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Step2CS > Minicases > Flashcards

Minicases Flashcards

1
Q

21yo F L temporal pain 2-3hr, flashes of light visual fields, weakness/numbness on R side, assoc w/ N/V, photophobia, FHx=migraine
DDx (8) and Workup (4)

A

DDx:

  • hemiplegic migraine
  • tension HA
  • cluster HA
  • TIA
  • partial seizure
  • pseudotumor cerebri
  • focal seizure (occipital parietal)
  • intracranial neoplasm

Workup:

  • MRI brain
  • CT head
  • CBC
  • ESR
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2
Q

26yo M R temporal HA, ipsilat rhinorrhea, eye tearing and redness, episodes same time every night 1wk, last 45min

DDx (5) and Workup (4)

A

DDx:

  • CLUSTER HA
  • migraine
  • trigeminal neuralgia
  • tension HA
  • intracranial neoplasm

Workup:

  • MRI brain
  • CT head
  • CBC
  • ESR
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3
Q

65yo F new onset intermittent R temporal HA, fever, blurred R eye vision, weight loss, jaw pain w/ chewing, shoulder stiffness; PE= R temporal tenderness, dec R eye visual acuity

DDx (9) and Workup (6)

A

DDx:

  • Temporal arteritis
  • vasculitis
  • migraine
  • cerebral abscess
  • cluster/tension HA
  • meningitis
  • carotid artery dissection
  • trigeminal neuralgia
  • TMJ syndrome

Workup:

  • temporal artery Bx
  • ESR
  • CRP
  • CBC
  • carotid doppler US
  • MRI brain
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4
Q

30yo F 1wk frontal HA, F, nasal discharge, worse w/ bending forward; PE= pain frontal/maxillary sinus palpation; Hx of allergies

DDx (5) and WU (3)

A

DDx:

  • acute sinusitis
  • tension HA
  • cerebral abscess
  • meningitis
  • intracranial neoplasm

WU:

  • CBC
  • sinus Xray
  • CT sinus
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5
Q

50yo F recurrent bilat squeezing HA, 3-4x/wk, towards end of day, stress in life, recently dec caffeine intake; PE=neuro exam normal

DDx (7) and WU (5)

A

DDx:

  • tension HA
  • migraine
  • caffeine or analgesic withdrawal
  • depression
  • cancer
  • cluster HA
  • pseudotumor cerebri

WU:

  • CBC
  • electrolytes
  • ESR
  • MRI brain
  • LP
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6
Q

35yo M p/w sudden HA, V, confusion, left hemiplegia, nuchal rigidity

DDx (8) and WU (8)

A

DDx:

  • subarachnoid hemorrhage
  • meningitis/encephalitis
  • intracranial hemorrhage
  • vertebral artery dissection
  • intracranial venous thrombosis
  • migraine
  • HTN encephalopathy
  • cancer

WU:

  • CT head w/o ctx
  • LP (open pressure and CSF analysis)
  • CBC
  • PT/PTT/INR
  • urine toxicology
  • digital subtration angiography (DSA)
  • MRI brain
  • CT angio
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7
Q

81yo M stepwise neurocog decline

A

DDx:

  • VASCULAR DEMENTIA
  • alzheimers
  • NPH
  • chronic SDH
  • cancer
  • depression
  • B12 def
  • neurosyphillis
  • hypothryoidism

WU:

  • CBC
  • VDRL/RPR
  • serum B12
  • TSH
  • MRI brain
  • CT head
  • LP w/ CSF analysis
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8
Q

70yo M insulin dependent p/w confusion, dizziness, palpitations, diaphoresis, weakness

A

DDx:

  • hypoglycemia
  • TIA
  • arrhythmia
  • medication induced

WU:

  • glucose
  • CBC
  • electrolytes
  • TSH
  • CPK-MB, troponin
  • echo
  • EKG
  • MRI brain
  • carotid doppler US
  • urine toxicology
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9
Q

73yo M acute L eye loss of vision, palpitations, SOB; Hx of AFib; no eye pain, d/c, redness, photophobia, HA, weakness or numbness

A

DDx:

  • RETINAL ARTERY OCCLUSION
  • retinal vein occlusion
  • acute angle closure glaucoma
  • retinal detachment
  • temporal arteritis

WU:

  • fluorescein angiogram
  • echo
  • carotid doppler US
  • intraocular tonometry
  • ESR/CRP
  • temporal artery Bx
  • CBC
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10
Q

35yo F intermittent vertigo, tinnitus, N, hearing loss w/i 1wk; PE is normal

A

DDx:

  • MENIERE DISEASE
  • BPPV
  • labyrinthitis
  • vestibular neuronitis
  • acoustic neuroma

WU:

  • Dix Hallpike maneuver
  • audiometry
  • electronystagmography
  • CBC
  • VDRL/RPR (syphilis is a cause of this)
  • MRI brain
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11
Q

