PD1 Block 2 materials Flashcards
Patient complains of RLQ pain, frequent Diarrhea, & crampy pain:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Crohn’s disease
Differentials:
1. UC
2. Carcinoid tumor
3. Colorectal cancer
Tests:
Colon biopsy
Colonoscopy
Guaiac stool test
Rx:
Steroids & immunosuppressants
Surgery (if not effective)
Patient complains of LLQ pain & frequent diarrhea that is sometimes bloody:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Ulcerative colitis
Differentials:
1. Crohn’s
2. Carcinoid syndrome
3. Colorectal cancer
Tests:
Colon biopsy
Colonoscopy
Guaiac stool test
Rx:
NSAIDS, Antibiotics, & Immunosuppressants
Patient complains of Abdominal pain, bouts of diarrhea & constipation, change in bowel habits, inability to empty the bowels, nausea, flatulence, & an urgent need to defecate:
What is your diagnosis?
What are your differentials?
What is the treatment?
Diagnosis: Irritable Bowel Syndrome (usually young women)
Differentials:
1. Ulcerative colitis
2. Crohn’s
3. Carcinoid syndrome
4. Colorectal cancer
Rx:
High fiber diet, reduce stress, & antidiarrheals
Patient complains of Crampy abdominal pain that comes & goes, Loss of appetite, & Constipation:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Bowel obstruction (adhesions from inflammation or poor cleaning post surgery)
Differentials:
1. Intussception
2. Hirschsprung disease
3. IBS
Tests:
Abdominal CT
Rx:
Remove obstruction & any ischemic/necrotic bowel
Patient complains of Abdominal pain, stomach cramps, nausea/vomiting, gagging, indigestion, fever, chills, malaise/sweating, dehydration, dizziness, headache & weakness:
What is your diagnosis?
What are your differentials?
What is the treatment?
Diagnosis: Food poisoning
Differentials:
1. Flu
2. Norovirus
3. Rotavirus
3. Adenovirus
Rx: It should resolve on its own
Patient complains of Abdominal pain, Watery diarrhea, vomiting, stomach cramps, excessive flatulence, & weight loss:
What is your diagnosis?
What are your differentials?
What is the treatment?
Diagnosis: Rotavirus
Differentials:
1. Food poisoning
2. Norovirus
3. Adenovirus
Rx:
Fluid replacement if it’s needed, otherwise it should resolve on its own in 3-7 days
Patient complains of Swollen legs (edema) & belly (ascites), yellow skin/eyes (jaundice), red palms if it’s a man they will also complain of easy bruising, abnormal bleeding, impotence, shrunken testes, & enlarged breasts (gynecomastia):
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis:
Alcoholic Liver Disease (history of alcohol abuse)
Differentials:
1. Non-alcoholic Fatty Liver Disease
2. Hep A,B,C
3. Fatty liver Disease
Tests:
Liver enzyme panel/liver function test
Rx: Stop drinking (long term!)
Patient complains of Abdominal pain, feeling of fullness in the right upper abdomen, nausea, loss of appetite/weight loss, yellow skin/eyes (jaundice), swollen legs (edema) & belly (ascites), extreme tiredness/mental confusion, & weakness:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Fatty liver disease
Differentials:
1. Alcoholic liver disease
2. Non-alcoholic liver disease
3. Hep A, B, C
Tests:
Liver enzyme panel/function test
Serum cholesterol & blood work
Rx: Change in diet, exercise, & weight loss
Patient complains of Belching, heart burn, nausea, regurgitation, bitter taste in the mouth, discomfort in the upper abdomen, dry cough, & difficulty swallowing:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: GERD
Differentials:
1. Esophageal cancer
2. MS
3. Stroke
4. Plummer-Vinson syndrome
Tests:
Blood work (iron levels)
Esophageal endoscopy
Rx:
Antacids, Proton pump inhibitors (Omeprazole), & H2 inhibitors (Cimetidine)
Patient complains of Severe iron deficiency, spooning nails (koilonychia), post cricoid dysphagia, upper esophageal webs, pallor, difficulty breathing, dyspnea, weakness, & tachycardia:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Plummer Vinson syndrome
Differentials:
1. Esophageal cancer
2. GERD
Tests:
Blood work (iron levels)
Esophageal endoscopy
Rx:
Iron supplements & mechanical dilation
Patient complains of fever, fatigue, loss of appetite, nausea/vomiting, abdominal pain, dark urine, clay-colored bowel poop:
What is your diagnosis?
