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Minicases Flashcards

1
Q

What are the key physical exam items for headache?

A
  1. vitals
  2. inspection and palpation of entire head
  3. neuro exam WITH fundoscopic exam
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2
Q

Top 5 differential:

21 yo F presents with several episodes of
throbbing left temporal pain that lasts
for 2–3 hours. Prior to its onset, she sees
flashes of light in her right visual field
and feels weakness and numbness on the
right side of her body for a few minutes.
Headaches are often associated with
nausea and vomiting. She has a family
history of migraine.

A
  1. Migraine (complicated)
  2. Tension headache
  3. Cluster headache
  4. Pseudotumor cerebri
  5. Trigeminal neuralgia

longshots: trigeminal neuralgia, CNS vasculitis, partial seizure, intracranial neoplasm

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3
Q

Top 5 workup:

21 yo F presents with several episodes of
throbbing left temporal pain that lasts
for 2–3 hours. Prior to its onset, she sees
flashes of light in her right visual field and feels weakness and numbness on the right side of her body for a few minutes.
Headaches are often associated with nausea and vomiting. She has a family history of migraine.

A
  1. CBC
  2. ESR
  3. CT - head
  4. MRI - brain
  5. LP
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4
Q

Top 5 most important Hx items:

21 yo F presents with several episodes of
throbbing left temporal pain that lasts for 2–3 hours. Prior to its onset, she sees flashes of light in her right visual field and feels weakness and numbness on the
right side of her body for a few minutes. Headaches are often associated with nausea and vomiting. She has a family history of migraine.

A
  1. THROBBING
  2. UNILATERAL
  3. ASSOCIATED NEURO (FLASHES OF LIGHT/WEAKNESS/NUMBNESS)
  4. NAUSEA/VOMITING
  5. FAMILY HX
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5
Q

top 5 differential:

26 yo M presents with severe right
temporal headaches associated with
ipsilateral rhinorrhea, eye tearing, and
redness. Episodes have occurred at the same time every night for the past week and last for 45 minutes.

A
  1. Cluster headache
  2. migraine
  3. tension headache
  4. sinusitis
  5. pseudotumor cerebri
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6
Q

top 5 workup:

26 yo M presents with severe right
temporal headaches associated with
ipsilateral rhinorrhea, eye tearing, and
redness. Episodes have occurred at the
same time every night for the past week
and last for 45 minutes.
A
  1. CBC
  2. ESR
  3. CT - head
  4. MRI - brain
  5. LP
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7
Q

top 5 differential:

65 yo F presents with severe, intermittent
right temporal headache, fever, blurred
vision in her right eye, and pain in her
jaw when chewing.

A
  1. temporal arteritis
  2. migraine
  3. cluster headache
  4. tension headache
  5. meningitis
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8
Q

top 5 workup:

65 yo F presents with severe, intermittent
right temporal headache, fever, blurred
vision in her right eye, and pain in her
jaw when chewing.

A
  1. CBC
  2. ESR
  3. CRP
  4. temporal artery biopsy
  5. carotid doppler
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9
Q

top 5 differential:

30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis.

A
  1. sinusitis
  2. migraine
  3. tension headache
  4. meningitis
  5. intracranial neoplasm
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10
Q

top 5 workup:

30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis.

A
  1. CBC
  2. Xray - sinus
  3. CT - sinus
  4. LP
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11
Q

top 5 workup:

25 yo M presents with high fever, severe
headache, confusion, photophobia, and
nuchal rigidity. Kernig’s and Brudzinski’s
signs are positive.

A
  1. CBC
  2. CT - head
  3. MRI - brain
  4. LP - CSF analysis including cell count, protein, glucose, gram stain, PCR for antigens and Cx)
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12
Q

Diagnosis and top 5 workup:

18 yo obese F presents with a pulsatile
headache, vomiting, and blurred vision
for the past 2–3 weeks. She is taking
OCPs.

A

Pseudotumor cerebri

  1. Urine hCG
  2. CBC
  3. CT - head
  4. LP - opening pressure and CSF analysis
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13
Q

top 5 differential:

57 yo M c/o daily pain in the right cheek
over the past month. The pain is electric
and stabbing in character and occurs
while he is shaving. Each episode lasts
2–4 minutes.

A
  1. trigeminal neuralgia
  2. tension headache
  3. migraine
  4. cluster headache
  5. TMJ dysfunction
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14
Q

top 3 workup:

57 yo M c/o daily pain in the right cheek
over the past month. The pain is electric
and stabbing in character and occurs
while he is shaving. Each episode lasts
2–4 minutes.

A
  1. CBC
  2. ESR
  3. MRI - brain
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15
Q

Top 10 key Hx items for CC of confusion/memory loss? What else is important about Hx gathering in this patient?

A
  • Must include Hx from family members/caregivers
    1. time course of cognitive deficits (acute vs chronic)
    2. associated symptoms (constitutional, incontinence, ataxia, hypothyroid, depression)
    3. waxing/waning nature (delirium)
    4. recent falls
    5. meds and recent med changes
    6. hx of stroke or other vascular dx
    7. STDs (syphilis)
    8. HIV risk factors
    9. EtOH use and nutritional status (B12)
    10. FHx of cognitive deficits (Alzheimers)
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16
Q

top 9 key physical exam items for confusion/memory loss?

A
  1. vitals
  2. complete neuro exam
  3. mini-mental status
  4. gait
  5. ENT
  6. cardiac
  7. pulmonary
  8. abdominal
  9. extremities
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17
Q

top 5 ddx:

81 yo M presents with progressive
confusion over the past several
years together with forgetfulness
and clumsiness. He has a history of
hypertension, diabetes mellitus, and two
strokes with residual left hemiparesis. His
mental status has clearly worsened after
each stroke (stepwise decline in cognitive
function).
A
  1. vascular dementia (multi-infarct)
  2. alzheimers
  3. NPH
  4. chronic subdural
  5. intracranial tumor

Ones w/ very specific hx items: B12 deficiency (nutrition), depression (SIGECAPS), neurosyphilis (promiscuity), hypothyroid (younger, cold intolerance, etc)

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18
Q

top 5 workup:

81 yo M presents with progressive
confusion over the past several
years together with forgetfulness
and clumsiness. He has a history of
hypertension, diabetes mellitus, and two
strokes with residual left hemiparesis. His
mental status has clearly worsened after
each stroke (stepwise decline in cognitive
function).
A
  1. CBC
  2. VDRL/RPR
  3. serum B12
  4. TSH
  5. MRI - brain
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19
Q

top 5 ddx:

84 yo F brought by her son c/o
forgetfulness (e.g., forgets phone
numbers, loses her way back home) along
with diffi culty performing some of her
daily activities (e.g., bathing, dressing,
managing money, using the phone). The
problem has gradually progressed over
the past few years.
A
  1. alzheimers
  2. vascular dementia
  3. depression
  4. hypothyroidism
  5. chronic subdural
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20
Q

top 5 workup:

84 yo F brought by her son c/o
forgetfulness (e.g., forgets phone
numbers, loses her way back home) along
with diffi culty performing some of her
daily activities (e.g., bathing, dressing,
managing money, using the phone). The
problem has gradually progressed over
the past few years.
A
  1. CBC
  2. VDRL/RPR
  3. serum B12
  4. TSH
  5. MRI - brain
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21
Q

top 5 ddx:

72 yo M presents with memory loss, gait
disturbance, and urinary incontinence for
the past six months.

A
  1. NPH
  2. alzheimers
  3. vascular dementia
  4. chronic subdural
  5. intracranial neoplasm
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22
Q

top 5 workup:

72 yo M presents with memory loss, gait
disturbance, and urinary incontinence for
the past six months.

A
  1. CT - head
  2. LP - opening pressure and analysis
  3. serum B12
  4. VDRL/RPR
  5. TSH
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23
Q

top 5 ddx:

55 yo M presents with a rapidly
progressive change in mental status,
inability to concentrate, and memory
impairment for the past two months. His
symptoms are associated with myoclonus
and ataxia.
A
  1. CJD
  2. vascular dementia
  3. lewy body dx
  4. wernicke’s encephelopathy
  5. NPH
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24
Q

top 5 workup:

55 yo M presents with a rapidly
progressive change in mental status,
inability to concentrate, and memory
impairment for the past two months. His
symptoms are associated with myoclonus
and ataxia.
A
  1. CBC
  2. BMP (electrolytes and Ca)
  3. serum B12
  4. VDRL/RPR
  5. MRI - brain
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25
Q

top 5 ddx:

70 yo insulin-dependent diabetic M
presents with episodes of confusion,
dizziness, palpitation, diaphoresis, and
weakness.

