POPE2 Flashcards
CC: I’m having a hard time w stairs.
48 yo F w fatigue for 6 months. hard time climbing stairs. weak, stiff, difficulty combing hair and putting on a shirt. food sticks in throat and trouble swallowing. lost 10lbs w out trying.
DDX: polymyositis, polymyalgia rheumatica, chronic fatigue, fibromyalgia, SLE.
PE: SKIN (rashes, periorbital rash, hands/knuckles, lateral thigh rash, nails)
MSK (inspect/ROM/strenth of hip and shoulder, distal strength hands/feet)
NEURO (EOMs, swallow, DTRs)
CC: rash is making me crazy x2 wks.
16 yo M hx of asthma w new rash behind ears/inner forearms/behind knees. itchy. wheezing, increased inhaler use. runny nose.
DDX: atopic derm, scabies, contact derm, psoriasis.
PE: VS (RR)
HEENT (allergic shiners, nasal patency, nasoscopy)
SKIN
LUNGS (ausc, exp wheeze, cap refill)
HEART (ausc)
CC: I can’t get rid of these hives x48hrs.
34 yo F itchy hives starrted on forearms now on chest/neck/face. come and go. intense itching. fatigue. anxious, lips feel swollen, tongue feels fat, SOB.
DDX: urticaria, anaphylaxis, drug rxn, food rxn. PE: VS (RR, HR) HEENT (mouth) SKIN LUNGS (I, A) CV (ausc, cap refil)
CC: i just can’t shake this bug x2wks.
18 yo F unwell x10days w slight fever, nasal congestion, mild sore throat, swollen glands in neck. vague HA, musc aches and pains all over, faint non puritic rash on chest. low appetite, nausea, but no vomitting or diarrhea. no immunizations since childhood.
DDX: infectious mono, influenza, measles, acute viral hep, URI, sinusitis, acute HIV. PE: VS (temp) SKIN (for rash) HEENT (nose, sinuses, mouth, ears) LYMPH HEART/LUNGS ADB (for tenderness/masses) MSK (for joint tenderness)
CC: I’m coughing and my side hurts x2 days.
64 yo M nonsmoker. deep, rattling cough productive of green/yellow sputum. some R sided chest pain when takes deep breath or coughs, improves when holds his side. hard time catching breath. chills, temp.
DDX: acute bronchitis, pneumonia, TB, URI, pertussis, influenza.
PE: VS (RR, temp)
LYMPH
PULM (IPPA + bronchophony + chest wall tenderness)
HEART (ausc, cyanosis, cap refil)
CC: I’m throwing up + diarrhea since yesterday.
23 yo F student w severe N/V/D x 12 hrs. stomach cramps, watery diarrhea w no mucus or blood. abd pain, fever, chills, light headed.
DDx: viral gastroenteritis, bacterial gastroenteritis, hepatitis, appendicitis, pregnancy. PE: VS (temp, HR, ortho BP) HEENT (MMM, icterus) SKIN (turgor) HEART/LUNGS ABD (IPPA + mcburney + rebound)
CC: i turned bright red on vacay to mex x4 days.
32 yo F w streaky red rash after sun exposure. vesicles, blisters, peeling, scaling, crusting. skin stings. applied sunscreen but not that much. meds: OCP + unknown abx.
DDx: sunburn, drug induced phytotoxicity, contact term, polymorphous light eruption, dermatomyositis.
PE: SKIN
NEURO (distal sensation & strength)
CC: my wife made me come in and get check for these rough and scaly spots.
72 yo skin exam guy.
DDx: SCC, Aks, SKs, Seb derm, BCC, melanoma.
PE: SKIN
CC: my finger is all swollen up x1 wk.
29 yo F w swollen and painful finger. no injury. centered over joint closest to fingernail and “looks like a sausage.” warm to touch but no redness or fever. no chills, abd pain, numbness, weakness. also rash on scale for several yrs and billet low back pain around hips.
DDX: Spondyloarthropathies (psoriatic arthritis, ankylosing spondylitis, reactive arthritis, IBD), septic arthritis, gout arthritis, bechet.
PE: VS (temp)
HEENT (mouth ulcers, conjunctivitis)
MSK (hands for swelling/erythema, joints of hands, ROM of hands, I/P/ROM of low back/hips)
SKIN
CC: i did something to my shoulder while painting x 3 wks ago.
47 yo house painter w R shoulder pain. started while reaching overhead to paint. no longer able to move arm above head, and feels a catching sensation. hurts to lie on side at night. taking a statin.
DDX: RC tendonitis/impingement/tear, biceps tendonitis, shoulder dislocation.
PE: Shoulder (IP, ROM, yergason, drop arm, apprehension, Neer/Hawkins)
neck/elbow
NEURO (distal pulses/sensation/DTRs)
CC: i hurt my knee skiing x6wks ago.
22 yo F knee twisted during a fall and felt “popping” sensation. immediate severe pain, difficult bearing weight. intermittent locking sensation and feels it will “give way.”
DDX: ACL/PCL/MCL/LCL, meniscal tear, bakers cyst, tibial fx.
PE: KNEE (IP + ROM, strength, valgus/varus laxity, patellar tap, patellar apprehension, lachman, mcmury, aply grind/distraction)
hip/ankle
NEURO (distal DTRs, sensation, pulses bilat)
CC: my legs hurt, gums are bleeding, keep getting nose bleeds for several days.
17 yo F w leg pains, achy in knees/thighs. gum bleeding, bruising, bloody noses. tired/run down.
DDX: ALL/AML, vit K def, VWD, Aplastic anemia, ITP/TTP.
PE: SKIN (purpura/petichiae)
HEENT (conjunctiva for pallor, nose for blood, mouth)
LYMPH
Abd (spleen, liver)
MSK
CC: I’ve got this weird swelling in my neck x1.5 months.
28 yo M painless swlling in neck. getting bigger. tonsillectomy.
DDX: benign (lipoma, goiter, salivary gland tumor, thyroid mass), malignant (metastatic testicular cx, non hodgkins lymphoma, CLL).
PE: HEENT (mouth, neck, IP)
LYMPH
GU (test exam)
CC: my legs and back are killing me x8 hrs.
35 yo african american M w sickle cell dz hx. acute pain in legs and low back. no trauma.
DDX: sickle cell crisis, osteomyelitis, spinal stenosis, multiple myeloma.
PE: VS (resp, pulse)
HEENT (conjunctiva for jaundice, ophthalmic exam for retinopathy)
LUNGS (ausc)
HEART (palpate hyperdynamic precordium, asuc, palpate pulses)
abd (spleen/liver)
MSK (I, P, blunt percuss back, ROM, strength, sensation, DTRs)
