Minicases Flashcards
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)
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
26yo M R temporal HA, ipsilat rhinorrhea, eye tearing and redness, episodes same time every night 1wk, last 45min
DDx (5) and Workup (4)
DDx:
- CLUSTER HA
- migraine
- trigeminal neuralgia
- tension HA
- intracranial neoplasm
Workup:
- MRI brain
- CT head
- CBC
- ESR
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)
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
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)
DDx:
- acute sinusitis
- tension HA
- cerebral abscess
- meningitis
- intracranial neoplasm
WU:
- CBC
- sinus Xray
- CT sinus
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)
DDx:
- tension HA
- migraine
- caffeine or analgesic withdrawal
- depression
- cancer
- cluster HA
- pseudotumor cerebri
WU:
- CBC
- electrolytes
- ESR
- MRI brain
- LP
35yo M p/w sudden HA, V, confusion, left hemiplegia, nuchal rigidity
DDx (8) and WU (8)
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
81yo M stepwise neurocog decline
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
70yo M insulin dependent p/w confusion, dizziness, palpitations, diaphoresis, weakness
DDx:
- hypoglycemia
- TIA
- arrhythmia
- medication induced
WU:
- glucose
- CBC
- electrolytes
- TSH
- CPK-MB, troponin
- echo
- EKG
- MRI brain
- carotid doppler US
- urine toxicology
73yo M acute L eye loss of vision, palpitations, SOB; Hx of AFib; no eye pain, d/c, redness, photophobia, HA, weakness or numbness
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
35yo F intermittent vertigo, tinnitus, N, hearing loss w/i 1wk; PE is normal
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
55yo F p/w dizziness started in am, N and has V, has had URI for 2d; no hearing loss or tinnitus
DDx:
- VESTIBULAR NEURONITIS
- labyrinthitis
- BPPV
- meniere disease
- vertibrobasilar stroke/TIA
WU:
- audiogram
- electronystagomography
- CT head
- MRI brain or MRA
55yo M s/p fall after felt dizzy and unsteady, transient LOC, PMHx of HTN and DM
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
33yo F p/w ascending weakness and numbness in lower legs for 2wks w/ recent URI; PE= lower leg weakness and hyporeflexia
DDx:
- Guillian Barre Syndrome
- MS
- transverse myelitis
- spinal cord compression
WU:
- CBC
- electrolytes
- electromyography
- LP w/ CSF analysis for inc protein
- MRI spine
40yo F p/w double vision and lidlag at night but resolves by am; PMHx of hypothyroidism
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
40yo F p/w fatigue, weight loss, sleepiness, cold intolerance, constipation and dry skin
DDx:
- HYPOTHYROIDISM
- depression
- DM
- anemia
WU:
- TSH/T4/T3
- Beck depression inventory
- HgA1c and fasting glucose
- CBC
50yo obese F p/w fatigue, daytime sleepiness, snores, never feels refreshed and Hx of HTN
DDx:
- OBSTRUCTIVE SLEEP APNEA
- hypothyroidism
- chronic fatigue syndrome
- narcolepsy
WU:
- Polysomnography
- nocturnal pulse oximetry
- CBC
- TSH
- EKG
30yo M p/w night sweats, cough, swollen glands for 1m and recently emigrated from Africa
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
45yo F p/w excessive sweating, weight loss, palpitations, D, and SOB
DDx:
- HYPERTHROIDISM
- pheochromocytoma
- carcinoid syndrome
- TB
WU:
- TSH/T4/T3
- 24hr catecholamines
- 5-HIAA
- CBC
- PPD
26yo F p/w sore throat, F, fatigue, loss of appetite for 1wk, epigastric and LUQ pain, cervical LAP, rash, bf had same thing
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
30yo p/w SOB, cough and wheezing worse with cold air, multiple episodes in past 4m
DDx:
- ASTHMA
- GERD
- bronchitis
- pneumonitis
WU:
- PFTs
- peak flow measurements
- CXR
- CBC
25yo F p/w 2wk nonproductive cough after she had sore throat and rhinorrhea 3wk ago
DDx:
- ATYPICAL PNEUMONIA
- asthma
- URI assoc cough
- postnasal drip
WU:
- CBC
- CXR
- IgM for mycoplasma pneumoniae
- urine legionella antigen
COPD exacerbation DDx and WU?
DDx:
- COPD exacerbation
- lung cancer
- pneumonia
WU:
- ABG
- CXR
- sputum stain and culture
- CBC
- PFT
- CT chest
- echo
60yo M p/w worsening dyspnea 6hr w/ cough that produces pink frothy sputum
DDx:
- PUMONARY EDEMA
- pneumonia
- CHF
WU:
- CXR
- ABG
- CBC
- EKG
- PFTs
- BNP