A
  1. hypoglycemia
  2. TIA
  3. arrhythmia
  4. delirium
  5. angina
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26
Q

top 5 workup:

70 yo insulin-dependent diabetic M
presents with episodes of confusion,
dizziness, palpitation, diaphoresis, and
weakness.

A
  1. glucose (fingerstick, then serum)
  2. CBC
  3. BMP (electrolytes)
  4. echo
  5. ECG
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27
Q

top 4 workup:

55 yo F presents with gradual altered
mental status and headache. Two weeks
ago she slipped, hit her head on the
ground, and lost consciousness for two
minutes
A
  1. non-con CT - head
  2. BMP (electrolytes)
  3. MRI - brain
  4. LP
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28
Q

top 7 key Hx items for depressed mood (other than SIGECAPS)?

A 
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor slowing
Suicidality
  1. timing (onset and duration)
  2. drugs and EtOH
  3. life stressors
  4. social functioning
  5. FHx of mood disorders
  6. prior episodes
  7. meds
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29
Q

key PE and psychological “PE” items for depressed mood?

A

Traditional PE:

  1. vitals
  2. HEENT
  3. neuro exam
  4. mini-mental

Psych PE:

  1. appearance
  2. behavior
  3. speech
  4. mood
  5. affect
  6. though process
  7. thought content
  8. cognition (mini-mental measures this)
  9. insight
  10. judgement
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30
Q

top 5 ddx:

68 yo M presents with a two-month
history of crying spells, excessive sleep,
poor hygiene, and a 7-kg weight loss, all
following his wife’s death. He cannot
enjoy time with his grandchildren
and reluctantly admits to thinking he
has seen his dead wife in line at the
supermarket or standing in the kitchen
making dinner.
A

*two months is cutoff in time for differentiation b/w bereavement and MDD (might also be diagnosed 2/2 marked impairment, worthlessness, psychosis or suicidal ideation

  1. normal bereavement
  2. adjustment disorder w/ depressed mood
  3. major depressive disorder
  4. schizoaffective disorder
  5. depressive disorder NOS
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31
Q

top 3 workup:

68 yo M presents with a two-month
history of crying spells, excessive sleep,
poor hygiene, and a 7-kg weight loss, all
following his wife’s death. He cannot
enjoy time with his grandchildren
and reluctantly admits to thinking he
has seen his dead wife in line at the
supermarket or standing in the kitchen
making dinner.
A
  1. TSH
  2. CBC
  3. urine toxicology
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32
Q

top 4 ddx:

42 yo F presents with a four-week history
of excessive fatigue, insomnia, and
anhedonia. She states that she thinks
constantly about death. She has suffered
fi ve similar episodes in the past, the fi rst
in her 20s, and has made two previous
suicide attempts. She further admits to
increased alcohol use in the past month.
A
  1. MDD
  2. substance-induced mood disorder
  3. dysthmia
  4. adjustment disorder
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33
Q

top 4 workup:

42 yo F presents with a four-week history
of excessive fatigue, insomnia, and
anhedonia. She states that she thinks
constantly about death. She has suffered
fi ve similar episodes in the past, the fi rst
in her 20s, and has made two previous
suicide attempts. She further admits to
increased alcohol use in the past month.
A
  1. blood alcohol
  2. urine toxicology
  3. TSH
  4. CBC
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34
Q

top 5 ddx:

26 yo F presents with a 3-kg weight loss
over the past two months, accompanied
by early-morning awakening, excessive
guilt, and psychomotor retardation.
She does not identify a trigger for the
depressive episode but reports several
weeks of increased energy, sexual
promiscuity, irresponsible spending,
and racing thoughts approximately six
months before her presentation.
A
  1. bipolar I
  2. bipolar II
  3. cyclothymia
  4. MDD
  5. schizoaffective disorder
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35
Q

1 item for workup:

26 yo F presents with a 3-kg weight loss
over the past two months, accompanied
by early-morning awakening, excessive
guilt, and psychomotor retardation.
She does not identify a trigger for the
depressive episode but reports several
weeks of increased energy, sexual
promiscuity, irresponsible spending,
and racing thoughts approximately six
months before her presentation.
A

urine toxicology

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36
Q

top 8 key Hx items for psychosis?

A
  1. positive Sxs: delusions, hallucinations, disorganized thoughts
  2. negative Sxs: blunted affect, social withdrawal, decreased motivation, decreased speech/thought
  3. cognitive Sxs: disorganized speech/thought
  4. paranoia
  5. age of first Sx onset
  6. previous hospitalizations for similar Sxs
  7. previous psych meds
  8. EtOH or substance abuse
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37
Q

top 5 ddx:

19 yo M c/o receiving messages from
his television set. He reports that he
did not have many friends in high
school. In college, he started to suspect
his roommate of bugging the phone.
In the same time frame, he stopped
going to classes because he felt that his
professors were saying horrible things
about him that no one else noticed. He
rarely showered or left his room and
has recently been hearing a voice from
his television set telling him to “guard
against the evil empire.”
A
  1. schizophrenia
  2. schizoid or schizotypal personality disorder
  3. schizophreniform disorder
  4. psychotic disorder 2/2 general medical condition
  5. substance-induced psychosis
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38
Q

top 4 workup:

19 yo M c/o receiving messages from
his television set. He reports that he
did not have many friends in high
school. In college, he started to suspect
his roommate of bugging the phone.
In the same time frame, he stopped
going to classes because he felt that his
professors were saying horrible things
about him that no one else noticed. He
rarely showered or left his room and
has recently been hearing a voice from
his television set telling him to “guard
against the evil empire.”
A
  1. urine toxicology
  2. TSH
  3. CBC
  4. BMP (electrolytes)
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39
Q

top 5 ddx:

28 yo F c/o seeing bugs crawling on her
bed over the past two days and reports
hearing loud voices when she is alone
in her room. She has never experienced
symptoms such as these in the past. She
recently ingested an unknown substance.
A
  1. substance-induced psychosis
  2. brief psychotic disorder
  3. schizophreniform disorder
  4. schizophrenia
  5. psychotic disorder due to a general medical condition
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40
Q

top 5 workup:

28 yo F c/o seeing bugs crawling on her
bed over the past two days and reports
hearing loud voices when she is alone
in her room. She has never experienced
symptoms such as these in the past. She
recently ingested an unknown substance.
A
  1. urine toxicology
  2. TSH
  3. CBC
  4. CMP (electrolytes + LFTs)
  5. BUN/Cr
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41
Q

top 5 ddx:

48 yo F presents with a one-week history
of auditory hallucinations, stating, “I am
worthless” and “I should kill myself.” She
also reports a two-week history of weight
loss, early-morning awakening, decreased
motivation, and overwhelming feelings
of guilt.

A
  1. schizoaffective disorder
  2. mood disorder w/ psychotic features
  3. schizophrenia
  4. schizophreniform disorder
  5. psychotic disorder due to a general medical condition
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42
Q

top 3 workup:

48 yo F presents with a one-week history
of auditory hallucinations, stating, “I am
worthless” and “I should kill myself.” She
also reports a two-week history of weight
loss, early-morning awakening, decreased
motivation, and overwhelming feelings
of guilt.

A
  1. TSH
  2. CBC
  3. BMP (electrolytes)
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43
Q

top 10 key hx items for dizziness?

A
  1. lightheaded vs vertigo
  2. auditory Sxs (hearing loss, tinnitus)
  3. duration of episodes
  4. context (ie, positioning, head trauma, etc)
  5. visual Sxs
  6. URI
  7. nausea
  8. neck pain or recent injury
  9. meds
  10. Hx of atherosclerotic or vascular Dx
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44
Q

top 10 key PE items for dizziness?

A
  1. vitals
  2. neuro exam
  3. romberg
  4. nystagmus
  5. Dix hallpike (just mention)
  6. gait
  7. hearing
  8. weber and rinne
  9. HEENT
  10. CV exam
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45
Q

top 5 ddx:

35 yo F presents with intermittent
episodes of vertigo, tinnitus, nausea, and
hearing loss over the past week.

