Minicases Flashcards

Question

44 F complains of episodes of dizziness on moving her head to the left. She feels that the room is spinning around her head. Dix hallpike maneuver reproduces the symptoms and elicits nystagmus

Answer 1

``` DDx BENIGN POSITIONAL VERTIGO Meniere disease Labyrinthitis Acoustic neuroma ``` Workup Audiometry Electro nystagmograph MRI Brain

Answer 2

``` DDx VESTIBULAR NEURONITIS Labyrinthitis Benign positional vertigo Meniere disease Vertebrobasilar stroke TIA ``` ``` Workup Audiogram Electro nystagmography CT Head MRI/MRA brain ```

Answer 3

``` DDx LABYRINTHITIS Vestibular neuronitis Meniere disease Acoustic neuroma Vertbrobasilar stroke/TIA ``` ``` Workup AUdiogram Electro-nystagmography CT Head MRI/MRA Brain ```

Answer 4

``` DDx GENERALIZED TONIC CLONIC SEIZURE Convulsive syncope Substance abuse/overdose Malingering Hypoglycemia ``` ``` Workup CBC Electrolytes Glucose Urine toxicology EEG MRI Brain CT Head LP CSF analysis, gram stain and culture ECG ```

Answer 5

``` DDx DRUG INDUCED HYPOTENSION (Causing SYNCOPE) Hypoglycemia Cardiac arrhythmia Syncope (vasovagal etc) Stroke MI Pulmonary embolism ``` ``` Workup Orthostatic vital signs CBC Electrolytes Glucose Echo cardiography CT Head ECG VQ Scan CTA chest with contrast D Dimer ```

Answer 6

``` DDx CARDIAC ARRHYTHMIA (causing syncope) Severe aortic stenosis Syncope (other causes) Seizure Pulmonary embolism ``` ``` Workup ECG Holter monitoring CBC Electrolytes Glucose Echo cardiography CT Head ```

Answer 7

``` DDx TRANSIENT ISCHEMIC ATTACK Stroke Migraine with sensory aura Hypoglycemia Seizure with Todd paresis ``` ``` Workup CT Head CBC Electrolytes Glucose Fasting lipid panel ECG MRI Brain Doppler US Carotid Echo cardiography EEG ```

Answer 8

``` DDx Stroke TIA Seizure with Todd paresis Intracranial neoplams/Pseudotumor cerebri Subdural hematoma Epidural hematoma Hypoglycemia ``` ``` Workup CT Head CBC Electrolytes Glucose PT/PTT/INR Fasting lipid panel MRI Brain MRA Doppler US carotid Echo cardiography ECG ```

Answer 9

``` DDx Guillain Barre syndrome Multiple sclerosis Transverse myelitis Spinal cord compression Peripheral neuropathy ``` ``` Workup CBC Electrolytes MRI Spine CPK Electro myography Nerve conduction studies LP CSF analysis PFTs Serum B12 Neurosyphilis ```

Answer 10

``` DDx MULTIPLE SCLEROSIS Stroke CNS vasculitis Conversion disorder Malingering CNS tumor Vitamin B deficiency Neurosyphilis ``` ``` Workup CBC ESR ANA ANCA VDRL/RPR Serum B12 MRI Brain & Spine LP CSF analysis Visual evoked potentials ```

Answer 11

``` DDx DIABETIC PERIPHERAL NEUROPATHY Alcoholic peripheral neuropathy B12 deficiency Uremic nephropathy Hypocalcemia Hyperventilation Paraproteinemia/myeloma ``` ``` Workup HbA1c Glucose ESR Calcium Serum B12 UA Thyroid function test Urea Electrolytes Serum and urine protein electrophoresis Electromyography Nerve conduction studies ```

Answer 12

``` DDx MYASTHENIA GRAVIS Intracranial neoplasm compressing CN III IV or VI Horner syndrome Botulism ``` ``` Workup Ice pack test Tensilon (endrophonium test) Anti ACh receptor antibodies Electromyography Nerve conduction studies CXR CT Chest MRI Brain ```

Answer 13

``` DDx TODD paralysis TIA Stroke Intracranial neoplasm Hemiplegic migraine Head injury Hypoglycemia Malingering ``` ``` Workup CBC Glucose Electrolytes Toxin levels EEG CT Brain MRI Brain Doppler US Carotid ```

Answer 14

