presentation- ddx Flashcards
21 yo female with visual aura, throbbing HA, sensory weakness/ numbness
*****migraine with aura tension HA psuedotumor cerebri neoplasm thromboembolic event (birth control?) CNS vasculitis partial seizure
w/u: MRI, LP w/ CSF, ESR
26 yo male with sharp HA, same time every day, with IPSILATERAL rhinorrea, tearing, eye redness, temporal pain that lasts SECONDS
*****cluster migraine tension pseudo tumor neoplasm
w/u: cbc, esr, MRI brain, CT head, LP csf
65 yo female, FEBRILE, unilateral temporal head ache with jaw claudication and ipsilateral blurred vision
TEMPORAL ARTERITIS migraine meningities carotid dissection trigeminal neuralgia TMJ
w/u-temp artery bx, esr, crp
(carotid us with doppler, MRI, CT)
30 yo female with FEVER, frontal ha, nasal dc, maxillary sinus pain
bacterial sinusitus**
migraine
meningitis
xray sinus, ct sinus, LP
35 yo male with SUDDEN severe HA, left sided hemiplegia, nuchal rigidity, n/v
SAH**** IC bleed meningitis/encephalitis intracranial neoplasm acute hypertension
w/u: NON CON CT, lp-csf, pt/ptt/inr, utox
21 yo obese female with pulsatile ha, v/m, blurred vision
PSUEDOTUMOR
migraine
intracranial venous thrombosis
w/u: CSF with opening pressure, urine Hcg
ddx/wu for trigeminal neuralgia
TMJ
cluster headache
migraine
tumor
MRI, ESR, cbc
81 yo with chronic memory loss, stepwise after strokes, hx of HTN
VASCULAR DEMENTIA B12 deficiency alzheimers thyroid NPH
w/u: B12, VDRL/PRP, TSH, CBC, Lytes, MRI brain
81 yo with memory loss, incontinence, disturbed gait over the last 6 months
NPH alzheimers vascular dementia intracranial neoplasm depression B12 deficiency depression
CT brain, VRDL/PRP, B12, TSH, LP w/ opening pressures
creutzfeld jacob
rapidly progressive dementia over a few months with STARTLE myoclonus
dx with EEG and CSF
random things to include on a confusion differential in an old person
chronic subdural hematoma depression b12 delirium neurosyphylis
73 yo male with sudden loss of vision in R eye, palpitations, SOB. Hx of afib
no HA, weakness, numbness, photophobia, redness, discharge
Retinal artery occlusion retinal vain occlusion acute angle glauc (would be painful) retinal detachment Temporal arteritis
Carotid US,
central retinal artery occlusion
acute, painless, unilateral vision loss
cherry red spot on macula
acute angle closure glaumcoma
opthalamic emergency –> red, painful, frontal headache, fixed, dilated pupil
differential for erectile dysfunction
drug side effects
medical d/o
psychological
PTSD vs Acute stress
1 month
normal grief can last up to…..
6 months
crying, sleeping, poor hygeine after death of loved one 2 months ago while seeing them in public places
Normal grief
Major depression with psychotic features
adjustment d/o with depressed mood
do physical exam, utox, tsh, cbc
dx of MDD
5/9 SIGECAPS, or SI
if alchol– > think substance induced depression
> 2 years, mild= dysthymia
bipolar 1 vs 2
1: manic +/- hypomanic phase
2: hypomanic, depressive phase
w/u: physical, mini mental, utox
MS differential and w/u
DDX: CNS vasculitis, conversion disorder, TIA, b12, tumor neurosyph
w/u: LP w/ CSF, MRI brain+spine, ESR, ANA, VRDL/RPR, CBC/lytes, b12
30yo male, imigrants, with night swests, cough, swollen glands for one month
TB acute HIV lymphoma leukemia hyperthyroid
w/u: PPD/quantiferon, CXR, HIV antibody, sputum gram stain acid fast, CBC
hyperthyroid like presentation including palpitations, weight loss, diarrhea
hyperthyroid, pheo, carcinoid
TSH, FT3, T4
24 hr catecholamines
5HIAA
26 yo female with sore throat, fever, severe fatigue, LUQ discomfort, LAD, rash. Boyfriend with SAME sx
MONO- monospot, anti-EBV ab
viral/bacterial pharyngitis- throat culture
