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BRS 2 > Patient Vignettes > Flashcards

Patient Vignettes Flashcards

1
Q

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?

A

Temporal arteritis
High ESR and CRP, giant cells on biopsy
Give high dose steroids and aspirin

(blindness due to posterior ciiary arterites involvement)

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2
Q

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?

A

Subarachnoid haemorrhage (could also be meningitis)
Neurological assessment
CT brain, lumbar pincture, mra, angiogram
1: Nimodipine and reduce BP

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3
Q

patient presents with a headache and complaining of a blocked nose and loss of smell (anosmia)
Ddx?
What would you see on X-ray?

A

sinuisitis

opacification of sinus

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4
Q

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?

A

psudomotor cerebri/idiopathic intracranial hypertension

young obese woman taking OCP

weight loss, diuretics, optic nerve sheath decompression, kumboperitoneal shunt, sinus stenting

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5
Q

Patient presents with a headache that only presents when they cough

Ddx?
Tx?

A

Chiari malformation
Treat cough
Skull base remodelling so meninges don’t catch

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6
Q

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?

A

trigeminal neuralgia - can be due to MS

carbamaszepine, lamotrigine, gabapentin, posterior fossa decompression

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7
Q

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?

A

atypical facial pain

tricyclics

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8
Q

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?

A

cervical spondylosis
rest, deep heat, NSAIDs
on X-ray there will be narrowing between vertebrae

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9
Q

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?

A

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

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10
Q

patient complains of a headache feeling like their head is in a vice (ie head and neck muscles feel tight)

Ddx?
Tx?

A

tension type headache

NSAIDs, paracetamol, TCAs,

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11
Q

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?

A

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

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12
Q

Pateint presents with a headache syaing they struggle to read things far aways. Ddx?
Tx?

A

Myopia

Correct with diverging lenses, conatc lenses or by removing lenses to redice regractive piwer of eye

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13
Q

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?

A

Hyperopia
Amblyopia
Correct with converging lens +- ctaract extraction, contact lens, intraocular lens

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14
Q

Patient presents worh headache and complaining of distorted vision. You notice them turning and tilting thier head.

Ddx?
Tx?

A

Astygmatism
Regular : cylindracl lenses +- spherical lenses, sx
Irregular: rigid cylinder lenses, sx

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15
Q

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

A

Third nerve palsy

Superior oblique and lateral recti unnoposed

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16
Q

78yr old man oresents with hallucinations and parkinsonian symptoms like a shiffling gait and hypomimism. Likely diagnosis?

A

Lewybbody dementia

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17
Q

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?

A

Encephalitis
Viral : hsv, measles, varicella, rubella

Other : mosquito, trauma, autoimmune

Tx: underlying cause eg. antivirals, steroids, antibiotics, analgesics, anticonvuslants

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18
Q

Patient oresents with neck stiffness, headache, and photophobia. These are red flag symptoms for what? What are the causes? Ix?

A

Meninigitis
Bacterial : meningococcal, pneumococcal, haemophilis influenzae type b, streptococcal
Viral & fungal
Do lumbar puncture and give IV abx

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19
Q 
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?
A

Panton valentine leukocidin - staphylococcus aureus

5 Cs , diabtes

Tetracycline
Chlorohexidine wash

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20
Q

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?

A

Pseudomonal folliculitis
Normally no tretament
Severe - ciprofloxacin

21
Q

Patient presents with leg sweing and in ill defined blanching erythema.
Ddx? Cause?
Tx?

A

Cellulitis
Staphylococcus aureua
Streptococcus pyogenes
Systemic abx

22
Q

Child presents with goldne crusty scabs around their mouth and it looks red underneath.
Ddx? Cause?
Tx?

A

Impetigo
Streptococci - non-bullous
Staphylococci - bullous

Topicla/systemic abx

23
Q

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?

A

Ecthyma

Severe form of streptococcal impetigo

24
Q

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?

A

Staphylococcus scalded skin syndrome
Edxfoliative toxin from infection at distant site - kidneys cannot excrete toxin quick enough

Resembels stevens-johnson syndrome / toxic epidermal necrolysis

25
Q

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?

A

Toxic shock syndrome
Group A staphylococcus aurues

Palmar/sole desquamation

26
Q

Patinet presents worried about a scaly patch on their armpit. They say it was inititaly pink but has now turned brown.
Ddx?
Cause?

A

Erythrasma

Corynebacterium minutissimum

27
Q

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?