``` DDx CARPAL TUNNEL SYNDROME SECONDARY TO OVERUSE Overuse injury of median nerve Cervical disc disease Medial epicondylitis ``` ``` Workup TSH CBC Electromyography Nerve conduction study ```

Answer 15

``` DDx DEPRESSION Adjustment disorder Hypothyroidism Anemia ``` ``` Workup PHQ 9 Beck Depression Inventory TSH CBC ```

Answer 16

``` DDx POST TRAUMATIC STRESS DISORDER Depression Generalized anxiety disorder Psychotic or delusional disorder Hypothyroidism ``` ``` Workup PHQ 9 Beck depression inventory CBC TSH Urine toxicology ```

Answer 17

``` DDx COLON CANCER Hypothyroidism Renal failure Hypercalcemia Depression ``` ``` Workup Rectal exam with stool guaiac test CBC CMP TSH Colonoscopy Barium enema CT Abdomen/Pelvis ```

Answer 18

``` DDx HYPOTHYROIDISM Depression Diabetes Anemia ``` ``` Workup TSH FT3 FT4 CBC Fasting glucose HbA1c ```

Answer 19

``` DDx OBSTRUCTIVE SLEEP APNEA Hypothyroidism Chronic fatigue syndrome Narcolepsy ``` ``` Workup CBC TSH Nocturnal pulse oximetry Polysomnography ECG ```

Answer 20

``` DDx DIABETES MELLITUS Atypical depression Primary polydipsia Diabetes insipidus ``` ``` Workup HbA1c Glucose tolerance test UA CBC Electrolytes BUN Crea Fasting glucose ```

Answer 21

``` DDx Shift Work Sleep disorder Sleep Apnea Depression Anemia Circadium rhythm disorder? ``` Workup CBC Nocturnal pulse oximetry Polysomnography

Answer 22

``` DDx TUBERCULOSIS Acute HIV infection Lymphoma Leukemia Hyperthyroidism ``` ``` Workup PPD QuantiFERON-TB Gold CBC CXR Sputum Gram stain, acid fast stain and culture HIV Antibody & RNA levels TSH FT4 CT Chest ```

Answer 23

``` DDx HYPERTHYROIDISM Pheochromocytoma Carcinoid syndrome Tuberculosis ``` ``` Workup TSH, FT4 24h urinary catecholamines 5 HIAA CBC PPD ```

Answer 24

DDx STRESS INDUCED insomnia Caffeine induced insomnia Insomnia with circadian rhythm sleep disorder Insomnia related to major depressive disorder ``` Workup Polysomnography Urine toxicology CBC TSH ```

Answer 25

DDx OBSTRUCTIVE SLEEP APNEA Daytime fatigue in primary hypersomnia Insomnia with circadian rhythm sleep disorder Insomnia related to major depressive disorder ``` Workup Polysomnography ECG CBC TSH ```

Answer 26

DDx INSOMNIA RELATED TO MAJOR DEPRESSIVE DISORDER Primary hypersomnia Insomnia with circadian rhythm sleep disorder Workup TSH CBC Polysomnography

Answer 27

``` DDx INFECTIOUS MONONUCLEOSIS Hepatitis Viral or bacterial pharyngitis Acute HIV infection Secondary syphilis ``` ``` Workup CBC w differential and peripheral smear Mnospot test Throat culture AST/ALT/Bilirubin/alkaline phosphatase HIV antibody and viral load Anti EBV antibodies VDRL/RPR ```

Answer 28

``` DDx HIV acute retroviral syndrome Infectious mononucleosis Hepatitis Viral pharyngitis Streptococcal tonsilitis/scarlet fever Secondary syphilis ``` ``` Workup CBC with differential and peripheral smear Throat culture HIV antibody and viral load CD4 count Monospot test LFTs VDRL/RPR ```

Answer 29

``` DDx PHARYNGITIS (Bacterial or viral) Mycoplasma pneumonia Acute HIV infection Infectious mononucleosis ``` Workup Centor criteria Throat swab for culture and rapid strepococcal antigen Monospot test CBC Serology test (cold agglutinin titer) for mycoplasma HIV antibody and viral load

Answer 30

``` DDx ASTHMA GERD Bronchitis Pneumonitis ``` ``` Workup CBC CXR Peak flow measurement PFTs ```

Answer 31

``` COPD - chronic bronchitis COPD - emphysema Bronchiectasis Lung cancer Tuberculosis ``` ``` Workup CBC Sputum gram stain and culture CXR PFTs CT Chest QuantiFERON TB Gold ```

