE findings
appears frail and uncomfortable
fever
diffuse abd tenderness
dehydration
W/u
blood culture
FOBT
fecal leukocyte 
fecal lactoferrin
79
Q

68 yo woman c/o chills, nausea, abdominal pain

Dx

HPI

PMHx

PE findings

W/u

Hepatitis A

A

Dx Hepatitis A

HPI
fatigue
malaise
anorexia
N/V
gradual onset

PMHx
sick contacts
travel to endemic areas

PE findings
low grade fever
RUQ pain
HSM
jaundice
LAD
W/u
AST/ALT
Bilirubin
AlkP/GGT LDH
Serum IgM/IgG
Anti-HAV
80
Q

68 yo woman c/o chills, nausea, abd pain

Dx

HPI

PMHx

PE findings

W/u

Acute cholangitis

A

Dx acute cholangitis

HPI
abd pain
jaundice
N/V

PMHx
choledocholithiasis

PE findings
uncomfortable 
FEVER
RUQ pain
jaundice
W/u
CBC w/ diff
CRP
ALT/AST/GGT
AlkP
Blood cultures
Transabd U/S
81
Q

70 yo man c/o abd pain

Dx

HPI

PMHx

PE findings

W/u

pancreatic cancer

A

Dx pancreatic cancer

HPI
upper abd pain
unintentional weight loss
light colored stool
dark urine
loss of apetite

PMHx
smoker
DM
heavy alcohol use

PE findings
jaundice
FHx cancer

W/u
Abdominal CT
CA 19-9
LFT

82
Q

Elderly man c/o increasing abdominal pain

Dx

HPI

PMHx

PE findings

W/u

Diverticulitis

A

Dx Diverticulitis

HPI
LLQ abd pain
several days duration
gradually increasing
diarrhea and constipation
PE findings
restless
LLQ tenderness
guarding
rebound

W/u
CT scan
Abd x-ray
CBC w/ diff

83
Q

65 yo c/o bloody stools

Dx

HPI

PMHx

PE findings

W/u

Diverticulosis

A

Dx Diverticulosis

HPI
painless rectal bleeding
constipation 
weak and fatigue
dizziness
PMHx
no fiber supplements
HTN
IBS
FHx diverticulosis
no FHx of colon cancer
W/u
rectal exam with FOBT
CBC w/diff
CT abdomen
Colonoscopy
84
Q

65 yo man c/o bloody stool

Dx

HPI

PMHx

PE findings

W/u

Colon cancer

A

Dx Colon cancer

HPI
painless rectal bleeding 
change in bowel habits
weak and fatigue
unintentional weight loss
PMHx
no screening colonoscopy
anemia
FHx colon cancer
smoking

PE findings
abdominal tenderness
abdominal mass

W/u
rectal exam with FOBT
CBC w/ diff
 CT abd
Colonoscopy
85
Q

65 yo man c/o bloody stool

Dx

HPI

PMHx

PE findings

W/u

Angiodysplasia

A

Dx Angiodysplasia

HPI
painless rectal bleeding 
stool black and tarry
fatigue
no weight loss
no hx of bruising

PMHx
anemia
no FHx of colon cancer

W/u
rectal exam w/ FOBT
CBC w/ diff
PT/PTT/INR
CT abdomen
Colonoscopy 
EGD
86
Q

70 yo man c/o acute abdominal pain

Dx

HPI

PMHx

PE findings

W/u

mesenteric ischemia

A

Dx mesenteric ischemia

HPI
acute abd pain
pain with meals
pain out of proportion to exam
weight loss
N/V
blood in stool

PMHx
arrhythmia, cardiac valvular disease, infective endocarditis, recent MI, ventricular aneurysm, aortic aneurysm, aortic athersclerosis
h/o metabolic acidosis

PE findings
diffuse abd pain on palpation
abd guarding
Rovsing sign/rebound

W/u
abd xray
CBC
ABG
Lactate 
Abd CT angiography
87
Q

Man c/o abdominal pain

Dx

HPI

PMHx

PE findings

W/u

large bowl obstruction

A

Dx large bowel obstruction

HPI
severe cramping and pain
diffuse and poorly localized
abdominal distention 
constipation
vomiting
unable to pass flatulus

PMHx
prior abdominal surgery

PE findings
restless, fever, abd distention, bowel sounds, normal or quiet, hyperresonance on abd percussion, tenderness on palpation

W/u
CBC w/ diff
Electrolytes/anion gap
Barium enema
Abd xray
colonoscopy
abd CT
88
Q

20 yo man c/o abdominal pain and diarrhea

Dx

HPI

PMHx

PE findings

W/u

Lactose intolerance

A

Dx lactose intolerance

HPI
bloating, diarrhea, nausea, flatulence, borborygmi,
Sx start 2 hrs after ingestion of lactose, abdominal cramps

PMHx
stomach problems

W/u
hydrogen breath test
stool acidity test
fecal lactoferrin levels
calprotectin levels
89
Q

20 yo man c/o abdominal pain and diarrhea

Dx

HPI

PMHx

PE findings

W/u

Traveler’s diarrhea

A

Dx Traveler’s Diarrhea

HPI
abd cramps
nausea
bloating
malaise
anorexia

PMHx
recent trip overseas
use of antacids for heartburn

PE findings
fever

W/u
FOB
Stool culture
Stool ova for parasites

90
Q

46 yo man c/o abdominal pain and diarrhea

Dx

HPI

PMHx

PE

W/u

Chron disease

A

Dx Chron disease

HPI
Prolonged diarrhea w/or w/o gross bleeding
Crampy abdominal pain
Steatorrhea
Aphthous ulcers or pain in mouth or gums
Odynophagia
Dysphagia
Weight loss
Fatigue fever
PMHx
Fhx IBD
PMHx eye problems (uveitis, irits, episcleritis), joint problems (sacroiliitis or ankylosing spondylitis), erythema nodosum and pyoderma gangrenosum
Recurrent UTI
Primary sclerosing cholangitis
Pulmonary manifestations