What are your differentials?
Diagnostic: Hep B
Differentials:
1. Fatty Liver Disease
2. Alcoholic Liver Disease
3. Hep C
Patient complains of loss of appetite, tired/weakness, fever, itchy skin, yellow skin/eye (jaundice), bloated belly, swollen legs (edema), & pain in the right upper abdomen:
What is your diagnosis?
What are your differentials?
What is the treatment?
Diagnosis: Metastatic cancer to the liver
Differentials:
1. Hep A,B,C
2. Infects
3. Fatty liver disease
Rx:
Surgical resection, Ablation (heat to kill the tumor), & a hepatic artery infusion (delivers chemo to the liver directly)
Patient complains of thick white discharge, vaginal itching/inflammation, pain during sex/urination:
What is your diagnosis?
What are your differentials?
What is the treatment?
Diagnosis: Yeast infection
Differentials:
1. Bacterial vaginosis
2. Genital herpes
3. Allergic reaction
4. Trichomoniasis
5. Gonorrhea
Rx: Fluconazole
Patient complains of abnormal discharge that’s thick/or/thin frothy & yellow/green discharge with a fishy smell and swelling & itching around the vagina
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Trichomoniasis (STI)
Differential:
1. Gonorrhea
2. Chlamydia
3. Bacterial vaginosis
Rx: Both partners take a single dose of metronidazole
Patient complains of pain when peeing, urine frequency & urgency, blood in the urine (hematuria), lower abdominal pain:
What is your diagnosis?
What are your differentials?
What is the treatment?
Diagnosis: UTI OR pyelonephritis
Differentials:
1. Pelvic inflammatory disorder
2. Cholecystitis
3. Appendicitis
4. Bladder cancer
Rx: Fluoroquinolone
Patient complains of Pain when peeing, urinary frequency & urgency, having a hard time starting & stopping urine stream, dribbling urine, & nocturia:
What is your diagnosis?
What are your differentials?
What is the treatment?
Diagnosis: BPH
Differentials:
1. Pyelonephritis
2. Bladder cancer
3. Appendicitis
Rx. Tamsulosin
Patient complains of dull pain or no pain in the testes, testes feel like a bag of worms & are not light translucent, testes might be different sizes & swollen, & the sperm count will be low:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Varicocele
Differentials:
1. Hydrocele
2. Testicular cancer
Tests:
Sperm count
Light translucency
Rx:
If there’s symptoms NSAIDS & surgery
If there’s no symptoms it should resolve on its own
Patient complains of swollen testes with or without discomfort or painless swelling of one or both testes:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Hydrocele
Differentials:
1. Varicocele
2. Testicular cancer
Tests:
Light translucency
Sperm count
Rx:
Monitor it as it should go away on its own
Patient complains of a red & swollen mass/or/bump in the umbilical region:
What is your diagnosis?
What are your differentials?
What is the treatment?
Diagnosis: Sister Mary Joseph nodule (malignant & metastatic umbilical nodule)
Differentials:
1. Hernia
2. Abdominal cancer
3. Trauma
Rx: Palliative surgery, mild chemo, & giving the best supportive care possible
Patient complains of clammy/sweaty skin, dizziness, fainting, tachycardia, nausea/vomiting, shortness of breath, & sudden severe pain in the belly/lower back/legs (note its a pulsatile abdominal mass)
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Abdominal aortic aneurysm
Differentials:
1. Umbilical hernia
2. SMJ nodule
3. Abdominal cancer
Test:
Abdominal CT
Rx:
Stent & surgery
Stop smoking (if they do)
Exercise & diet management
Patient complains of abnormal penis discharge that can be white/yellow/or green in color, a burning feeling when peeing, & inflamed/swollen fore skin or tender testes:
What is your diagnosis?