Answer 32

``` DDx PNEUMONIA COPD exacerbation (bronchitis) Lung abscess Lung Cancer Tuberculosis Pericarditis ``` ``` Workup CBC Sputum gram stain and culture CXR CT Chest ECG QuantiFERON TB Gold ```

Answer 33

``` DDx ATYPICAL PNEUMONIA Asthma URI Associated cough (post infectious) Post nasal drip GERD ``` ``` Workup CBC Induced sputum Gram stain and culture CXR IgM detection for Mycoplasma pneumoniae Urine Legionella antigen ```

Answer 34

``` DDx LUNG CANCER Tuberculosis Lung Abscess COPD Vasculitis Interstitial Lung disease CHF ``` ``` Workup CBC Sputum Gram stain culture and cytology CXR CT Chest QuantiFERON TB Gold ANCA Broncoscopy Echocardiography ```

Answer 35

``` DDx COPD EXACERBATION (bronchitis) Lung Cancer Pneumonia URI CHF ``` ``` Workup CBC CXR ABG PFTs Sputum gram stain and culture CT Chest Echo cardiography ```

Answer 36

``` DDx TUBERCULOSIS Pneumonia Lung Abscess Vasculitis Lymphoma Metastatic Cancer HIV AIDS Sarcoidosis ``` ``` Workup CBC PPD/QuantiFERON Gold Sputum gram stain, acid fast stain and culture CXR CT Chest Broncoscopy HIV Antibody Lymph node biopsy ```

Answer 37

``` DDx TUBERCULOSIS Pneumonia (including PCP) Bronchitis Asthma Acute HIV infection CHF (cardiomyopathy) ``` ``` Workup CBC PPD/QuantiFERON TB Gold Sputum gram stain, acid fast stain and culture CXR HIV antibody and viral load Echo cardiography ```

Answer 38

``` DDx CONGESTIVE HEART FAILURE Cardiac valvular disease GERD Pulmonary fibrosis COPD Post nasal drip ``` ``` Workup CBC CXR ECG Echo cardiography PFTs BNP CT Chest ```

Answer 39

``` DDx PULMONARY EDEMA Pneumonia CHF Mitral Valve stenosis Arrythmia Asthma ``` ``` Workup CXR ECG CBC ABG PFTs BNP ```

Answer 40

``` DDx MYOCARDIAL INFARCTION GERD Angina Costochondritis Aortic dissection Pericarditis Pulmonary embolism Pneumothorax ``` ``` Workup ECG CPK MB Troponin CXR CBC Electrolytes Helical CT Echo cardiography Cardiac catherization D Dimer ```

Answer 41

``` DDx SICKLE CELL DISEASE - Acute chest syndrome Pulmonary embolism Pneumonia Myocardial infarction Pneumothorax Aortic dissection ``` ``` Workup CBC with reticulocyte count and peripheral smear LDH ABG D Dimer CXR CPK MB Troponin ECG CTA chest with IV Contrast ```

Answer 42

``` DDx GERD Esophagitis Peptic ulcer disease Esophageal spasm MI Angina ``` ``` Workup ECG Barium swallow Upper endoscopy Esophageal pH monitoring H pylori stool antigen ```

Answer 43

DDx STABLE ANGINA Esophageal spasm Esophagitis ``` Workup ECG CPK MD Troponin CXR CBC Electrolytes Exercise stress test Upper endoscopy pH Monitor Cardiac catheterization ```

Answer 44

``` DDx PERICARDITIS Aortic dissection MI Costochondritis GERD Esophageal rupture ``` ``` Workup ECG CPK MB Troponin CXR Echo cardiography CBC Upper endoscopy ESR ```

Answer 45

``` DDx Costochondritis Pneumonia MI Pulmonary embolism Pericarditis Pleurisy Muscle strain ``` ``` Workup ECG CXR CPK MB Troponin CBC ```

Answer 46

``` DDx PULMONARY EMBOLISM Pneumonia Costochondritis MI CHF Aortic Dissection ``` ``` Workup D Dimer CTA Chest CXR ECG ABG CPK MB Troponin CBC Electrolytes BUN Crea Glucose Doppler US - legs ```

Answer 47

``` DDx AORTIC DISSECTION MI Pericarditis Esophageal rupture GERD Pancreatitis Fat Embolism ``` ``` Workup Transthoracic Echocardiogram ECG CPK MB Troponin CXR CBC Amylase/Lipase CTA Chest MRI MRA Aorta Aortic Angiography Upper endoscopy ```

Answer 48

