POPEs Flashcards
CC: blood in my peex1day
42yo F w urinary urgency/frequency/dysuria x 48hrs. blood in urine. urinating a tiny amount every 2-3hrs. 30packyrhx. sexually active w 1 M parter. routinely use condoms. fam hx of “kidney probs.” no fever/chills/back pain/vag discharge
DDX: cystitis, pyelonephritis, SLE, PKD, bladder/renal cx.
PE: GA, VS (BP/wt), HEENT (periorbital edema), heart/lungs (auscultate), abd (I, Palpate for tenderness/masses/ascites/kidneys, Percuss for CVA tenderness), Skin (rash), Extremities (edema), GU
CC: too tired to go to school or work x3days.
17yo F w hx of swelling x3 days. fatigued, decrease in urination, sometimes blood in urine. no urgency/frequency/dysuria. no N/V/D, fever, chills. gained 7 lbs in 3 days. no sig PMH. 2-3wks ago had a cold and sore throat that resolved w out tx.
DDX: post infection glomerulonephritis, minimal change dz, focal segmental glomerulosclerosis, nephrotic syndrome, pregnancy.
PE: GA, VS (BP, wt), HEENT (periorbital edema), heart/lungs (auscultate), abd (I, Palpate for tenderness/masses/ascites/kidneys, percuss), extremities (for edema), GU (inspect for edema)
CC: my side is killing me and I’m throwing up x6 hrs.
32 YO M w 6hr hx of constant back pain that woke him up. radiates from right side of back into groin, 8/10. N+ vomitted once. possible hematuria. no penile discharge/testicular or scrotal pain, hx of trauma or pertinent PMH. no meds.
DDX: kidney stone, AAA, testicular cx, pancreatitis, testicular torsion, appendicitis.
PE: GA, VS (rechk temp), skin (jaundice), heart/lungs (auscultate), abd (inspect, ausc for bs and abd bruits, palpate, peritoneal signs), msk (inspect/palpate back), GU
CC: my legs are cramping x3 days.
64yo M w 3 day hx of intermittent bilat lower extremity cramping occurring at night. able to ambulate but legs feel tired/weak. no N/V/D/SOB/palpitations. on diuretic for CHF. vit D deficient
DDX: hypokalemia, hypocalcemia, dehydration, vasc insuff (claudication).
PE: GA, heart/lungs (ausc), PV (inspect for color change, hair dist, ulcers, pulses, temp, edema), msk (LE for tenderness), neuro (inspect for tremors in extremities, LE strength, LE sensation, LE DTRs, gait, chovstek sign for hypocalcemia)
CC: my wife made me come in to talk about this diarrhea x3months.
25yo M w 3mo hx of 4-5 loose stools daily w occasional bright red blood mixed in. crampy LLQ pain and fecal urgency. no fever/anoexia/N/V/wtloss, no hx of alt diarrhea and constipation. no hx of hemorrhoids.
DDX: UC, Crohn’s, IBD, CRC.
PE: GA, VS (wt, orthoBP), HEENT (oral cavity for ulcerations/freckling – peutz jeghers syndrome for hereditary polyposis syndrome, sclera for perilimbal flush – uveitis from IBD), skin (inspect for lesions/pyoderma, gangrenosum/erythema nodosum/flushing/telangectasias–IBD, turgor), heart/lungs, abd (inspect, ausc, palpate, percuss), msk (joint pain/tenderness w IBD), rectal exam
CC: my stomach hurts x12 hrs.
13 yo M for RLQ pain for 12 hrs. pain started near umbilicus last night, and he vomitted twice. anorexia and fever. low urine output/dark urine. no irratative voiding sxs/D/constipation.
DDX: appendicitis, testicular torsion, gastroenteritis, intussusception.
PE: VS (temp), skin (turgor), heart/lungs, abd (I, ausc, Palp for tenderness/masses/liver/spleen, percuss, McBurneys, rebound tenderness), GU
CC: sick to stomach and turning yellow x3 days.
58yo unemployed iron worker. hx of IVDU. Nx3days. yellow skin. no appetite. vague upper abd pain. light colored stools. chills/sweats/fever. cigarets taste bad. no diarrhea/constipation/melena/hematemasis.
DDx: Hep C, Hep B, cholangitis, biliary obstruction, HCC or panc cx.