PE
Febrile
Abd tender to palpation
Abd mass

W/u
Abd x-ray
Rectal exam w/ FOBT
CBC
ESR and CRP
PANCA and ASCA 
Electrolytes
Colonoscopy
Capsule endoscopy
UGI Series
MRE
91
Q

36 yo woman c/o abdominal pain

Dx

HPI

PMHx

PE

W/u

IBS

A

Dx IBS

HPI
Diarrhea w/ alternating constipation
Abd cramps better with defecation
Diffuse abdominal pain

PMHx
Anxiety
Excessive stress
FHx
Child abuse

PE
Generalized abd tenderness

92
Q

46 yo man c/o abdominal pain and diarrhea

Dx

HPI

PMHx

PE

W/u

Psuedomembranous colitis

A

Dx Psuedomembranous colitis

HPI
Watery diarrhea
Abd pain and cramps
No blood in stool

PMHx
Allergies
Abx therapy
Hospitalization

PE
Diffuse abdominal tenderness to palpation

W/u
CBC w/ diff
Stool assay for C. difficile
Rectal exam and FOBT
Stool for ova and parasites
93
Q

30 yo woman c/o sudden onset abdominal pain

Dx

HPI

PMHx

PE

W/u

Appendicitis

A

Dx Appendicitis

HPI
Periumbilical/sharo
Progressive to RLQ
Anorexia/fever
N/V
Diarrhea
Malaise
Indigestion/flatulence

PMHx
IBD

PE
Fever
Psoas/obturator sign
Rovsing sign
McBurney point tenderness

W/u
CBC w/ diff
Abd U/S; if negative or inconclusive then abd CT

94
Q

40 yo woman c/o abdominal pain

Dx

HPI

PMHx

PE

W/u

Polycystic kidney disease

A

Dx Polycystic kidney disease

HPI
Headache
Hematuria
Polyuria

PMHx
FHx of kidney disease
HTN
UTI

PE
HTN

W/u
Abd U/S
Abd CT
Bun and Creatinine

95
Q

33 yo woman c/o sudden onset severe abdominal pain

Dx

HPI

PMHx

PE

W/u

Ectopic pregnancy

A

Dx Ectopic pregnancy

HPI
Sudden LLQ/RLQ pain
Severe, progressive
Unilateral 
Amenorrhea
Vaginal bleeding/spotting
N/V
Breast fullness
Weakness
PMHx
Previous ectopic
Fallopian tube pathology and surgery
Abdominal surgery
In-utero DES exposure
PID/ infertility
Uterine anomalies
Smoker
Progesterone contraception/IUD

PE
Tenderness
Gaurding

W/u
Pelvic exam
Serum quantitative bhCG
Transvaginal U/S

96
Q

33 yo woman c/o sudden onset severe abdominal pain

Dx

HPI

PMHx

PE

W/u

PID

A

Dx PID

HPI
Lower abd pain
Gradual or sudden
Dull and achy b/l
Progressive
Fever
Purulent vaginal discharge
N/V
Anorexia/malaise
Onset following menses
PMHx
Multiple partners
Unprotected sex
Bacterial vaginosis
Recent gyn procedure
HIV
PE
Abd- Tenderness, Guarding
W/u
Pelvic exam
NAAT/cultures for chlamydia and gonorrhea
Vaginal secretions
KOH
Transvaginal U/S
97
Q

30 yo c/o sudden onset severe abdominal pain

Dx

HPI

PMHx

PE

W/u

Ovarian torsion

A

Dx Ovarian torsion

HPI
Sharp, intermittent, unilateral, worsening lower abd pain
Precipitated by exercise
Radiates to flank, back, and/or groin
Fever
N/V

PMHx
Previously resolved episodes
Pelvic surgery
Ovulation induction

W/u
Pelvic exam
Pelvic U/S Doppler

98
Q

30 yo woman c/o sudden onset abdominal pain

Dx

HPI

PMHx

PE

W/u

ovarian cyst rupture

A

Dx ovarian cyst rupture

HPI
Unilateral onset
Diffuse
Exercise precipitated
Vaginal bleeding
N/V
Shoulder pain

PMHx
LMP 2 wks ago (midcycle)

PE
Cullen sign

W/u
Pelvic exam
Pelvic U/S Abd CT

99
Q

55 yo man c/o vomiting blood

Dx

HPI

PMHx

PE

W/u

Mallory-Weiss syndrome

A

Dx Mallory-Weiss syndrome

HPI
Bright red blood w/ gastric content after lots of alcohol
Lightheadedness
Epigastric abdominal pain

PMHx
Smoking
Heavy alcohol use

PE
Pallor
Diaphoretic
Alcohol breath

W/u
CBC w/ diff
EGD

100
Q

Middle-aged c/o difficulty swallowing

Dx

HPI

PMHx

PE

W/u

Achalasia

A

Dx Achalasia

HPI
Progressive dysphagia both liquid and solid
a/w regurgitation of undigested food
a/w retrosternal pain
a/w coughing when lying flat

PE
Thin
CV exam WNL

W/u
Esophageal manometry
Barium esophagram
Endoscopy

101
Q

Young man c/o headache

Dx

HPI

PMHx

PE

W/u

Meningitis

A

Dx Meningitis

HPI
Severe headache 
Photophobia
Nuchal rigidity
Fever

PMHx
Rash or recent URI
recent travel

PE
Brudzinski sign
Kernig sign
Nuchal rigidity

W/u
CBC w/ diff
serum glucose
electrolytes
blood cultures
CT head
lumbar puncture
102
Q

Middle-aged man c/o headache

Dx

HPI

PMHx

PE

W/u

Subarachnoid hemorrhage

A

Dx Subarachnoid hemorrhage

HPI 
Severe headache
sudden onset
photophobia
nuchal rigidity
LOC
confusion
vomiting

