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USMLE step 2CS > Minicases > Flashcards

Minicases Flashcards

1
Q

Headache: History

A
  • OPQRST
  • unilateral vs bilateral
  • dull vs stabbing
  • intensity
  • disturb sleep
  • neurological sxs (paresthesia, weakness, numbness, ataxia, stiffness)
  • n/v
  • exacerbating factors: fatigue, menses, food, exercise
  • alleviating: rest, medication
  • Family history
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2
Q

Headache: PE

A 
Vitals
Inspect & palpate head
ENT
Neuro exam
Fundoscopic
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3
Q

Headache DDX

A 
Migraine
Tension headache
Cluster headache
Psuedotumor cerebri
Trigeminal neuralgia
CNS vasculitis
Neoplasm
Meningitis
Sinusitis
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4
Q

Headache: Workup

A 
CBC
ESR
CT-head
MRI-brain
LP
XR- Sinus
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5
Q

Confusion: History

A 
History from family members
Time course: acute vs chronic
Associated sxs: constitutiaonl, ataxia, hypothyroid, depression
Screen for delirium: waxing/waning
Falls
Medications

PMH: stroke, vascular disease, syphillis, HIV, alcohol, vitamin B deficiency

FH: Alzheimer

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6
Q

Confusion PE

A 
Vitals
Neuro Exam
MMSE
Gait
ENT, Heart Lung, abdomen, Ext
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7
Q

Confusion DDx

A 
Vascular dementia
Alzheimer disease
NPH
Chronic subdural hematoma
Intracranial tumor
Depression
B12 deficiency
Hypothyroidism
Creutzfeldt-Jakob
Hypoglycemia
Wernicke encephalopathy
Delirium
SIADH
TIA
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8
Q

Confusion Workup

A 
CBC
VRDL/RPR
B12
TSH
MRI-Brain
CT-Head
LP
EEG
Glucose
Electrolytes
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9
Q

Depressed mood: History

A 
Onset
Duration
Sleep patterns
Appetite
Weight change
Drug and alcohol use
Life stresses
Guit
Suicidality
Social function
Decreased interest
Energy
Concentration
Suicidality
Agitation
Retardation

FH: Mood disorders
PMH: prior episodes
Meds

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10
Q

Depressed Mood PE

A

Vitals
HEENT
Neuro
MSE (behavior, speech, mood, affect, thought process, content, cognition, insight, judgement)

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11
Q

Depressed Mood DDx

A 
Bereavement
adjustment disorder with depressed mood
Schizoaffective disorder
depressive disorder
MDD
Bipolar I Disorder
Substance-induced
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12
Q

Depressed Mood Workup

A 
Physical Exam
MSE
TSH
CBC
Urine Toxicology
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13
Q

Psychosis History

A

Positive sxs: Hallucinations, Delusions, Disorganized thoughts, catatonic behavior
Negative sxs: blunted affect, social withdrawal, decreased motivation, decreased speech, thought patterns

PMH: age at first sxs, hospitalizations
Social hx: alcohol/ substance use

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14
Q

Psychosis PE

A

Vitals

MSE

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15
Q

Psychosis DDx

A 
Schizophrenia
Schizoid or schizotypal personality DO
Schizophreniform
Psychotic DO d/t medication
Depression with psychotic features
Substance induced psychosis
Schizoaffective DO
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16
Q

Dizziness History

A 
Lightheadedness
vertigo
auditory (hearing loss, tinnitis)
duration
positioning
head trauma
Associated sxs: visual disturbance, URI, nausea, neck pain

Meds
PMH: atherosclerotic disease

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17
Q

Dizziness PE

A 
Vitals
Neuro exam
Romberg
Nystagmus
Dix-Hallpike
Gait
Hearing
Weber/Rinne
ENT
CV
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18
Q

Psychosis Workup

A 
MSE
Urine Toxicology
TSH
CBC
Electrolytes
AST/ALT
Beck Depression Inventory
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19
Q

Dizziness DDx

A 
Meniere disease
vestibular neuronitis
labyrinthitis
BPPV
Acoustic neuroma
Orthostatic hypotention
Vertebrobasilar insufficiency
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20
Q

Dizziness Workup

A 
Vitals
Orthostatic vitals
CBC
Electrolytes
MRI-brain
Dix-Hallpike
Audiogram
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21
Q

