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step 2 cs- differential > presentation- ddx > Flashcards

presentation- ddx Flashcards

1
Q

21 yo female with visual aura, throbbing HA, sensory weakness/ numbness

A 
*****migraine with aura
tension HA
psuedotumor cerebri
neoplasm
thromboembolic event (birth control?)
CNS vasculitis
partial seizure

w/u: MRI, LP w/ CSF, ESR

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2
Q

26 yo male with sharp HA, same time every day, with IPSILATERAL rhinorrea, tearing, eye redness, temporal pain that lasts SECONDS

A 
*****cluster
migraine
tension
pseudo tumor
neoplasm

w/u: cbc, esr, MRI brain, CT head, LP csf

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3
Q

65 yo female, FEBRILE, unilateral temporal head ache with jaw claudication and ipsilateral blurred vision

A 
TEMPORAL ARTERITIS
migraine
meningities
carotid dissection
trigeminal neuralgia
TMJ

w/u-temp artery bx, esr, crp
(carotid us with doppler, MRI, CT)

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4
Q

30 yo female with FEVER, frontal ha, nasal dc, maxillary sinus pain

A

bacterial sinusitus**
migraine
meningitis

xray sinus, ct sinus, LP

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5
Q

35 yo male with SUDDEN severe HA, left sided hemiplegia, nuchal rigidity, n/v

A 
SAH****
IC bleed
meningitis/encephalitis
intracranial neoplasm
acute hypertension

w/u: NON CON CT, lp-csf, pt/ptt/inr, utox

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6
Q

21 yo obese female with pulsatile ha, v/m, blurred vision

A

PSUEDOTUMOR
migraine
intracranial venous thrombosis

w/u: CSF with opening pressure, urine Hcg

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7
Q

ddx/wu for trigeminal neuralgia

A

TMJ
cluster headache
migraine
tumor

MRI, ESR, cbc

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8
Q

81 yo with chronic memory loss, stepwise after strokes, hx of HTN

A 
VASCULAR DEMENTIA
B12 deficiency
alzheimers
thyroid
NPH

w/u: B12, VDRL/PRP, TSH, CBC, Lytes, MRI brain

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9
Q

81 yo with memory loss, incontinence, disturbed gait over the last 6 months

A 
NPH
alzheimers
vascular dementia
intracranial neoplasm
depression
B12 deficiency
depression

CT brain, VRDL/PRP, B12, TSH, LP w/ opening pressures

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10
Q

creutzfeld jacob

A

rapidly progressive dementia over a few months with STARTLE myoclonus

dx with EEG and CSF

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11
Q

random things to include on a confusion differential in an old person

A 
chronic subdural hematoma
depression
b12
delirium
neurosyphylis
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12
Q

73 yo male with sudden loss of vision in R eye, palpitations, SOB. Hx of afib

no HA, weakness, numbness, photophobia, redness, discharge

A 
Retinal artery occlusion
retinal vain occlusion
acute angle glauc (would be painful)
retinal detachment
Temporal arteritis

Carotid US,

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13
Q

central retinal artery occlusion

A

acute, painless, unilateral vision loss

cherry red spot on macula

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14
Q

acute angle closure glaumcoma

A

opthalamic emergency –> red, painful, frontal headache, fixed, dilated pupil

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15
Q

differential for erectile dysfunction

A

drug side effects
medical d/o
psychological

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16
Q

PTSD vs Acute stress

A

1 month

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17
Q

normal grief can last up to…..

A

6 months

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18
Q

crying, sleeping, poor hygeine after death of loved one 2 months ago while seeing them in public places

A

Normal grief
Major depression with psychotic features
adjustment d/o with depressed mood

do physical exam, utox, tsh, cbc

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19
Q

dx of MDD

A

5/9 SIGECAPS, or SI

if alchol– > think substance induced depression

> 2 years, mild= dysthymia

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20
Q

bipolar 1 vs 2

A

1: manic +/- hypomanic phase
2: hypomanic, depressive phase

w/u: physical, mini mental, utox

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21
Q

MS differential and w/u

A

DDX: CNS vasculitis, conversion disorder, TIA, b12, tumor neurosyph

w/u: LP w/ CSF, MRI brain+spine, ESR, ANA, VRDL/RPR, CBC/lytes, b12

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22
Q

30yo male, imigrants, with night swests, cough, swollen glands for one month

A 
TB
acute HIV
lymphoma
leukemia
hyperthyroid

w/u: PPD/quantiferon, CXR, HIV antibody, sputum gram stain acid fast, CBC

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23
Q

hyperthyroid like presentation including palpitations, weight loss, diarrhea

A

hyperthyroid, pheo, carcinoid

TSH, FT3, T4
24 hr catecholamines
5HIAA

24
Q

26 yo female with sore throat, fever, severe fatigue, LUQ discomfort, LAD, rash. Boyfriend with SAME sx

A

MONO- monospot, anti-EBV ab
viral/bacterial pharyngitis- throat culture
acute HIV- HIV ab
syphilis