PMHx
recent h/o head injury

PE
nuchal rigidity
MMSE altered

W/u
Head CT

103
Q

Young woman c/o headache

Dx

HPI

PMHx

PE

W/u

Migraine

A

Dx Migraine

HPI 
Unilateral headache
pulsating 
photophobia
visual disturbances
associated with food, menses
nausea precipitated by stress, hunger, fatigue

PMHx
OCP use
FHx of similar headaches

W/u
—-

104
Q

45 yo woman c/o headache

Dx

HPI

PMHx

PE

W/u

Tension headache

A

Dx Tension Headache

HPI 
pain in lower back of head on both sides
radiates to neck 
constant pressure
mild to moderate pain

PMHx
increased stress
sleep deprivation
recent eye strain

PE
tense neck and shoulder muscles

105
Q

45 yo man c/o headache

Dx

HPI

PMHx

PE

W/u

Cluster headache

A

Dx Cluster headache

HPI
unilateral orbital pain
recurrent w/ periods of spontaneous remission
severe
associated rhinorrhea and nasal congestion
No aura

PMHx
prior episodes of same headache

W/u
—

106
Q

65 yo man c/o forgetfulness

Dx

HPI

PMHx

PE

W/u

Alzheimer Disease

A

Dx Alzheimer Disease

HPI 
progressive memory loss
confusion
occupational functioning impairment
personality and mood changes
progressive deterioration
falls
urinary incontinence
fatigue and weakness

PMHx
Fhx of Alzheimer

PE
MMSE
FND
Gait disturbance

W/u
Brain MRI
Brain PET scan

107
Q

65 yo man c/o forgetfulness

Dx

HPI

PMHx

PE

W/u

Vascular dementia

A

Dx Vascular dementia

HPI
cognitive deficits and memory
social and occupational functioning impairment
personality and mood changes, abulia, apathy

step-like decline
falls
urinary incontinence
fatigue and weakness

PMHx
HTN
strokes or CVA/dz
high cholesterol

PE
MMSE 
FND
Gait disturbance
Hyperreflexia
Babinski
Pseudobulbar palsy (CN 5,7,9,10,11,12)

W/u
Brain CT and MRI

108
Q

65 yo man c/o forgetfulness

Dx

HPI

PMHx

PE

W/u

Prion Disease

A

Dx Prion Disease

HPI
rapid progression of psychiatric Sx
Depression, agitation, apathy, insomnia, irritability, social withdrawal, psychotic features (delusions and hallucinations)

PMHx
FHx of prion disease
FHx psychiatric

PE
abnormal sensation
gait ataxia
involuntary movements
immobility
paresis of upward gaze
cognitive impairment
startle response and mutism
W/u
EEG
LP
Examination of tonsillar tissue
Brain CT and MRI
109
Q

65 yo man c/o vertigo

Dx

HPI

PMHx

PE

W/u

Benign positional vertigo

A

Dx Benign positional vertigo

HPI
episodic (seconds) with loss of balance
N/V
Sudden onset with change in head position

PMHx
---
PE
---
W/u
Dix-Hallpike test
CBC w/diff
CT of head
Audiogram
110
Q

65 yo man with headache and confusion

Dx

HPI

PMHx

PE

W/u

Cerebrovascular accident

A

Dx Cerebrovascular accident

HPI
FND < 24 hrs
sudden

PMHx
HTN
DM
high cholesterol
A-fib not compliant with Warfarin
FHx of early CAD
smoking

PE
FND

W/u
Head CT
Brain MRI ECG
CBC w/diff
PT/PTT/INR
Electrolytes
Fasting blood lipids and glucose
111
Q

70 yo woman c/o severe headache and stiff neck

Dx

HPI

PMHx

PE

W/u

Subdural hematoma

A

Dx Subdural hematoma

HPI 
headache
confusion
somnolence
N/V
head trauma
falls with progressive FNDs
Seizures

PMHx
frequent fall
alcoholism
h/o anticoagulant medication

PE
FNDs
gait abnormalities
nuchal rigidity
Brudzinsky/Kernig
Babinski
Hemiplegia (R or L)
Bruises from falls
W/u
Head CT
Brain MRI
LP-CSF analysis
CBC w/diff
PT/PTT/INR
Urine toxicology
112
Q

70 yo woman c/o severe headache and facial pain

Dx

HPI

PMHx

PE

W/u

Trigeminal neuralgia

A

Dx Trigeminal neuralgia

HPI
Headache
Sharp facial pain electric, shock-like, or stabbing
repetitive episodes ( at least three)
lacrimation, conjunctival injection, and rhinorrhea
facial muscle spasm

PMHx
migraine
HTN
chronic facial pain
dull continuous pain in the jaw

PE
no FNDs except some sensory loss
precipitation of painful attack by tactile stimulation of facial trigger zone

W/u
Brain CT and MRI

113
Q

60 yo woman c/o severe headache

Dx

HPI

PMHx

PE

W/u

Temporal arteritis

A

Dx Temporal arteritis

HPI 
right or left temporal headache
tongue claudication
jaw claudication
blurred vision
acute tinnitus

PMHx
recurrently diagnosed with PRP

PE
Fever
Tenderness on scalp over temporal area
jaw claudication
decreased visual acuity
W/u
ESR
Biopsy of temporal artery
LFT
CRP
Platelet
114
Q

58 yo woman c/o sudden onset back pain

Dx

HPI

PMHx

PE

W/u

lumbar muscle strain

A

Dx Lumbar muscle strain

HPI 
lower back pain 
sudden after cleaning house
dull and achy b/l
no radiation
numbness tingling or weakness
PMHx
similar episode in apst
smoking
weight gain and sedentary life style
during heavy work and strenuous exercise
FMHx back pain

PE
paraspinal tenderness and spasm
no sensory deficits and motor impairments in LE