``` DDx HYPOGLYCEMIA Cardiac arrhythmia Angina Hyperthyroidism Hyperventilation episodes Panic attack Pheochromocytoma Carcinoid syndrome ``` ``` Workup Glucose CBC Electrolytes TSH ECG 24 urinary catecholamines 5 HIAA ```

Answer 49

``` DDx PANIC ATTACK Generalized anxiety disorder Specific phobia Acute stress disorder Hyperthyroidism Substance abuse/dependence Pheochromocytoma ``` ``` Workup CBC Electrolytes TSH FT4 ECG Echo cardiography Urine toxicology 24 H urinary catecholamines ```

Answer 50

``` DDx SOCIAL PHOBIA Avoidant personality disorder Agoraphobia/Specific phobia Panic attack Generalized anxiety disorder Substance abuse/dependence Hyperthyroidism ``` ``` Workup CBC Electrolytes ECG TSH FT4 ```

Answer 51

``` DDx MITRAL VALVE PROLAPSE Cardiac Arrhythmia Panic Attack Pheochromocytoma ``` ``` Workup ECG TEE Event monitor Holter Monitor 24 h urinary catecholamines ```

Answer 52

``` DDx HYPERTHYROIDISM Cancer HIV Dieting/Diet Drugs Anorexia nervosa Malabsorption ``` ``` Workup TSH FT4 CBC BMP HIV antibody Urine toxicology Age appropriate cancer screening ```

Answer 53

``` DDx SMOKING CESSATION Drug side effect Hypothyroidism Cushing Syndrome PCOS Diabetes mellitus Atypical Depression ``` ``` Workup CBC BMP Glucose TSH 24 H urine free cortisol Dexamethasone suppression test ```

Answer 54

``` DDx INSULINOMA Reactive postprandial hypoglycemia Cushing syndrome Pregnancy ``` ``` Workup Blood glucose Plasma insulin after induced hypoglycemia Glucose tolerance test 24 H urine free cortisol Urine B HCG ```

Answer 55

``` DDx ESOPHAGEAL CANCER Achalasia Esophagitis Systemic Sclerosis Esophageal stricture ``` ``` Workup CBC CXR Upper endoscopy with biopsy Barium swallow CT Chest ```

Answer 56

``` DDx PLUMMER VINSON SYNDROME Esophageal Cancer Diffuse Esophageal Spasm Esophagitis Achalasia Systemic sclerosis ``` ``` Workup CBC Serum Iron, TIBC Barium Swallow Upper endoscopy Esophageal manometry ```

Answer 57

``` DDx ACHALASIA Plummer Vinson Syndrome Esophageal cancer Esophagitis Systemic sclerosis Esophageal stricture Zenker Diverticulum ``` ``` Workup CXR Upper endoscopy Barium Swallow Esophageal manometry ```

Answer 58

``` DDx ESOPHAGITIS (CMV, HSV, HIV, Pill induced) Systemic sclerosis GERD Esophageal stricture ``` ``` Workup CBC Upper endoscopy Barium swallow HIV antibody and viral load CD4 count ```

Answer 59

``` DDx Hodgkin/non-Hodgkin lymphoma Tuberculosis HIV Thyroid nodule Metastatic GI or Head and Neck Malignancy ``` ``` Workup CBC w differential BMP ESR CRP Lymph node biopsy PPD/QuantiFERON TB Gold CXR TSH HIV Antibody/RNA US Neck Upper endoscopy Fine needle aspiration ```

Answer 60

``` DDx PREGNANCY Hypercalcemia Diabetes Mellitus Gastritis/GERD UTI Depression Eating disorder Substance use (e.g. alcohol) ``` ``` Workup Urine HCG Pelvic exam US Transvaginal CBC Electrolytes (Ca, glucose) Liver function test UA Urine culture ```

Answer 61

``` DDx NEPHROLITHIASIS Renal cell carcinoma Pyelonephritis GI Etiology (appendicitis) ``` ``` Workup UA Urine culture, sensitivity and cytology BUN Crea CT Abdomen US Renal KUB IVP Blood culture ```

Answer 62

``` DDx PANCREATIC CANCER Cholangiocarcinoma Primary sclerosing cholangitis Chronic pancreatitis Cholecystitis/choledocholithiasis Acute viral hepatitis Abdominal aortic aneurysm Peptic ulcer disease ``` ``` Workup CT Abdomen CBC Electrolytes Amylase, lipase AST/ALT/Biliruben/alkaline phosphatase US Abdomen ```