Loss of Consciousness History

A 
Preceding Sxs (nausea, diaphoresis, palpitations, pallor, lightheadedness)
Postural
Exertional
Traumatic
Stressful
Painful
Claustraphobic
Dehydration
Tongue biting
Incontinence
Tonic-clonic movementes
prolonged confusion
dyspnea

PMH: PE risk factors, Heart disease, arrhythmia, HTN, DM
Social: alcohol/ drug use

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22
Q

LOC PE

A 
Vitals
orthostatics
Neuro
Carotid and cardiac exam
Lung exam
LE exam
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23
Q

LOC DDx

A 
Tonic Clonic seizures
Drug induced orthostatic hypotension
Cardiac arrhythmia
SYncope
Stroke
MI
PE
Malingering
Hypoglycemia
Seizure
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24
Q

LOC Workup

A 
CBC
electrolytes
Urine toxicology
MRI-brain
CT-brain
LP
EKG
EEG
Holter monitoring
Glucose
Substance-induced
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25
Numbness History
``` Distribution Unilateral vs bilateral duration progression pain constitutional signs ``` PMH: diabetes, alcoholism, atherosclerotic disease
26
Numbness PE
Vitals Neuro MSK vascular
27
Numbness DDx
``` TIA Hypoglycemia Seizure Stroke Intracranial neoplasm Guillain Barre Myasthenia peripheral neuropathy Conversion D/O Neurosyphyllis CNS vasculitis Syringomyelia Hypocalcemia Hyperventilation AML Todd paralysis Malingering ```
28
Numbness Workup
``` CBC Glucose electrolytes EKG CT-head MRI-brain Doppler carotids Echnocardiogram EEG PT/PTT/INR LP B12 Tensilon Test HbA1c ```
29
Fatigue History
``` Duration Sleep Snoring Waking up choking/ gasping Witnessed apnea overexertion stress depression emotional programs Lifestyle changes Shift changes Diet Weight changes Thyroid ``` PMH: anemia, bleeding Meds Social: alcohol/ drugs
30
Fatigue PE
``` Vitals ENT (conjunctival pallor, oropharynx/palate, lymphadenopathy, thyroid) CV Lung Neuro Extremity Consider rectal, FOBT ```
31
Fatigue DDx
``` Depression Adjustment DO Hypothyroidism Anemia PTSD Psychotic DO Colon cancer OSA DM Sleep deprivation ```
32
Fatigue Workup
``` CBC TSH HIV/STD FOBT Urine Toxicology HbA1c Polysomnography UA BUN/Cr Urine Toxicology ```
33
Night Sweats History
``` Onset duration severity frequency timing Recent URI Cough, hemoptysis, lymphadenoathy, fever, rash, weightloss, diarrhea, n/v, early satiety, sexual exposure, sick contacts High risk: prisoner, homeless ``` Menstrual history
34
Night sweat PE
``` Vitals HEENT throat inspection Heart/ Lungs Skin MSK ```
35
Night Sweats DDX
``` TB Acute HIV Lymphoma Leukemia Hyperthyroidism ```
36
Night Sweats workup
``` PPD CBC CXR Sputum gram stain HIV antibody TSH, FT4 ```
37
Insomnia history
``` Duration trouble falling asleep multiple awakenings early morning wakenings daytime sleepiness snorning nightmares depression caffeine sleep hygiene ``` PMH: other medical problems-- arthritis, DM Social: work, recreation, lifestyle, stressors
38
Insomnia PE
Vitals | MSE
39
Insomnia DDx
``` Stress induced caffeine induced Circadian rhythm sleep disorder MDD OSA ```
40
Insomnia Workup
CBC TSH Polysomnography EKG
41
Sore throat History
``` Duration Fever ENT (early pain, nasal or sinus congestion) Odynphagia Swollen glands Cough Rash Sick contacts ``` Social: HIV risk fators
42
Sore throat PE
``` Vitals ENT exam (thrush, tonsillar exudate, lymphadenopathy) Lung Abdominal Skin ```
43
Sore throat DDx
``` infectious Mononucleosis Hepatitis Pharyngitis Acute HIV Syphilis Streptococcal tonsillitis Scarlet fever Mycoplasma pneumonia ```
44
Sore throat workup