W/u
L-spine x-ray
L-spine MRI

115
Q

58 yo woman c/o progressive onset pain in the legs

Dx

HPI

PMHx

PE

W/u

lumbar spinal stenosis

A

Dx Lumbar spinal stenosis

HPI 
progressive onset
back pain and b/l leg pain
alleviate by sitting and bending forward
aggravated by walking and standing

PMHx
back pain
b/l pain in buttocks and posterior thighs
FM hx back pain

PE
antalgic gait
wide based gait
abnormal romberg
vibration deficits
No SLR

W/u
L-S spine x-ray
L-S spine CT
L-S spine MRI

116
Q

58 yo woman c/o progressive onset pain in the legs

Dx

HPI

PMHx

PE

W/u

Disc herniation

A

Dx Disc herniation

HPI
severe back pain radiation down to buttock, leg foot, and ankle
Associate numbness and paraesthesia
worse with cough, sneezing, and prolonged sitting
precipitated by heavy lifting
bowel and bladder Sx if b/l disc herniation

PMHx
back pain
occupation- labor job
sciatica

PE
loss of sensation in L5-S1 distribution
SLR ipsilateral 
Crossed straight leg test
Loss DTRs
Impaired ankle reflex
ankle dorsireflexion weakness
great toe extensor weakness
W/u
L-S spine x-ray
L-S spine CT 
L-S spine MRI
lower extremity
EMG
117
Q

35 yo woman c/o numbness and tingling in her legs

Dx

HPI

PMHx

PE

W/u

Multiple Sclerosis

A

Dx Multiple Sclerosis

HPI
relapsing remiting sensory weakness and visual disturbances
pain, light touch, and proprioceptive loss
b/l sensory loss in limb and face from certain level down
vertigo
fatigue
urinary incontinence
heat sensitivity
gait disturbance, incoordination, balance problems
headache
painful spasms

PMHx
epilepsy
anxiety, depression, cognitive impairment
anemia
sleep d/o and sleep apnea
thyroid d/o and infxns
mobility limitations
trigeminal neuralgia
back pain
restless leg syndrome
PE
weakness associated with spasticity, hyperreflexia, and clonus
Lhermitte phenomenon
monocular vision/visual field loss (scotoma) and difficulty discerning color
Marcus gunn pupils
internuclear ophthalmoplegia
horizontal nystagmus
spastic paraparesis
limb ataxia
W/u
brain MRI
spinal MRI
CS analysis for oligo-clonal bands
visual evoked potential
somatosensory evoked potential
118
Q

55 yo man c/o numbness in hands and feet

Dx

HPI

PMHx

PE

W/u

Diabetic peripheral neuropathy

A

Dx Diabetic peripheral neuropathy

HPI 
numbness and tingling in hands and feet for few mos
pain in legs >6 mo
constipation
Impotence
vision problems
PMHx
DM 
alcoholism
HTN
otitis media

PE
decreased soft vibratory and position sense
sores on feet

W/u
Glucose level
HbA1c
nerve conduction study
EMG
119
Q

66 yo man c/o forgetfulness

Dx

HPI

PMHx

PE

W/u

Parkinson disease

A

Dx Parkinson disease

HPI 
feeling slow in processing information and thinking for last few months
loss of dexterity (noted when dressing)
slight tremor
malaise
sleep disturbances
decreased sense of smell
bradykinesia
constipation

PMHx
occupation: e.g. farmer

PE
soft spoke, slow speech, hypomimia (masked facies)
resting tremor 
bradykinesia
rigidity
120
Q

30 yo woman c/o headache

Dx

HPI

PMHx

PE

W/u

Idiopathic intracranial hypertension

A

Dx Idiopathic intracranial hypertension

HPI 
throbbing headache
headache worse in morning and with coughing/sneezing
N/V
Pulsatile tinnitus
Double vision

PMHx
Isotretinoin for acne

PE
CNS examination
Fundoscopy
Obese

W/u
Brain CT
LP w/ CSF analysis

121
Q

35 yo woman c/o pain in left hand

Dx

HPI

PMHx

PE

W/u

Carpal tunnel syndrome

A

Dx Carpal tunnel syndrome

HPI
1- 3th phalange and wrist
Numbness and tingling
Pain radiated up forearm

PMHx
occupation involves repetitive movement
hypothyroidism
multiple pregnancies

PE
tenderness to palpation of 1st digits and wrist
decreased muscle strength of left hand
decreases sensation in first 3 digits 
Phalen or Tinel sign

W/u
Left hand x-ray
EMG
Nerve conduction study

122
Q

Middle-aged woman c/o joint pain

Dx

HPI

PMHx

PE

W/u

Rheumatoid arthritis

A

Dx Rhematoid Arthritis

HPI 
Morning stiffness < 1 hr
6 wks
improved w/ motion
swelling of hands
low-grade fever
fatigue for several mos

PMHx
FHx of RA

PE
rheumatoid nodules
decreased ROM on hands and fingers
tender joints with ROM

W/u
anti-CCP
ANA, RF
Hand/wrist x-ray

123
Q

Middle-aged woman c/o joint pain

Dx

HPI

PMHx

PE

W/u

SLE

A

Dx SLE

HPI 
photosensitivity
oral ulcers
alopecia
weight loss
swelling and redness of affected joints
fatigue

PMHx
FHx of immune disease

PE
Malar/discoid rash
low grade fever
petechiae
decreased ROM on affected joints
tender joints w/ ROM
W/u 
ANA 
anti-dsDNA Ab
Anti-smith Ab
Complement level
antiphospholipid Ab
INR
124
Q

Middle-aged woman c/o joint pain

Dx

HPI

PMHx

PE

W/u

Lyme disease

A

Dx Lyme disease

HPI 
erythema migrans rash
arthralgias/myalgias
onset: migratory/ polyarticular
tick bite
lives in northeast, mid atlantic, upper midwest
swelling and redness of affected joints
fatigue