A
  1. Menieres dx
  2. vestibular neuronitis
  3. labyrinthitis
  4. BPV
  5. acoustic neuroma
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46
Q

top 4 workup:

35 yo F presents with intermittent
episodes of vertigo, tinnitus, nausea, and
hearing loss over the past week.

A
  1. CBC
  2. VDRL/RPR
  3. dix hallpike
  4. MRI - brain
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47
Q

top 5 ddx:

55 yo F c/o dizziness for the past day.
She feels faint and has severe diarrhea
that started two days ago. She takes
furosemide for her hypertension.

A
  1. orthostatic hypotension due to dehydration
  2. vestibular neuronitis
  3. labyrinthitis
  4. BPV
  5. vertebrobasilar insufficiency
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48
Q

top 5 workup:

55 yo F c/o dizziness for the past day.
She feels faint and has severe diarrhea
that started two days ago. She takes
furosemide for her hypertension.

A
  1. orthostatic vitals
  2. CBC
  3. BMP (electrolytes)
  4. stool exam for blood and fecal leukocytes
  5. dix hallpike
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49
Q

top 5 ddx:

65 yo M presents with postural dizziness
and unsteadiness. He has hypertension
and was started on hydrochlorothiazide
two days ago.

A
  1. drug induced orthostatic hypotension
  2. vestibular neuronitis
  3. labyrinthitis
  4. BPV
  5. brain stem/cerebellar tumor
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50
Q

top 5 workup:

65 yo M presents with postural dizziness
and unsteadiness. He has hypertension
and was started on hydrochlorothiazide
two days ago.

A
  1. orthostatic vitals
  2. CBC
  3. BMP (electrolytes)
  4. BUN/Cr
  5. MRI - brain
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51
Q

top 5 ddx:

44 yo F c/o dizziness on moving her
head to the left. She feels that the room
is spinning around her head. Tilt test
results in nystagmus and nausea.

A
  1. BPV
  2. vestibular neuronitis
  3. labyrinthitis
  4. menieres dx
  5. brain neoplasm
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52
Q

top 3 workup:

44 yo F c/o dizziness on moving her
head to the left. She feels that the room
is spinning around her head. Tilt test
results in nystagmus and nausea.

A
  1. MRI - brain
  2. dix hallpike
  3. audiogram
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53
Q

top 5 ddx:

55 yo F c/o dizziness that started this
morning. She is nauseated and has
vomited once in the past day. She had a
URI two days ago and has experienced
no hearing loss.
A
  1. vestibular neuronitis
  2. labyrinthitis
  3. menieres dx
  4. BPV
  5. spinal dx/injury
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54
Q

top 5 workup:

55 yo F c/o dizziness that started this
morning. She is nauseated and has
vomited once in the past day. She had a
URI two days ago and has experienced
no hearing loss.
A
  1. dix hallpike
  2. CBC
  3. BMP
  4. electronystagmography
  5. MRI/MRA - brain
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55
Q

top 5 ddx:

55 yo F c/o dizziness that started this
morning and of “not hearing well.” She
feels nauseated and has vomited once in
the past day. She had a URI two days ago.

A
  1. labyrinthitis
  2. vestibular neuronitis
  3. menieres dx
  4. acoustic neuroma
  5. vertebrobasilar insufficiency
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56
Q

top 4 workup:

55 yo F c/o dizziness that started this
morning and of “not hearing well.” She
feels nauseated and has vomited once in
the past day. She had a URI two days ago.

A
  1. audiogram
  2. electronystagmography
  3. MRI/MRA - brain
  4. dix hallpike/tilt test
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57
Q

top 10 key Hx items for LOC?

A
  • *WITNESSES???**
    1. preceding Sxs (nausea, diaphoresis, palpitations, pallor, lightheadedness)
    2. context (exertional, postural, traumatic, stress, painful, experience of claustrophobia, dehydration)
    3. tongue-biting
    4. incontinence
    5. movements (tonic-clonic)
    6. post-ictal state (confusion)
    7. dyspnea
    8. personal or FHx of CVD
    9. arrhythmia
    10. EtOH or drug use
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58
Q

top 5 key PE items for LOC?

A
  1. vitals, including orthostatics
  2. complete neuro exam
  3. CV exam (include carotid auscultation)
  4. pulmonary exam
  5. LE exam (signs of vascular Dx)
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59
Q

top 5 ddx:

26 yo M presents after falling and losing
consciousness at work. He had rhythmic
movements of the limbs, bit his tongue,
and lost control of his bladder. He was
subsequently confused (as witnessed by
his colleagues).
A
  1. seizure (complex tonic-clonic [grand mal])
  2. convulsive syncope
  3. substance abuse/OD
  4. hypoglycemia
  5. malingering
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60
Q

top 7 workup:

26 yo M presents after falling and losing
consciousness at work. He had rhythmic
movements of the limbs, bit his tongue,
and lost control of his bladder. He was
subsequently confused (as witnessed by
his colleagues).
A
  1. CBC
  2. BMP w/ glucose
  3. EEG
  4. MRI - brain
  5. CT - head (noncon, if hit)
  6. ECG (this becomes number one if CV cause suspected)
  7. LP - CSF analysis
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61
Q

top 9 key Hx items for numbness or weakness?

A
  1. distribution
  2. duration
  3. progression
  4. pain (esp. headache, neck or back pain)
  5. consitutional Sxs
  6. other neuro Sxs
  7. Hx of diabetes
  8. EtOH use
  9. vascular Dx
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62
Q

top 4 key PE items for numbness or weakness?

A
  1. vitals
  2. neuro exam
  3. MSK exam
  4. vascular exam (peripheral pulses)
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63
Q

top 5 ddx:

68 yo M presents following a 20-minute
episode of slurred speech, right facial
drooping and numbness, and right hand
weakness. His symptoms had totally
resolved by the time he got to the ER.
He has a history of hypertension, diabetes
mellitus, and heavy smoking.
A
  1. TIA
  2. hypoglycemia
  3. seizure
  4. stroke
  5. facial nerve palsy
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64
Q

top 9 workup:

68 yo M presents following a 20-minute
episode of slurred speech, right facial
drooping and numbness, and right hand
weakness. His symptoms had totally
resolved by the time he got to the ER.
He has a history of hypertension, diabetes
mellitus, and heavy smoking.
A
  1. CBC
  2. glucose
  3. BMP
  4. ECG
  5. CT - head
  6. MRI - brain
  7. Doppler - carotids
  8. echo
  9. EEG
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65
Q

top 5 ddx:

68 yo M presents with slurred speech,
right facial drooping and numbness, and
right hand weakness. Babinski’s sign is
present on the right. He has a history
of hypertension, diabetes mellitus, and
heavy smoking.
A
  1. stroke
  2. TIA
  3. seizure
  4. intracranial neoplasm
  5. subdural/epidural hematoma
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66
Q

top 6 workup:

68 yo M presents with slurred speech,
right facial drooping and numbness, and
right hand weakness. Babinski’s sign is
present on the right. He has a history
of hypertension, diabetes mellitus, and
heavy smoking.
A
  1. CBC
  2. BMP
  3. PT/PTT
  4. CT - head
  5. MRI - brain
  6. Doppler - carotids
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67
Q

top 5 ddx:

33 yo F presents with ascending loss of
strength in her lower legs over the past
two weeks. She had a recent URI

A
  1. Guillan barre
  2. MS
  3. polymyositis
  4. myasthenia
  5. peripheral neuropathy
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68
Q

top 7 workup:

33 yo F presents with ascending loss of
strength in her lower legs over the past
two weeks. She had a recent URI

A
  1. CBC
  2. BMP
  3. CPK
  4. LP - CSF analysis
  5. MRI - spine
  6. EMG/nerve conduction study
  7. tensilon test
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69
Q

top 5 ddx:

30 yo F presents with weakness, loss of
sensation, and tingling in her left leg
that started this morning. She is also
experiencing right eye pain, decreased
vision, and double vision. She reports
feeling “electric shocks” down her spine
upon fl exing her head.
A
  1. MS
  2. stroke
  3. conversion disorder
  4. malingering
  5. CNS tumor
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70
Q

top 5 workup:

30 yo F presents with weakness, loss of
sensation, and tingling in her left leg
that started this morning. She is also
experiencing right eye pain, decreased
vision, and double vision. She reports
feeling “electric shocks” down her spine
upon fl exing her head.
A
  1. CBC
  2. VDRL/RPR
  3. MRI - brain
  4. LP - CSF analysis
  5. retinal evoked potentials
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71
Q

top 5 ddx:

55 yo M presents with tingling and
numbness in the hands and feet (gloveand-
stocking distribution) over the past
two months. He has a history of diabetes
mellitus, hypertension, and alcoholism.
There is decreased soft touch, vibratory,
and position sense in the feet.