``` CBC with peripheral smear Monospot test throat culture AST/ALT HIV antibody VDRL/RPR CD4 Throat swab for culture and rapid streptococcal antigen ```
45
Cough/SOB history
``` acute vs chronic frequency Sputum constitutional URI post-nasal drip dyspnea wheezing chest pain heartburn Timing exposures ``` SocHx: smoking hx PMH: lung disease Allergies Medications
46
Cough PE
``` Vitals pulse oximetry nasal mucosa Heart Lung, lymph nodes extremities clubbing, cyanosis, edema ```
47
Cough DDx
``` asthma GERD Bronchitis Pneumonitis Foreign body COPD Bronchiectasis Lung cancer TB Pneumonia Lung abscess pericarditis URI associated cough (post-infectious) Post-nasal drip CHF TB Sarcoidosis Cancer ```
48
Cough Workup
``` CBC sputum gram stain CXR CT Chest PPD IgM mycoplasma, Urine legionella HIV EKG Echo PFTs BNP Bronchoscopy ```
49
Chest Pain history
``` Location Quality severity radiation duration context associated sxs: sweating, nausea, dyspnea, palpitation, sense of doom Exacerbating, alleviating PE: DVT, coagulopathy, malignancy, recent immbilization ``` PMH: HTN, hyperlipidemia Social: Smoking Family hx: early MI
50
Chest pain PE
``` Vitals BP in both arms JVD PMI Chest wall tenderness, heart sounds, ,pulses lung abdominal ```
51
Chest pain DDx
``` MI GERD Angina Costochondritis Aortic dissection pericarditis pneumothorax Esophagitis esophageal spasm ```
52
Chest pain workup
``` EKG CK-MB, troponin CXR echocardiogram CTA Upper endoscopy cardiac carth amylase, lipiase TEE ```
53
Palpitations History
gradual vs acute onset/ offset context (exertion, caffeine anexiety
54
Palpitations PE
vitals endocrine thyroid (exopthalmos, lid retraction, lid lag, gland size, bruit) CV
55
Palpitations DDx
``` Hypoglycemia Panic attack Social phobia cardiac arrhythmia angina Hyperthyroidism GAD ```
56
Palpitations workup
``` CBC glucose electrolytes TSH EKG Holter Echnocardiograph MSE Urine toxicology ```
57
Weight loss History
``` amount suration intention diet body image anxiety deprssion palpation tremor diarrhea blood in stool or urine ``` Fam Hx: thyroid, cancers Social: HIV, tobacco, alcohol, drug use
58
Weight loss PE
Vitals | Physical
59
Weight loss ddx
``` Hyperthyroidism cancern HIV infection Dieting Diet drugs Anorexia Malabsorption ```
60
Weight gain History
``` amount duration timing smoking depression diet history hypothyroid: Fatigue, Constipation, skin/hair/nail changes menstrual irregularity ``` Social: alcohol/drug use
61
Weight gain PE
``` Vitals Cushings (HTN, central obesity, Moon facies, buffalo hump, supraclavicular fat pads, purple abdominal striae) ```
62
Weight gain DDX
``` Smoking cessation Drug side effect hypothyroidism Cushing PCOS DM Atypical depression ```
63
Weight gain workup
``` CBC electrolytes glucose TSH Dexamethasone suppression ```
64
Weight loss workup
``` TSH CBC electrolytes HIV antibody Urine toxicology ```
65
Dysphagia History
``` Solids/ liquids Progression Constitutional ( weight loss) Drooling Regurgitation odynophagia GERD Medications ``` Social: HIV, smoking PMH: raynauds
66
Dysphagia PE
Vitals HEENT Heart, lung, abdomen Skin
67
Dysphagia DDx
``` Esophagela cancer Achalasia Esophagitis Systemic sclerosis Esophageal stricture Mitral valve stenosis Zenker Diverticulum ```
68
Dysphagia Workup
``` CBC CXR Endoscopy with biopsy Barium swallow HIV antibody CD4 CT chest ```
69
Nausea/ Vomiting History
``` Acuity onset abdominal pain relation to meals sick contacts possible food poisoning possible pregnancy neuro sxs associated GI sxs alleviating factors ```
70
Nausea/Vomiting PE
``` Vitals ENT Fundoscopic exam complete abdominal exam heart lungs rectal ```
71
Nausea/Vomiting DDx
