PE

Question 1

Headache differential

Answer 1

Primary (3):

• Tension HA
• Migraine HA
• Cluster HA

Secondary (14):
Intracranial Pressure
     - Intracranial bleed**
     - Intracranial neoplasm**
     - Pseudotumor cerebri   
   Vascular
     - Temporal arteritis**
     - Stroke**
  Infectious
     - Meningitis**
     - Sinusitis
   Neuro
     - Partial seizure
     - Trigeminal neuralgia
   MSK/OMM
     - Cervical somatic dysfunction
     - Trigger point
   Other
     - Angle-closure glaucoma**
     - Pheochromocytoma
     - Rebound HA (caffeine or analgesics)

Question 2

Headache U/E questions

Answer 2

Fevers
Unexpected weight loss
Worse lying down, bending forward, or at night
Nausea/vomiting
Vision changes (halos or stars, blurriness, changes in visual field, etc)

Question 3

Confusion/Memory Loss differential

Answer 3

Neurodegenerative
   -Alzheimer's (memory, words)
   -Lewy Body dementia (motor + cognitive)
   -Parkinson's (motor before cognitive; tremor)
   -Creutzfeldt-Jakob (myoclonus, behavior, sleep)
Intracranial pressure ish
   -Normal pressure hydrocephalus (gait, incontinence)
   -Chronic subdural hematoma
   -Intracranial neoplasm
Depression
Neurosyphilis
Hypothyroidism
FEN
   -B12 deficiency
   -Wernicke's encephalopathy
   -Hypoglycemia
   -Hyponatremia

Question 4

Acute Loss of Vision differential

Answer 4

Retinal artery occlusion
Retinal vein occlusion
Acute angle-closure glaucoma
Retinal detachment
Temporal arteritis

Question 5

Depressed Mood differential

Answer 5

MDD
PDD (dysthymia)
Bipolar I
Bipolar II
Schizoaffective 
normal bereavement
adjustment disorder
depression NOS

Question 6

Vertigo differential

Answer 6

• BPPV (positional, nausea, neg ROS)
• Meniere disease
• Vestibular neuritis/labyrinthitis (severe, persistent, post-infectious)
• Herpes Zoster oticus (ipsi pain/paralysis)
• Vestibular schwannoma

Question 7

Memory Loss Questions

Answer 7

• Onset and progression
• Gradual vs stepwise (degen vs vascular)
• Difficulty moving/turning (Parkinson’s/Lewy Body)
• Tremor (Parkinson’s/Lewy Body)
  
  • • frequency, action vs rest
• Speech, words (stroke, frontotemp, Alzheimer’s)
• Behavior (frontotemp, Creutzfeld-Jakob)
• Sleep, myoclonus (Creutzfeld-Jakob)
• Incontinence (NPH)
• ***ADLs (eat, bathe, dress, transfer, continence)
• Meds

Question 8

Ankle sprain PE

Answer 8

ATFL (anterior drawer)
CFL (forced inversion)
PTFL (posterior drawer)
If all three are injured, assess: 
- talar dome (joint line tenderness)
- 5th metatarsal (tenderness)
- navicular (tenderness)
- syndesmosis (squeeze test and external rotation test)
Also assess:
- Achilles
- Ability to bear weight

Question 9

Lateral Ankle Sprain Plan

Answer 9

• XR if bony tenderness or inability to bear weight
• RICE for 2-3 days
• +/- NSAIDS, but not too much?
• Consider deferred exam at 5 days post-injury if diagnosis uncertain

Question 10

Chest Pain U/E differential

Answer 10

Most common:
- ACS
- PE
- Aortic dissection
Also consider:
- Esophageal rupture
- Pericarditis/tamponade
- Tension pneumothorax