A
  1. diabetic peripheral neuropathy
  2. alcoholic peripheral neuropathy
  3. B12 deficiency
  4. hypocalcemia
  5. hyperventilation
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72
Q

top 5 workup:

55 yo M presents with tingling and
numbness in the hands and feet (gloveand-
stocking distribution) over the past
two months. He has a history of diabetes
mellitus, hypertension, and alcoholism.
There is decreased soft touch, vibratory,
and position sense in the feet.

A
  1. HbA1C
  2. ESR
  3. Ca (&BMP)
  4. serum B12
  5. serum and urine protein electrophoresis (for paraprotienemia/myeloma)
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73
Q

top 5 ddx:

40 yo F presents with occasional double
vision and droopy eyelids at night with
normalization by morning.

A
  1. myasthenia gravis
  2. horner’s syndrome
  3. MS
  4. intracranial tumor (sp., compressing CN III, IV or VI)
  5. ALS
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74
Q

top 6 workup:

40 yo F presents with occasional double
vision and droopy eyelids at night with
normalization by morning.

A
  1. tensilon test
  2. ACh receptor Abs
  3. CXR
  4. CT - chest
  5. MRI - brain
  6. EMG
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75
Q

top 5 ddx:

25 yo M presents with hemiparesis (after
a tonic-clonic seizure) that resolves over
a few hours.

A
  1. Todd’s paralysis
  2. TIA
  3. stroke
  4. complicated migraine
  5. malingering
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76
Q

top 5 workup:

25 yo M presents with hemiparesis (after
a tonic-clonic seizure) that resolves over
a few hours.

A
  1. CBC
  2. BMP (repeat x3 over several hours)
  3. EEG
  4. MRI - brain
  5. U/S - carotids
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77
Q

top 10 unique Hx items for excessive fatigue and sleepiness?

A
  1. sleep hygiene
  2. snoring
  3. waking up w/ choking/gasping
  4. witnessed apnea
  5. overexertion
  6. stress levels
  7. depression/other emotional issues
  8. recent lifestyle changes
  9. shift changes at work
  10. recent weight changes
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78
Q

Top 3 ROS areas to focus for excessive fatigue and sleepiness?

A
  1. thyroid
  2. blood/bleeding/clotting
  3. CV
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79
Q

top 7 key PE items for excessive fatigue and sleepiness?

A
  1. vitals
  2. head and neck (conjuctival pallor, oropharynx/palate, LAN, thyroid)
  3. CV
  4. pulmonary
  5. abdominal exam
  6. neuro exam
  7. rectal w/ OBT
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80
Q

top 5 ddx:

40 yo F c/o feeling tired, hopeless,
and worthless and of having suicidal
thoughts. She recently discovered that
her husband is homosexual.

A
  1. depression
  2. adjustment disorder
  3. hypothyroidism
  4. anemia
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81
Q

top 3 workup:

40 yo F c/o feeling tired, hopeless,
and worthless and of having suicidal
thoughts. She recently discovered that
her husband is homosexual.

A
  1. CBC
  2. TSH
  3. HIV/STD testing
82
Q

top 5 ddx:

44 yo M presents with fatigue, insomnia,
and nightmares about a murder that he
witnessed in a mall one year ago. Since
then, he has avoided that mall and has
not gone out at night.
A
  1. PTSD
  2. depression
  3. generalized anxiety disorder
  4. psychotic or delusional disorder
  5. hypothyroidism
83
Q

top 4 workup:

44 yo M presents with fatigue, insomnia,
and nightmares about a murder that he
witnessed in a mall one year ago. Since
then, he has avoided that mall and has
not gone out at night.
A
  1. CBC
  2. TSH
  3. Ca
  4. urine toxicology
84
Q

top 5 ddx:

55 yo M presents with fatigue, weight
loss, and constipation. He has a family
history of colon cancer.

A
  1. colon cancer
  2. hypothyroidism
  3. renal failure
  4. hypercalcemia
  5. depression
85
Q

top 5 workup:

55 yo M presents with fatigue, weight
loss, and constipation. He has a family
history of colon cancer.

A
  1. rectal w/ OBT
  2. CBC
  3. CMP (electrolytes, Ca, BUN/Cr, AST/ALT, TSH)
  4. colonoscopy
  5. barium enema
86
Q

top 5 ddx:

40 yo F presents with fatigue, weight
gain, sleepiness, cold intolerance,
constipation, and dry skin.

A
  1. hypothyroidism
  2. depression
  3. diabetes
  4. anemia
87
Q

top 4 workup:

40 yo F presents with fatigue, weight
gain, sleepiness, cold intolerance,
constipation, and dry skin.

A
  1. TFTs (TSH, FT3, FT4)
  2. CBC
  3. serum glucose
  4. HbA1c
88
Q

top 5 ddx:

50 yo obese F presents with fatigue
and daytime sleepiness. She snores
heavily and naps 3–4 times per day
but never feels refreshed. She also has
hypertension.
A
  1. OSA
  2. hypothyroidism
  3. chronic fatigue syndrome
  4. narcolepsy
89
Q

top 5 workup:

50 yo obese F presents with fatigue
and daytime sleepiness. She snores
heavily and naps 3–4 times per day
but never feels refreshed. She also has
hypertension.
A
  1. CBC
  2. TSH
  3. nocturnal pulse ox
  4. polysomnography
  5. ECG
90
Q

top 5 ddx:

20 yo M presents with fatigue, thirst,
increased appetite, and polyuria.

A
  1. DM type 1
  2. atypical depression
  3. primary polydipsia
  4. diabetes insipidus
  5. DM type 2
91
Q

top 7 workup:

20 yo M presents with fatigue, thirst,
increased appetite, and polyuria.

A
  1. fingerstick glucose
  2. GTT
  3. HbA1c
  4. UA
  5. CBC
  6. electrolytes w/ glucose
  7. BUN/Cr
92
Q

top 4 ddx:

35 yo M policeman c/o feeling tired and
sleepy during the day. He changed to the
night shift last week.

A
  1. sleep deprivation
  2. sleep apnea
  3. depression
  4. anemia
93
Q

top 3 workup:

35 yo M policeman c/o feeling tired and
sleepy during the day. He changed to the
night shift last week.

A
  1. CBC
  2. nocturnal pulse ox
  3. polysomnography
94
Q

top 10 unique Hx items for night sweats?

A
  1. patterns
  2. recent URI
  3. associated pulmonary Sxs (cough, hemoptysis, pleuritic chest pain)
  4. LAN
  5. fever
  6. rash
  7. malaise
  8. weight loss
  9. pruritis
  10. travel hx/exposure to high risk populations
95
Q

top 7 key PE items for night sweats?

A
  1. vitals
  2. HEENT (look for LAN)
  3. CV
  4. pulmonary
  5. abdominal (look for HSM)
  6. skin exam
  7. MSK exam (look for join pain)
96
Q

top 5 ddx:

30 yo M presents with night sweats,
cough, and swollen glands of one
month’s duration.

A
  1. TB
  2. acute HIV
  3. lymphoma
  4. leukemia
  5. hyperthyroidism
97
Q

top 5 workup:

30 yo M presents with night sweats,
cough, and swollen glands of one
month’s duration.

A
  1. PPD
  2. CBC
  3. CXR
  4. sputum gram stain, AFB and Cx
  5. HIV Ab
98
Q

top 10 unique Hx items for insomnia?

A
  1. description (trouble falling asleep vs multiple awakenings vs early morning awakening)
  2. daytime sleepiness
  3. other, significant PMHx (pain from arthritis, etc)
  4. snoring
  5. nightmares
  6. depression
  7. caffiene use
  8. EtOH and drug use
  9. work/lifestyle (constant travel w/ jet lag, shift work, etc)
  10. stress levels and general sleep hygeine
99
Q

BIG two PE items for insomnia?

A
  1. vitals

2. MMSE

100
Q

top 4 ddx:

25 yo F presents with a three-week history
of difficulty falling asleep. She sleeps
seven hours per night without nightmares
or snoring. She recently began college
and is having trouble with her boyfriend.
She drinks 3–4 cups of coffee a day.

