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STEP 2 CS CASES > Pertanent Positives > Flashcards

Pertanent Positives Flashcards

1
Q

Laryngeal cancer

A 
Cervical LAD
Worsening horseness over past 3 months
Weight loss, decreased appetite, and low grade fever.
History of smoking and/or ETOH use
Advance age
PE:  Fever
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2
Q

Laryngitis

A 
Recent viral infection such as flu 4 weeks ago.
History of smoking
Polluted air
Low grade fever
GERD
PE: Low grade fever
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3
Q

Laryngeal polyps

A

Over use such as teacher/singer

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4
Q

Laryngeal cancer, Laryngitis, Laryngeal polyps

Tests

A

Laryngoscopy
ESR
US neck
CT chest/neck

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5
Q

Disk Herniation

A

Neck pain that increases with movement.
Radiculopathy (numbness left arm)
PE: Loss of pinprick sensation to dorsum of left hand hand and posterior left forearm.

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6
Q

Cervical fracture

A

Rapid rotation neck preceded pain.
Pain increases with movement.
Osteopenia on DEXA scan.

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7
Q

Neck muscle spasm

A

Rapid rotation of neck preceded pain

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8
Q

Disk Herniation, Cervical fracture, Neck spasm

Tests

A

XR-C-spine
MRI-C-spine
Nerve conduction study

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9
Q

Cholecystitis

A 
Pain is exacerbated by heavy fatty foods
Associated with nausea and vomiting
Female gender, age in 40's
PE: Epigastric tenderness
positive Murphey's sign
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10
Q

Peptic Ulcer Disease

A

History of NSAID use
Epigastric pain 2-3 hours after meals
Pain is exacerbated by hunger and fatty foods and is relieved by antacids
PE: Epigastric tenderness

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11
Q

Gastritis

A

History of NSAID use
Epigastric pain associated with food
Nausea and vomiting
PE: Epigastric tenderness

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12
Q

Cholecystitis, Peptic Ulcer Disease, Gastritis

A

Rectal exam, stool for occult blood
US abdomen
Upper endoscopy
H. Pylori antibody testing

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13
Q

Migraine

A

Unilateral, sharp headache
Associated with nausea and vomiting
Photophobia
PE: Severe sharp pain with lack of neurologic findings

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14
Q

Tension headache

A

Chronic headaches
Associated with stress at work
Improves with sleep
PE: Severe sharp pain with lack of neurologic findings

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15
Q

Itracranial mass lesion

A

Headaches associated with nausea and vomiting

Family history of brain tumor

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16
Q

Migraine, Tension headache, Itracranial mass lesion

Tests

A

CBC
CT head or MRI brain
LP
CT sinus

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17
Q

Pregnancy

A

Change in menstrual cycle
Regular sexual activity
Previous successful pregnancy

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18
Q

Hyperprolactinomia

A

Galactorrhea

Oligomenorrhea

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19
Q

Polycystic ovary syndrome

A

Weight gain
Hirsutism
Oligomenorrhea

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20
Q

Pregnancy, Hyperprolactinomia, Polycystic ovary syndrome

Tests

A

Urine hCG
Pelvic and breast exam
Prolactin, TSH
LH, FSH

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21
Q

Vulvovaginitis

A

White vaginal discharge
Fishy odor of discharge
Vaginal pruritus

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22
Q

Cervicitus

A

White vaginal discharge
Dyspareunia
Sexual activity without barrier contraception

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23
Q

Endometriosis

A

Dysmenorrhea

Dyspareunia

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24
Q

Vulvovaginitis, Cervicitus, Endometriosis

Tests

A

Pelvic exam
Wet mount, KOH prep, “whiff test”
Cervical cultures (chlamydia and gonorrhea DNA probes)
Laprascopy

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25
Q

Presbycusis

A 
Bilateral, progressive hearing loss
Advanced age
Hypertension
PE: Positive Rinne test
Lack of lateralization on Weber test
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26
Q

Cochler nerve damage

A

Prior exposure to loud sounds
Bilateral hearing loss
PE: Positive Rinne test
Lack of lateralization on Weber test

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27
Q

Otosclerosis

A

Bilateral, progressive hearing loss
Advanced age
PE: Lack of lateralization on Weber test

