Pertinent positives

Question 1

migraine

Answer 1

F>M
unilateral, sharp/stabbing headache
\+/- aura, nausea, vomiting, photophobia
\+/- family history
lack of neuro findings

Question 2

tension headache

Answer 2

bilateral, squeezing headache
associated with stress/sleep deprivation
hrs-days long
worsens as day progresses

Question 3

intracranial mass lesion

Answer 3

possible presenting symptom (1/3 patients)
similar to migraine
+/- weight loss, neuro findings

Question 4

pseudotumor cerebri

Answer 4

diplopia or other visual changes

papilledema or normal if within first few days

Question 5

cluster headache

Answer 5

M>F
unilateral periorbital pain
\+/- ipsilateral nasal congestion, rhinorrhea, lacrimation, redness of eye, +/- horners syndrome
daily pain episodes occur in clusters
pain can awaken patient at night

Question 6

sinusitis

Answer 6

pain upon palpation of forehead

Question 7

typical pneumonia

Answer 7

abrupt onset fevers, chills
pleuritic chest pain (worse with inspiration)
productive cough
dyspnea
increased tactile fremitus (airspace consolidation)
\+/- bronchial BS
\+/- crackles/rales
**exam findings absent in up to 2/3 pts

Question 8

URI-associated cough

Answer 8

persists for 1-2 weeks or up to 6-8 wks in patients with underlying asthma

Question 9

PCP pneumonia

Answer 9

dry cough

dyspnea

Question 10

TB

Answer 10

constitutional symptoms: fever, night sweats, unintentional weight loss
hemoptysis
recent exposure to active TB
** place in respiratory isolation!
** need PPD skin test

Question 11

Lung cancer

Answer 11

long-time smoker
constitutional symptoms: fever, night sweats, unintentional weight loss
hemoptysis
clubbing - COPD patient with underlying malignancy

Question 12

Lung abscess

Answer 12

gradual onset (wks-mos) of fatigue, fever, night sweats, cough
foul-smelling expectoration

Question 13

atypical pneumonia - mycoplasma pneumoniae, chlamydia pneumoniae, legionella

Answer 13

gradual onset fever, fatigue, headache, myalgia, sore throat, hoarseness, chest pain
non-productive cough
\+/- blood-streaked sputum
legionella: GI symptoms
mycoplasma: severe ear pain

Question 14

exacerbation of chronic bronchitis (COPD exacerbation)

Answer 14

increased sputum production
increased wheezing
increased dyspnea

Question 15

generalized anxiety disorder

Answer 15

fatigue
sleep disturbances - insomnia
tension, fears, irritable, difficulty concentrating
tachycardia, sweating, hyperventilation, palpitations, tremor
find source of anxiety

Question 16

caffeine induced insomnia

Answer 16

most common pharm cause of insomnia
intake of caffeine
increased latency to sleep onset, more frequent arousals, reduction in total sleep time - several hrs after ingestion

Question 17

hyperthyroidism

Answer 17

fatigue
unintentional weight loss
heat intolerance
anxiety, tremor, palpitations, sweating
frequent BMs
menstrual irregularities

Question 18

depression

Answer 18

Sleeping - sleep onset insomnia, sleep maintenance insomnia, early-morning wakefulness
Interest - lost interest in activities used to enjoy
Guilty
Energy - lost
Concentration difficulty
Appetite changed
Psychomotor agitation or lethargy
Suicidal/homicidal ideation

Question 19

insomnia 2/2 adjustment disorder

Answer 19

symptoms occur within three months of stressful event and end six months after stressor (change in job, lost love one, illness, exam)
significant impairment to one’s life
mood/behavior changes
insomnia: increased sleep latency, frequent awakenings, and/or early-morning awakenings

Question 20

illicit drug use

Answer 20

cocaine, amphetamines - increased sympathetic activity

insomnia

Question 21

OSA

Answer 21

insomnia: difficulty initiating and maintaining sleep, early-morning awakenings
snore loudly
wake up feeling tired
obese
large tonsils

Question 22

pneumothorax/hemothorax

Answer 22

unilateral loss of BS
hyperresonance
shifting of trachea AWAY from affected side
JVD

Question 23

cholecystitis

Answer 23

female, fat, forty
RUQ pain - constant, follows fatty meals
N/V
+ Murphy’s sign

Question 24

biliary colic

Answer 24

intermittent RUQ pain

Question 25

PUD

Answer 25

“burning” epigastric pain - better with antacids/food

hx NSAIDs, smoker

Question 26

gastritis

Answer 26

epigastric pain - milder than PUD
N/V
hx NSAIDs

Question 27

perforated peptic ulcer

Answer 27

diffuse abdominal pain

rebound tenderness, involuntary gaurding

Question 28

gastric cancer

Answer 28

early satiety
anorexia, weight loss
L. supraclavicular mass (virchow’s node)

Question 29

appendicitis

Answer 29

RLQ - gradual onset, worse with movement (peritoneal signs)
low-grade fever
N/V
rebound tenderness, involuntary guarding
\+ rovsing's, psoas sign

Question 30

PID

Answer 30

low ab pain
low-grade fever
\+/- abnormal menstrual bleeding, N/V
recent STD and unprotected sex with untreated partner
hx multiple sex partners

Question 31

ruptured ectopic pregnancy

Answer 31

crampy lower ab pain
N/V
vaginal spotting (five weeks after amenorrhea)

Question 32

ruptured ovarian cyst

Answer 32

sudden onset, unilateral lower ab pain

rebound tenderness + guarding

Question 33

viral gastroenteritis

Answer 33

crampy ab pain
N/V/D
low-grade fever

Question 34

spontaneous abortion

Answer 34

LMP >4 wks ago
crampy ab pain
vaginal spotting
fever - possibly septic abortion

Question 35

endometriosis

Answer 35

chronic pelvic pain
dysmenorrhea 
dyspareunia
infertility
acute, severe pain - rebound tenderness: ruptured endometrioma