``` Pregnancy gastritis hypercalcemia DM UTI Depression ```
72
Nausea/vomiting Workup
``` Urine B-HCG Pelvic exam U/S pelvis CBC electrolytes calcium glucose UA Urine cx Baseline pap cervical cx rubella Hep B VDRL ```
73
Abdominal Pain History
``` Location quality intensity duration radiation timing ( timing to meals) associated sxs (constitutional, GI, cardic, pulmonary, renal) Exacerbating and alleviating factors ``` Past surgical hx PMH: gallstones, atherosclerosis, vascular disease Meds Social Hx: alcohol and drug use, drug violence
74
Abdominal Pain DDx
``` Nephrolithiasis RCC Pyelonephritis appendicitis pancreatic cancer acute viral hepatitis chronic pancreatitis cholecystitis AAA PUD Gastritis Mallory-Weiss tear Hepatitis Ascending cholangitis mesenteric ischemia Splenic rupture Intestinal obstruciton volvulus Gastroenteritis Ileus Hernia Ruptured ovarian cyst Crohns ulcerative colitis abscess ectopic pregnancy ```
75
Constipation/ Diarrhea History
``` Frequency and volume of stools duration of change in bowel habits associate sys ( constituational, abdominal pain, bloating) thyroid diet (fiber, fluid) medications sick contacts travel camping HIV ``` Past surgical hx PMH: DM, pancreatitis Social hx: alcohol and drug use Family hx: colon cancer
76
Constipation/ Diarrhea PE
``` vitals thyroid/endocrine abdominal rectal exam female pelvic exam ```
77
Constipation/ Diarrhea DDX
``` colorectal cancer IBS Diverticulosis GI parasitic infection Low fiber diet Celiac disease Gastroenteritis Lactose intolerance C.diff Giardiasis Hyperthyroidism ```
78
Abdominal Pain workup
``` Rectal exam Pelvic exam Urine HCG CBC Electrolytes Colonscopy CT- abdoment/ pelvis Stool for ova and parasites UA CXR ```
79
Constipation workup
``` rectal exam stool for occult blood CBC electrolytes CT abdomen/pelvis C.diff toxin in stool AST/ALT/ALk phos Stool leukocytes, culture, giardia, entamoeba Hydrogen breath test Small bowel series ```
80
Upper GI Bleeding History
``` Amount Duration context (severe vomiting, alcohol ingestion, nosebleed) Associated sxs ( N/V/abd pain) easy bleeding ``` Meds (wafarin, NSAIDS) PMH: peptic ulcer, liver disease, AAA
81
Upper GI Bleeding PE
``` Vitals Orthostasis ENT Heart Lung abdominal pain rectal exam ```
82
Upper GI Bleed DDX
``` Peptic ulcer Gastritis Gastric cancer Esophageal varices Mallory Weiss ```
83
Upper GI Bleed Workup
``` Rectal exam CBC, electrolytes ASL/ALT Bilirubin Endoscopy Barium swallow ```
84
Blood in stool history
Melena vs. bright red blood amount duration associated sxs ( constitutional, abdominal or rectal pain, tenesmus, constipation) trauma Medications (warfarin) PMH: easy bleeding, vascular dz
85
Blood in stool PE
Vitals Orthostatic abdominal rectal exam
86
Blood in stool Workup
``` rectal exam cbc PT/PTT AST/ALT/ bilirubin/alk phos CEA Colonoscopy CT abdomen/pelvis Barium enema CT-abdomen/ pelvis AXR ```
87
Blood in stool DDx
``` UC Crohn Hemorrhoids Diverticulosis Dysentery Angiodysplasia anal dissure ischemic bowel disease Upper Gi bleeding IBD Colorectal cancer ```
88
Hematuria history
``` amount duration clots associated (constitutional, renal colic, dysuria, irritative or voiding sxs) vigorous exercise ``` Meds PMH: cancer, easy bleeding, stones social: alcohol/drugs
89
Hematuria PE
``` Vitals Lymph nodes abdominal exam GU Rectal exam extremities ```
90
Hematuria DDx
``` Bladder cancer RCC Nephrolithiasis Acute GN prostate cancer Coagulation DO PKD UTI ```
91
Hematuria Workup
``` GU exam UA Urine Cytology BUN/Cr PSA CBC PT/PTT US-renal/blasser CT-abd/pelvis IVP UA rectal exam ```
92
Other urinary sxs