PE: VS (temp), HEENT (jaundice/icterus, MMM), skin (jaundice, IVDU inj sites, alc stigmata, turgor), heart/lungs, abd (inspect, ausc, palpate, percuss, measure liver size, ascites).
CC: my side aches and cramps after i eat x 2 wks.
47yo overwt F w intermittent abd pain under R ribs. pain starts after eating fast food. cramp, comes/goes, gets better hrs after food. sometimes heart burn. NO JAUNDICE.
DDX: cholecystitis (biliary colic), PUD, dyspepsia, hurt rib or musc.
PE: HEENT (icterus), heart/lungs, abd (inspect, ausc, palpate, murphy sign, rebound tenderness, percuss), msk (chest wall for abnormalities/tenderness), rectal
CC: my mouth is sore and my hair is falling out x3 months.
36yo triathlete w dry skin, mouth sores, hair falling out. HA, anorexia, nausea over last 10 days. vomitting in last 48hrs. eats healthy. bronzed skin.
DDX: vit B deficiency, hypothyroid, vit a toxicity, iron deficiency anemia.
PE: SKIN (inspect for color changes, hair loss patterns, hair texture, skin dryness, nail brittleness), HEENT (icterus, mouth/tongue, thyroid), HEART/LUNG, NEURO (DTRs), ABD (tenderness, HSM)
CC: tongue is burning and feet won’t stop tingling x6 wks.
62 yo F w pain and burning of tongue. feels raw/irritated. difficult to eat. anorexia and has lost 8 lbs in 1 month. tingling in feet x3 months. slightly off balance
DDX: B12 deficiency, diabetes, dehydration, alcoholism, drug SE.
PE: SKIN (pallor, turgor), HEENT (icterus, inspect mouth/tongue), HEART/LUNGS, NEURO (distal sensation, proprioception, vib sensation, romberg, RAM, gait)
CC: I’ve got this spot on my breast x1 month.
28yo F gave birth 2 wks ago. L breast has area that is swollen, firm to touch, not esp tender. mild erythema and dimpling to skin over area. no changes in R breast.
DDx: breast cx, mastitis, cellulitis, abscess, lipoma.
PE: HEART/LUNGS, LYMPH, BREAST, ABD (HSM)
CC: I’ve been coughing a lot and wake up drenched in sweat x 3 months.
68yo M w 30packyrhx w worsening cough. thick sputum in morning, better as day goes on. 2 wks has been tinged w blood. feeling feverish. drenched in sweat.
DDX: lung cx, pneumonia, TB, COPD, bronchitis.
PE: VS (rechk resp), HEENT (nasoscopy, oropharynx), NECK (trach dev), HEART, LUNGS (IPPA +bronchophony), LYMPH
CC: I’ve got a fever and i don’t feel good x1 day.
32 yo homeless M w hx of IVDU began feeling feverish w chills. fatigue/achy, esp in hips/knees. aching over sternal area. slightly SOB. neg HIV test 6 months ago. hx of ETOH abuse, 30packyrhx, abscesses at inj sites.
DDX: endocarditis, penumonia, TB, MI, HIV, drug withdrawal.
PE: VS (temp, HR, RR), Skin (splinter hem, osler, janeway, abscesses), HEENT (fundo for roth spots), LUNGS (IPPA), HEART (inspect, palpate for heaves/thrills, ausc), LYMPH, MSK (hips/knees)
CC: nd to have my BP checked.
39yo F ref by OBGYN for elevated BP readings. asymptomatic. no SOB, chest pain, numbness, weakness. 20packyrhx, no hx of cardiac dz
DDX: primary htn, secondary htn (to meds or OSA, or thyroid disorder), white coat syndrome.
PE: VS (BP in both arms), HEENT (fundo), NECK (JVD, thyroid), LUNGS, HEART (inspect, palpate, ausc, ausc for bruits, palpate/measure PMI), PV (hair dist, cyanosis, edema, temp, cap refill, dist pulses)
CC: reg checkup post MI.
58yo M w PMH of MI x yrs ago. ends reg BP checkup. feels well, stopped smoking,exercises. 2 months ago back of legs and thighs hurt while walking uphill for 2+blocks. better w rest. no hx of trauma
DDX: PAD, venous insuff, occlusive dz of LE, lumbar disc dz, DVT.
PE: VS (rechk BP), LUNGS, HEART (ausc, palpate and measure AA, pulses, ausc for bruits, LE for color/ulcers/hair dist/ vericosities, palpate for edema/temp, cap refill)