25
Q

test to add to cough if:

  • hemoptysis
  • sputum
  • dypsnea
A
  • bronch
  • sputum gram stain and culture
  • echo
26
Q

45 yo F with retrosternal burning after heavy meals and lying down, relieved by antacids

A

GERD, pud, esophageal spasm, MI

EGD, pH monitoring, h pylori stool antigen, barium swallow
EKG

27
Q

things that could maybe look like very stable angina

A

esophageal spasm

esophagitis

28
Q

w/u for stable angina

A

stress test, ekg, lytes, trop/ck-mb

29
Q

ascending cholangitis test vs cholecystitis

A

MRCP/ERCP

also do ast/alt/alk phos/bili

30
Q

test to do when suspicious o peptic ulcer dz/perferated ulcer

A

rectal exam and stool for occult blood

31
Q

work up for bowel obstruction

A

abdominla xray
ct
colonoscopy
rectal exam

32
Q

70yo female with crampy abdominal pain, dark bowel movement, history of afib

A

acute mesenteric ischemia- abdominal ct angiogram
diverticulitis
peptic ulcer disease
gastroenteritis

33
Q

work up for young female with RLQ pain

A

torsion, ruptured cyst, appendicitis, pid, ectopic

pelvic, hcg, abdominal us, vaginal us

34
Q

30yo female with 6 mnths of periumbilical pain that is relieved with pooping

A

IBS, chrons, celiac, GI parasitic infection

hcg (if young enough), stool for ova parasite, colonoscopy,

35
Q

watery diarrhea after travel

A

travelers diarrhea
giardiasis
amebiasis
hepatitis A

stool leuks, culture,
viral hepatitis serologis
cbc
cmp

36
Q

test for lactose intolerance

A

hydrogen breath test

37
Q

something to test for in diarrhea!!

A

TSH

38
Q

painless bright red blood per rectum

A

diverticulosis
hemmorroids
angiodysplasia

39
Q

23yo female obese with 6 months ammenorrhea, facial hair

A

PCOS (test/DHEAS, FSH/LH, transvag US)
hyperprolocatinemia
thyroid disease
ovarian/adrenal tumor

bhcg, testosterone, DHEAS, FSH/LH, TSH, transvaginal US

40
Q

18yo female who is skinny and exercises incessantly with no period

A

anorexia –> LTYES
pregnancy- hcg
hyperthyroid –> TSH, T4

41
Q

teenager with xs vaginal bleeding irregularly for months

A

AUB
coagulation d/o (hemophilia, vonwillebrand)
molar preg

pelvic, pap, CBC, Pt/ptt, hcg, cervical culture, TSH/LH/FSH

42
Q

61 obese postmenopausal female with endometrial bleeding

A

endometrial cancer- endo bx, endo curettage
endometrial hyperplasia
adenomyosis

43
Q

45yog5p5 with postcoital bleeding

A

cervical cancer
cervical polyp
trauma
endometrial cancer

HPV testing, colpo with bx

44
Q

28 yo female at 8 weeks with lower abd pain, vaginal bleeding

A

spont abortion- hcg
ectopic
molar preg- quant hcg

45
Q

vaginal discharge

A

vaginitis (candidal, trichimonal)
bacterial vaginosis
cervicitis (GC/CT)

wet mount, KOH prep, cervical culture

46
Q

carpal tunnel ddx

A

carpal tunnel
median nerve compression
root C6, C7 radiculopathy

nerve conduction studies, EMG, US wrist, MRI cspine

47
Q

CAGE

A

Cut down?
Annoyed by questioning?
Guilt?
Eye opener?

48
Q

28yo f with MCP tenderness, L knee pain, morning stifness for irst hour of waking

A

RA
SLE
disseminated gonoccocal arthritis
IBD?

RF, esr, ANA, anti ds DNA, cervical culture for GC/CT

49
Q

hip facture and pelvic fracture can be different

A

XR hip/pelvis
serum calcium and vit d
dexa scan

50
Q

things to think about in suspected abuse

A

substance abuse –> utox

osteogenesis imperfecta –> xray skeletal survey

51
Q

45yo male with red, swollen knee and fever

A 
septic arthritis
gout
lymes
trauma
reactive arthritis

arthrocentesis with synovial fluid analysis (count, gram stain, culture, crystals), ESR, lyme serologies, xray, uric acid levels, blood cx

52
Q

plantar fascitis ddx

A

plantr facscitis
heel fracture
splinter/ foregin body

xray, bone scan

53
Q

60yo f with pain in both knees when walking, relieved by rest, with recent CABG

A

PVD (intermittent claudication)
lumbar spinal stenosis
leriche syndrome

ABI, lower extremetiy doppler, angiography, MRI L spine

54
Q

ddx of DVT with red swollen calf

A

don’t forget cellulitis!!
myositis - CPK

do CBC, CPK, d dimer and le US with doppler

55
Q

something for ddx of someone anxious/depressed, constipated

A

hypercalcemia

step 2 cs- differential (2 decks)

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