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28
Q

Presbycusis, Cochler nerve damage, Otosclerosis

Tests

A

Audiometry
Tympanography
Brain stem auditory evoked potentials

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29
Q

Physiologic jaundice

A

Infant in first week of life

No changes in feeding, urination, or bowel movements

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30
Q

ABO or Rh incompatibility

A

Infant in first week of life

Mother and father with different ABO types

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31
Q

Neonatal sepsis

A

History of maternal infection

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32
Q

Physiologic jaundice, ABO or Rh incompatibility, Neonatal sepsis
Tests

A

Total and indirect bilirubin
Blood typing
Direct Coombs test
CRP

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33
Q

Viral URI

A 
Fever (101F)
Rhinorrhea
Sibling with URI
Daycare attendance
Increased breathing rate
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34
Q

Pneumonia

A

Fever (101F)
Daycare attendance
Sibling with URI
Increased breathing rate

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35
Q

Otitis media

A

Fever (101F)
Irritability
Daycare attendence

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36
Q

Viral URI, Pneumonia, Otitis media

Tests

A 
CBC with differential
Blood culture
UA and urine culture
CXR
Respiratory viral panel
Pneumatic otoscopy
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37
Q

Pneumonia

A 
Persistent cough
Low grade fever
PE: Increased tactile fremitus
Decreased breath sounds right side
Temperature 99.9F
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38
Q

URI-associated cough (post-infectious cough)

A

Recent URI
Low grade fever
White sputum production
PE: Temperature 99.9F

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39
Q

Acute bronchitis

A 
Low grade fever 
Persistent cough
White sputum production
PE: Increased tactile fremitus
Temperature 99.9F
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40
Q

Pneumonia, URI-associated cough (post-infectious cough), Acute bronchitis
Tests

A

CXR
CBC with differential
Sputum gram stain and culture

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41
Q

Extrahepatic biliary obstruction

A 
Light colored stools, dark urine
Pruritus
Father with pancreatic cancer
PE: Jaundice
scleral icterus
RUQ tenderness
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42
Q

Viral hepatitis

A 
History of blood transfusion
Recent travel to Mexico
PE: Jaundice
scleral icterus
RUQ tenderness
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43
Q

Acetaminophen hepatotoxicity

A 
Frequent acetaminophen use
Concomitant alcohol use 
PE: Jaundice
scleral icterus
RUQ tenderness
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44
Q

Extrahepatic biliary obstruction, Viral hepatitis. Acetaminophen hepatotoxicity
Tests

A

AST/ALT/bilirubin/alkaline phosphatase
US RUQ abdomen
Viral hepatitis serologies

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45
Q

Meniere’s disease

A 
Sensation of room spinning
Left sided hearing loss
tinnitus
sensation of aural fullness
PE: Decreased hearing acuity on the left
Positive Rinne test
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46
Q

Benign paroxysmal positional vertigo

A

Sensation of room spinning
Onset with positional changes
Duration 20-30 minutes

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47
Q

Orthostatic hypotension causing dizziness

A

History of diarrhea

Taking antihypertensive medication

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48
Q

Meniere’s disease, Benign paroxysmal positional vertigo, Orthostatic hypotension causing dizziness
Tests

A

Dix-Hallpike maneuver
Audiometry
MRI brain

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49
Q

Gout

A 
Monoarticular joint pain and tenderness
History of swollen toe
Occasional alcohol use
PE: Joint tenderness and stiffness
Swelling at left knee
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50
Q

Rheumatoid arthritis

A 
Morning joint stiffness
Family history of rheumatoid arthritis
Systemic symptoms (anorexia, weight loss, fatigue, fever)
PE: Joint tenderness and stiffness 
Temperature 99.9F
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51
Q

Systemic lupus erythematosus

A 
Systemic symptoms (anorexia, weight loss, fatigue)
History of multiple ulcers
History of 2 spontaneous abortions 
Raynaud's phenomenon
PE: Joint tenderness and stiffness
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52
Q

Gout, Rheumatoid arthritis, Systemic lupus erythematosus

tests

A

CBC with differential
Immunologic testing (ANA, dsDNA, RF, CCP)
Knee aspiration with Gram stain, culture, and inspection for crystals.
XR left knee and both hands

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53
Q

Plantar fasciitis

A

Training for marathon
Pain is gradual
Pain is worse with first few steps in the morning and after prolonged sitting
PE: Tenderness over medial calcaneal tuberosity
Pain with toe dorsiflexion

