Minicases Flashcards
Physical exam for headache
vital signs, inspection and palpation of the entire head; ENT inspection; complete neuro exam including fundascopic!
Ddx for headache
Migraine, tension HA, cluster HA, pseduotumor cerbetri, sinusitis, intracranial neoplasm, meningitis, SAH, trigeminal neuralgia
Sx of cluster headache
unilateral and pain near the eye + rhinorrhea, eye tearing, redness
Workup of cluster headache
CBC, CT head, MRI brain, LP: CSF analysis, ESR
Sx of migraine
Throbbing pain, aura (visual changes and weakness), nausea, vomiting, photo/phonophobia. Family history
Workup of migraine
CBC, ESR, CT head, MRI brain, LP: CSF analysis
Right temporal headache, fever, blurry vision and pain in jaw
Temporal arteritis (giant cell)
Workup for Temporal arteritis
ESR, CBC, CRP, temporal artery biopsy, carotid doppler US, MRI brain, LP: CSF analysis
Sx of sinusitis
Frontal headache, fever, nasal discharge, pain w palpation of the frontal and maxillary sinuses. History of allergies
Workup of sinusitis
CBC, Sinus XR, CT sinus, LP: CSF analysis
Sx of Tension headache
Bilateral squeezing, happens at the end of the work day and several times per week, recent stress, decrease caffeine intake
Workup of sinusitis
CBC, electrolytes, ESR, CT head, LP: CSF analysis
Sx of SAH
Sudden severe HA, vomiting, confusion, left hemiplegia, nuchal rigidity
Workup of SAH
Non contrast head CT, LP: CSF analysis, CBC, PT/PTT/INR, urine tox
Sx of meningitis
High fever, severe HA, confusion, photophobia, nuchal rigidity
Sx of pseudo tumor cerebri
Obese female, pulsatile HA, vomiting, blurred vision, taking OCP
Workup of pseudo tumor cerebri
Urine hCG, CBC, head CT, LP: opening pressure and CSF analysis
Confusion/memory loss: Key History
Get info from family, time course (acute vs. chronic/gradual), associated sx, impact n ADL, delirium, falls, medication, hx of stroke, alcohol use, family hx
Associated sx of confusion/memory loss
Incontinence, ataxia, hypothyroid symptoms, depression
Physical exam: Confusion/memory loss
Vital signs, complete neuro exam including mini mental and gait, ENT, heart, lungs, abd and extremities
Ddx of Confusion/memory loss
Alzheimer’s, Vascular (multi-infarct) dementia, normal pressure hydrocephalus, depression, B12 deficiency, neurosyphilis. hypothyroidism, Lewy bobdy dementia,
Workup for Confusion/memory loss
CBC, LDRL/RPR, Serum B12, TSH, Brain MRI, CT head, LP: CSF analysis
Sx of vascular (multi-infarct) dementia
Progressive confusion over years + forgetfulness and clumsiness. Hx of HTN, DM, strokes (with worsening mental status = stepwise decline in cognitive function)
Sx of normal pressure hydrocephalus
“Wet, wacky, wobbly” - urinary incontinence, gait disturbances, and memory loss
History in Depressed Mood
Onset, duration, sleep pattern, appetite, weight changes, drug and alcohol use, life stresses, excessive guilt, suicidality, social function, decreased interest (anhedonia), decreased energy, decreased concentration, psychomotor agitation/retardation, family hx
Physical exam for Depressed Mood
Vital signs, head and neck exam, neuro exam, mental status (appearance, behavior, speech, mood, affect, thought process, thought content, cognition, insight and judgement
Workup for Depressed Mood
TSH, CBC, Urine tox, Beck depression inventory, blood alcohol level
Key history in dizziness
Lightheadedness vs. vertigo, auditory sx (hearing loss, tinnitus), duration of sx, context (position, head trauma), associated sx (visual disturbance, URI, N/V), neck pain, meds
Physical exam for Dizziness
Vital signs, neuro exam: Romberg, nystagmus, tilt test (Dix-Hallpike), gait, hearing, and Weber and Rinne, ENT, cardiovascular exam
DDx for Dizziness