Duration obstructive (hesitancy, diminished stream, sense of incomplete emptying, straining, post void dribbling) irritative sxs (urgency, frequency, nocturia) Constitutional (bone pain( Medications PMH: Uti, stones, DM Social: Alcoholism
93
Other urinary sxs PE
``` vitals abdominal exam (suprapubic) genital exam rectal exam Focused neuro exam ```
94
Urinary Sxs DDX
``` Urethritis cystitis prostatitis acute pylonephritis Nephrolithiasis RCC Lower UTI Stress incontinence Urge incontinence Overflow incontinence DM ```
95
Urinary Sxs Workup
``` genital exam rectal exam urine culture gram stain/ culture Chlamydia and gonorrhea PCR US -renal CT-abdomen Bun/Cr IVP cystourethroscopy ```
96
Erectile Dysfunction History
``` Duration Severity nocturnal erections libido stress or depression trauma ``` Medications PMH: HTN, DM, high cholesterol, atherosclerotic vascular disease social: smoking, alcohol and drug
97
Erectile Dysfunction PE
Vitals CV Genital and rectal exam
98
Erectile Dysfunction DDX
``` Drug related ED HTN DM Psychogenic peyronie ```
99
Erectile dysfunction Workup
GU exam Rectal exam Glucose CBC
100
Amenorrhea History
Primary vs secondary duration pregnancy associated sxs (Headache, decreased peripheral vision, galactorrhea, hirsutism, hot flashes, vaginal dryness, thyroid) PMH: anorexia, dieting, exercise, pregnancy, uterine infections PSH: D&C Meds SocHx: drug use
101
Amenorrhea PE
Vitals Breast exam Pelvic exam
102
Amenorrhea DDX
``` pregnancy anovulatory cycle hyperprolactinemia UTI thyroid disease PCOS Ovarian or adrenal malignancy premature ovarial failure Prolactinoma pituitary tumor menopause Sheehan syndrome Asherman syndrome Anorexia ```
103
Amenorrhea Workup
``` Pelvic exam Urine hCG US pelvis CBC, electrolytes UA urine cx prolactin TSH Pap LH/FSH prolactin Testosterone DHEAS MRI-Brain ACTH Hysteroscopy Urine Cortisol ```
104
Vaginal Bleeding History
``` Pre/post menopausal duration amount menstrual history relation to last period associated ( diacharge, pain, Urinary sxs) Trauma ``` Medication (wafarin, POC) PMH: easy bleeding, abnormal pap
105
Vaginal Bleeding PE
Vitals Abdominal exam Pelvic exam
106
Vaginal Bleeding DDx
``` Dysfunctional uterine bleeding coagulation DO cervical cancer molar pregnancy hypothyroidism DM Endometrial Ca Cervical CA atrophic endometrium atrophic vaginitis trauma Spontaneous abortion Ectopic ovarian torsion PID ```
107
Vaginal Bleeding Workup
``` Pelvic exam Urine HCG Cervical cultures US pelvis CBC Pt/PTT Prolactin TSH LH/FSH ```
108
Vaginal Discharge History
``` amount color consistency odor duration associated vaginal burning pain last menstrual period use of contraceptives tampons douches ``` PMH: STD
109
Vaginal Discharge PE
Vitals abdominal pain complete pelvic exam
110
Vaginal discharge DDX
Bacterial vaginosis Vaginitis-candida Cervicitis (Gonorrhea, chlamydia) Vaginitis-trichomonal
111
Vaginal Discharge Workup
``` Pelvic exam Wet mount cervical cx KOH pH ```
112
Dyspareunia History
``` Duration timing associated sxs (vaginal discharge, painful meses, GI sxs, hot flashes) Sexual history Trauma Domestric violence Endometriosis PID ``` PSH: prior abd/GU surgeries
113
Dyspareunia PE
VItals Abdominal exam pelvic exam
114
Abuse history
``` confidentiality question about physical, sexual or emotional abuse safety, backup plan hx of accidents mental illness ``` SocHx: drug use, firearms
115
Abuse PE
vitals complete exam pelvic exam
116
Abuse DDX
Rape Domestic violence Substance abuse
117
Abuse workup
``` pelvic exam urine hcg wet mount KOH x-ray ( skeletal survey) CBC HIV antibody ```