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54
Q

Calcaneal stress fracture

A

Training for a marathon
Diffuse pain over heel
Refractory to conservative management
PE: Tenderness over plantar heel and arch

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55
Q

Achilles tendinitis

A

Training for a marathon

PE: Pain with toe dorsiflexion

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56
Q

Plantar fasciitis, Calcaneal stress fracture, Achilles tendinitis
Tests

A

XR right ankle/foot
Bone scan
MRI right ankle/foot

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57
Q

Acute otitis media

A

Fever 101F
Pulling at the right ear; fatigued and not watching TV usual
History of otitis media
Runny nose and cough that have subsided

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58
Q

Meningococcal meningitis

A

Maculopapular facial rash that has spread to the chest, back, and abdomen
Fever 101F
Difficulty sleeping for 2 days
Recent episode of vomiting

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59
Q

Scarlet fever

A

Maculopapular facial rash that has spread to the chest, back, and abdomen
Fever 101F
Difficulty swallowing for 2 days

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60
Q

Acute otitis media, Meningococcal meningitis, Scarlet fever

Tests

A 
Pneumatic otoscopy
LP CSF analysis
CBC with differential
Blood culture
UA and urine culture
Throat culture
Platelets, PT/PTT, D-dimer, fibrin split products, fibrinogen
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61
Q

Pulmonary tuberculosis

A

Fever and night sweats with fatigue
Worsening cough of 1 month’s duration
Close contact with patients with active TB
Decreased appetite with unintentional weight loss of 6lbs over 2 months
PE: Blood-tinged mucus

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62
Q

Lung cancer

A

Fever and night sweats with fatigue
Decreased appetite with unintentional weight loss of 6lbs over 2 months
History of heavy smoking and chronic bronchitis
PE: Blood tinged mucus

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63
Q

Typical pneumonia

A

Fever
Mucus production
History of heavy smoking and chronic bronchitis
PE: Sputum production

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64
Q

Pulmonary tuberculosis, Lung cancer, Typical pneumonia

Tests

A 
PPD or Quantiferon Gold
CBC
Blood cultures
Sputum Gram stain, AFB smear
CXR PA and lateral
CT chest
 Bronchoscopy
Lung biopsy
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65
Q

Pancreatic cancer

A

History of smoking and eating foods that are high in fat content
Unintentional weight loss of 8 lbs over past 6 months
Foul smelling, greasy looking stools
PE: Mild epigastric pain

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66
Q

Depression

A

Feelings of sadness
Loss of interest in activities, early awakening, impaired concentration, low energy
Decreased appetite, and unintentional weight loss

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67
Q

Chronic pancreatitis

A

History of alcohol use
Worsening epigastric discomfort that radiates to the back
Foul smelling, greasy looking stools
PE: Mild epigastric pain

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68
Q

Pancreatic cancer, Depression, Chronic pancreatitis

Tests

A 
CBC, stool for occult blood
Glucose
Fecal fat studies
Amylase, lipase
AST/ALT/bilirubin/alkaline phosphatase 
CT abdomen
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69
Q

Medication induced erectile dysfunction

A

Taking propanolol
Onset of ED coincides with propranolol use
No early morning or nocturnal tumescence

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70
Q

Erectile dysfunction secondary to vascular disease

A

History of hypertension
History of hyperlipidemia
Hair loss
No early morning or nocturnal tumescence

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71
Q

Hypogonadism

A

Loss of libido and ED
Hair loss
No early morning or nocturnal tumescense

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72
Q

Medication induced erectile dysfunction
Erectile dysfunction secondary to vascular disease
Hypogonadism
Tests

A 
Genital and rectal exams
Serum glucose
Testosterone level
Prolactin, TSH, LH/FSH
Ferritin
MRI brain
Doppler US penis
Dynamic cavernosography
73
Q

Anxiety

A

Impaired concentration, irritability, difficulty sleeping, muscle tension, sweating, and palpitations
Anxiety over academic achievement
No history of substance use
PE: Tachycardia (HR 102/minute)

74
Q

Caffeine induced insominia

A

Drinks 4-5 cups of caffeine per day
Spends 2 hours awake before falling asleep
History of heart palpitations that are more pronounced after drinking caffeine
PE: Tachycardia (HR 102/minute)