55yo F p/w dizziness started in am, N and has V, has had URI for 2d; no hearing loss or tinnitus

A

DDx:

  • VESTIBULAR NEURONITIS
  • labyrinthitis
  • BPPV
  • meniere disease
  • vertibrobasilar stroke/TIA

WU:

  • audiogram
  • electronystagomography
  • CT head
  • MRI brain or MRA
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12
Q

55yo M s/p fall after felt dizzy and unsteady, transient LOC, PMHx of HTN and DM

A

DDx:

  • DRUG INDUCED ORTHOSTATIC HYPOTENSION
  • hypoglycemia
  • cardiac arrhythmia
  • syncope
  • stroke
  • MI
  • PE

WU:

  • orthostatic vital signs
  • CBC
  • electrolytes and glucose
  • echo
  • CT head
  • EKG
  • VQ scan
  • CTA
  • D dimer
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13
Q

33yo F p/w ascending weakness and numbness in lower legs for 2wks w/ recent URI; PE= lower leg weakness and hyporeflexia

A

DDx:

  • Guillian Barre Syndrome
  • MS
  • transverse myelitis
  • spinal cord compression

WU:

  • CBC
  • electrolytes
  • electromyography
  • LP w/ CSF analysis for inc protein
  • MRI spine
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14
Q

40yo F p/w double vision and lidlag at night but resolves by am; PMHx of hypothyroidism

A

DDx:

  • MG
  • MS
  • Lambert Eaton syndrome
  • cancer compressing CN3/4/5

WU:

  • ice pack test
  • Tensilon test
  • anti-AHc receptor antibodies
  • electromyography
  • CT chest
  • MRI brain
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15
Q

40yo F p/w fatigue, weight loss, sleepiness, cold intolerance, constipation and dry skin

A

DDx:

  • HYPOTHYROIDISM
  • depression
  • DM
  • anemia

WU:

  • TSH/T4/T3
  • Beck depression inventory
  • HgA1c and fasting glucose
  • CBC
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16
Q

50yo obese F p/w fatigue, daytime sleepiness, snores, never feels refreshed and Hx of HTN

A

DDx:

  • OBSTRUCTIVE SLEEP APNEA
  • hypothyroidism
  • chronic fatigue syndrome
  • narcolepsy

WU:

  • Polysomnography
  • nocturnal pulse oximetry
  • CBC
  • TSH
  • EKG
17
Q

30yo M p/w night sweats, cough, swollen glands for 1m and recently emigrated from Africa

A

DDx:

  • TB
  • acute HIV infection
  • lymphoma

WU:

  • PPD
  • QuantiFERON-TB Gold
  • CXR
  • CBC
  • sputum Gram stain, acid fast stain and cultures
  • HIV ab and RNA levels
  • CT chest
18
Q

45yo F p/w excessive sweating, weight loss, palpitations, D, and SOB

A

DDx:

  • HYPERTHROIDISM
  • pheochromocytoma
  • carcinoid syndrome
  • TB

WU:

  • TSH/T4/T3
  • 24hr catecholamines
  • 5-HIAA
  • CBC
  • PPD
19
Q

26yo F p/w sore throat, F, fatigue, loss of appetite for 1wk, epigastric and LUQ pain, cervical LAP, rash, bf had same thing

A

DDx:

  • INFECTIOUS MONO
  • viral or bacterial pharyngitis
  • acute HIV infection

WU:

  • CBC w/ diff and peripheral smear
  • Monospot test
  • throat culture
  • HIV antibody and viral RNA load
20
Q

30yo p/w SOB, cough and wheezing worse with cold air, multiple episodes in past 4m

A

DDx:

  • ASTHMA
  • GERD
  • bronchitis
  • pneumonitis

WU:

  • PFTs
  • peak flow measurements
  • CXR
  • CBC
21
Q

25yo F p/w 2wk nonproductive cough after she had sore throat and rhinorrhea 3wk ago

A

DDx:

  • ATYPICAL PNEUMONIA
  • asthma
  • URI assoc cough
  • postnasal drip

WU:

  • CBC
  • CXR
  • IgM for mycoplasma pneumoniae
  • urine legionella antigen
22
Q

COPD exacerbation DDx and WU?

A

DDx:

  • COPD exacerbation
  • lung cancer
  • pneumonia

WU:

  • ABG
  • CXR
  • sputum stain and culture
  • CBC
  • PFT
  • CT chest
  • echo
23
Q

60yo M p/w worsening dyspnea 6hr w/ cough that produces pink frothy sputum

A

DDx:

  • PUMONARY EDEMA
  • pneumonia
  • CHF

WU:

  • CXR
  • ABG
  • CBC
  • EKG
  • PFTs
  • BNP

Step2CS (2 decks)

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