A
  1. stress-induced insomnia
  2. caffeine-induced insomnia
  3. circadian rhythm disorder
  4. insomnia related to major depressive disorder
101
Q

top 5 workup:

25 yo F presents with a three-week history
of diffi culty falling asleep. She sleeps
seven hours per night without nightmares
or snoring. She recently began college
and is having trouble with her boyfriend.
She drinks 3–4 cups of coffee a day.

A
  1. polysomnography
  2. mental status exam
  3. urine toxicology
  4. CBC
  5. TSH
102
Q

top 4 ddx:

55 yo obese M presents with several
months of poor sleep and daytime
fatigue. His wife reports that he snores
loudly.

A
  1. OSA
  2. daytime fatigue in primary hypersomnia
  3. circadian rhythm disorder
  4. insomnia related to major depressive disorder
103
Q

top 4 workup:

55 yo obese M presents with several
months of poor sleep and daytime
fatigue. His wife reports that he snores
loudly.

A
  1. CBC
  2. TSH
  3. polysomnography
  4. ECG
104
Q

top 3 ddx:

33 yo F c/o three weeks of fatigue and
trouble sleeping. She states that she falls
asleep easily but wakes up at 3 A.M. and
cannot return to sleep. She also reports
an unintentional weight loss of 3.5 kg
along with an inability to enjoy the
things she once liked to do.
A
  1. insomnia related to major depressive disorder
  2. primary hypersomnia
  3. circadian rhythm disorder
105
Q

top 4 workup:

33 yo F c/o three weeks of fatigue and
trouble sleeping. She states that she falls
asleep easily but wakes up at 3 A.M. and
cannot return to sleep. She also reports
an unintentional weight loss of 3.5 kg
along with an inability to enjoy the
things she once liked to do.
A
  1. mental status exam
  2. TSH
  3. CBC
  4. polysomnography
106
Q

top 9 unique Hx items for sore throat?

A
  1. fever
  2. ear pain
  3. recent/current URI
  4. odynophagia
  5. swollen glands
  6. cough
  7. rash
  8. sick contacts
  9. HIV risk factors
107
Q

top 5 PE items for sore throat?

A
  1. vitals
  2. ENT exam (look for thrush, exudates, erythema, and LAN)
  3. pulmonary
  4. abdominal
  5. skin exam
108
Q

top 5 ddx:

26 yo F presents with sore throat, fever,
severe fatigue, and loss of appetite for
the past week. She also reports epigastric
and LUQ discomfort. She has cervical
lymphadenopathy and a rash. Her
boyfriend recently experienced similar
symptoms.

A
  1. infectious mononucleosis
  2. hepatitis
  3. viral/bacterial pharyngitis
  4. acute HIV infection
  5. secondary syphillis
109
Q

top 5 workup:

26 yo F presents with sore throat, fever,
severe fatigue, and loss of appetite for
the past week. She also reports epigastric
and LUQ discomfort. She has cervical
lymphadenopathy and a rash. Her
boyfriend recently experienced similar
symptoms.

A
  1. CBC w/ peripheral smear
  2. monospot (heterophile nuclear Ab test)
  3. throat swab and Cx
  4. LFTs (AST/ALT/bilirubin/alk phos)
  5. HIV ELISA/p24 Ab test
110
Q

top 5 ddx:

26 yo M presents with sore throat, fever,
rash, and weight loss. He has a history of
IV drug abuse and sharing needles.

A
  1. HIV, acute retroviral syndrome
  2. infectious mononucleosis
  3. hepatitis
  4. viral pharyngitis
  5. endocarditis
111
Q

top 5 workup:

26 yo M presents with sore throat, fever,
rash, and weight loss. He has a history of
IV drug abuse and sharing needles.

A
  1. CBC w/ peripheral smear
  2. HIV ELISA/p24 Ab test
  3. CD4 count
  4. monospot (heterophile nuclear Ab test)
  5. throat swab and Cx
112
Q

top 4 ddx:

46 yo F presents with fever and sore
throat.

A
  1. pharyngitis (bacterial vs viral)
  2. mycoplasma pneumonia
  3. acute HIV infection
  4. infectious mononucleosis
113
Q

top 4 workup:

46 yo F presents with fever and sore
throat.

A
  1. throat swab for Cx and RST
  2. monospot (HNAb test)
  3. CBC
  4. HIV Ab and viral load
114
Q

top 10 unique Hx items for cough/SOB?

A
  1. acute vs chronic
  2. presence & description of sputum
  3. postnasal drip
  4. dyspnea (or cough)
  5. wheezing
  6. chest pain
  7. recent exposures
  8. hx of lung disease
  9. allergies
  10. meds (ACEi, esp.)
115
Q

top 8 key PE items for cough/shortness of breath?

A
  1. vitals
  2. pulse ox
  3. nasal mucosa exam
  4. oropharynx
  5. CV
  6. pulmonary
  7. lymph nodes (neck, axillary and inguinal)
  8. extremity exam (clubbing, cyanosis, edema)
116
Q

top 5 ddx:

30 yo M presents with shortness of
breath, cough, and wheezing that worsen
in cold air. He has had several such
episodes over the past four months

A
  1. asthma
  2. GERD
  3. bronchitis
  4. penumonia
  5. foreign body
117
Q

top 5 workup:

30 yo M presents with shortness of
breath, cough, and wheezing that worsen
in cold air. He has had several such
episodes over the past four months

A
  1. CBC
  2. CXR
  3. peak flow measurement
  4. PFTs
  5. methacholine challenge test
118
Q

top 5 ddx:

56 yo F presents with shortness of breath
as well as with a productive cough that
has occurred over the past two years for
at least three months each year. She is a
heavy smoker.

A
  1. COPD
  2. bronchiectasis
  3. lung cancer
  4. tuberculosis
119
Q

top 5 workup:

56 yo F presents with shortness of breath
as well as with a productive cough that
has occurred over the past two years for
at least three months each year. She is a
heavy smoker.

A
  1. CBC
  2. CXR
  3. sputum gram stain and Cx
  4. PFTs
  5. CT - chest
120
Q

top 5 ddx:

58 yo M presents with pleuritic chest
pain, fever, chills, and cough with
purulent yellow sputum. He is a heavy
smoker with COPD.

A
  1. pneumonia
  2. bronchitis
  3. lung abscess
  4. lung cancer
  5. tuberculosis
121
Q

top 5 workup:

58 yo M presents with pleuritic chest
pain, fever, chills, and cough with
purulent yellow sputum. He is a heavy
smoker with COPD.

A
  1. CBC
  2. sputum gram stain and Cx
  3. CXR
  4. CT - chest
  5. ECG
122
Q

top 5 ddx:

25 yo F presents with two weeks of a
nonproductive cough. Three weeks ago
she had a sore throat and a runny nose.

A
  1. atypical pneumonia
  2. reactive airway dx
  3. URI-associated
  4. postnasal drip
  5. GERD
123
Q

top 5 workup:

25 yo F presents with two weeks of a
nonproductive cough. Three weeks ago
she had a sore throat and a runny nose.

A
  1. CBC
  2. induced sputum gram stain and Cx
  3. CXR
  4. IgM detection for Mycoplasma pneumoniae
  5. urine legionella antigen
124
Q

top 5 ddx:

65 yo M presents with worsening cough
over the past six months together with
hemoptysis, dyspnea, weakness, and
weight loss. He is a heavy smoker.

A
  1. lung cancer
  2. tuberculosis
  3. lung absces
  4. COPD
  5. vasculitis
125
Q

top 5 workup:

65 yo M presents with worsening cough
over the past six months together with
hemoptysis, dyspnea, weakness, and
weight loss. He is a heavy smoker.

A
  1. CBC
  2. sputum gram stain, Cx and cytology
  3. CXR
  4. CT - chest
  5. PPD
126
Q

top 5 ddx:

55 yo M presents with increased dyspnea
and sputum production over the past
three days. He has COPD and stopped
using his inhalers last week. He also
stopped smoking two days ago.
A
  1. acute COPD exacerbation (bronchitis)
  2. lung cancer
  3. pneumonia
  4. URI
  5. CHF
127
Q

top 5 workup:

55 yo M presents with increased dyspnea
and sputum production over the past
three days. He has COPD and stopped
using his inhalers last week. He also
stopped smoking two days ago.
A
  1. CBC
  2. CXR
  3. PFTs
  4. sputum gram stain and Cx
  5. CT - chest
128
Q

top 5 ddx:

34 yo F nurse presents with worsening
cough of six weeks’ duration together
with weight loss, fatigue, night sweats,
and fever. She has a history of contact
with tuberculosis patients at work.
A
  1. tuberculosis
  2. pneumonia
  3. lung abscess
  4. lymphoma
  5. HIV/AIDS
129
Q

top 5 workup:

34 yo F nurse presents with worsening
cough of six weeks’ duration together
with weight loss, fatigue, night sweats,
and fever. She has a history of contact
with tuberculosis patients at work.
A
  1. CBC
  2. PPD
  3. sputum gram stain, AFB and Cx
  4. CXR
  5. CT - chest
130
Q

top 5 ddx:

35 yo M presents with shortness of breath
and cough. He has had unprotected sex
with multiple sexual partners and was
recently exposed to a patient with active
tuberculosis.

A
  1. TB
  2. pneumonia (including PCP)
  3. bronchitis
  4. CHF
  5. asthma
131
Q

top 5 workup:

35 yo M presents with shortness of breath
and cough. He has had unprotected sex
with multiple sexual partners and was
recently exposed to a patient with active
tuberculosis.

A
  1. CBC
  2. PPD
  3. sputum gram stain, AFB, GMS
  4. CXR
  5. HIV ELISA
132
Q

top 5 ddx:

50 yo M presents with a cough that
is exacerbated by lying down at night
and improved by propping up on three
pillows. He also reports exertional
dyspnea.
A
  1. CHF
  2. cardiac valvular dx
  3. GERD
  4. pulmonary fibrosis
  5. COPD
133
Q

top 5 workup:

50 yo M presents with a cough that
is exacerbated by lying down at night
and improved by propping up on three
pillows. He also reports exertional
dyspnea.
A
  1. CBC
  2. CXR
  3. ECG
  4. echocardiography
  5. PFTs
134
Q

What are the top 6 unique Hx items for chest pain?

A
  1. context (exertional, postprandial, positional)
  2. associated symptoms (sweating, nausea, dyspnea, palpitations, sense of doom)
  3. cardiac risk factors (hypertension, hyperlipidemia, smoking, FHx)
  4. Hx of heart dx or diagnostic testing
  5. prior hx of similar symptoms
  6. PE risk factors (hx of DVT, coagulopathy, malignancy, recent immobilization)
135
Q

What are the top 8 key PE items for chest pain?

A
  1. vitals (including BP in both arms)
  2. heart auscultation
  3. JVD
  4. PMI and chest wall tenderness
  5. peripheral pulses
  6. edema
  7. pulmonary exam
  8. abdominal exam
136
Q

top 5 ddx:

60 yo M presents with sudden onset
of substernal heavy chest pain that has
lasted for 30 minutes and radiates to
the left arm. The pain is accompanied
by dyspnea, diaphoresis, and nausea.
He has a history of hypertension,
hyperlipidemia, and smoking.
A
  1. Myocardial infarction (MI)
  2. GERD
  3. angina
  4. costochondritis
  5. aortic dissection
137
Q

top 5 workup:

60 yo M presents with sudden onset
of substernal heavy chest pain that has
lasted for 30 minutes and radiates to
the left arm. The pain is accompanied
by dyspnea, diaphoresis, and nausea.
He has a history of hypertension,
hyperlipidemia, and smoking.
A
  1. ECG
  2. CPK-MD and Troponins I and T
  3. CXR
  4. CBC w/ electrolytes
  5. echocardiography/cardiac cath
138
Q

top 5 ddx:

20 yo African-American F presents with
acute onset of severe chest pain. She
has a history of sickle cell disease and
multiple previous hospitalizations for
pain and anemia management.
A
  1. sickle cell - pulmonary infarction
  2. pneumonia
  3. PE
  4. MI
  5. pneumothorax
139
Q

top 5 workup:

20 yo African-American F presents with
acute onset of severe chest pain. She
has a history of sickle cell disease and
multiple previous hospitalizations for
pain and anemia management.
A
  1. CBC w/ retics, LDH and peripheral smear
  2. ABG
  3. CXR
  4. CPK-MD and troponins I and T
  5. ECG
140
Q

top 5 ddx:

45 yo F presents with a retrosternal
burning sensation that occurs after
heavy meals and when lying down. Her
symptoms are relieved by antacids.

A
  1. GERD
  2. esophagitis
  3. peptic ulcer disease
  4. esophageal spasm
  5. MI
141
Q

top 5 workup:

45 yo F presents with a retrosternal
burning sensation that occurs after
heavy meals and when lying down. Her
symptoms are relieved by antacids.

A
  1. ECG
  2. barium swallow
  3. upper endoscopy
  4. esophageal pH monitoring
  5. urea breath test
142
Q

top 3 ddx:

55 yo M presents with retrosternal
squeezing pain that lasts for two minutes
and occurs with exercise. It is relieved by
rest and is not related to food intake.

A
  1. stable angina
  2. esophageal spasm
  3. esophagitis
143
Q

top 5 workup:

55 yo M presents with retrosternal
squeezing pain that lasts for two minutes
and occurs with exercise. It is relieved by
rest and is not related to food intake.

A
  1. ECG
  2. CPK-MB and troponins
  3. CXR
  4. CXR
  5. echocardiography
144
Q

top 5 ddx:

34 yo F presents with retrosternal
stabbing chest pain that improves when
she leans forward and worsens with deep
inspiration. She had a URI one week
ago.
A
  1. pericarditis
  2. aortic dissection
  3. MI
  4. costochondritis
  5. GERD
145
Q

top 4 workup:

34 yo F presents with retrosternal
stabbing chest pain that improves when
she leans forward and worsens with deep
inspiration. She had a URI one week
ago.
A
  1. ECG
  2. CPK-MB and troponins
  3. CXR
  4. CBC
146
Q

top 5 ddx:

34 yo F presents with stabbing chest pain
that worsens with deep inspiration and is
relieved by aspirin. She had a URI one
week ago. Chest wall tenderness is noted.

A
  1. costochondritis
  2. pneumonia
  3. MI
  4. PE
  5. pericarditis
147
Q

top 5 workup:

34 yo F presents with stabbing chest pain
that worsens with deep inspiration and is
relieved by aspirin. She had a URI one
week ago. Chest wall tenderness is noted.

A
  1. ECG
  2. CPK-MB
  3. CXR
  4. CBC
148
Q

top 5 ddx:

70 yo F presents with acute onset of
shortness of breath at rest and pleuritic
chest pain. She also presents with
tachycardia, hypotension, tachypnea,
and mild fever. She is recovering from
hip replacement surgery.
A
  1. PE
  2. pneumonia
  3. costochondritis
  4. MI
  5. CHF
149
Q

top 6 workup:

70 yo F presents with acute onset of
shortness of breath at rest and pleuritic
chest pain. She also presents with
tachycardia, hypotension, tachypnea,
and mild fever. She is recovering from
hip replacement surgery.
A
  1. ECG
  2. CXR
  3. ABG
  4. CPK-MB and troponins
  5. CBC and electrolytes
  6. CTPA vs D-dimer
150
Q

top 5 ddx:

55 yo M presents with sudden onset of
severe chest pain that radiates to the
back. He has a history of uncontrolled
hypertension.

A
  1. aortic dissection
  2. MI
  3. pericarditis
  4. esophageal rupture
  5. esophageal spasm
151
Q

top 5 workup:

55 yo M presents with sudden onset of
severe chest pain that radiates to the
back. He has a history of uncontrolled
hypertension.

A
  1. ECG, CPK-MB and tropoonins
  2. CXR
  3. CBC, amylase and lipase
  4. TEE
  5. MRI/MRA - aorta
152
Q

What are the top 6 unique Hx items for palpitations?

A
  1. gradual vs acute onset/offset
  2. context (exertion, caffeine, anxiety)
  3. associated Sxs (lightheadedness, chest pain, dyspnea)
  4. hyperthyroid Sxs
  5. Hx of bleeding or anemia
  6. Hx of heart disease
153
Q

What are the 5 key PE items for palpitations?

A
  1. vitals/general (tremor)
  2. endocrine/thyroid exam
  3. HEENT (look for exopthalmos, lid lag, lid retraction, gland size)
  4. check for carotid bruits
  5. CV exam
154
Q

top 5 ddx:

70 yo diabetic M presents with episodes of
palpitations and diaphoresis. He is on insulin.

