Patient Vignettes Flashcards
60yr old female complaining of headache on one sode of her head, pain is worse when chewing. She also mentions her eyesight has got worse recently.
Ddx?
Ix?
Dx?
Temporal arteritis
High ESR and CRP, giant cells on biopsy
Give high dose steroids and aspirin
(blindness due to posterior ciiary arterites involvement)
Patient describes a heacdache that feels as though theyve been hit on the back of the head. Upon asking they have a stiff neck and find bright light makes it worse.
Ddx?
Ix?
Tx?
Subarachnoid haemorrhage (could also be meningitis)
Neurological assessment
CT brain, lumbar pincture, mra, angiogram
1: Nimodipine and reduce BP
patient presents with a headache and complaining of a blocked nose and loss of smell (anosmia)
Ddx?
What would you see on X-ray?
sinuisitis
opacification of sinus
a 24 year old with BMI 30 presents with a headache and tinnitus. she also mentions she’s had vision changes.
Dhx : OCP
RFs?
Ddx?
Tx?
psudomotor cerebri/idiopathic intracranial hypertension
young obese woman taking OCP
weight loss, diuretics, optic nerve sheath decompression, kumboperitoneal shunt, sinus stenting
Patient presents with a headache that only presents when they cough
Ddx?
Tx?
Chiari malformation
Treat cough
Skull base remodelling so meninges don’t catch
Patient presents with facial pain that they describe as an electric shock when something light touches their face.
Ddx? what can this be a symptom of?
Tx?
trigeminal neuralgia - can be due to MS
carbamaszepine, lamotrigine, gabapentin, posterior fossa decompression
a 50 year old woman complains of a dull aching facial pain. she also says she’s been feeling down lately. theres no sensory loss.
Ddx?
Tx?
atypical facial pain
tricyclics
a 78yr old man complains of a headache on both sides of the back of his head that is worse when he moves his neck. He has no nausea but says the pain can radiate forwards sometimes
Ddx?
Tx?
Ix?
cervical spondylosis
rest, deep heat, NSAIDs
on X-ray there will be narrowing between vertebrae
patient is complaining of headaches and times when they have blindspots in their vision. The headaches always last longer than 3 hours and occur about 5 times a month. They describe the pain as pulsatile. They’ve also been having mood changes, polyuria, tingling and nasuea. They say the symtoms last for about 2 days but darkness makes them better.
Ddx?
Tx?
migraines
acute: NSAIDS with triptans and anti-emetic (metoclopramide)
avoid triggers, stay hydrated, avoid hypoglycaemia
chronic prophylaxis: TCAs, B blockers, serotonin antagognists, CCBs, anticonvulsants, botox, erenumab
patient complains of a headache feeling like their head is in a vice (ie head and neck muscles feel tight)
Ddx?
Tx?
tension type headache
NSAIDs, paracetamol, TCAs,
33yr old man complains of one-sided headaches that last between 15 minutes and 3 hours and sometimes happen multiple times a day. they also mention that their eyes have been watering a lot and that they have been sweating on their face
Ddx?
Other symptoms?
Tx?
prophylaxis?
cluster headache
autonomic symptoms - eyelid welling, ptosis, miosis, nasal congestion, agitation
acute: inhaled oxygen to inhibit neuronal activation in trigeminocervical complex & nasal/SC sumatriptan
prophylaxis: prednisolone, valproate, lithium. gabapentin
Pateint presents with a headache syaing they struggle to read things far aways. Ddx?
Tx?
Myopia
Correct with diverging lenses, conatc lenses or by removing lenses to redice regractive piwer of eye
Patient presents with a headache and eyepain. They say they are having trouble reading books but not all the time.
Ddx? What can this progress to?
Tx?
Hyperopia
Amblyopia
Correct with converging lens +- ctaract extraction, contact lens, intraocular lens
Patient presents worh headache and complaining of distorted vision. You notice them turning and tilting thier head.
Ddx?
Tx?
Astygmatism
Regular : cylindracl lenses +- spherical lenses, sx
Irregular: rigid cylinder lenses, sx
You see a patient with a right eye that is down and out and a droopy eyelid. What nerve is affected and explain what you see
Third nerve palsy
Superior oblique and lateral recti unnoposed
78yr old man oresents with hallucinations and parkinsonian symptoms like a shiffling gait and hypomimism. Likely diagnosis?
Lewybbody dementia
Patient initially presents to you having fits with a history of flu like symptoms, pyrexia and a headache. Over a few hours they become more ocnfused and then lose conscioussness. Most likely diagnosis? And cause? Tx?