75
Q

Hyperthyroidism

A

Anxiety
History of unintentional weight loss, tremor, fatigue, sweating, palpitations, and increased bowel movements
PE: Tachycardia (HR 102/minute)

76
Q

Anxiety, Caffeine induced insomnia, Hyperthyroidism

Tests

A

TSH, FT3, FT4

77
Q

Foreign body aspiration

A

Sudden onset while playing with toys

Noisy breathing

78
Q

Croup

A

Noisy breathing
Difficulty breathing
Fever for the past week

79
Q

Epiglottitis

A

Occasional voice hoarseness

Occasional muffling

80
Q

Foreign body aspiration, Croup, Epiglottitis

Tests

A 
ABG
CXR PA and lateral
XR neck, AP and lateral
CBC with differential
Bronchoscopy
Direct laryngoscope
81
Q

Appendicitis

A 
Right lower abdominal pain
Pain exacerbated by movement
Nausea and vomiting
Low grade fever
PE: RLQ direct and rebound tenderness
RLQ gaurding
Temperature 100.5F
Positive Rovsing's sign
Positive Psoas sign
82
Q

Pelvic inflammatory disease

A 
STD 6 months ago with untreated partner 
Nausea and vomiting
Spotting
Unprotected sex with multiple partners
Low grade fever
PE: RLQ tenderness
Temperature 100.5F
83
Q

Ruptured ectopic pregnancy

A 
Last menstrual period 5 weeks ago and spotting
Crampy lower abdominal pain 
Pain is exacerbated by movement
Nausea and vomiting
Pain is of recent onset
PE: RLQ rebound tenderness
RLQ guarding
84
Q

Appendicitis, Pelvic inflammatory disease, Ruptured ectopic pregnancy
Tests

A 
Urine hCG
Pelvic exam
Cervical cultures
U/S abdomen and pelvis
CT abdomen and pelvis
CBC
85
Q

Alzheimer’s disease

A 
Steady cognitive decline
Memory impairment
Impaired executive functioning
Decline in activities of daily living
PE: Failed 3 item recall
86
Q

Vascular (“multi-infarct”) dementia

A 
Previous stroke
History of coronary artery disease (MI)
Hypertension
Impaired executive functioning
PE: Decreased strength in left upper extremity
DTRs 3+ in left upper and lower extremities
Positive Babinski bilaterally
Failed 3 item recall
87
Q

Dementia syndrome of depression

A

Dysphoria after husband’s death
impaired executive funtioning
Memory impairment
PE: Failed 3 item recall

88
Q

Alzheimer’s disease, Vascular (“multi-infarct”) dementia, Dementia syndrome of depression
Tests

A 
CT head or MRI brain
EEG or SPECT 
CBC 
Serum B12, TSH, RPR
Electrolytes, calcium, glucose
BUN/Cr
89
Q

Major depressive disorder

A 
Dysphoria, anhedonia
Loss of appetite
Passive suicidal ideation
Decreased energy/fatigue
Impaired concentration
Early awakening
90
Q

Hypothyrodism

A

Fatigue for 3 months
Cold intolerance
Hair loss
Weight gain

91
Q

Post traumatic stress disorder

A

Nightmares about the trauma
Negative mood/anhedonia
Decreased concentration
Difficulty staying asleep

92
Q

Major depressive disorder, Hypothyrodism, Post traumatic stress disorder

A

TSH
CBC
HIV antibody

93
Q

Domestic violence

A 
Admits to physical abuse 
Exhibits self blame
Attempts to defend husband
Episodes of abuse directed at child
PE: Symmetrical bruises on extremities
94
Q

Diabetes mellitus

A

Polyuria, polydipsia
Obesity
Family history of diabetes

95
Q

Anemia

A

Fatigue/weakness
Heavy menstrual flow
PE: Conjunctival pallor

96
Q

Domestic violence, Diabetes mellitus, Anemia

Tests

A 
Serum glucose, HbA1c,
CBC
Serum iron, ferritin, TIBC, serum B12
UA
Electrolytes
97
Q

PCP intoxication

A 
Drug use 1 day before presentation
Visual hallucinations
Noncommand auditory hallucinations
Delusions
Myalgias
PE: Tachycardia (HR 110/minute)
Hypertension (BP 140/80)
Vertical gaze nystagmus
98
Q