PMHx
hx of tick bite or walking in woods

PE
bell palsy
bradycardia
heart block
target rash not present at this stage
low grade fever
decreased ROM on affected joints
tender joints w/ ROM

W/u
Lyme titer: ELISA/Western blot

125
Q

Middle-aged woman c/o pain in left hip

Dx

HPI

PMHx

PE

W/u

Osteoarthritis

A

Dx Osteoarthritis

HPI 
Morning stiffness < 30 min
monoarticular/polyarticular
asymmetric
insidious progression
worse with exercise
relieved by rest
PMHx
FHx of OA
obesity
trauma/ repetitive stress
previous surgery

PE
< ROM

W/u
Hip x-ray

126
Q

Middle-aged woman c/o pain in left hip

Dx

HPI

PMHx

PE

W/u

Polymyalgia rheumatica

A

Dx Polymyalgia rheumatica

HPI 
morning stiffness > 30 min
Distal extremities
Fatigue
Anorexia/weight loss
Fever
Headache
Scalp tenderness

PMHx
carpal tunnel
temporal arteritis

PE
PIP affected
nodules

W/u
ESR
CRP
MRI or U/S of involved joint

127
Q

multiple-aged woman c/o pain in left hip

Dx

HPI

PMHx

PE

W/u

multiple myeloma

A

Dx multiple myeloma

HPI 
bone pain: spine, long bones, skull, pelvis, chest
severe/intermittent
worse with movement
relieved by rest
fatigue/generalized weakness
weight loss

PMHx
anemia
recent bacterial infection

PE
back pain

W/u
serum protein electrophoresis
U/A bence jones proteins &amp; albumin
peripheral smear
skeletal survey
serum Ca
128
Q

45 yo man c/o worsening joint pain and morning stiffness

Dx

HPI

PMHx

PE

W/u

psoriatic arthritis

A

Dx psoriatic arthritis

HPI 
joint pain with polyarthriris
oligo arthritis (asymmetrical but at multiple joints)
morning stiffness > 30 min
worse with prolonged immobility
better with physical exercise
back pain
h/o skin disease
PMHx
FHx psoriasis
FHx RA
spondyloarthritis
enthesitis and tenosynovitis
arthritis mutilans
CV diseases or stroke
achilles tendinitis and planter fasciitis 
gout
PE
stress pain,, joint line tenderness and effusion in affected joint
DIP join pain and deformity
sausage digits
decreased ROM in affected joints
dactylitis
skin lesions over joint pressure points
nail pitting, onycholysis
hyperkeratosis
splinter hemorrhages
pitting edema
conjunctivitis and uveitis
W/u
CBC
ESR CRP
FR ANA
anti-CCP
HLA B27
xray and MRI of affected joint
Arthrocentesis and sinovial fluid analysis
BUN/uric acid
U/A
129
Q

patient c/o pain in left foot

Dx

HPI

PMHx

PE

W/u

gout

A

Dx gout

HPI 
acute
 swelling of ankle joint
monoarticular or oligoarticular
asymmetric
increased with purines (foods)
increased with exercise
low-grade fever
PMHx
prior episode 
trauma/diuretics
alcohol
nephrolithiasis
metabolic syndrome

PE
podagra
erythema

W/u
joint aspiration with synovial fluid analysis
angle x-ray for crystal
uric acid level in blood

130
Q

45 yo man with worsening joint pain and morning stiffness

Dx

HPI

PMHx

PE

W/u

disseminated gonococcal infection

A

Dx disseminated gonococcal infection

HPI 
c/o tenosynovitis
asymmetric mono or poly-arthralgia
dermatitis
fever, chills
generalized malaise
multiple partners
unprotected sex

PMHx
congenital or acquired complement deficiency
SLE
STI

PE
purulent arthritis
pustular or veiculopustular dermatitis
tenosynovitis with redness and warmth around tendon sheath

W/u
CBC w diff
synovial fluid analysis
blood culture on tayer-martin media
PCR for gonoccocal DNA
skin lesions specimens
131
Q

45 yo man c/o worsening joint pain

Dx

HPI

PMHx

PE

W/u

Lateral epicondilitis

A

Dx lateral epicondilitis

HPI 
elbow pain,swelling, loss of motion
repetitive elbow movement
numbness and tingling in the hand
cervical neck pain
PMHx
trauma
smoking
gout
gonorrhea
IBS

PE
local tenderness, swelling, redness at affected jiont
impaired ROM
sensory loss

W/u
CXR
X-ray and MRI of affected joint
arthrocentesis
CBC 
uric acid level
132
Q

43 yo woman c/o hip pain

Dx

HPI

PMHx

PE

W/u

Hip dislocation

A

Dx hip dislocation

HPI
fall

PMHx
long term smoker
recent hip replacement surgery

PE
tenderness to palpation of hip
limited ROM

W/u
hip-x-ray
MRI of affected hip

133
Q

82 yo woman c/o inability to bear weight

Dx

HPI

PMHx

PE

W/u

hip fracture

A

Dx hip fracture

HPI
fall
hip pain

PMHx
osteoporosis

PE
tenderness on palpation of hip

W/u
hip-x-ray
MRI of affected hip

134
Q

45 yo woman c/o muscle weakness

Dx

HPI

PMHx

PE

W/u

myasthenia gravis

A

Dx myasthenia gravis

HPI 
worse at night/exertion- weakness 
weakness better with rest
diplopia
dysphagia and difficulty chewing
slurred speech
droopy eyelids
progressive fatigue
jaw weakness w/ chewing
difficulty walking up stairs
no muscle pain

PMHx
FHx of hypothyroidism and RA

PE
slurred speech
drooping eyelids
decreased muscle strength
decreased flexes in UE and LE b/l
W/u
ACH receptor Abs
muscle specific tyrosine kinase Abs
anti-striated muscle Abs
EMG
nerve conduction study
135
Q