Encephalitis
Viral : hsv, measles, varicella, rubella
Other : mosquito, trauma, autoimmune
Tx: underlying cause eg. antivirals, steroids, antibiotics, analgesics, anticonvuslants
Patient oresents with neck stiffness, headache, and photophobia. These are red flag symptoms for what? What are the causes? Ix?
Meninigitis
Bacterial : meningococcal, pneumococcal, haemophilis influenzae type b, streptococcal
Viral & fungal
Do lumbar puncture and give IV abx
Derm Patient presents wiht folliculitis and recurrent painful abcesses. They have diabetes and live in overcrowded housing. You also notice they have a few cuts on their body. Ddx and cause? RFs? Tx?
Panton valentine leukocidin - staphylococcus aureus
5 Cs , diabtes
Tetracycline
Chlorohexidine wash
Derm
A young paitient oresents with numerous red papules on their abdomen. They mention that they swim for their school and practice every day. Msot likely diagnosis? Tx?
Pseudomonal folliculitis
Normally no tretament
Severe - ciprofloxacin
Patient presents with leg sweing and in ill defined blanching erythema.
Ddx? Cause?
Tx?
Cellulitis
Staphylococcus aureua
Streptococcus pyogenes
Systemic abx
Child presents with goldne crusty scabs around their mouth and it looks red underneath.
Ddx? Cause?
Tx?
Impetigo
Streptococci - non-bullous
Staphylococci - bullous
Topicla/systemic abx
Patient presents with an ilcer on their foot that looks like a punch whole and is surrounded by eryhtmea. Rhey mention they did have a skin problem a while ago where they had a gold crsury sore.
Ddx? Cause?
Ecthyma
Severe form of streptococcal impetigo
Parents bring in their baby as they are concerned about a blistering rash that is diffuse and erythematous with some oozing. They mention their abby did have conjunctivitis rceently.
Ddx?
Cause?
Other differentials?
Staphylococcus scalded skin syndrome
Edxfoliative toxin from infection at distant site - kidneys cannot excrete toxin quick enough
Resembels stevens-johnson syndrome / toxic epidermal necrolysis
Pateint oresents to A&E febrile, hypotensive and with a diffuse eryhrema. They have CNS abnormalities and musucmar weakness. After doing fbc they are thrombocytopenic.
Ddx?
Cause?
What shoudl you see in 1-2 weeks?
Toxic shock syndrome
Group A staphylococcus aurues
Palmar/sole desquamation
Patinet presents worried about a scaly patch on their armpit. They say it was inititaly pink but has now turned brown.
Ddx?
Cause?
Erythrasma
Corynebacterium minutissimum
Pateint comes in with little pits on the soles of their feet. They say rheyve been treating it like atheltes foot as theyve had this before but its not going away.
Ddx?
Cause?
Tx?
Pitted keratolysis
Corynebacteria
Topical clindamycin
A butcher comes in with a rash and swelling on his hand. He says its slowly spread over the last few weeks.
Ddx?
Cause?
Erysipeloid
Erysipelothrix rhusiopathiae
A livestock farmer presents with a necrotic ulcer on his finger but says he has no pain. There is sureounding oedema and on lymph node palpation there is pain.
Ddx?
Cause?/RF
Anthrax
Bacillus anthracis from handling bone meal
Child presents with a tender superificicla bullous that is erythematous in the fat pad of thei finger.
Ddx?
Cause?
Blistering distal dactylitis
Staphylococcus aureus/streptococcus pyogenes
Patient oresents with sharply demarcated erythematous painful rash with some blistering on their face. There is local lymphadenopathy and they have fever and malaise
Ddx?
Cause?
Tx?
Erysipelas
B haemyric streptococci , staph aureus
IV abx
A 10yr old child presents with a blanching rash over their whole body that has a sand paper texture. Parents say they did have an URT infextuon rceently and has been feeling unwell for the last 2 days with no appetite, fever and headache. The rash initially started on the tummy then spread.
Ddx?
Cause?
Complications?
Scarlet fever
URTI with eryrhigenic toxin oroduxing streptococcous pyogenes
Otitis, sinusitis, pneumonia, meningitis
Patient presents with a dry wheezy cough that is worse on exertion and when its spring. Likely diagnosis and cardinal features?
Tests?
Tx options?