Substance induced psychosis

A 
Drug use 1 day before presentation
Visual hallucinations
Noncommand auditory hallucinations
Delusions
No history of non-drug-related psychosis
Does not associate drug use with presentation
PE: Dilated pupils
99
Q

PCP intoxication, Substance induced psychosis

A 
Urine toxicology
Electrolytes
CPK
Urine myoglobin
Mental status exam
100
Q

COPD/Chronic bronchitis

A

Chronic cough
Sputum production
History of smoking 1PPD x 10 years
Worked as coal miner

101
Q

Pneumoconiosis

A

Worked as coal miner

Chronic cough

102
Q

Pulmonary tuberculosis

A 
Recent emigration from Africa
Chronic cough
Weight loss
Blood tinged sputum
Dyspnea
Chest pain
TB exposure
103
Q

COPD/Chronic bronchitis, Pneumoconiosis, Pulmonary tuberculosis
Tests

A

CXR PA and lateral
PPD or Quantiferon gold
CBC

104
Q

Colorectal cancer

A

Blood mixed with stool for 1 month
Family history of colorectal cancer
Unintentional weight loss of 10lbs
Change in bowel habits

105
Q

Hemorrhoids

A

History of hemorrhoids
Hematochezia
Fresh blood on toilet paper or in toilet bowel

106
Q

C difficile colitis

A

Acute diarrhea

Recent antibiotic exposure

107
Q

Colorectal cancer, Hemorrhoids, C difficile colitis

Tests

A 
Rectal exam, stool for occult blood
Colonoscopy
Stool for C difficile PCR
Fecal leukocytes
CBC
Anoscopy
flexible proctosigmoidoscopy
108
Q

Parkinson’s disease

A

Resting tremor that is evident with the affected body part supported and completely at rest.
Improves with voluntary movement
PE: Low frequency tremor in upper extremity
Bradykinetic gait
Upper extremity rigidity

109
Q

Essential tremor

A 
Possible family history of tremor
Action tremor
PE: Tremor in distal upper extremity
Tremor with arms out stretched
Positive F/N
110
Q

Physiologic tremor

A

Resting tremor

PE: Tremor in distal upper extremity

111
Q

Parkinson’s disease, Essential tremor, Physiologic tremor

Tests

A

MRI brain

112
Q

Hypothyrodism

A 
Oligomenorrhea and hypomenorrhea
Chronic dry skin
Chronic cold intolerance
Weight gain
Deepening of voice
Constipation
Depression
Fatigue
113
Q

Smoking cessation

A

Weight gain following smoking cessation normally 5 pounds

114
Q

Lithium related weight gain

A 
On going lithium therapy
Cold intolerance
Dry skin
Confusion
Dizziness
Headache
Lethargy
Hair loss
Fatigue
115
Q

Hypothyrodism, Smoking cessation, Lithium related weight gain
Tests

A

TSH
Serum lithium level
Fasting glucose, cholesterol, triglycerides

116
Q

Viral gastroenteritis

A

Acute watery diarrhea
Low grade fever 100.5F
Day care attendance

117
Q

Bacterial diarrhea

A

Acute diarrhea
Day care attendance
Low grade fever 100.5F

118
Q

Malabsorption

A

Watery diarrhea
Dry mouth
Juice in babies of this age group

119
Q

Viral gastroenteritis, Bacterial diarrhea, Malabsorption

A

Physical exam
Rotavirus enzyme immunoassay/norovirus PCR
Electrolytes
Stool leukocytes, culture, ova and parasitology and pH

120
Q

Intussusception

A 
Abdominal pain
Vomiting
Bloody ("currant jelly") stools
Recent viral illness
Low grade temperature
121
Q

Monosymptomatic primary nocturnal enuresis

A

Chronic nocturnal enuresis
Family history of enuresis
History of never being continent

122
Q

Urinary tract infection

A

Enuresis

Possible dyduria

123
Q

Secondary enuresis

A

Nocturnal enuresis
Major trauma
Life or environmental change (divorce, major illness, abuse)

124
Q

Monosymptomatic primary nocturnal enuresis, Urinary tract infection, Secondary enuresis
Tests

A

Genital exam
UA
Urine culture

125
Q

Sleep apnea and Narcolepsy in children

A

Can cause enuresis

126
Q

Functional bladder disorder

A

Void several times a day
Hold urine until the last moment
Wet small volumes almost every night
Sometimes multiple times a night