A
  1. hypoglycemia
  2. cardiac arrhythmia
  3. angina
  4. hyperthyroidism
  5. hyperventilation
155
Q

top 5 workup:

70 yo diabetic M presents with episodes of
palpitations and diaphoresis. He is on insulin.

A
  1. glucose
  2. CBC & electrolytes
  3. TSH
  4. BUN/Cr
  5. ECG/Holter
156
Q

What are the top 10 unique Hx items for weight loss?

A
  1. amount of weight loss
  2. how long since first started
  3. diet hx
  4. psych stuff (body image, anxiety, depression)
  5. B Sxs (fever, chills, night sweats)
  6. palpitations/tremors
  7. GI issues (diarrhea, n/v)
  8. FHx of thyroid dx or cancers (big ones: breast, prostate, lung, colon)
  9. HIV risk factors
  10. EtOH and drug use
157
Q

What PE items should be done for weight loss, minus except MAYBE neuro?

A
  1. vitals

2. all the rest (everything)

158
Q

top 5 ddx:

42 yo F presents with a 7-kg weight loss
over the past two months. She has a fine
tremor, and her pulse is 112.

A
  1. hyperthyroidism
  2. cancer (carcinoid, pheo)
  3. HIV infection
  4. exogenous causes (drug use, surreptitious thyroxine use)
  5. anorexia nervosa (w/ possible concominant drug use for weight loss)
159
Q

top 5 workup:

42 yo F presents with a 7-kg weight loss
over the past two months. She has a fine
tremor, and her pulse is 112.

A
  1. TSH w/ FT3 and FT4
  2. CBC and electrolytes
  3. HIV ELISA
  4. urine toxicology
  5. urinary/serum free metanephrines/ serum 5-HIAA
160
Q

What are the top 7 unique Hx items for weight gain?

A
  1. amount of weight gain
  2. since when
  3. associated setting (recent medication changes, smoking changes, depression, other big life changes)
  4. diet history
  5. hypothyroid Sxs (fatigue, cold intolerance, weight distribution, skin/hair/nail changes, moon face, purple striae)
  6. menstrual irregularities
  7. GI issues (constipation)
  8. EtOH or drug use (marijuana)
161
Q

What PE items should be completed for weight gain, except MAYBE neuro?

A
  1. vitals
  2. everything else, with particular emphasis on signs of cushing’s (hypertension, central obesity, moon face, buffalo hump, supraclavicular fat pads, purple abdominal striae)
162
Q

top 5 ddx:

44 yo F presents with a weight gain
of > 11 kg over the past two months.
She quit smoking three months ago
and is on amitriptyline for depression.
She also reports cold intolerance and
constipation.
A
  1. smoking cessation
  2. dug side effect
  3. hypothyroidism
  4. cushing’s syndrome
  5. PCOS
163
Q

top 5 workup:

44 yo F presents with a weight gain
of > 11 kg over the past two months.
She quit smoking three months ago
and is on amitriptyline for depression.
She also reports cold intolerance and
constipation.
A
  1. CBC w/ electrolytes
  2. serum glucose
  3. TSH
  4. 24 hour urinary free cortisol
  5. dexamethasone suppression test
164
Q

Top 5 unique Hx items for dysphagia?

A
  1. solids vs liquids vs both (progressive)
  2. Associated constitutional Sxs (weight loss, fever)
  3. Drooling, regurgitation or pain
  4. Hxs of: GERD, HIV/HIV risk factors, smoking or Raynaud’s
  5. Meds or recent med changes
165
Q

Top 6 key PE items for dysphagia?

A
  1. vitals
  2. Head and neck
  3. Heart
  4. Pulmonary
  5. Abdominal
  6. Skin (looking for signs of scleroderma/CREST)
166
Q

top 5 ddx:

75 yo M presents with dysphagia that started with solids and progressed to liquids. He is an alcoholic and a heavy smoker. He has had an unintentional weight loss of 7 kg over the past four
months.

A
  1. esophageal cancer
  2. achalasia
  3. esophagitis
  4. systemic sclerosis
  5. esophageal stricture
167
Q

top 5 workup:

75 yo M presents with dysphagia that
started with solids and progressed to
liquids. He is an alcoholic and a heavy
smoker. He has had an unintentional
weight loss of 7 kg over the past four
months.
A
  1. CBC
  2. CXR
  3. endoscopy w/ biopsy
  4. barium swallow
  5. CT - chest
168
Q

top 5 ddx:

45 yo F presents with dysphagia for two
weeks together with fatigue and a craving
for ice and clay

A
  1. Plummer-vinson syndrome
  2. esophageal cancer
  3. esophagitis
  4. achalasia
  5. systemic sclerosis
169
Q

top 4 workup:

45 yo F presents with dysphagia for two
weeks together with fatigue and a craving
for ice and clay

A
  1. CBC
  2. Iron studies: serum iron, ferritin, TIBC
  3. barium swallow
  4. endoscopy
170
Q

top 5 ddx:

48 yo F presents with dysphagia for both
solid and liquid foods that has slowly
progressed in severity over the past year.
It is associated with regurgitation of
undigested food, especially at night.
A
  1. achalasia
  2. plummer-vinson
  3. esophageal cancer
  4. esophagitis
  5. systemic sclerosis
171
Q

top 4 workup:

48 yo F presents with dysphagia for both
solid and liquid foods that has slowly
progressed in severity over the past year.
It is associated with regurgitation of
undigested food, especially at night.
A
  1. CXR
  2. endoscopy
  3. barium swallow
  4. esophageal manometry
172
Q

top 5 ddx:

38 yo M presents with dysphagia and pain
on swallowing solids more than liquids.
Exam reveals oral thrush.

A
  1. esophagitis (CMV, HSV, pill-induced, candida)
  2. systemic sclerosis
  3. GERD
  4. esophageal stricture
  5. zenker’s diverticulum
173
Q

top 5 unique Hx items for n/v?

A
  1. abdominal pain
  2. relation to meals
  3. any sick contacts
  4. pregnancy features/hx
  5. neuro Sxs (headache, stiff neck, vertigo, focal numbness)
174
Q

top 5 key PE items for n/v?

A
  1. vitals
  2. ENT
  3. fundoscopic (for ICP)
  4. complete abdominal exam
  5. +/- heart, lung, rectal
175
Q

top 5 ddx:

20 yo F presents with nausea, vomiting
(especially in the morning), fatigue, and
polyuria. Her last menstrual period was
six weeks ago, and her breasts are full
and tender. She is sexually active with
her boyfriend, and they use condoms for
contraception.
A
  1. pregnancy
  2. gastritis
  3. hypercalcemia
  4. diabetes mellitus
  5. UTI
176
Q

top 5 workup:

20 yo F presents with nausea, vomiting
(especially in the morning), fatigue, and
polyuria. Her last menstrual period was
six weeks ago, and her breasts are full
and tender. She is sexually active with
her boyfriend, and they use condoms for
contraception.
A
  1. urine hCG
  2. pelvic exam
  3. U/S - pelvis
  4. standard labs: CBC, electrolytes, Ca, glucose
  5. UA & UCx
177
Q

top 5 unique Hx items for abdominal pain?

A
  1. relation to meals
  2. associated Sxs: constitutional, GI, cardiac, pulmonary, renal, pelvic
  3. Hx of: abdominal surgery, gallstones, renal stones, vascular dx
  4. EtOH and drug use
  5. domestic violence
178
Q

top 5 key PE items for abdominal pain?