Asthma
Allergen sensitization, airway inflammintion from eosinophils and type 2 lymphocytes, reversible airway obstruction
- Fraction of exhaled nitric oxide >40
Blood and induced sputum elsinophil counts - Airway obstruction on spirometry <0.7
- Bronchodilator reversibility >12%
Inhaled corticosteroids Leukotriene receptor antagonists Beta 2 agonists Anticholenergic therapies Anti IgE antibodies - omalizumab Anti IL5 antibodies - mepolizumab
A 64 yr old hospitialized patient presents with a severe chest infection. He is confused, has resp rate of 31. His blood pressure is 100/58 and urea is 6.6
What is his CURB-65 score? Next steps?
Most likely cause of pneumonai?
3
Tazocin and gentamycin IV for 5-7 days
Oxygen, fluids, analgesia
HAP - staphylococcus aureus / pseudomonas aeruginosa
You see a baby that has a croupy cough, tachypnea, wheezing on expiration and nasal flaring.
Lokely diagnosis?
Other symptoms?
RFs?
Respiratory syncytial virus
Hypoxia and cyanosis, chest wall retractions
Premature birth, congenital heart/lung disease
Patient prevents with prolonged epistaxis. They also say theyve been having heavy periods and easily bruise (echymosis). Ddx?
Causes?
Ic?
Tx?
Primary haemostasis bleeding
DIC , autoimmune thrombocytopenic purpura, VWD, ehlers danos, drugs, scurvy, leukaemia
Platelet count, VWF assay, PT and APPT normal
Replace vwf, stop drugs, immunosuppression, splenectomy 
Desmopressin
Transexamic acid
Parient presents with spontaneous joint bleeding and muscle weakness. Likely diagnosis?
Haemophilia
Avoid IM injections
Haemarthrosis
Patient presents complaining of chest pain and coughing blood. They are shirt of breath and have a heart rate of 120bpm. Ddx?
Pulmonary embolims
Pateont presents with a painful swollen leg, red and warm. Ddx?
DVT
a 83 year old presents with hearing loss, what do they most likely have?
presybycusis
a child presents with watery diarrhoea, what is the most likely cause? treatment? vaccine?
rotavirus
oral rehydration
rotarix vaccine
theres an outbreak of diarrhoea on a cruise ship, what is the most likely cause?
norovirus
patient presents feeling unwell. they look jaundiced. upon examination they have an enlarged gall bladder and epigastric pain they say they feel in their back as well. they mention they have unintentionally lost wt over the past year.
likely diagnosis?
palpable gallbladder known as?
what does back pain suggest?
head of pancreas ductal adenocarcinoma
courvoisiers sign
posteriore capsule invasion and irresectability
patient presents with postprandial RUQ pain , says it radiates to the shoulder. also feel nauseous. likely diagnosis? what would you see on US? management?
bilary colic
cholelithiasis - gallstones in gallbladder
analgesia, antiemetics, spasmolytics
±cholecystectomy
patient presents with acute severe RUQ pain and a fever. upon examination positive for Murphy's sign ↑ WCC & CRP US shows thickened gallbladder wall Ddx? what is Murphy's sign? management?
acute cholecystitis
pain on inspiration when palpating right subdiaphragamtic region
fluids, abx, analgesia, bloods, cholecystectomy
patient presents with Charcot's triad, ↑ WCC, CRP. LFTs and +ve MCS US shows bilary dilatation what is the triad? ddx? management?
jauncice, fever, RUQ pain
acute cholangitis
fluids, iv abx, analgesia
ERCP to clear bile duct or stenting
patient presents with severe epigastric pian radiating to their back they have N&V SHx shows alcohol abuse in the past Ddx? what would Ix show? how would you score severity? management?
acute pancreatitis low Ca2+ ↑ amylase & lipase ↑ WCC do CT & US modified Glasgow criteria fluid resus, O2, analgesia, antiemetics, ±ITU/HDU
a 41yr old pregnant woman comes in worried because she thinks her baby hasn’t been moving around as much as normal. she has graves disease. upon examination she does have swollen ankles and a BP of 130/93 mmHg (previously 120/75mmHg)
likely diagnosis and subtype? why?
risk factors?
preeclampsia
early onset because of foetal symptoms
40yrs, BMI? (≥30) autoimmune graves disease
patient presents with painful joints and some skin inflammation. they also say their achilles tendons have been a bit tender. upon asking they mentioned they had a stomach bug a few weeks ago.
Ddx?
tendon inflammation?
Mx?
reactive arthritis
enthesitis
NSAIDs ± DMARDs