127
Q

Simple febrile seizure

A

Seizure duration

128
Q

Meningitis

A

Tonic-clonic seizure
Fever Tmax 102.9F
Decreased appetite
Decreased urine output

129
Q

Hyponatremia

A

Seizure

Poor family waters down infant formula

130
Q

Simple febrile seizure, Meningitis, Hyponatremia

A

LP CSF analysis
CBC
Elecrolytes

131
Q

Infectious mononucleosis

A 
Sore throat 2 weeks (exudative pharyngitis)
LUQ pain
Recent history of ill contact
PE: LUQ tenderness
Lymphadenopathy
Splenomegaly
132
Q

Acute HIV infection

A

Sore throat 2 weeks
Two sexual partners over the past year, active with men and women
Treated for gonorrhea 4 months ago

133
Q

Streptococcal pharyngitis

A

Sore throat 2 weeks
Low grade fever
History of cigarette smoking
PE: Lymphadenopathy

134
Q

Infectious mononucleosis, Acute HIV infection, Streptococcal pharyngitis
Tests

A 
CBC with peripheral smear
Monospot test
Anti-EBV antibodies
HIV antibody and viral load
Throat culture
135
Q

Convulsive syncope

A

Loss of consciousness for several minutes
Arms and legs shaking for 30 seconds
No subsequent confusion or weakness

136
Q

Cardiac arrhythmia

A

Loss of consciousness preceded by palpitations and lightheadedness
Taking a B-blocker (atenolol)
No subsequent confusion or weakness
History of MI

137
Q

Seizure

A 
Loss of consciousness lasting several minutes
Arms and legs shaking for 30 seconds
Sudden onset
Tongue biting
Incontinence
Prolonged confusion
Drowsiness postictally
138
Q

Convulsive syncope, Cardiac arrhythmia, Seizure

Tests

A 
CBC
Electrolytes
ECG and Holter or event monitor
CT head or MRI brain
EEG
139
Q

Vasovagal sycnope

A 
Nausea
Sweating
Tachycardia
Pallor
Feeling "Faint"
140
Q

Myocardial ischemia or infarction

A

Pressure like substernal chest pain
Pain radiates to left arm, upper back, and neck
Pain awakens patient at nght

141
Q

Cocaine induced myocardial ischemia

A

History of cocaine use
Last used yesterday afternoon
Pressure like substernal chest pain

142
Q

GERD

A

Pain in midchest
Previous pain relieved by antiacids
Previous pain occurred after heavy meals

143
Q

Myocardial ischemia or infarction, Cocaine induced myocardial ischemia, GERD
Tests

A 
ECG
Cardiac enzymes (CPK, CPK-MB, troponins)
Transthoracic echocardiography
Upper endoscopy
Urine toxicology
144
Q

Bladder cancer

A 
Hematuria
Straining on urination
Weak urinary stream and dribbling
Work as painter (exposure to industrial solvents)
History of smoking 1 PPD x 30 years
145
Q

Urolithiasis

A

Hematuria
Straining on urination
PE: CVA tenderness

146
Q

Benign prostatic hypertrophy

A

Polyuria, nocturia
Weak urinary stream and dribbling
Straining on urination

147
Q

Bladder cancer, Urolithiasis, Benign prostatic hypertrophy

Tests

A 
Genital exam
Rectal exam
Cystoscopy
US renal
UA
CT abdomen/pelvis
PSA
148
Q

Disk herniation

A 
Low back pain
Pain started after lifting heavy boxes
Pain radiates to left thigh and foot
Pain worsens with movement and is relieved by lying still
PE: Positive straight leg raise
149
Q

Lumbar spinal stenosis

A

History of intermittent low back pain and leg pain with ambulation
Pain resolves with sitting
PE: Walks with back slightly bent forward

150
Q

Metastatic prostate cancer

A

Difficulty urinating
Incomplete emptying of bladder
Low back pain

151
Q

Disk herniation, Lumbar spinal stenosis, Metastatic prostate cancer
Tests

A

XR L spine
MRI L spine
Rectal exam
PSA

152
Q

Pneumothorax

A

Left sided chest pain following an MVA
Pain is exacerbated by movement and deep breaths
Dyspnea
JVD
PE: Decreased breath sounds over left lung field
RR 22/minute

153
Q

Hemothorax

A

Left sided chest pain following an MVA
Dyspnea
Cough

PE: Decreased breath sounds over left lung field
RR 22/minute
Hypovolemic shock

154
Q

Pneumonia

A 
Unilateral chest pain
Productive cough
Low grade fever
PE: Temperature 100F
RR: 22/minute
155
Q

Pneumothorax, Hemothorax, Pneumonia

Tests

A

CXR

Sputum and blood Gram stain and culture

156
Q

Normal pregnancy

A

Amenorrhea for 6 weeks
Positive pregnancy test
Bilateral breast engorgement
Nausea and weight gain

157
Q

Ectopic pregnancy

A

Amenorrhea 6 weeks

Positive pregnancy test

158
Q

Molar pregnancy

A

Positive pregnancy test

Nausea

159
Q

Normal pregnancy, Ectopic pregnancy, Molar pregnancy

Tests

A

Urine hCG
US pelvis
Breast/pelvic exams
Blood type, Rh, antibody screen

160
Q

Type 1 diabetes mellitus

A

Polyuria, polydipsia
Recent weight gain
Hyperglycemia

161
Q

Type 2 diabetes mellitus

A

Polyuria, polydipsia
Recent weight gain
Hyperglycemia

162
Q

Secondary cause of diabetes

A

Obesity

163
Q

Type 1 diabetes mellitus, Type 2 diabetes mellitus, Secondary cause of diabetes
Tests

A 
Insulin and C peptide levels
Islet cell antibodies
HbA1c
Electrolytes, glucose
UA and urine microalbumin
24 hour urine free cortisol
164
Q

Humeral fracture

A

Pain following fall on outstretched arm
Pain increases with arm movement
PE: Tenderness over upper and middle right arm
Restricted range of motion

165
Q

Shoulder dislocation

A

Pain following fall on outstretched arm
Pain increases with arm movement
PE: Right arm externally rotated and slightly abducted
Pain and restricted range of motion on shoulder exam

166
Q

Osteoporosis

A

Advanced age

167
Q

Humeral fracture, Shoulder dislocation, Osteoporosis

Tests

A

XR right shoulder and arm
MRI shoulder
Bone density scan (DEXA)

168
Q

Insulin induced hypoglycemia

A

Episodes of palpitations and diaphoresis that resolve with drinking orange juice
Tight glycemic control

169
Q

Diabetic peripheral neuropathy

A

History of diabetes mellitus
Constant numbness and tingling in feet
PE: Absent ankle jerk

170
Q

Organic erectile dysfunction

A

Loss of erection for 2 years with absence of early morning erection
History of diabetes mellitus
History of alcohol use
Taking lovastatin and atenolol

171
Q

Insulin induced hypoglycemia, Diabetic peripheral neuropathy, Organic erectile dysfunction

A 
Genital exam
Serum glucose, HbA1c
UA, urine microalbumin, Bun/Cr
Doppler US penis
Nerve conduction studies
172
Q

Rib fracture

A

Physical assualt
Right chest pain
Pain is exacerbated by movement and deep breaths
PE: Tenderness to palpation right chest wall

173
Q

STD

A

Sexual assault by 2 men

No condoms use

174
Q

Pregnancy

A

Unprotected vaginal intercourse with possible ejaculation
No OCP use
Last menstrual period 3 weeks ago

175
Q

Rib fracture, STD, Pregnancy

A 
Pelvic exam
XR skeletal survey
CXR
Urine hCG
Wet mount, KOH prep, cervical culture, gonorrhea and chlamydia tests
HIV antibody, VDRL, HBV antigen
176
Q

Deep venous thrombosis

A

Recent 15 hour plane flight
Weight gain of 50lbs over the past 3 years
Taking oral OCPs for 2 years
Father with DVT (possible familial thrombophilia)
PE: Homan’s sign
Pitting edema
Swollen, tender, red, warm right calf

177
Q

Cellulitus

A

Cuts to right leg secondary to fall
Low grade fever
PE: Swollen, tender, red, warm right calf
Temperature 99.9F

178
Q

Rupture of Baker’s cyst

A

Spasmodic pain in right calf

PE: Swollen, tender right calf

179
Q

Deep venous thrombosis, Cellulitus, Rupture of Baker’s cyst

Tests

A 
Doppler US legs
D-dimer
Hypercoagulability testing
CBC with differential
Wound and blood cultures

STEP 2 CS CASES (2 decks)

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