Answer 63

``` DDx ACUTE PANCREATITIS Peptic ulcer disease Cholecystitis/Choledocholithiasis Gastritis Abdominal aortic aneurysm Mesenteric ischemia Alcoholic pancreatitis Boerhaave syndrome ``` ``` Workup CBC Electrolytes BUN Crea Amylase, lipase AST, ALT, Bilurubin, alkaline phosphatase US Abdomen CT Abdomen Upper endoscopy ECG ```

Answer 64

``` DDx ACUTE CHOLECYSTITIS Choledocholithiasis Hepatitis Ascending cholangitis Peptic Ulcer Disease Fitz Hugh Curtis syndrome Acute Subhepatic appendicitis ``` ``` Workup CBC AST ALT Bilirubin Alkaline Phosphatase US Abdomen CT Abdomen Blood culture ```

Answer 65

``` DDx ASCENDING CHOLANGITIS Acute gallstone cholangitis Acute Cholecystitis Hepatitis Primary sclerosing cholangitis Fitz Hugh Curtis syndrome ``` ``` Workup CBC AST ALT bilirubin alkaline phosphatase Blood culture Viral hepatitis serologies US Abdomen MRCP ERCP ```

Answer 66

``` DDx ACUTE HEPATITIS Acute cholecystitis Ascending cholangitis Choledocholithiasis Pancreatitis Primary sclerosing cholangitis Primary biliary cirrhosis Acute glomerulonephritis ``` ``` Workup CBC Amylase Lipase AST ALT Biliruben Alkaline phosphatase Viral hepatitis serologies UA US Abdomen ERCP MRCP ```

Answer 67

``` DDx PEPTIC ULCER DISEASE Gastritis GERD Cholecystitis Mesenteric ischemia ``` ``` Workup Rectal exam, stool for occult blood Amylase, lipase, Lactate AST ALT Bilirubin Alkaline phosphatase CXR KUB CT Abdomen Upper endoscopy H pylori testing Blood culture ```

Answer 68

``` DDx SPLENIC RUPTURE Kidney stone Rib fracture Pneumonia Perforated peptic ulcer Splenic infarct ``` ``` Workup CBC Electrolytes CXR CT Abdomen US abdomen (if hemodynamically unstable) ```

Answer 69

DDx INTESTINAL OBSTRUCTION Small bowel or colon cancer Vovulus Gastroenteritis Food poisoning Ileus Hernia ``` Workup Rectal exam CBC Electrolytes Abd XR CT abdomen/pelvis w/contrast Colonoscopy ```

Answer 70

DDx Mesenteric ischemia/infarction Diverticulitis Peptic Ulcer Disease Gastroenteritis Acute Pancreatitis Cholecystitis ``` Workup Rectal exam CBC Amylase, lipase, lactate ECG XR abd CT abd Mesenteric angiography Barium Enema ```

Answer 71

DDx OVARIAN TORSION Appendicitis Nephrolithiasis Ectopic Pregnancy Ruptured Ovarian Cyst PID Bowel Infarction or perforation ``` Workup Pelvic Exam Urine HCG Doppler US Pelvis/transvaginal Rectal Exam UA CBC CT Abdomen Laproscopy Chlamydia and Gonorrhea Testing VDRL/RPR ```

Answer 72

DDx Diverticulitis Crohn Disease Ulcerative colitis Gastroenteritis Abscess ``` Workup Rectal exam CBC Electrolytes CXR XR Abdominal Blood culture ```

Answer 73

``` DDx APPENDICITIS Gastroenteritis Diverticulitis Crohn Dse Nephrolithiasis Volvulus or other intestinal obstruction Perforation Acute cholecystitis ``` ``` Workup CBC w diff Electrolytes XR Abd CT Abd US abd Blood culture ```

Answer 74

``` DDx Irritable Bowel syndrome Crohn dse Celiac dse Chronic pancreatitis GI parasitic infection (amebiasis, giardiasis) Endometriosis ``` ``` Workup Rectal exam FOBT Pelvic exam Urine HCG CBC Electrolytes Colonoscopy CT Abd pelvis Stool for Ova E histolytica antigen ```

Answer 75

DDX PID Endometriosis Dysmenorrhea Vaginitis Cystitis Spontaneous abortion Pyelonephritis ``` Workup Pelvic Exam Urine HCG Cervical cultures CBC ESR UA w culture US pelvis ```