A

Pitted keratolysis
Corynebacteria
Topical clindamycin

28
Q

A butcher comes in with a rash and swelling on his hand. He says its slowly spread over the last few weeks.
Ddx?
Cause?

A

Erysipeloid

Erysipelothrix rhusiopathiae

29
Q

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

A

Anthrax

Bacillus anthracis from handling bone meal

30
Q

Child presents with a tender superificicla bullous that is erythematous in the fat pad of thei finger.
Ddx?
Cause?

A

Blistering distal dactylitis

Staphylococcus aureus/streptococcus pyogenes

31
Q

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?

A

Erysipelas
B haemyric streptococci , staph aureus
IV abx

32
Q

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?

A

Scarlet fever
URTI with eryrhigenic toxin oroduxing streptococcous pyogenes

Otitis, sinusitis, pneumonia, meningitis

33
Q

Patient presents with a dry wheezy cough that is worse on exertion and when its spring. Likely diagnosis and cardinal features?
Tests?
Tx options?

A

Asthma
Allergen sensitization, airway inflammintion from eosinophils and type 2 lymphocytes, reversible airway obstruction

  1. Fraction of exhaled nitric oxide >40
    Blood and induced sputum elsinophil counts
  2. Airway obstruction on spirometry <0.7
  3. Bronchodilator reversibility >12%
Inhaled corticosteroids 
Leukotriene receptor antagonists 
Beta 2 agonists
Anticholenergic therapies
Anti IgE antibodies - omalizumab
Anti IL5 antibodies - mepolizumab
34
Q

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?

A

3
Tazocin and gentamycin IV for 5-7 days
Oxygen, fluids, analgesia
HAP - staphylococcus aureus / pseudomonas aeruginosa

35
Q

You see a baby that has a croupy cough, tachypnea, wheezing on expiration and nasal flaring.
Lokely diagnosis?
Other symptoms?
RFs?

A

Respiratory syncytial virus
Hypoxia and cyanosis, chest wall retractions
Premature birth, congenital heart/lung disease

36
Q

Patient prevents with prolonged epistaxis. They also say theyve been having heavy periods and easily bruise (echymosis). Ddx?
Causes?
Ic?
Tx?

A

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

37
Q

Parient presents with spontaneous joint bleeding and muscle weakness. Likely diagnosis?

A

Haemophilia
Avoid IM injections
Haemarthrosis

38
Q

Patient presents complaining of chest pain and coughing blood. They are shirt of breath and have a heart rate of 120bpm. Ddx?

A

Pulmonary embolims

39
Q

Pateont presents with a painful swollen leg, red and warm. Ddx?

A

DVT

40
Q

a 83 year old presents with hearing loss, what do they most likely have?

A

presybycusis

41
Q

a child presents with watery diarrhoea, what is the most likely cause? treatment? vaccine?

A

rotavirus
oral rehydration
rotarix vaccine

42
Q

theres an outbreak of diarrhoea on a cruise ship, what is the most likely cause?

A

norovirus

43
Q

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?

A

head of pancreas ductal adenocarcinoma
courvoisiers sign
posteriore capsule invasion and irresectability

44
Q

patient presents with postprandial RUQ pain , says it radiates to the shoulder. also feel nauseous. likely diagnosis? what would you see on US? management?

A

bilary colic
cholelithiasis - gallstones in gallbladder
analgesia, antiemetics, spasmolytics
±cholecystectomy

45
Q 
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?
A

acute cholecystitis
pain on inspiration when palpating right subdiaphragamtic region
fluids, abx, analgesia, bloods, cholecystectomy

46
Q 
patient presents with Charcot's triad, ↑ WCC, CRP. LFTs and +ve MCS
US shows bilary dilatation
what is the triad?
ddx?
management?
A

jauncice, fever, RUQ pain
acute cholangitis
fluids, iv abx, analgesia
ERCP to clear bile duct or stenting

47
Q 
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?
A 
acute pancreatitis
low Ca2+
↑ amylase & lipase 
↑ WCC
do CT & US
modified Glasgow criteria 
fluid resus, O2, analgesia, antiemetics, ±ITU/HDU
48
Q

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?

A

preeclampsia
early onset because of foetal symptoms
40yrs, BMI? (≥30) autoimmune graves disease

49
Q

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?

A

reactive arthritis
enthesitis
NSAIDs ± DMARDs

BRS 2 (12 decks)

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