Meniere’s disease, benign positional vertigo, vestibular neuronitis, labyrinthitis, orthostatic hypotension
Sx of Meniere’s disease
Intermittent episodes of vertigo, tinnitus, nausea, and hearing loss
Sx of benign positional vertigo
Dizziness w head movement = room spinning, nausea, no hearing changes
Sx of vestibular neuronitis
Dizziness, nausea, vomiting, past URI and no hearing loss
Sx of Labyrinthitis
Dizziness and not hearing well, nausea, vomiting, past URI
Workup of Dizziness
CBC, orthostatic vital signs, Dix-Hallpike, MRI brain, VDRL/RPR, electrolytes, audiogram
Work up on Loss of Consciousness/Seizure
CBC, electrolytes, glucose, urine tox, EEG, MRI brain. CT head, LP: CSF analysis, ECG
DDx for Loss of Consciousness
Seizure, orthostatic hypotension (syncope), cardiac arrhythmia
DDx for Numbness/Weakness
TIA, stroke, seizure, Guillian-Barre, MS, Diabetic peripheral neuropathy
History for Fatigue and Sleepiness
Duration, sleep hygiene, snoring, waking up choking/gasping, witnessed apnea, overexertion, stress, depression, lifestyle changes: work, diet, thyroid sx, bleeding or anemia, meds, alcohol, caffeine, drugs
Fatigue and Sleepiness: Physical Exam
Vital signs, ENT exam (conjunctival pallor, oropharynx/palate, lymphadenopathy, thyroid exam); heart, lungs, and, neuro, and extremities (pallor, coolness at distal parts)
DDx for Fatigue and Sleepiness
Depression, hypothyroid, anemia, OSA, diabetes, anemia/colon cancer,
Work up for Fatigue and Sleepiness
CBC, TSH, Beck Depression Index, Occult blood testing, HA1C, glucose tolerance test
History for Sore Throat
Duration, fever, ENT sx (ear pain, nasa or sinus congestion) odynophagia, swollen glands, cough, rash, sick contacts, HIV risk factors
Sore Throat: Physical exam
Vital signs, ENT exam, lymphadenopathy, lung, abdominal (splenomegaly), skin exam
DDx for Sore Throat
Pharyngitis (bacterial or viral), Infectious Mononucleosis, acute HIV retroviral syndrome
Workup for Sore Throat
CBC with peripheral smear, throat swab for culture and rapid strep antigen, monospot test, HIV test
History for Cough/Shortness of breath
Acute vs chronic, timing, presence/description of sputum, hemoptysis, associated sx (URI, postnasal drip, dyspnea, wheezing, chest pain, heart burn), exacerbating and alleviating factors, smoking, vomiting, allergies, meds (AECi)
Physical exam for Cough/Shortness of breath
Vital signs, pulse ox, nasal mucosa, oropharynx, heart, lungs, lymph nodes, and extremities (clubbing, cyanosis, edema)
DDx for Cough/Shortness of breath
Asthma, COPD, GERD, Bronchitis, Pneumonia, post nasal drip, postinfectious, Lung cancer, TB, CHF
Workup for Cough/Shortness of breath
CBC, chest xray, sputum gram stain and culture, PFTs, peak flow measurement, PPD,
Physical exam for Chest pain
Vital signs, BP in both arms, complete cardiovascular exam (JVD, PMI, chest wall tenderness, heart sounds, pulses, edema), lung, abdominal, lower extremities (DVT)
DDx for Chest Pain
MI, GERD, Angina, Costochondritis, Aortic dissection, PE, pericarditis
Workup for Chest pain
EKG, CPK-MB and troponins, chest xray, CBC, echo, cardiac cath, D-dimer, electrolytes, Barium swallow/upper endoscopy
History for palpitations
Gradual vs. acute on/offset, context (exertion, caffeine, anxiety), lightheadedness, loss of consciousness, chest pain, dyspnea, fever, sweating, pale skin, flushing, diarrhea, hyperthyroid sxs, hx of heart disease, hypertension, dm
Physical exam for palpitations
Vital signs, endocrine/thyroid exam: exophthalmos, lid retraction, lid lag, gland size, bruit and tremor, complete cardiovascular exam
DDx for Palpitations
Hypoglycemia, cardiac arrhythmia, angina, hyperthyroidism, panic attack, substance use, mitral valve prolapse
Workup for Palpitations
CBC, glucose, electrolytes, TSH, EKG, Holter monitor, urine tox, echo