A
  1. vitals
  2. heart
  3. pulmonary
  4. abdominal, including: guarding, rebound, Murphy’s, CVA palpation
  5. (rectal)
  6. (pelvic)
179
Q

top 4 ddx:

45 yo M presents with sudden onset
of colicky right-sided fl ank pain that
radiates to the testicles, accompanied by
nausea, vomiting, hematuria, and CVA
tenderness.
A
  1. nephrolithiasis
  2. renal cell carcinoma
  3. pyelonephritis
  4. GI etiology (appendicitis)
180
Q

top 5 workup:

45 yo M presents with sudden onset
of colicky right-sided fl ank pain that
radiates to the testicles, accompanied by
nausea, vomiting, hematuria, and CVA
tenderness.
A
  1. rectal
  2. UA
  3. UCx and sensitivity
  4. BUN/Cr
  5. CT - abdomen
181
Q

top 5 ddx:

60 yo M presents with dull epigastric
pain that radiates to the back, together
with weight loss, dark urine, and
clay-colored stool. He is a heavy drinker
and smoker.
A
  1. pancreatic cancer
  2. acute viral hepatitis
  3. chronic pancreatitis
  4. cholecystitis/ choledocholithiasis
  5. abdominal aortic aneurysm
182
Q

top 5 workup:

60 yo M presents with dull epigastric
pain that radiates to the back, together
with weight loss, dark urine, and
clay-colored stool. He is a heavy drinker
and smoker.
A
  1. rectal
  2. CBC and electrolytes
  3. amylase and lipase
  4. LFTs (AST/ALT/bilirubin/alk phos)
  5. U/S - abdomen
183
Q

top 5 ddx:

56 yo M presents with severe
midepigastric abdominal pain that
radiates to the back and improves when
he leans forward. He also reports
anorexia, nausea, and vomiting. He is an
alcoholic and has spent the past three
days binge drinking.
A
  1. acute pancreatitis
  2. peptic ulcer disease
  3. cholecystits/choledoco
  4. gastritis
  5. AAA
184
Q

top 5 workup:

56 yo M presents with severe
midepigastric abdominal pain that
radiates to the back and improves when
he leans forward. He also reports
anorexia, nausea, and vomiting. He is an
alcoholic and has spent the past three
days binge drinking.
A
  1. rectal
  2. CBC w/ electrolytes
  3. BUN/Cr
  4. LFTs (AST/ALT/bilirubin/alk phos)
  5. U/S - abdomen
185
Q

top 5 ddx:

41 yo obese F presents with RUQ
abdominal pain that radiates to the right
scapula and is associated with nausea,
vomiting, and a fever of 101.5°F. The
pain started after she had eaten fatty
food. She has had similar but less intense
episodes that lasted a few hours. Exam
reveals positive Murphy’s sign.
A
  1. acute cholecystitis
  2. hepatitis
  3. choledocolithiasis
  4. ascending cholangitis
  5. peptic ulcer dx
186
Q

top 5 workup:

41 yo obese F presents with RUQ
abdominal pain that radiates to the right
scapula and is associated with nausea,
vomiting, and a fever of 101.5°F. The
pain started after she had eaten fatty
food. She has had similar but less intense
episodes that lasted a few hours. Exam
reveals positive Murphy’s sign.
A
  1. rectal
  2. CBC
  3. LFTs (AST/ALT/bili/AP)
  4. U/S abdomen
  5. HIPA scan
187
Q

top 5 ddx:

43 yo obese F presents with RUQ
abdominal pain, fever, and jaundice. She
was diagnosed with asymptomatic
gallstones one year ago.

A
  1. ascending cholangitis
  2. acute cholecystitis
  3. hepatitis
  4. choledocolithiasis
  5. sclerosing cholangitis
188
Q

top 5 workup:

43 yo obese F presents with RUQ
abdominal pain, fever, and jaundice. She
was diagnosed with asymptomatic
gallstones one year ago.

A
  1. rectal
  2. CBC
  3. LFTs
  4. viral hepatitis serologies
  5. U/S - abdomen
189
Q

top 5 ddx:

25 yo M presents with RUQ pain, fever,
anorexia, nausea, and vomiting. He has
dark urine and clay-colored stool.

A
  1. acute hepatitis
  2. acute cholecystitis
  3. ascending cholangitis
  4. choledocolithiasis
  5. pancreatitis
190
Q

top 5 workup:

25 yo M presents with RUQ pain, fever,
anorexia, nausea, and vomiting. He has
dark urine and clay-colored stool.

A
  1. rectal
  2. CBC
  3. amlyase and lipase
  4. LFTs
  5. viral hepatitis serologies
191
Q

top 5 ddx:

21 yo F presents with acute onset of
severe RLQ pain, nausea, and vomiting.
She has no fever, urinary symptoms, or
vaginal bleeding and has never taken
OCPs. Her last menstrual period was
regular, and she has no history of STDs.
A
  1. ovarian torsion
  2. appendicitis
  3. nephrolithiasis
  4. ectopic pregnancy
  5. ruptured ovarian cyst
192
Q

top 5 workup:

21 yo F presents with acute onset of
severe RLQ pain, nausea, and vomiting.
She has no fever, urinary symptoms, or
vaginal bleeding and has never taken
OCPs. Her last menstrual period was
regular, and she has no history of STDs.
A
  1. pelvic exam
  2. urine hCG
  3. rectal
  4. U/S - pelvis w/ color flow
  5. UA
193
Q

top 5 ddx:

68 yo M presents with LLQ abdominal
pain, fever, and chills for the past three
days. He also reports recent onset of
alternating diarrhea and constipation. He
consumes a low-fi ber, high-fat diet.

A
  1. diverticulitis
  2. crohn’s dx
  3. UC
  4. gastroenteritis
  5. abscess
194
Q

top 5 workup:

68 yo M presents with LLQ abdominal
pain, fever, and chills for the past three
days. He also reports recent onset of
alternating diarrhea and constipation. He
consumes a low-fi ber, high-fat diet.

A
  1. rectal
  2. CBC w/ electrolytes
  3. CXR
  4. AbdXR
  5. CT - abdomen
195
Q

top 5 ddx:

20 yo M presents with severe RLQ
abdominal pain, nausea, and vomiting.
His discomfort started yesterday as a
vague pain around the umbilicus. As the
pain worsened, it became sharp and
migrated to the RLQ. McBurney’s and
psoas signs are positive.
A
  1. acute appendicitis
  2. gastroenteritis
  3. diverticulitis
  4. crohn’s dx
196
Q

top 5 workup:

20 yo M presents with severe RLQ
abdominal pain, nausea, and vomiting.
His discomfort started yesterday as a
vague pain around the umbilicus. As the
pain worsened, it became sharp and
migrated to the RLQ. McBurney’s and
psoas signs are positive.
A
  1. rectal
  2. CBC w/ electrolytes
  3. AbdXR
  4. CT - abdomen
  5. U/S - abdomen
197
Q

top 5 ddx:

30 yo F presents with periumbilical pain
for six months. The pain never awakens
her from sleep. It is relieved by
defecation and worsens when she is
upset. She has alternating constipation
and diarrhea but no nausea, vomiting,
weight loss, or anorexia.
A
  1. IBS
  2. crohn’s dx
  3. celiac dx
  4. chronic pancreatitis
  5. GI parasitic infection
198
Q

top 5 workup:

30 yo F presents with periumbilical pain
for six months. The pain never awakens
her from sleep. It is relieved by
defecation and worsens when she is
upset. She has alternating constipation
and diarrhea but no nausea, vomiting,
weight loss, or anorexia.
A
  1. rectal
  2. stool OBT
  3. pelvic
  4. urine hCG
  5. CBC w/ electrolytes
199
Q

top 5 ddx:

24 yo F presents with bilateral lower
abdominal pain that started with the first
day of her menstrual period. The pain is
associated with fever and a thick,
greenish-yellow vaginal discharge. She
has had unprotected sex with multiple
sexual partners.
A
  1. PID
  2. endometriosis
  3. STD/vaginitis
  4. cystitis
  5. spontaneous abortion
200
Q

top 5 workup:

24 yo F presents with bilateral lower
abdominal pain that started with the fi rst
day of her menstrual period. The pain is
associated with fever and a thick,
greenish-yellow vaginal discharge. She
has had unprotected sex with multiple
sexual partners.
A
  1. pelvic
  2. rectal
  3. urine hCG
  4. cervical Cxs
  5. CBC/ESR/UA/UCx
201
Q

What are the top 10 unique Hx items for constipation/diarrhea?

A
  1. frequency and volume of stools
  2. associated Sxs (constitutional, abdominal pain, bloating, incomplete evacuation)
  3. stool color change (melena/Fe overload) or frank blood
  4. thyroid dx Sxs
  5. diet (esp. fiber and fluid intake)
  6. recent med changes (esp. antibiotics)
  7. sick contacts
  8. recent travel (esp. camping)
  9. HIV risk factors
  10. FHx of CC
202
Q

What are the top 5 PE items for constipation/diarrhea?

A
  1. vitals
  2. thyroid/endocrine exam
  3. abdominal exam
  4. rectal exam
  5. pelvic exam (if female)

Step 2 CS (3 decks)

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