What are your differentials?
What is the treatment?
Diagnosis: Gonorrhea
Differentials:
1. Trichomonas
2. Chlamydia
Rx: Ceftriaxone
Patient complains of pain when peeing or ejaculating, urine frequency, thin white discharge, & a sore/swollen head/fore skin:
What is your diagnosis?
What are your differentials?
What is the treatment?
Diagnosis: Trichomoniasis
Differentials:
1. Gonorrhea
2. Chlamydia
Rx: Metronidazole
Patient complains of urine incontinence, a missed period, tender/swollen breasts, nausea/vomiting, fatigue, & urine frequency:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: pregnancy
Differentials:
1. Pyelonephritis
2. STD
3. Overactive bladder syndrome
4. Menopause
Tests:
pregnancy test
Rx:
Kegel exercises & Pessary (inserted into the vaginal to support the urethra)
Patient complains of Urine incontinence, irregular periods, vaginal dryness, hot flashes & chills, weight gain, night sweats, & sleep issues:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Menopause
Differentials:
1. Pregnancy
2. Pyelonephritis
3. STD
4. Overactive bladder
Test:
pregnancy test
Rx:
Hormone therapy & diet supplementation
The Breast cyst .Mastolgia
fluid-filled sacs inside the breast that are usually
benign, that can be one or multiple.
A smooth, easily movable round or oval lump that may have smooth edges (benign)
● Nipple discharge (clear, yellow, straw colored or dark brown)
● Breast pain or tenderness
● An increase lump size and breast tenderness just before your period
● Better after your period
fluid-filled sacs inside the breast that are usually
benign, that can be one or multiple.
A smooth, easily movable round or oval lump that may have smooth edges (benign)
● Nipple discharge (clear, yellow, straw colored or dark brown)
● Breast pain or tenderness
● An increase lump size and breast tenderness just before your period
● Better after your period
The Breast cyst .Mastolgia
Patient complains of abdominal pain in the upper-right region, tenderness in the right region of the abdomen, nausea and vomiting, swelling of the abdomen, fever, persistent itching, jaundice, indicated by yellow eyes and skin, brown urine.:
What is your diagnosis?
What are your differentials?
What is the diagnostic test
What is the treatment?
Diagnosis: Splenomegaly caused by liver cirrhosis
Differential Diagnosis: Infection, Cystic Fibrosis, juvenile rheumatoid
arthritis
Treatment: surgery to remove your spleen (splenectomy)
PT has Abdo mass in Left Flank: PT has Abdo mass in Left Flank
Diagnosis:
Renal cell Carcinoma
Diff:
Cyst, renal infection, kidney stone
Tests:
-urine sample
- blood work (WBC)
-X-ray
-CT
-Biopsy
-ultrasound
Tx:
Surgery, radiation, palliative of terminal
Pt complains of a scrotal mass: Painless palpable mass in the testes
Scrotum feels heavy
Pain in scrotum
Dull ache in groin
Lower back pain
Breast tenderness
Differentials: Traumatic injury and varicocele
Tests:
- Digital exam
- Ultrasound
- Blood work
- Tumor markers
- Increase in serotonin