45 yo man c/o muscle weakness

Dx

HPI

PMHx

PE

W/u

Guillain-Barre syndrome

A

Dx Guillaine-Barre syndrome

HPI 
ascending symmetrical weakness
numbness and tingling
progressive fatigue
diplopia
slurred speech

PMHx
recent URI

PE
low BP and high HR
ptosis
loss of DTR in LE b/l
decreased muscle strenth in LE b/l

W/u
EMG, nerve conduction study
PFTs (FVC, negative inspiratory force)

136
Q

Dx

HPI

PMHx

PE

W/u

cellulitis

A

Dx cellulits

HPI 
ankle area extending up
LLE +/- puncture wound
welling/erythema/unilateral
fever/chills/malaise
no drainage
PMHx
trauma few days ago
skin disorder at site
DM or HIV
Surgery

PE
Lymph nodes
Erythema

W/u
CBC w/ diff

137
Q

patient c/o pain in left lower leg

Dx

HPI

PMHx

PE

W/u

Peripheral arterial disease

A

Dx Peripheral arterial disease

HPI 
worse with ambulation
worse when climbing stairs
better with rest
intermittent/cramping/claudication
PMHx
hyperlipidemia
DM
MI
HTN
smoker
Fhx
PE
diminished/absent pulses
shiny skin/absent hair
cold feet 
thickened toe nails
impaired sensation

W/u
ankle/brachial arterial pressure

138
Q

57 yo woman c/o significant pain and swelling of her left leg for past several days

Dx

HPI

PMHx

PE

W/u

deep vein thrombosis

A

Dx deep vein thrombosis

HPI
pain w/ leg swelling (difference of 3 cm circumference)
OCPs and smoking
sedentary lifestyle
dyspnea of sudden onset, chest pain, fatigue if complicated with PE

PMHx
malignancy
prior DVT
immobilization
>3days
surgery > 30 min
pregnancy
estrogen Tx
smoking 
obestiy
h/o venous thromboembolism
PE
localized tenderness 
entire leg swollen
pitting edema 
collateral superficial veins
increased warmth at affected side
tachypnea
W/u
doppler U/S of LE
D-Dimer
CTA
ant-phospholipid ABs
Factor V leiden
Protein C S
INR, PT, PTT
Homocysteine level
antithrombin III Factor VIII
CXR
ABG
ECG
139
Q

50 yo man c/o pain in heel and bottom of foot

Dx

HPI

PMHx

PE

W/u

Plantar fascitis

A

Dx plantar fascitis

HPI
sharp unilateral pain
worse at period of rest and in morning

PMHx
smoking
runner

PE
Obese
pain reproduced by bending foot and toes up toward shin

140
Q

45 yo man c/o gradual onset of localized chest pain

Dx

HPI

PMHx

PE

W/u

Costochondritis

A

Dx costochondritis

HPI 
region pain syndrome
stinging pain
pain reproducible
multiple areas of chest tenderness
absence of cough

PE
tenderness at upper costal cartilage of costochondral or costosternal junctions
localized muscle tension
no heat erythema or localized swelling

W/u
CXR

141
Q

patient c/o dizziness

Dx

HPI

PMHx

PE

W/u

panic disorder

A

Dx panic disorder

HPI
unexpected episodes of palpitations, SOB, dizziness

associated w/ sweating, trembling, chest pain, palpitiations, and circumoral numbness
persistent concern about future attacks

PMHx
anxiety
no substance use d/o
caffeine use

W/u
—

142
Q

patient c/o dizziness

Dx

HPI

PMHx

PE

W/u

acute alcohol intoxication

A

Dx acute alcohol intoxication

HPI 
dizziness
euphoria
ataxia
slurred speech
vomiting
confusion

PMHx
alcohol abuse
alcoholism
stressful job

PE
alcohol scent on breath
unstable gait
slurred speech
MMSE

W/u
serum ethanol level
urine tox
serum glucose level

143
Q

25 yo man c/o visual hallucinations

Dx

HPI

PMHx

PE

W/u

substance-induced psychosis

A

Dx substance-induced psychosis

HPI
disorientation
acute intoxication of alcohol

PMHx
alcoholic
cannabis use

W/u
urine tox

144
Q

23 yo man c/o restlessness

Dx

HPI

PMHx

PE

W/u

Schizophrenia

A

Dx Schizophrenia

HPI
> 6 mo delusions, hallucinations (auditory), social dysfxn, disorganized speech

interferes with normal functioning

PMHx
FHx

PE
MMSE
impaired judgement
blunt affect

W/u
urine tox
head CT
brain MRI
brain PET scan
145
Q

18 yo man c/o difficulty concentrating

Dx

HPI

PMHx

PE

W/u

Schizoaffective disorder

A

Dx Schizoaffective disorder

HPI 
delusions
hallucinations
alogia
avolition
anhedonia
irritable mood
excessive agitation

PMHx
anxiety
risk taking behavior

PE
disorganized speech
blunt affect

W/u
CBC w/ diff
electrolytes
serum glucose cortisol
urine tox
serum alcohol
TSH
146
Q

25 yo woman c/o fatigue

Dx

HPI

PMHx

PE

W/u

Bipolar disorder

A

Dx Bipolar disorder
DIG FAST

HPI 
sad mood > 2wks
early morning wakefulness
anhedonia
loss of concentration
decreased appetite
suicidal ideation
associated with periods of increased energy, excessive spending, and increased promiscuous sexual activity

PMHx
FHx similar Sx

PE
affect depressed
mood c/w affect

W/u
CBC w/ diff
electrolytes
serum glucose
cortisol
urine tox
serum alcohol level
TSH
147
Q

20 yo woman c/o depressed mood

Dx

HPI

PMHx

PE

W/u

Adjustment disorder

A

Dx Adjustment disorder

HPI 
loss of interest
feeling of hopelessness
better with removal of stressors
sadness
anhedonia
difficulty concentration