118
Dyspareunia workup
``` pelvic exam wet mount KOH US pelvic laparoscopy ```
119
Joint/Limb History
``` location duration intensity quality pattern Constitutional ( red eye, genital ulcers, diarrhea, dysuria, rash, focal numbness, weakness) exacerbating and alleviating factors DVT risk ``` SocHx: alcohol and drug use FamHx: rheumatic
120
Joint/Limb PE
Vitals HEENT MSK Neurovascular
121
Joint/Limb DDx
``` Domestic violence Factitious D/O Substance abuse SLE RA Psoriatic Hip fracture Hip dislocation Osteoarthritis Septic arthritis Gout Trauma Reiter Sprain epicondylitis PVD DVT Shoulder dislocation ```
122
Joint/Limb Workup
``` ANA Anti-ds DNA Xray Arthrocentesis RF, ESR Uric acid CT/MRI DEXA PT/PTT Doppler CPK urine myoglobin TSH ```
123
Low Back pain History
``` Location quality intensity radiation context (moving, bending, twisting) timing associated (constitutional, incontience) URI ``` PMH: DM, renal stones SocHx: IVDU, smoking
124
Low Back pain PE
``` Vitals Neuro (L4-S1) back palpation ROM hip exam Rectal ```
125
Low back DDX
``` disk herniation lumbar muscle strain AAA vertebral compression fractures PVD Malingering Ankylosing spondylitis ```
126
Low Back workup
Xray- Spine MRI Spine CT spine ABI
127
Child with Fever History
``` Severity Duration localizing sxs appetite rash sick contacts day care immunization ```
128
Child with fever PE
``` Vitals HEENT Neck Heart Lung Abdominal Skin exam ```
129
Child with fever DDX
``` sepsis meningitis pneumonia UTI Acute OM Measles Rubella Roseola Varicella Gastroenteritis UTI URI ```
130
Child with fever workup
``` PE CBC electrolytes UA Urine culture Blood cultures CXR LP- CSF analysis UA Throat swab ```
131
Child with GI sxs history
Onset, location, quality, intensity, radiation Associated sxs ( constitutional, GI, cardiac, pulm, renal pelvic) Exacerbating and alleviating factors day care immunication changes in weight Medications
132
Child with GI PE
``` vitals heart and lung abdominal rectal pelvic ```
133
Child with GI ddx
``` pyloric stenosis duodenal atresia GERD gastroenteritis Hepatitis UTI Hypothyroidism intussusception appendicitis Meckel Diverticulum Volvulus Gasteroenteritis Malingering IBS lactose intolerance Colic lactose intolerance testicular torsion sepsis ```
134
Child with GI sxs workup
``` PE CBC Electrolytes US-abd barium swallow Contrast enema US abdomen CT abdomen Blood cx Stool exam amylase/ lipase FOBT ```
135
Child with Red eye History
``` onset location duration Discharge Sick contacts Immunication Constitutional: GI, cardiac, pulmonary, renal) ``` Medications
136
Child with red eye ddx
``` Bacterial conjunctivitis viral conjunctivitis keratitis sesonal allergies uveitis ```
137
Child with red eye workup
``` PE Opthalmoscopic exam CBC Electrolytes Discharge Slit lamp ```
138
Child with short stature
``` Prenatal and birth history growth history PMH Medications FamHx Constitutional: GI, cardiac, pulm, renal, pelvis ```
139
child with short stature PE
``` Vitals height weight HEENT Heart, lung Abdominal exam neuro exam ```
140
Child with short stature DDx
``` Familial short stature GH deficiency Hypothyroid Chronic renal insufficiency Genetic ```
141
Behavioral problems in childhood hisotyr
Onset, severity, duration, triggers developmental history changes in environment
142
behavior problems PE
Vitals | neuro exam
143
Behavior problems DDX
``` ADHD Adjustment DO Substance abuse age appropriate Manic ODD Manic Conduct DO Oppositional Defiant DO ```
144
Behavioral problems workup
Physical exam MSE Urine toxicology

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