Tx: surgical removal of a testicle, chemo
Diagnosis: Seminoma
Pt complains of menorrhagia
Cc:
Pain during sex
Abdo pain
Pain while using the toilet
Bloody discharge
Pain in the lower back
Differentials:
Polyps or fibrinoid in the uterus, ovarian cyst, cervical trauma
Tests:
- Pap smear
- Ultrasound
- Endometrium biopsy
- Digital vaginal exam
Tx: hysterectomy, chemo, and radiation
Diagnosis:
Uterine cancer
Pt complains of Jaundice
Cc:
The skin and sclera have yellow hue
Excessive drinker
Fever fatigue
Nausea and vomit
Right Upper Quad pain
Differentials:
Viral hep and gallstone
Tests:
-Blood work-AST ALT Bilirubin Ammonina
- Ct scan
- liver biopsy
Tx: Abstinence from alcohol, nutritional support, vitamin K, and routine checkups
Diagnosis:
Alcoholic Hep
Pt complains of constipation
Cc: Abdo pain, fatigue, weight gain, poor appetite, cold
Differentials: Intestinal obstruction, drug induced- anticholinergics
Tests:
-Thyroid function
- Ultrasound
-barium enema
-colonoscopy
Tx:
L-thyoxine, replacement of follow up monitoring routinely
Diagnosis:
Hypothyroidism
Pt complains of Right lower Quadrant pain
Cc: Severe sharp, Knife pain, pain radiates to Mc Burney’s point/ umbilicus
Rebound tenderness is present, as fever, and nausea.
Differentials: PID, ectopic pregnancy
Tests:
-blood work- Wbc and Hcg
-pelvic exam and swab
-urine analysis
-ultrasound
-ct of abdo
Tx: Appendectomy then pain management and supportive care.
Diagnosis:
Acute Appendicitis
Pt complains of abdo Left Lower Quadrant pain
Cc: N/V/F, Abdo tenderness, constipation, chills
Differentials:
Ovarian cysts, colon obstruction
Tests:
- Blood work – WBC, CT,
- Ultrasound
- colonoscopy
Tx: diet changes, antibiotics pain management with drugs
Diagnosis:
Diverticulitis
Pt complains of foul diarrhea
Cc: Abdo pain and cramping, weight loss, lethargy, F/N, dehydrated
Differentials: E. coli, un’s, Ulcerative colitis
Tests:
-Vitals
-blood tests -wbc
-colonoscopy
-fecal sample
Tx: Vancomycin and Probiotics
Diagnosis:
C.Dliff
Pt complains of Abdo Mass in Left upper Quad
Cc: Thin stool with Blood, Abdo pain and cramp, OTC drugs do not relieve pain, weight loss,
Fatigue
Differentials: Splenomegaly, Splenic cyst
Tests:
-Blood work-cbc
-fecal
-occult blood test
-ultrasound
-colonoscopy with biopsy
Tx: Surgical resection, chemoradiation
Diagnosis:
Cholelithiasis/ gallstones
Pt complains of abdo Right Upper quad pain
Cc: Intense pain that radiates to back, pain in the right shoulder, nausea and vomiting, loss of
appetite, and jaundice.
Differentials:
Alcoholic or viral hepatitis, hepatic flexure obstruction
Tests:
- Bloodwork WBC
- Liver function
- Ultrasound biopsy
Tx: cholecystostomy drug- Ursodiol
Diagnosis:
Cholelithiasis/ gallstones
Pt comes in with wight loss over month
Cc:
Pain epigastric
Jaundice
Radiating Pain in the lower back
Differentials: stomach cancer, necrotic pancreatitis,
Tests:
increased amylase, lipase, alkaline phosphatase, CA 19-9, and carcinoembryonic antigen
(CEA).