PMHx
loss of job 1mo ago

PE
depressed affect
affect c/w mood

W/u
CBC w/ diff
electrolytes
serum glucose
cortisol
urine tox
serum alcohol level
TSH
148
Q

25 yo woman c/o fatigue

Dx

HPI

PMHx

PE

W/u

Major depressive disorder

A

Dx Major depressive disorder

HPI
(5/9) SIGECAPS + depressed mood or anhedonia

PMHx
Fhx psych conditions

PE
decreased concentration of MMSE
depressed affect
mood c/w affect
lack of eye contact
W/u
CBC w/ diff
electrolytes
serum glucose
cortisol
urine tox
serum alcohol level
TSH
149
Q

35 yo woman c/o fatigue

Dx

HPI

PMHx

PE

W/u

Normal bereavement (<6mo)

vs
persistent complex bereavement disorder (>12mo)

A

Dx Normal bereavement

HPI 
anhedonia
anorexia
trouble concentrating
trouble sleeping

PMHx
loss of husband 6 mo ago

W/u
—

150
Q

20 yo woman c/o fatigue

Dx

HPI

PMHx

PE

W/u

social anxiety disorder (social phobia)

A

Dx social anxiety disorder

HPI
persistent fear of one or more social or performance situations
diaphoresis, tremors, palpitations, nausea in public places
avoidance of public spaces

PMHx
anxiety

PE
anxious affect
mood c/w affect

W/u
CBC w/ diff
electrolytes
serum glucose
cortisol
urine tox
serum alcohol level
TSH
151
Q

mother c/o child becoming irritable

Dx

HPI

PMHx

PE

W/u

lead poisoning

A

Dx lead poisoning

HPI 
anorexia
abd pain/constipation
poor attention span
distractability
impulsiveness/hyperactivity
pica/lethargy
vomiting
headache

PMHx
old building
low socioeconomic status

PE
---
W/u
physical exam
blood lead level 
CBC
152
Q

mother c/o child becoming irritable lately

Dx

HPI

PMHx

PE

W/u

Iron deficiency anemia

A

Dx Iron deficiency anemia

HPI 
anorexia
lethargy
fatigue
pallor
irritability
poor feeding
pica
mainly milk

PMHx
low birth weight
blood loss
systolic murmur

PE
---
W/u
Physical exam
peripheral smear
serum iron/ferritin
TIBC/FEP 
reticulocyte count
FOBT
CBC/MCV/RDW
153
Q

mother c/o child becoming irritable lately

Dx

HPI

PMHx

PE

W/u

ADHD

A

Dx ADHD

HPI 
inattention/hyperactive
impulsive
multiple settings
<12 yo
> 6 mo
distracted/disorganized
forgetful
constant fidgeting
short attention span
tasks not completed

PMHx
FHx psychiatric d/o

W/u
physical exam
psychiatric mental status evaluation

154
Q

Parent c/o 7 yo child with irritability

Dx

HPI

PMHx

PE

W/u

oppositional defiant disorder

A

Dx oppositional defiant disorder

HPI 
patterns of argumentative behavior
> 6 mo
often loses temper/angry
argues with authority
annoys classmate
blames others for his mistakes
PMHx
---
PE
---
W/u
physical exam
155
Q

Mother c/o child with fever and rash

Dx

HPI

PMHx

PE

W/u

Measles

A

Dx Measles

HPI 
cough, coryza, and conjunctivitis
recent travel or exposure to sick persons
transient respiratory Sx
Fever
Malaise, anorexia
diarrhea
lethargy

PMHx
otitis media
missed vaccinations

PE
fever
maculopapular rash
koplik spots 
keratitis or corneal ulcerations
non-purulent conjunctivitis
LAD
W/u
Physical exam
serum measles
IgM and IgG Abs
RT-PCR for measles virus 
RNA
CBC w/ diff
156
Q

Mother c/o newborn with fever and lethargy

Dx

HPI

PMHx

PE

W/u

Neonatal sepsis

A

Dx Neonatal sepsis

HPI 
fever
lethargy
poor feeding poor tone 
irritability
seizures
PMHx
inherited metabolic disorders
hypoxia
acidosis
GBS infection
maternal chorioamnionitis
intrapartum-fetal tachycardia
APGAR <6
Meconium ileus
PE
respiratory distress: tachypnea, flaring, grunting, and use of respiratory muscles
tachycardia
hypotension
fever
W/u
physical exam
cbc w/ diff
blood cultures 
LP
CXR (if respiratory distress)
157
Q

Mother c/o newborn with irritability and crying

Dx

HPI

PMHx

PE

W/u

colic

A

Dx colic

HPI 
irritability
paroxysmal crying (esp. at night)
relieved by flatus or bowel movement
normal feeding
PE
face of baby flushed
distended and tensed abdomen
clenched fingers
stiff and extended arms
otherwise NL PE

W/u
bring child for PE

158
Q

Mother c/o newborn who is irritable and cries inconsolably

Dx

HPI

PMHx

PE

W/u

intussusception

A

Dx intussesception

HPI 
progressive intermittent cramping
sudden every 15-20 min
inconsolable cry
bilious emesis
lethargy
alerted consciousness

PMHx
reactive lymphoid hyperplasia
gastroenteritis
FHx GI problems: Meckel, Chron, celiac, cystic fibrosis

PE
drawing legs to abdomen
distension
palpable sausage-shaped abd mass

W/u
bring child for PE
FOBT for gross blood and currant jelly stool
abd U/S
abd plain x-ray
159
Q