acute HIV- HIV ab
syphilis
test to add to cough if:
- hemoptysis
- sputum
- dypsnea
- bronch
- sputum gram stain and culture
- echo
45 yo F with retrosternal burning after heavy meals and lying down, relieved by antacids
GERD, pud, esophageal spasm, MI
EGD, pH monitoring, h pylori stool antigen, barium swallow
EKG
things that could maybe look like very stable angina
esophageal spasm
esophagitis
w/u for stable angina
stress test, ekg, lytes, trop/ck-mb
ascending cholangitis test vs cholecystitis
MRCP/ERCP
also do ast/alt/alk phos/bili
test to do when suspicious o peptic ulcer dz/perferated ulcer
rectal exam and stool for occult blood
work up for bowel obstruction
abdominla xray
ct
colonoscopy
rectal exam
70yo female with crampy abdominal pain, dark bowel movement, history of afib
acute mesenteric ischemia- abdominal ct angiogram
diverticulitis
peptic ulcer disease
gastroenteritis
work up for young female with RLQ pain
torsion, ruptured cyst, appendicitis, pid, ectopic
pelvic, hcg, abdominal us, vaginal us
30yo female with 6 mnths of periumbilical pain that is relieved with pooping
IBS, chrons, celiac, GI parasitic infection
hcg (if young enough), stool for ova parasite, colonoscopy,
watery diarrhea after travel
travelers diarrhea
giardiasis
amebiasis
hepatitis A
stool leuks, culture,
viral hepatitis serologis
cbc
cmp
test for lactose intolerance
hydrogen breath test
something to test for in diarrhea!!
TSH
painless bright red blood per rectum
diverticulosis
hemmorroids
angiodysplasia
23yo female obese with 6 months ammenorrhea, facial hair
PCOS (test/DHEAS, FSH/LH, transvag US)
hyperprolocatinemia
thyroid disease
ovarian/adrenal tumor
bhcg, testosterone, DHEAS, FSH/LH, TSH, transvaginal US
18yo female who is skinny and exercises incessantly with no period
anorexia –> LTYES
pregnancy- hcg
hyperthyroid –> TSH, T4
teenager with xs vaginal bleeding irregularly for months
AUB
coagulation d/o (hemophilia, vonwillebrand)
molar preg
pelvic, pap, CBC, Pt/ptt, hcg, cervical culture, TSH/LH/FSH
61 obese postmenopausal female with endometrial bleeding
endometrial cancer- endo bx, endo curettage
endometrial hyperplasia
adenomyosis
45yog5p5 with postcoital bleeding
cervical cancer
cervical polyp
trauma
endometrial cancer
HPV testing, colpo with bx
28 yo female at 8 weeks with lower abd pain, vaginal bleeding
spont abortion- hcg
ectopic
molar preg- quant hcg
vaginal discharge
vaginitis (candidal, trichimonal)
bacterial vaginosis
cervicitis (GC/CT)
wet mount, KOH prep, cervical culture
carpal tunnel ddx
carpal tunnel
median nerve compression
root C6, C7 radiculopathy
nerve conduction studies, EMG, US wrist, MRI cspine
CAGE
Cut down?
Annoyed by questioning?
Guilt?
Eye opener?
28yo f with MCP tenderness, L knee pain, morning stifness for irst hour of waking
RA
SLE
disseminated gonoccocal arthritis
IBD?
RF, esr, ANA, anti ds DNA, cervical culture for GC/CT
hip facture and pelvic fracture can be different
XR hip/pelvis
serum calcium and vit d
dexa scan
things to think about in suspected abuse
substance abuse –> utox
osteogenesis imperfecta –> xray skeletal survey
45yo male with red, swollen knee and fever
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
plantar fascitis ddx
plantr facscitis
heel fracture
splinter/ foregin body
xray, bone scan
60yo f with pain in both knees when walking, relieved by rest, with recent CABG
PVD (intermittent claudication)
lumbar spinal stenosis
leriche syndrome
ABI, lower extremetiy doppler, angiography, MRI L spine
ddx of DVT with red swollen calf
don’t forget cellulitis!!
myositis - CPK
do CBC, CPK, d dimer and le US with doppler
something for ddx of someone anxious/depressed, constipated
hypercalcemia