Tx:
surgical removal, pancreaticoduodenectomy or distal pancreatectomy is preferred to a total
pancreatectomy to preserve some of the pancreatic function
Diagnosis:
pancreatic adenocarcinoma
Pt comes in presents with vague upper abdominal discomfort
Cc:
nausea, and early satiety.
daily NSAID user.
pale on examination
anemic.
mild abdominal tenderness
melanotic stool
Differentials: H. Pylori, food poisoning
Tests:
Blood count CBC
GI endoscopy
H. Pylori test
Tx:
Blood transfusion
Colonoscopy
Diagnosis:
Dyspepsia and Peptic Ulcer Disease
Pt several-year history of abdominal pain and constipation. denies any fever, weight loss,
heartburn, or bloody stools
Differentials:
Crohns, Colorectal cancer, Celiacs
Tests:
Blood count CBC
Hemoccult test
Initial screening
Tx: High fiber diet, reduce stress,
Diagnosis:
Irritable Bowel syndrome
Pt come in 4 months of history and daily burning sensation epigastric pain. Get worst
after eating and lying down and improves with PPI use. Symptoms of reactive airway
disease and hoarseness.
Tests:
Endoscopy
Barium esophagogram
Tx: H2 blockers, PPI, lifestyle changes, diet changes, surgical GE fundoplication
Diagnosis: GERD can lead to Barrett esophagus and lead to esophageal adenocarcinoma
Pt young comes in after Binge drinking with N/V. Abdo pain radiating to back
Cc: fever, leukocytosis, hemoconcentration
Diagnosis: Acute Pancreatitis can lead to pulmonary and cardiac and renal dysfunction
Pt comes with asymptomatic abdo mass. Non tender mass with prominent aortic
pulsation. Femoral pulse and popliteal pulse appear more prominent that usual
Test: Angio, ultrasound.
Diagnosis: Abdominal Aortic aneurysm
-old person presents to your office for a routine checkup. He reports having occasional
bloody stools and you discover guaiac-positive stools. He is a bit pale, but hemodynamically
stable at the moment. You decide that further evaluation of this bleeding is necessary, but
most of it can be carried out on an outpatient basis with close follow-up
Most likely diagnosis: Hemorrhoids.
Next diagnostic step: Complete blood count (CBC) and colonoscopy.
Next step in therapy: Discontinue NSAID use and decrease alcohol
consumption.
Diagnosis: Lower Gastrointestinal Bleeding
old woman with chronic kidney disease (CKD).
She has a history of uncontrolled diabetes and currently has uncontrolled
hypertension. She presents with periorbital edema, long-standing lower extremity
edema, an S4 and displaced PMI, and central obesity. The urinalysis
shows hyaline casts, 3+ proteinuria and glucose, negative ketones, and
hemoglobin 10.9 g/dL with an MCV of 82.3 g/dL.
Most likely diagnosis: Acute worsening of chronic kidney disease
Next diagnostic step: Measurement of serum electrolytes, blood urea nitrogen
(BUN), and creatinine; imaging of the kidneys
Next step in therapy: Further history to identify and remove any offending
agents (such as nonsteroidal anti-inflammatory drugs [NSAIDs]), and control
of blood pressure and diabetes; may require dialysis if she develops complications
such as pulmonary edema, severe hyperkalemia, or anuria.
Diagnosis: CKD
28-year-old woman presents for evaluation of irregular menstrual cycles for the past year. She is
obese and noted to have gained 30 lb. She is found to be hirsute and to have acanthosis nigricans.
Her pelvic examination is normal.
Most likely diagnosis: Anovulatory menstrual cycles secondary to polycystic ovarian
syndrome (PCOS)
➤ Initial laboratory test: Pregnancy test
➤ Treatment to regulate cycle: Oral contraceptive pills
Diagnosis: Menstrual Cycle Irregularity
A 25-year-old woman presents with a foul-smelling vaginal discharge. She has a greenish, frothy
discharge and a “strawberry cervix” noted on examination.
➤ Organism most likely to cause this infection: Trichomonas vaginalis
➤ Expected microscopic examination findings: Motile, flagellated trichomonads, and many
white blood cells.
➤ Recommended treatment: Metronidazole 2 g by mouth in a single dose for both the patient
and her sexual partner.
Metronidazole 500 mg twice a day for a week is an alternate regimen.
Diagnosis: Vaginitis