Mother c/o newborn to pass stool

Dx

HPI

PMHx

PE

W/u

Hirschsprung disease

A

Dx Hirschsprung disease

HPI
a/w brown vomit
abd swelling
flatulence

W/u
Physical exam

160
Q

16 yo girl c/o cold intolerance

Dx

HPI

PMHx

PE

W/u

anorexia nervosa

A

Dx anorexia nervosa

HPI
weight loss
food restriction
excessive exercise

PMHx
use of laxatives 
amenorrhea
brittle hair
fatigue
FHx of eating d/o

PE
thin appearance
lanugo
HYPOTENSION

W/u
electrolytes
cbc

161
Q

patient c/o fatigue

Dx

HPI

PMHx

PE

W/u

hypothyroidism

A

Dx Hypothyroidism

HPI 
weight gain
cold intolerance
dry skin
brittle hair/puffy face/sleepiness
constipation
depressed mood
muscle weakness
decreased mood
muscles weakness
decreased sweating
hoarseness
lower extremity edema
impaired memory
tongue enlargement
PMHx
potential drug induced- lithium
hypothalamic-pituitary axis damage
menstrual abnormalities
carpal tunnel
h/o autoimmune disease
FHx of hypothyroidism
PE
loss of eye brows
periorbital edema
DTR: delayed relaxation
edema

W/u
TSH
Free T3

162
Q

patient c/o fatigue

Dx

HPI

PMHx

PE

W/u

B12 deficiency

A

Dx B12 deficiency

HPI 
weight loss
decreased appetite
unsteady gait 
numbness/tingling of feet and hands
perception of wearing stockings or gloves
constipation or diarrhea
sore tongue/weakness
psychosis/memory loss
pallor palpitations
dyspnea on exertion
PMHx
vegan diet
alcoholic
pernicious anemia
chron disease/celiac
GI resection
acid suppressing drug
metformin
bacterial overgrowth

PE
Romberg sign
altered gait

W/u
cbc
peripheral smear
serum b12 
methylmalonic acid
homocysteine
163
Q

patient c/o fatigue

Dx

HPI

PMHx

PE

W/u

iron deficiency anemia

A

Dx iron deficiency anemia

HPI 
angular chelitis
pica
lethargy/pallor
palpitations/dyspnea on exertion
poor exercise tolerance
lightheadedness
leg cramps
glossitis/koilonychia
PMHx
GI bleed
menorrhagia
celiac sprue
recent infections
bacterial overgrowth
systolic murmur

PE
pallor
tachycardia

W/u
ferritin
serum iron
TIBC/CBC
peripheral smear
164
Q

patient c/o fatigue

Dx

HPI

PMHx

PE

W/u

Non-Hodgkin Lymphoma

A

Dx Non-Hodgkin Lymphoma

HPI 
fever/night sweats/ weight loss
skin rash, pruritis
anorexia/weight loss
N/V
complex regional pain
abd fullness
early satiety
headache
lethargy
seizure

PMHx
PMHx or FHx lymphoma or hematopoietic malignancy
radiation or chemoTx
exposure to agricultural pesticides and hair dyes

PE
painless, peripheral lymphadenopathy
HSM
fever
FNDs
W/u
cbc w/diff
serum LDH and uric acid
serum Ca 
peripheral smear
serum protein electrophoresis
CXR
CT abd
PET/CT brain
LN Bx
165
Q

35 yo woman c/o fatigue

Dx

HPI

PMHx

PE

W/u

PTSD

A

Dx PTSD

HPI
flashbacks
nightmares
Sxs > 1 mo

PMHx
major stressor

166
Q

67 yo man with personal problem

Dx

HPI

PMHx

PE

W/u

drug-related erectile dysfunction

A

Dx drug-related erectile dysfunction

HPI
h/o ED
non compliant with DM or HTN medications

PMHx
HTN, DM, MI
radical prostatectomy

PE
abn peripheral sensation on LE
abn femoral/peripheral pulse
alopecia, gynecomastia
visual field defects
W/u
genital examinations
nocturnal penile tumescence test
MRI brain
glucose level and hgbA1c
Testosterone and prolactin
duplex doppler of penis
Lipid profile
167
Q

patient c/o tremor, palpitations, anxiety

Dx

HPI

PMHx

PE

W/u

DM

A

Dx DM

HPI 
poly- uria/dipsia/phagia
h/o hypoglycemia Sx
weight gain or loss (DM I)
sedentary lifestyle
high fat diet
h/o claudication
PMHx
CV dz
HTN
high cholesterol
PAD
obesity 
smoking

PE
obese
diminished LE peripheral pulses
decreased LE sensation

W/u
blood glucose 
hgbA1c
fasting lipid profile
urine albumin
AST/ALT
serum creatinine
TSH (if type DM 1)
168
Q

41 yo woman c/o insomnia

Dx

HPI

PMHx

PE

W/u

Domestic violence

A

Dx domestic violence

HPI 
h/o abd pain
depressed mood
difficulty falling asleep
pain on bruised area
abd pain or other Sx

PMHx
depression
visiting the clinic multiple times w/o a clear dz

PE
bruises
inspection of other skin or body parts with traces of trauma in different stages of healing

W/u
x-ray skeletal survey
Fast U/S for soft tissue damage

169
Q

41 yo woman c/o insomnia

Dx

HPI

PMHx

PE

W/u

stress induced insomnia

A

Dx stress induced insomnia

HPI 
issue falling asleep and staying asleep
anxiety
fatigue
unreasonable worries and tension
impaired daytime function
inability to concentrate weight loss or gain
memory problems
h/o x.s coffee
PMHx
FHx of bipolar disorder or other psychiatric disorder
h/o starting new medication
anxiety d/o
very stressful situation
complex regional pain
using recreational drugs and alcohol

PE
nl thyroid exam
DTR intact b/l
motor 5/5 b/l

W/u
cbc
TSH, T3, free T4

170
Q

35 yo woman c/o fatigue

Dx

HPI

PMHx

PE

W/u

obstructive sleep apnea

A

Dx obstructive sleep apnea

HPI
snoring
morning headaches
excessive daytime sleepiness

PMHx
smoker

PE
obese
hypertensive

W/u
polysomnography

STEP 2 CS (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions