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Step 2 CS Cases > Presentations, Differentials, Work up > Flashcards

Presentations, Differentials, Work up Flashcards

1
Q

Patient is a 52 y/o male w/ h/o 6 month cough w/hemoptysis, night sweats, low-grade temps, fatigue, sharp/pleuritic chest pain, and loss of 20 lbs unintentionally within the last 4 months.

Social Hx: significant for recent prison release, sexually active w/men w/o condom use

Differentials?

A

Tuberculosis

Pneumocystis jiroveci pneumonia

HIV

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2
Q

Patient is a 52 y/o male w/ h/o 6 month cough w/hemoptysis, night sweats, low-grade temps, fatigue, sharp/pleuritic chest pain, and loss of 20 lbs unintentionally within the last 4 months.

Social Hx: significant for recent prison release, sexually active w/men w/o condom use

Work/up?

A

CBC w/diff

CXR

sputum gram stain and culture

PPD or quantiferon gold

HIV RNA PCR

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3
Q

Patient is a 63 y/o M presenting to the clinic for back pain for the past three days. Associated with fever, chills, dysuria, polyuria, fatigue, and nausea.

PMH- recurrent UTIs

On PE, patient has suprapubic tenderness, fever, tachycardia, and right CVA tenderness

Possible diagnosis?

A

Pyelonephritis

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4
Q

Patient is a 63 y/o M presenting to the clinic for h/o 3 days of back pain. ROS: dysuria, poluria, fever PMH- Diabetes and recurrent UTIs

PE- significant for suprapubic tenderness

Possible diagnosis?

A

Cystitis

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5
Q

Patient is a 63 y/o M presenting to the clinic for h/o 3 days of back pain that radiates to his groin. ROS: polyuria, dysuria, nausea

PE- tachycardia, CVA tenderness on right side, suprapubic tenderness

Possible diagnosis?

A

nephrolithiasis

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6
Q

Patient has dysuria, polyuria, and suprapubic tenderness. Differentials?

A

UTI

Nephrolithiasis

Cystitis

Pyelonephritis

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7
Q

Patient has dysuria, polyuria, and suprapubic tenderness.

Work up?

A

CBC w/diff

U/A

Urine culture

Renal U/S

CT abd/pelvis without IV contrast

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8
Q

Patient is a 72 y/o F presenting to the clinic for bloody stool for one day.

Differentials?

A

Diverticulosis

Hemorrhoids

Colon Cancer

Upper GI bleed

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9
Q

Patient is a 72 y/o F w/ painless bloody stool for one day. ROS: +weakness, +dizziness

No significant FH of colon cancer

PE shows no adominal masses, no fever, NAD

Possible diagnosis?

A

Diverticulosis

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10
Q

Patient is a 72 y/o F w/painless bloody stool with no weight loss, no abdominal masses, and no fever. Patient is in NAD and the blood is present when she wipes.

Possible diagnosis?

A

Hemorrhoids

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11
Q

Patient is a 72 y/o F w/h/o blood in stools. She has never had a colonoscopy.

What diagnosis should you be concerned for?

A

Colon cancer

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12
Q

Patient is a 72 y/o F w/ painless bloody stool for one day. ROS: +weakness, +dizziness

No significant FH of colon cancer

PE shows no adominal masses, no fever, NAD

Work up?

A

Rectal exam (be sure to explain this to the patient in the counseling)

FOBT

CBC w/diff

PT/PTT/INR

CT scan of abd/pelvis

Colonoscopy

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13
Q

Patient is a 23 y/o f w/ irregular periods for the past ten years. Differential?

A

PCOS

Endometriosis

Pituitary tumor

Cushing Syndrome

Hyperthyroidism/Hypothyroidism

Anorexia Nervosa

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14
Q

Patient is a 23 y/o F w/ irregular menstrual cycles for the last 10 years. G0P0, FH of DM, ROS: +dysmenorrhea, acne, weight gain of 15lbs in last 5 yrs

PE: increased abdominal girth, hirsutism, facial acne

Possible diagnosis?

A

PCOS

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15
Q

Patient is a 23 y/o F w/irregular periods for 10 yrs. ROS: +15 lbs weight gain in last 5 yrs, constipation

PE: shows increased abdominal girth

Possible diagnosis?

A

hypothyroidism

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16
Q

Patient is a 23 y/o F w/irregular periods for 10 yrs. ROS: +15 lbs weight gain in last 5 yrs

PE: shows increased abdominal girth, facial acne, hirsuitism

Possible diagnosis?

A

Cushing syndrome

Pituitary Tumor

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17
Q

Patient is a 23 y/o F w/ irregular menstrual cycles for the last 10 years. G0P0, FH of DM, ROS: +dysmenorrhea, acne, weight gain of 15lbs in last 5 yrs

PE: increased abdominal girth, hirsutism, facial acne

Work up?

A

Pelvic Exam

FSH/LH

Serum hCG

Pelvic U/S

HbA1c, serum glucose

lipid panel (total cholesterol, HDL, LDL, TGs)

24-hr urinary cortisol excretion

Free testosterone level

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18
Q

Patient is a 16 y/o M w/sore throat for 1 day.

Possible differentials?

A

viral pharyngitis

bacterial pharyngitis

laryngitis

Mononucleosis

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19
Q

Patient is a 16 y/o M w/sore throat for one day. ROS: +odynophagia, fatigue, sick contacts, nasal discharge

PE: erythema on posterior pharynx, fever (no lymphadenopathy, no exudates)

Possible diagnosis?

A

Viral pharyngitis

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20
Q

Patient is a 16 y/o M w/sore throat for one day. ROS: +odynophagia, fatigue, sick contacts, headache

PE: erythema on posterior pharynx, fever

Possible diagnosis?

A

Bacterial pharyngitis

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21
Q

Patient is a 16 y/o M w/sore throat for one day. ROS: +odynophagia, fatigue, sick contacts

PE: erythema on posterior pharynx, fever

*Age of patient
Possible diagnosis?

A

infectious mononucleosis

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22
Q

Patient is a 16 y/o M w/sore throat for one day. ROS: +odynophagia, fatigue, sick contacts

PE: erythema on posterior pharynx, fever

Workup?

A

CBC w/diff

Peripheral blood smear

Rapid strep test

Throat culture

Monospot test

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23
Q

43 y/o M presents w/ hearing loss for the past 5 yrs.

Hearing loss is bilateral, progressively worsening, trouble hearing in noisy environments. Social hx: farmer exposed to loud noises, uses headphones often; normal Rinne’s and Weber’s tests

Possible diagnosis?

A

Presbycusis

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24
Q

43 y/o M presents w/ hearing loss for the past 5 yrs.

Hearing loss is bilateral, progressively worsening, trouble hearing in noisy environments. Social hx: farmer exposed to loud noises, uses headphones often, cleans ears with Q-tips daily; normal Rinne’s and Weber’s tests

Possible diagnosis?

A

Ruptured tympanic membrane

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25
Q

43 y/o M w/bilateral hearing loss w/hx of daily aspirin use

On PE, no erythema, polups, or exudates, minimal ear wax

Possible dx?

A

Hearing loss due to aspirin toxicity

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26
Q

43 y/o M presents w/ hearing loss for the past 5 yrs w/ h/o aspirin use daily.

Hearing loss is bilateral, progressively worsening, trouble hearing in noisy environments. Social hx: farmer exposed to loud noises, uses headphones often, cleans ears with Q-tips daily; normal Rinne’s and Weber’s tests

Workup?

A

CBC w/diff

Serum salicylate acid level

Audiogram

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27
Q

Patient is a 75 y/o M who has sudden onset of slurring speech.

Differential dx?

A

TIA

Cerebrovascular Accident

Subdural hematoma

Ruptured Aneurysm

Seizure

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28
Q

Workup for cerebrovascular accident and TIA differentials

A

Lipid panel (total cholesterol, LDL, HDL, TGs)

CBC w/diff

electrolytes

EKG

Carotid U/S

CT w/o contrast of head

MRI of brain

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29
Q

45 y/o M w. severe headache for the past 4 hours.

Possible Differentials?

A

Subarachnoid hemorrhage due to rupture aneurysm

Hypertensive crisis

substance-induced hemorrhage

Meningitis

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30
Q

45 y/o M with generalized headache, 10/10 sharp pain, aggravated by movement w/no relief from OTC meds.
ROS: +nausea

Social Hx: smokes 1-2 packs of cigarettes/day

FH: uncle w/PCKD

On PE: brudzinski test is +, hypertensive, afebrile, A+Ox2 (not sure of the date)

Possible dx?

A

Ruptured cerebral aneurysm (SAH)

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31
Q

45 y/o M with generalized headache, 10/10 sharp pain, aggravated by movement w/ no relief from OTC meds.
ROS: +nausea

Social Hx: smokes 1-2 packs of cigarettes/day, snorts cocaine

On PE: brudzinski test is +, hypertensive, A+Ox2 (not sure of the date)

Possible dx?

A

Cocaine-induced hypertensive intracranial hemorrhage

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32
Q

45 y/o M w/ generalized headache that he rates 10/10 intensity, aggravated by movement and no relief from OTC meds. ROS: +nausea

PE: A+Ox2 (cannot remember the date), hypertensive, bradycardia, brudzinski test +

*no papilledema or optic disc blurring on fundoscopy

Possible dx?

A

Meningitis

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33
Q

45 y/o M w/ generalized headache that he rates 10/10 intensity, aggravated by movement and no relief from OTC meds. ROS: +nausea

PE: A+Ox2 (cannot remember the date), hypertensive, bradycardia, brudzinski test +

*no papilledema or optic disc blurring on fundoscopy

Workup?

A

CBC w/diff

Urine toxicology

CT head w/o contrast

LP

MRI of brain

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34
Q

31 y/o F presents w/severe abd pain for the last 5 hrs.

Possible differentials?

A

Ectopic pregnancy

Appendicitis

Ruptured ovarian cyst

Spontaneous Abortion

Ovarian torsion

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35
Q

31 y/o f w. sudden onset of RUQ abd pain that is constant and dull; radiates to the back, alleviated by leaning forward. ROS: +nausea, vomiting (3 episodes)

FH: gallstones

Social Hx: heavy alcohol use

PE: voluntary guarding, tachycardia,f ever, SOB, TTP in RUQ, LUQ, and epigastrium

Possible dx?

A

Pancreatitis

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36
Q

31 y/o F w. sudden onset RUQ abd pain that is constant. ROS: nausea, vomiting, fever, SOB

FH: gallstones

PE: fever, tachycardia, RUQ pain, voluntary guarding

Possible dx?

A

Acute cholecystitis

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37
Q

31 y/o F w/ sudden onset of RUQ abd pain.

Meds: NSAID use daily

Social Hx: heavy alochol use

PE: tachycardia, diffusely tender abdomen, guarding

Possible dx?

A

Peptic ulcer disease

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38
Q

31 y/o F w/ sudden onset of RUQ abd pain.

Meds: NSAID use daily

FH: gallstones

Social Hx: heavy alochol use

PE: tachycardia, diffusely tender abdomen, guarding

Workup?

A

CBC w/diff

Electrolytes, glucose

lipase

AST, ALT, bilirubin, alkaline phos

U/S RUQ abd

CT scan of abd

EGD

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39
Q

30 y/o F w. recurrent diarrhea for the past year.

Possible differential?

A

Crohn’s disease

Ulcerative colitis

Celiac disease

Chronic infectious diarrhea

Irritable Bowel Syndrome

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40
Q

30 y/o F w/ diarrhea for one year; 10-20 BMs per day.
ROS: abdominal cramps, 20 lb weight loss, fever, arthralgias

PMH: fecal incontinence, perianal fistula

FH: uncle had partial gut resection

Possible dx?

A

Crohn’s disease

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41
Q

30 y/o F w/ diarrhea for one year; 10-20 BMs per day.
ROS: 20 lb weight loss, fever, arthralgias

PMH: fecal incontinence

FH: uncle had partial gut resection

Possible dx?

A

Ulcerative colitis

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42
Q

30 y/o F w/ diarrhea for one year; 10-20 BMs per day.
ROS: fever, occasional gross blood in stool

PMH: fecal incontinence

Possible dx?

A

chronic infectious diarrhea

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43
Q

30 y/o F w/ diarrhea for one year; 10-20 BMs per day.
ROS: abdominal cramps, 20 lb weight loss, fever, arthralgias

PMH: fecal incontinence, perianal fistula

FH: uncle had partial gut resection

Workup?

A

Rectal exam w/FOBT

CBC w/diff

Electrolytes

stool culture for ova, parasites, fecal leukocytes, stool antigen for E.histolytica

pANCA

Colonoscopy

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44
Q

55 y/o M w/ abd pain and yellow skin for the past 2 weeks.

Differential dx?

A

Viral Hepatitis

Alcoholic hepatitis

Acute pancreatitis

Hepatic failure

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45
Q

Patient is a 55 y/o M w/ jaundice, RUQ abd pain, choluria, acholic stools, fatigue.

Social hx: alcoholic, homeless, lives in a shelter

PE: thin, scleral icterus, jaundice, RUQ tenderness, -murphy’s sign, tender hepatomegaly

Possible dx?

A

Alcholic hepatitis

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46
Q

55 y/o M w/ jaundice, weight loss, choluria, acholic stools.

Social hx: IVDU of heroin, homeless/lives in a shelter, multiple sexual partners without condom use

Probable diagnosis?

A

Viral hepatitis (B or C)

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47
Q

55 y/o M w/jaundice, choluria, acholic stools, RUQ abd pain, anorexia.

Meds: acetaminophen use daily

PE: hepatomegaly, RUQ abd tenderness, jaundice, scleral icterus

A

Acetaminophen toxicity

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48
Q

55 y/o M w/jaundice, choluria, acholic stools, RUQ abd pain, anorexia.

Meds: acetaminophen use daily

PE: hepatomegaly, RUQ abd

Workup?

A

CBC w/diff

AST, ALT, alk phos, bilirubin, albumin, total protein

PT, PT, INR

HCV antibody, HCV PCR, HBsAg, HBV core Ab IgM

Acetaminophen level

RUQ U/S

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49
Q

66 y/o M w/worsening cough

Possible differential dx?

A

COPD exacerbation

CHF

PNA

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50
Q

66 y/o w/worsening cough, DOE, hemoptysis, 20 lb weight loss, fatigue

PMH: COPD

Social hx: 40 pack/yr smoking

PE: tachycardia, tachypnea, low pulse ox, scattered expiratory wheezes, decreased tactile fremitus

Possible dx?

A

lung cancer

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51
Q

66 y/o M w. worsening cough w/increased sputum production. ROS: fever, DOE, wheezing, chest tightness

PMH: COPD

Social Hx: 40 pack/yr smoking

Possible dx?

A

PNA

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52
Q

66 y/o M w/worsening cough w/increased sputum production, DOE, fever, and intermittent chest tightness.

PMH: COPD w/increased use of rescue inhaler

PE: tacyhcardia, tachypnea, low pulse ox sat, expiratory wheezes, decreased tactile fremitus, lack of dullness to percussion

Possible dx?

A

COPD exacerbation

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53
Q

66 y/o M w/worsening cough w/increased sputum production, DOE, fever, and intermittent chest tightness.

PMH: COPD w/increased use of rescue inhaler

PE: tacyhcardia, tachypnea, low pulse ox sat, expiratory wheezes, decreased tactile fremitus, lack of dullness to percussion

Workup?

A

CBC w/diff

Pulmonary function tests

sputum gram stain and culture

ABG

CXR

Blood cultures

EKG

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54
Q

60 y/o M w/intermittent blood in urine over the past month.

Possible differentials?

A

Bladder cancer

Prostate cancer

Urine discoloration due to medication side effect

Nephritis

urethral trauma

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55
Q

Patient is a 60 y/o M w/hematuria, blood present throughout micturition. ROS: polyuria, increased urinary urgency, weight loss

Social Hx: 60 pack yr smoking hx

Possible dx?

A

bladder cancer

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56
Q

60 y/o M w/hematuria.

PMH: recent pharyngitis, HTN

Possible dx?

A

poststreptococcal glomerulonephritis

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57
Q

60 y/o M w/hematuria. ROS: nocturia, polyuria, increased urinary urgency, weight loss

FH: dad had prostate cancer

Possible dx?

A

prostate cancer

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58
Q

Patient is a 60 y/o M w/hematuria, blood present throughout micturition. ROS: polyuria, increased urinary urgency, weight loss

Social Hx: 60 pack yr smoking hx

Work up?

A

Prostate exam

ASO titers

U/A

Urine culture

PSA

Urine cytology

Cystoscopy

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59
Q

1 y/o M w/diarrhea

Possible differentials?

A

viral gastroenteritis

bacterial gastroenteritis

Giardiasis

Food poisoning

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60
Q

1 y/o M w/irritability, blood diarrhea, recent travel hx, vomiting, fever, and sick contacts.

Possible dx?

A

bacterial gastroenteritis

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61
Q

1 y/o M w/irritability, watery diarrhea, low-grade fever, vomiting, daycare exposure

Possible dx?

A

Viral gastroenteritis

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62
Q

1 y/o M w/ irritability, watery/foul-smelling diarrhea, recent travel hx, vomiting

Possible dx?

A

giardiasis

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63
Q

1 y/o M w/irritability, blood diarrhea, recent travel hx, vomiting, fever, and sick contacts.

workup?

A

CBC w/diff

electrolytes

stool culture, test for ova, parasites, fecal leukocytes

Rotavirus enzyme immunoassay

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64
Q

43 y/o w/dizziness.

Possible differential?

A

BPPV

Acoustic neuroma

Meneiere’s disease

Intracranial tumor

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65
Q

43 y/o F w/episode vertigo, episodes lasts 20 minutes to a few hrs, tinnitus, hypoacusia, ataxia during episodes, nausea, vomiting, aural fullness.

PE: Weber test- lateralization to the right, normal Rinne test

Possible Dx?

A

Meniere’s disease

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66
Q

43 y/o F w/ episodic vertigo worse w/positional changes, ataxia during episodes, nausea, vomiting

PE: CNs 2-12 intact, motor strength 5/5, sensory intact

Possible dx?

A

Benign paroxysmal positional vertigo

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67
Q

43 y/o F w/ vertigo that progressively worsened over the last 6 months. ROS: tinnitus, hypoacusia, ataxia during episodes, aural fullness

PE: normal Rinne test, Weber test laterialziation to the right

Possible dx?

A

acoustic neuroma

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68
Q

43 y/o F w/ vertigo that progressively worsened over the last 6 months. ROS: tinnitus, hypoacusia, ataxia during episodes, aural fullness

PE: normal Rinne test, Weber test laterialization to the right

Workup?

A

Dix-Hallpike test

MRI of head

Audiogram

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69
Q

52 y/o M w/difficulty swallowing.

Possible differential?

A

Esophageal stricture

Achalasia

Esophageal cancer

Zenker diverticulum

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70
Q

52 y/o M w/progressive dysphagia to solids, 9lbs unintentional weight loss, sensation of food stuck in the throat

PMH: GERD

Social Hx: 30 pack yr smoking hx, drinks EtoH daily

PE: thin and cachetic

Possible dx?

A

esophageal cancer

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71
Q

62 y/o M w/ dysphagia of solids, regurgitation of food, unintentional weight loss

PMH: GERD

Possible dx?

A

Esophageal stricture

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72
Q

62 y/o M w/dysphagia, regurgitation of food at night, and unintentional weight loss.

Possible dx?

A

achalasia

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73
Q

52 y/o M w/progressive dysphagia to solids, 9lbs unintentional weight loss, sensation of food stuck in the throat

PMH: GERD

Social Hx: 30 pack yr smoking hx, drinks EtoH daily

PE: thin and cachetic

Workup?

A

CBC w/diff

Barium esophagram

EGD

Esophageal manometry

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74
Q

60 y/o M w/ SOB.

Possible differential?

A

Pulmonary embolism

MI

COPD exacerbation

Pleural effusion

Cardiac Tamponade

CHF exacerbation

Non-ischemic cardiomyopathy

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75
Q

60 y/o M w/ SOB. ROS: DOE, orthopnea, leg swelling, cough

PMH: HTN, DM II, HLD

FH: heart disease

Social hx: smoking hx

PE: spO2 of 90%, rales bilaterally, JVD, S3 gallop, HTN, +2 LE pitting edema bilaterally

Possible dx?

A

Congestive Heart Failure

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76
Q

60 y/o M w/ DOE, orthopnea, paroxysmal dyspnea, LE swelling, fevers.

Social Hx: cocaine use

PE: spo2 90%, rales bilaterally, JVD, S3 gallop, +2 LE pitting edema bilaterally

Possible dx?

A

Non-ischemic cardiomyopathy

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77
Q

60 y/o M w/ SOB. ROS: DOE, orthopnea, leg swelling, cough

PMH: HTN, DM II, HLD

FH: heart disease

Social hx: smoking hx, cocaine use

PE: spO2 of 90%, rales bilaterally, JVD, S3 gallop, HTN, +2 LE pitting edema bilaterally

Workup?

A

CBC w/diff

Electrolytes

BNP

EKG

CXR

Echocardiogram

Urine toxicology

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78
Q

45 y/o M w/chronic nose bleeds.

Possible differential?

A

ITP

Substance abuse induced nose bleeds

Immunodeficiency

Hemophilia A

Hemophilia B

Hepatic failure

Nutritional deficiency (vit K or C)

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79
Q

45 y/o M w/chronic nosebleeds. ROS: weight gain, decreased appetite, easy bruising, itchy skin, 2 episodes of heavy nose bleeding

Meds: excessive use of acetaminophen

Social hx: heavy drinking hx, sexually active w/multiple women w/o condom use

PE: jaundice, scleral icterus, multiple bruises, dullness to percussion of abd

Possible dx?

A

hepatic failure

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80
Q

45 y/o M w/chronic nosebleeds. ROS: easy bruising

Social Hx: poor diet, heavy drinking use

PE: poor dentition, thin extremities, multiple bruises

Possible dx?

A

nutritional deficiency (such as vit K or vit C)

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81
Q

45 y/o M w/recurrent episodes of epistaxis, two episodes of heavy bleeding and easy bruising.

PE: multiple bruises

Possible dx?

A

ITP

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82
Q

45 y/o M w/chronic nosebleeds. ROS: weight gain, decreased appetite, easy bruising, itchy skin, 2 episodes of heavy nose bleeding

Meds: excessive use of acetaminophen

Social hx: heavy drinking hx, sexually active w/multiple women w/o condom use

PE: jaundice, scleral icterus, multiple bruises, dullness to percussion of abd

Workup?

A

CBC w/diff

ASt, ALT, Alk phos, bilirubin, albumin, total protein

PT, PT, INR

U/S of RUQ

Vitamin C level

Acetaminophen level

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83
Q

14 y/o girl w/weight loss

Possible differential?

A

Anorexia Nervosa

Bulimia

Depression

Hyperthyroidism

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84
Q

14 y/o f w/ 25 lb intentional weight loss, exercising excessively, distorted body image, amenorrhea, laxative use

Possible dx?

A

anorexia nervosa

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85
Q

14 y/o f w/ 25 lb weight loss, amenorrhea, palpitations, and heat intolerance.

Possible dx?

A

hyperthyroidism

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86
Q

14 y/o f w/ 25 lb weight loss, amenorrhea, palpitations, and heat intolerance.

Workup?

A

Electrolytes

TSH, FT4, FT3

FSH, LH, prolactin

BUN, Cr

EKG

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87
Q

55 y/o M w/decreased energy for the past three years.

Differential?

A

Hypothyroidism

Depression

OSA

Iron deficiency anemia

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88
Q

55 y/o M w/ fatigue, weight gain, numbness in right hand, constipation, voice change, cold intolerance, impaired memory

FH: uncle has sjogren’s syndrome

PE: dry and scaly skin, decreased sensation in right hand, overweight

Possible dx?

A

hypothyroidism

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89
Q

55 y/o M w/ fatigue for the past 3 yrs, constipation, cold intolerance, leg cramps, impaired memory.

PE: dry and scaly skin

Possible dx?

A

iron deficiency anemia

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90
Q

55 y/o M w/ fatigue for the past 3 yrs, constipation, cold intolerance, leg cramps, impaired memory.

PE: dry and scaly skin, overweight

Workup?

A

rectal exam, FOBT

TSH, FT4

CBC w/diff

peripheral smear

ferritin levels

TIBC levels

serum FE

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91
Q

48 y/o F w/ abd pain.

Possible diff?

A

acute cholecystitis

acute pancreatitis

appendicitis

Peptic ulcer disease

Gastritis

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92
Q

48 y/o F w/diffuse abd pain w/hx of NSAID use and burning epigastric pain that is relieved by antacids.

Possible dx?

A

Peptic ulcer disease

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93
Q

48 y/o F w/intermittent, burning epigastric pain after meals. Relieved by milk and antacids. +intermittent nausea, +occasional vomiting

Meds: NSAIDs for arthritis, Maalox

Workup?

A

rectal exam, FOBT

U/S of RUQ

EGD

Urea breath test

AST, ALT, bilirubin

Lipase

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94
Q

21 y/o F w/ sudden abd pain, rated 7/10. LMP was 5 weeks ago. ROS: nausea, intermittent spotting

Social Hx: 3 sexual partners in last year, no condom use, STD one month ago

Workup?

A

Pelvic exam

Urine hCG

U/A

CBC w/diff

U/S of abd/pelvis

Cervical cultures

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95
Q

31 y/o F w/ sudden abd pain, rated 7/10. LMP was 5 weeks ago. ROS: nausea, intermittent spotting

Social Hx: 3 sexual partners in last year, no condom use, STD one month ago

Possible differential?

A

ectopic pregnancy

spontaneous abortion

appendicitis

PID

ruptured ovarian cyst

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96
Q

74 y/o M w/right arm pain in the upper and middle sections.

Possible differential?

A

humeral fracture

shoulder dislocation

elder abuse

rotator cuff tear

osteoporosis

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97
Q

74 y/o M w/right arm pain in the upper and middle sections.

Workup?

A

X-ray of affected area

MRI of shoulder

DEXA scan

98
Q

46 y/o M w/ chest pain.

Possible differential?

A

MI

PE

Costochondritis

Pericarditis

Cardiac tamponade

Gerd

Esophageal spasm

99
Q

46 y/o M w/ chest pain that started 40 minutes ago. It is constant 7/10 and radiates to the neck and left arm. ROS: SOB

PMH: HTN, HLD, GERD

Social hx: smokes 1-2 PPD for last 20 yrs, uses cocaine occasionally- last used one day ago.

Possible differential?

A

MI secondary to comorbid conditions

MI secondary to cocaine use

Aortic dissection

100
Q

46 y/o M w/ chest pain that started 40 minutes ago. It is constant 7/10 and radiates to the neck and left arm. ROS: SOB

PMH: HTN, HLD, GERD

Social hx: smokes 1-2 PPD for last 20 yrs, uses cocaine occasionally- last used one day ago.

Workup?

A

Electrolytes

ECG

CXR

Echocardiogram

Troponins, CKMB

urine tox

101
Q

7 month old child w/fever.

Possible differentials?

A

Croup

Meningitis

Viral URI

Otitis media

102
Q

7 month old child w/ 101 fever for one day. ROS: + runny nose, irritable, not eating well, SOB; no cough, ear pulling, ear discharge, or rash

Social hx: goes to daycare, brother was sick with a cold

Immunizations are UTD

Differentials?

A

Viral URI

PNA

Meningitis

UTI

103
Q

7 month old child w/ 101 fever for one day. ROS: + runny nose, irritable, not eating well, SOB; no cough, ear pulling, ear discharge, or rash

Social hx: goes to daycare, brother was sick with a cold

Immunizations are UTD

Workup?

A

CBC w/diff

Blood culture

CXR

LP w/CSF analysis

U/A

Urine culture

104
Q

18 month old F w/fever for 2 days. ROS: + rash on her chest, back, belly, and face but none on her arms or legs. Started two days ago on her face and then spread to her chest, back, and belly.

PMH- had otitis media three months ago tx w/ amoxicillin

Immunizations-UTD

Possible differentials?

A

Otitis media recurrent

Scarlet Fever

Parvovirus B19

Roseola

Rocky Mountain Spotty Fever

Meningococcal meningitis

Varicella

105
Q

18 month old F w/fever for 2 days. ROS: + rash on her chest, back, belly, and face but none on her arms or legs. Started two days ago on her face and then spread to her chest, back, and belly.

PMH- had otitis media three months ago tx w/ amoxicillin

Immunizations-UTD

Workup?

A

Pneumatic otoscopy

Tympanometry

LP w/CSF analysis

CBC w/diff

Skin lesion scrapings

throat culture

blood culture

U/A

urine culture

Varicella ab titer

Parvovirus B19 IgM ab

106
Q

26 y/o M w/cough. Started one week ago; associated w/ runny nose and fever. Pt had sore throat two weeks ago, which resolved. ROS: +sputum w/white mucus, sharp pain on right side of chest when he takes a deep breath, 8/10 intensity.

PMH: never had a PPD

Social hx: smokes 1 PPD, drinks on weekends, sexually active w/multiple F partners- no condom usage

Possible differential?

A

Viral URI

Acute bronchitis

PNA

107
Q

26 y/o M w/cough. Started one week ago; associated w/ runny nose and fever. Pt had sore throat two weeks ago, which resolved. ROS: +sputum w/white mucus, sharp pain on right side of chest when he takes a deep breath, 8/10 intensity.

PMH: never had a PPD

Social hx: smokes 1 PPD, drinks on weekends, sexually active w/multiple F partners- no condom usage

Workup?

A

CBC w/diff

CXR

Sputum gram stain and culture

blood culture

PPD test

108
Q

56 y/o F w/ consistent cough for one month. ROS: + fever, nightsweats, blood streaked sputum, foul-smelling cough, unintentional weight loss

Social Hx: works as an RN in a nursing home, smokes 2 PPD for the last 35 yrs

Possible differentials?

A

TB

Lung cancer

Lung abscess

PNA

109
Q

56 y/o F w/ consistent cough for one month. ROS: + fever, nightsweats, blood streaked sputum, foul-smelling cough, unintentional weight loss

Social Hx: works as an RN in a nursing home, smokes 2 PPD for the last 35 yrs

Workup?

A

CBC w/diff

Electrolytes

CXR

PPD test

Sputum gram stain and culture

blood cultures

110
Q

52 y/o F w/yellow eyes and skin; started three weeks ago. ROS: +pruritis, RUQ tenderness, acholic stools, dark urine, nausea

Meds: tylenol (2400 mg every day)

Social hx: traveled to Mexico 2 months ago, drinks 1-2 glasses per wine every day for the last 30 yrs

Possible differential?

A

Choledocholithiasis

Pancreatic cancer

Cholangiocarcinoma

Hepatic toxicity due to Acetaminophen use

Alcoholic Hepatitis

Hepatitis A

Primary biliary cirrhosis

111
Q

52 y/o F w/yellow eyes and skin; started three weeks ago. ROS: +pruritis, RUQ tenderness, acholic stools, dark urine, nausea

Meds: tylenol (2400 mg every day)

Social hx: traveled to Mexico 2 months ago, drinks 1-2 glasses per wine every day for the last 30 yrs

Workup?

A

CBC w/diff

electrolytes

AST, ALT, bilirubin, Alk phos

lipase

PT, PTT, INR

serum acetaminophen level

viral hepatitis serology panel

U/S of RUQ

CT scan of abd

112
Q

65 y/o F w/forgetfulness. She needs some help w/ bathing, feeding, toileting, dressing, and transferring into and out chairs and the bed. Daughter shops and cooks for her. She also pays the bills.

ROS: feels upset about the memory difficulties, +left arm weakness, unintentional weight loss, decreased appetite; denied incontinence, ataxia

PMH: patient falls often. She hit her head a few weeks ago but did not get it checked out. Had a stroke a few years ago. Had an MI multiple years ago.

Social hx: lives w/daughter; husband passed one year ago; has a good support system

Possible differential?

A

Vascular dementia

Alzheimer’s dementia

Subdural hematoma

Pseudodementia

Vit B12 deficiency

113
Q

65 y/o F w/forgetfulness. She needs some help w/ bathing, feeding, toileting, dressing, and transferring into and out chairs and the bed. Daughter shops and cooks for her. She also pays the bills.

ROS: feels upset about the memory difficulties, +left arm weakness, unintentional weight loss, decreased appetite; denied incontinence, ataxia

PMH: patient falls often. She hit her head a few weeks ago but did not get it checked out. Had a stroke a few years ago. Had an MI multiple years ago.

Social hx: lives w/daughter; husband passed one year ago; has a good support system

Workup?

A

CBC w/diff

Electrolytes, calcium, BUN/Cr, glucose

CT w/o contrast of head

MRI of brain

TSH, FT4, FT3

B12, VDRL test

114
Q

56 y/o M comes to the clinic for diabetic f/u. What are some questions you should ask this patient?

A

When was he initially diagnosed with diabetes?

Which type of diabetes does he have?

Which medications is he taking currently?

Has he experienced any side effects with the medication?

How many times a day are you taking the medication?

How many times is he checking his sugar a day?

What is the highest number reading? Lowest? Average?

What was the last HbA1c?

ROS: episodes of low blood sugar, shakiness, dizziness, sweating, heart palpitations, constipation, diarrhea, numbness, tingling, early satiety, change in weight, change in appetite, increased urinary frequency, increased thirst, blood in urine, change in vision, recent foot infection, nausea, vomiting

Continue w/PAM HR FOSS and fill in the blanks

115
Q

60 y/o M w/ type II DM w/numbness and tingling.

Workup for f/u?

A

CBC w/diff

Electrolytes, glucose

HbA1c

U/A

albumin to Cr ratio

BUN/Cr

Nerve conduction studies

116
Q

When a patient presents w/ tinnitus, difficulty hearing, and dizziness, what should you rule out since it can cause Meniere’s disease?

A

Neurosyphilis, which can be ruled via VDRL test

117
Q

If you are not sure whether a patient’s hearing difficulty is central or peripheral, which test can you order to diagnose central vestibular disease?

A

Brain Stem Auditory Evoked Potentials

118
Q

46 y/o M w/fatigue.

Possible differential?

A

Cancer

Depression

Hypothyroidism

Iron deficiency Anemia

Sleep disorder

119
Q

When a patient presents w/ sadness, which questions should you ask on ROS?

A

Sig e caps

Sleep
Interest
Guilt
Energy levels
Concentration/focus
Appetite 
Psychomotor retardation
Suicide (Any thoughts of wanting to hurt yourself or others)
120
Q

Patient w/ depression should also be ruled out for hypothyroidism. Which questions should be asked on ROS?

A

Cold/Heat intolerance
Skin/hair changes
Bowel changes- constipation/diarrhea?

121
Q

If a patient admits to having thoughts of suicide but does not want to act on it, what you must counsel w/the patient?

A

Suicide Contract

If you ever feel as though you want to act on your thoughts, please contact your physician or go to the ER. Can you promise me that you will do this?

122
Q

Diagnostic workup for obstructive sleep apnea?

A

Ambulatory nocturnal pulse ox

Polysomnography

123
Q

Work up for iron deficiency anemia?

A

CBC w/diff

Fe serum level

Ferritin level

TIBC level

serum B12

Electrolytes

124
Q

35 y/o F w/ a headache.

Possible differential?

A

Migraine

Tension Headache

Meningitis

SAH

Intracranial tumor

Pseudotumor cerebri

125
Q

Patient suspected of pseudotumor cerebri should have what in the diagnostic workup?

A

LP- CSF analysis; open pressure will be increased

126
Q

35 y/o M has one episode of hematuria and dysuria.

PE: +CVA on right side

Possible dx?

A

urolithiasis

127
Q

Workup for urolithiasis?

A

Genital exam

Rectal exam

U/A

Urine culture

Urine cytology

Bun/Cr

Renal U/S

128
Q

What is the classic triad for renal cell carcinoma?

A

hematuria

flank pain

palpable mass

129
Q

65 y/o M presenting for f/u w/HTN. Which questions should be asked?

A

When were you diagnosed with HTN?

What are your current meds?

How often are you taking your meds?

Are you experiencing any side effects with your medications?

ROS: chest pain, headache, dizziness, sweating, palpitations, SOB, urinary changes, change in bowel movements, nausea/vomiting, change in vision

Always fill in w/ PAM HR FOSS

130
Q

Patient has erectile dysfunction. Which questions should be asked during the interview?

A

Have you experienced morning or nocturnal erections?

How is your desire to participate in sexual intercourse?

Have you been experiencing any marital or work problems?

Have you experienced recent feelings of anxiety or stress?

Have you experienced any leg or buttock pain while walking or resting?

131
Q

What should be checked on PE in a patient w/HTN?

A

fundoscopic exam

Carotid auscultation- looking bruits

Listen to heart and lungs

Palpate for PMI

Listen and palpate abd

132
Q

Workup for erectile dysfunction?

A

Free testosterone level

genital exam

rectal exam

LH/FSH levels

Prolactin levels

TSH levels

Electrolytes, glucose

133
Q

Propanolol can cause which significant side effect in male patients?

A

erectile dysfunction

134
Q

Workup for HTN f/U?

A

U/A

Bun/Cr

electrolytes, glucose

total cholesterol, LDL, HDL, TGs

ECG

135
Q

33 y/o F w/knee pain.

Possible differential?

A

Rheumatoid arthritis

osteoarthritis

SLE

Meniscal tear

gout

pseudogout

Reiter syndrome

Gonoccocal arthritis

136
Q

33 y/o F w/ knee pain for the past two days. Has difficulty moving left knee in any direction. There is redness and swelling. Rest and tylenol alleviates some pain. Moving and walking makes the pain worse. ROS: wrist, fingers, big toe have joint pain, stiffness in the am, mouth ulcers, fatigue, Raynaud’s phenomenon, lost 10 lbs in last month, decreased appetite

PMH: 2 spontaneous abortions, had gonorrhea one year ago

FH: Mom has RA

Social hx: drinks on the weekends, smokes 1 PPD for last 20 yrs, doesn’t always use condoms, has 4 sexual partners in the last year

Possible differential?

A

RA

SLE

Gonoccocal septic arthritis

Nongonoccocal septic arthritis

137
Q

33 y/o F w/ knee pain for the past two days. Has difficulty moving left knee in any direction. There is redness and swelling. Rest and tylenol alleviates some pain. Moving and walking makes the pain worse. ROS: wrist, fingers, big toe have joint pain, stiffness in the am, mouth ulcers, fatigue, Raynaud’s phenomenon, lost 10 lbs in last month, decreased appetite

PMH: 2 spontaneous abortions, had gonorrhea one year ago

FH: Mom has RA

Social hx: drinks on the weekends, smokes 1 PPD for last 20 yrs, doesn’t always use condoms, has 4 sexual partners in the last year

Workup?

A

CBC w/diff

Arthocentesis of left knee

XR of left knee, wrist, fingers

pelvic exam

cervical swab and culture

ANA ab, ESR, Anti-ccp IgG ab

blood culture

138
Q

66 y/o M w/tremor

Differential?

A

Parkinson’s disease

Alcohol withdrawal

anxiety

essential tremor

pheochromocytoma

hyperthyroidism

139
Q

66 y/o M w/ right hand tremor that started 6 months ago and is progressively worse. Tremor is at rest only. Patient has trouble pushing the grocery cart when shopping with his wife.

PMH: had a bilateral tremor in college when drinking too much caffeine, HLD, asthma

Social hx: retired, married, drinks one cup of coffee daily, denied alcohol use

Possible differential?

A

Parkinson’s disease

Essential tremor

Physiological tremor

psychogenic tremor

140
Q

66 y/o M w/ right hand tremor that started 6 months ago and is progressively worse. Tremor is at rest only. Patient has trouble pushing the grocery cart when shopping with his wife.

PMH: had a bilateral tremor in college when drinking too much caffeine, HLD, asthma

Social hx: retired, married, drinks one cup of coffee daily, denied alcohol use

Workup?

A

Electrolytes

MRI-brain

heavy metal screen

141
Q

58 y/o M w/ chest pain for one hr.

VS: tachycardic, tacypnea

Possible differential?

A

MI

PE

Angina

Esophageal spasm

142
Q

58 y/o M w/ chest pain for one hr. Substernal sharp pain 7/10, not relieved by rest.

FH: Mom has DM2, HTN; heart disease in the family

VS: tachycardic, tacypnea

Most likely diagnosis?

A

Acute MI

143
Q

58 y/o M w/ chest pain for one hr. Chest pain started after strenuous activity. ROS: SOB

FH: heart disease

VS: tachycardic, tacypnea

Possible diagnosis?

A

Angina pectoris

144
Q

58 y/o M w/ chest pain for one hr. Chest pain occurred after eating a meal. Retrosternal pain

Social hx: son is moving to college and he is stressed out.

VS: tachycardic, tacypnea, normal BP

Possible diagnosis?

A

esophageal spasm

145
Q

58 y/o M w/ chest pain for one hr. Substernal sharp pain 7/10, not relieved by rest.

FH: Mom has DM2, HTN; heart disease in the family

VS: tachycardic, tacypnea

Workup?

A

troponins, CKMB
EKG
CXR
Echocardiogram

146
Q

68 y/o M w/ +prostate biopsy for adenocarcinoma of the prostate. In order to go on to treatment, what tests should be ordered?

A

Bone scan

CT scan of abd/pelvis

147
Q

60 y/o M w/ difficulty urinating, weak stream, getting worse over time, nocturia, and hesitancy when urinating.

Possible differential?

A

BPH

Prostate Cancer

UTI

148
Q

24 y/o F w/ weakness for the last 2 months.

Possible differential?

A

Multiple Sclerosis

Myasthenia Gravis

Botulism

Guillian-Barre Syndrome

Chronic fatigue syndrome

Depression

Hypothyroidism

149
Q

24 y/o F w/weakness for the past 2 months. ROS: fatigue, blurry vision and diplopia, jaw weakness, slurred speech.

Weakness is better with rest- worse as the day progresses

Most likely diagnosis?

A

Myasthenia Gravis

150
Q

24 y/o F w/weakness for the past 2 months. Ros: fatigue, blurry vision and diplopia, slurred speech. Symptoms began after a diarrheal illness.

Most likely diagnosis?

A

Guillain-Barre Syndrome

151
Q

24 y/o F w/weakness for the past 2 months.
ROS: fatigue, blurry vision and diplopia, jaw weakness and weakness with chewing, and slurred speech.

Social Hx: lives in a dorm for grad school; eats a lot of canned foods

Most likely diagnosis?

A

Botulism

152
Q

24 y/o F w/weakness for the past 2 months. ROS: fatigue, blurry vision and diplopia, jaw weakness, slurred speech.

Weakness is better with rest- worse as the day progresses

Workup?

A

AcH receptor antibodies

anti-SM ab

Botulinum toxin blood test

FVC

Tensilon test

EMG

CXR

153
Q

61 y/o M w/ fatigue.
ROS: nausea, vomiting, unintentional weight loss

Social hx: quit smoking 6 months ago; smoked 1 PPD for 30 yrs, drinks 2-3 drinks per day and 3-4 drinks on the weekend

Possible differential

A

Pancreatic cancer

Alcoholic hepatitis

Hepatocarcinoma

Chronic pancreatitis

154
Q

61 y/o M w/ fatigue w/ abdominal pain that radiates to the back.

ROS: nausea, vomiting, unintentional weight loss

Social hx: quit smoking 6 months ago; smoked 1 PPD for 30 yrs, drinks 2-3 drinks per day and 3-4 drinks on the weekend

Possible diagnosis

A

Pancreatic cancer or chronic pancreatitis

155
Q

61 y/o M w/ fatigue.
ROS: nausea, vomiting, unintentional weight loss

Social hx: quit smoking 6 months ago; smoked 1 PPD for 30 yrs, drinks 2-3 drinks per day and 3-4 drinks on the weekend

Workup?

A

CBC w/diff

Electrolytes, glucose

lipase, AST, ALT, bilirubin

CT abd

156
Q

53 y/o M w/2 day h/o hearing loss in the left ear.

Possible differential?

A

Meniere’s disease

Perilymph fistula

Complete canal obstruction

Otitis externa

chronic otitis media

157
Q

50 y/o M w/gradual loss of hearing in left ear.

Possible differential?

A

middle ear effusion

otosclerosis

cholesteatoma

158
Q

26 y/o M w/ cough for the last 2 weeks. Constant coughing, small amount of white mucus. Had runny nose, cough, and mild fever one week ago.

ROS: chest pain 4/10, hurts on the right side; worse when taking a deep breath and coughing.

social hx: 50 sexual partners w/i last yr, drinks 2-3 alcoholic drinks on the weekend

Possible differential?

A

Acute bronchitis

PNA

Pleural effusion of the right side

PCP PNA

TB

159
Q

26 y/o M w/ cough for the last 2 weeks. Constant coughing, small amount of white mucus. Had runny nose, cough, and mild fever one week ago.

ROS: chest pain 4/10, hurts on the right side; worse when taking a deep breath and coughing.

social hx: 50 sexual partners w/i last yr, drinks 2-3 alcoholic drinks on the weekend

Workup?

A

CXR

CBC w/diff

HIV screening

PPD test

160
Q

49 y/o M who passed out a couple of hours ago.

Possible differential?

A

hypoglycemic episode

seizure

vasovagal syncope

arrhythmia

drug-induced orthostatic hypotension

aortic stenosis

161
Q

49 y/o M who passed out a couple of hours ago. Patient was taking groceries to his car when he felt lightheaded, dizzy, and had heart palpitations. He lost consciousness and fell down. His wife was with him and she witness him shaking for 30 seconds.

Possible differential?

A

convulsive syncope

vasovagal syncope

Cardiac arrhythmia

drug-induced orthostatic hypotension

seizure

aortic stenosis

162
Q

49 y/o M who passed out a couple of hours ago. Patient was taking groceries to his car when he felt lightheaded, dizzy, and had heart palpitations. He lost consciousness and fell down. His wife was with him and she witness him shaking for 30 seconds.

Workup?

A

CBC

Electrolytes, glucose

CXR

CT of head w/o contrast (since he fell)

ECG and Holter monitoring for 24 hrs

EEG

Echocardiogram

163
Q

30 y/o F w/weight gain.

Possible differential?

A

Hypothyroidism

Diabetes mellitus

Depression

Normal Pregnancy

164
Q

30 y/o F w/20 lb weight gain in the last 3 months.
ROS: hair loss, cold intolerance, dry skin
Ob/Gyn: LMP 1 week ago
PMH: bipolar disorder
Meds: lithium

Social Hx: quit smoking 3 months ago

Possible differential?

A

hypothyroidism

weight gain secondary to smoking cessation

lithium induced weight gain

165
Q 
weight gain in the last 3 months. 
ROS: hair loss, cold intolerance, dry skin
Ob/Gyn: LMP 1 week ago
PMH: bipolar disorder
Meds: lithium

Social Hx: quit smoking 3 months ago

Workup?

A

TSH, FT4

Urine hCG

Electrolytes, glucose

lithium serum level

166
Q

36 y/o F who has not had a menstrual period recently.

Possible differential?

A

Normal Pregnancy

Premature ovarian failure

Prolactinoma/Hyperprolactinemia

Hypothyroidism

167
Q

36 y/o F who has not had a menstrual period in the last 3 months.

ROS: galactorrhea bilaterally, facial hair, 15 lb weight gain in the last yr.

Ob/gyn: G1P1
Meds: none
FH: mother-menopause at 55

Workup?

A

pelvic exam
breast exam

urine bhCG

CBC w/diff

LH/FSH

electrolytes, glucose

TSH, FT4

prolactin

168
Q

28 y/o F w/pain during sexual intercourse.

Possible differential?

A

Vaginismus

PID

Vulvovaginitis

Cervicitis

Domestic violence

169
Q

28 y/o F w/pain during intercourse for the past 3 months. ROS: vaginal discharge (white w/fishy odor).

Ob/GYN: G0P0, sexually active w/boyfriend, uses the patch for contraception, last PAP smear was 6 months ago, LMP 2 weeks ago; menstrual cycles have become painful over the past 2 yrs

Possible differential?

A

Vulvovaginitis

Cervicitis

Endometriosis

Pelvic tumor

170
Q

28 y/o F w/pain during intercourse for the past 3 months. ROS: vaginal discharge (white w/fishy odor).

Ob/GYN: G0P0, sexually active w/boyfriend, uses the patch for contraception, last PAP smear was 6 months ago, LMP 2 weeks ago; menstrual cycles have become painful over the past 2 yrs

Workup?

A

pelvic exam

cervical culture

wet mount, KOH prep

U/S pelvis

171
Q

51 y/o M w/ back pain.

Possible differential?

A

muscle sprain

Herniated disc

spinal fracture

Aortic dissection

Metastatic Cancer

Multiple myeloma

172
Q

Patient with back pain who works in construction asks for time off.

What should you do?

A

Have the patient switch to light duty work for a while.

173
Q

51 y/o M w/back pain for one week, which occurred after lifting some heavy boxes. Pain is sharp 8/10, better lying still, worse when walking

ROS: difficulty emptying bladder for the last 6 months, back pain for the last year on and off.

Social hx: smokes 1 PPD for last 18 yrs, drinks 1-2 drinks on weekends

Possible differential?

A

Lumbar muscle Strain

Lumbar herniated disc

Degenerative arthritis

Lumbar spinal stenosis

Metastatic Prostate Cancer

174
Q

51 y/o M w/back pain for one week, which occurred after lifting some heavy boxes. Pain is sharp 8/10, better lying still, worse when walking

ROS: difficulty emptying bladder for the last 6 months, back pain for the last year on and off.

Social hx: smokes 1 PPD for last 18 yrs, drinks 1-2 drinks on weekends

Workup?

A

Rectal exam

CBC w/diff

Electrolytes

PSA

X-ray of lumbar spine

175
Q

6 month old F w/diarrhea.

Possible differential?

A

rotavirus

bacterial diarrhea

malabsorption

UTI

intussusception

bactermia

176
Q

6 month old F w/diarrhea.

Workup?

A

rotavirus enzyme immunosassay

electrolytes

stool sample for leukocytes and ova

U/A

AXR

blood cultures

177
Q

75 y/o M w/ bilateral hearing loss.

Possible differential?

A

Presbycusis

Cochlear nerve damage due to loud noise

Otosclerosis

Meniere’s disease

Ototoxicity

Acoustic neroma

178
Q

75 y/o M w/bilateral hearing loss.

Workup?

A

audiogram

tympanogram

brain stem evoked potentials

CT scan of head

179
Q

A tympanogram is used for ?

A

to distinguish middle ear from inner ear dysfunction

180
Q

A tympanogram shows?

A

represents the conduction of sound in the middle ear

181
Q

8 y/o M w/urinary incontinence.

Possible differential?

A

UTI

primary enuresis

secondary enuresis due to trauma

182
Q

8 y/o M w/urinary incontinence at night. He has never been dry at night for more than 6 months. He wets the bed 2-3/week.

FH: dad was incontinent at night until 10 y/o

Social Hx: no recent moves, does well in school, can’t go to sleepovers due to the c/c

Probable diagnosis?

A

primary nocturnal enuresis

183
Q

8 y/o M w/urinary incontinence at night. He has never been dry at night for more than 6 months. He wets the bed 2-3/week.

FH: dad was incontinent at night until 10 y/o

Social Hx: no recent moves, does well in school, can’t go to sleepovers due to the c/c

Workup?

A

Genital exam

U/A

Urine culture

U/S of kidneys

184
Q

25 y/o M who comes to the ER after being involved in a motor vehicle accident.
ROS: SOB, left chest pain, tenderness in LUQ

Possible differential?

A

Tension pneumothorax

Hemothorax

Rib fracture

splenic rupture

Pleuritis

185
Q

25 y/o M who comes to the ER after being involved in a motor vehicle accident.

ROS: SOB, left chest pain, tenderness in LUQ

Social Hx: occasional alcohol use

Workup?

A

CBC w/diff

Electrolytes

CXR

CT scan of chest

Pulse Ox (when SOB)

Urine toxicology (was the accident related to drugs)

BAL (was the motor vehicle accident related to alcohol)

186
Q

25 y/o F who presents to the ER after being sexually assaulted. ROS: SOB, left sided chest pain

Possible differential?

A

Rib/bone fracture

Pneumothorax

Hemothorax

Cervicitis

Vulvovaginitis

HIV

Normal Pregnancy

187
Q

25 y/o F who presents to the ER after being sexually assaulted. ROS: SOB, left sided chest pain

Workup?

A

genital exam

urine bHCG

U/A

cervical swab for gonorrhea and chlamydia

wet mount, KOH prep

XR- skeletal survery

HIV ab, VDRL, HBV antigen

rape kit

CXR

188
Q

When a patient comes in regarding pregnancy test, what should be the start of the conversation?

A

When was the LMP?

Menarche?

Regularity?

*basically the OB/GYN hx first.

***Make sure to ask if this was a planned pregnancy and if the pregnancy is desired.

189
Q

30 y/o F w/positive pregnancy test.

Possible differential?

A

Normal pregnancy

Ectopic pregnancy

Molar pregnancy

190
Q

30 y/o F w/positive pregnancy test.

Workup?

A

pelvic exam

breast exam

urine bhCG

CBC w/diff

electrolytes, glucose

U/S of pelvis

PAP smear

Cervical swab for cervical culture

U/A

urine culture

TSH

blood type, RH ab screen

RPR, rubella IgG, HBsAg, HIV ab

191
Q

20 y/o F w/difficulty sleeping.

Possible differential?

A

insomnia secondary to anxiety

insomnia secondary to depression

adjustment insomnia

caffeine-induced insomnia

hyperthyroidism

sleep/wake cycle disorder

192
Q

20 y/o F w/difficulty sleeping.

Workup?

A

CBC w/diff

TSH, FT4

Polysomnogram

193
Q

Screening tool for depression?

A

Beck Depression Inventory

194
Q

If you are concerned that the patient has depression, at the end of the interview, ask the patient what?

A

if they can be screened for depression. Medical assistant or nurse will administer it.

195
Q

55 y/o M presenting to the clinic for life insurance request. After talking to him, you discover that he has been having increased thirst, increased urination, and weight gain.

On PE, he is overweight, and has a mallampati score of 3.

Possible differential?

A

Type II DM

OSA

Hypothyroidism

UTI

196
Q

55 y/o M presenting to the clinic for life insurance request. After talking to him, you discover that he has been having increased thirst, increased urination, and weight gain.

On PE, he is overweight, and has a mallampati score of 3.

Workup?

A

CBC w/diff

U/A

BUN/Cr

electrolytes, glucose

HbA1c

Polysomnogram

197
Q

45 y/o M comes to the clinic for a pre-employment physical. After talking with him, you discover that he had a concussion about one month ago.

Social Hx: drinks 3-4 shots of whiskey per day

On PE, he is A+Ox2 without knowing the date. He appears tremulous and is mildly short of breath.

Possible differential?

A

Subdural hematoma

Wernicke’s encephalopathy

Alcohol withdrawal syndrome

Hepatic encephalopathy

198
Q

45 y/o M comes to the clinic for a pre-employment physical. After talking with him, you discover that he had a concussion about one month ago.

Social Hx: drinks 3-4 shots of whiskey per day

On PE, he is A+Ox2 without knowing the date. He appears tremulous and is mildly short of breath.

Workup?

A

CBC w/diff

Electrolytes, glucose

AST, ALT, Alk phos, bilirubin, albumin

PT, PTT, INR

MRI of brain

EEG

EtoH serum levels (blood alcohol level)

199
Q

Patient is on the phone and requesting a medication refill. When going through the ROS, patient admits to having a dry cough, using more pillows to sleep at night, and lower extremity swelling. +15 lb weight gain in the last 6 months. Last seen PCP 14 months ago.

PMH: HTN

Meds: lisinipril 10 mg PO qd

Possible differential?

A

CHF

Renal insufficiency

Drug-induced cough

200
Q

Patient is on the phone and requesting a medication refill. When going through the ROS, patient admits to having a dry cough, using more pillows to sleep at night, and lower extremity swelling. +15 lb weight gain in the last 6 months. Last seen PCP 14 months ago.

PMH: HTN

Meds: lisinipril 10 mg PO qd

Workup?

A

U/A

BUN/CR

Electrolytes

BNP

CXR

TSH, FT4, FT3

albumin

lipid panel (total cholesterol, HDL, LDL, TGs)

EKG

201
Q

52 y/o M comes to the clinic for blood in urine that has been going on for the past 2 days.

Social hx: just ran a marathon two days ago

Possible diagnosis?

A

Rhabdomyolysis

202
Q

52 y/o M comes to the clinic for blood in urine that has been going on for the past 2 days.

Social hx: just ran a marathon two days ago

Workup?

A

U/A

urine cytology

urine myoglobin

BUN. CR, albumin

CBC w/diff

Electrolytes

Cystoscopy

U/S renal

203
Q

60 y/o M presents to the clinic for constipation. ROS: 10 lbs weight loss in the last 3 months, occasional blood in stool, decreased appetite, dizziness, weakness

FH: dad had colon cancer

Social Hx: smokes 1 PPD for the last 30 yrs

Possible differential?

A

Colorectal carcinoma

Diverticulitis

204
Q

59 y/o M comes to the clinic for left hand tremor. Occurs at rest, disappears with movement. No problems with the right hand.

Possible differential?

A

Parkinson’s disease

Essential tremor

Physiological tremor

Mid-brain lesion

Drug-induced tremor

205
Q

59 y/o M comes to the clinic for left hand tremor. Occurs at rest, disappears with movement. No problems with the right hand.

Workup?

A

CBC w/diff

MRI of brain

heavy metal screening

206
Q

Asking about handwriting changes and gait changes are important for which diagnosis?

A

Parkinson’s disease

207
Q

Any time someone mentions that they have passed out, which things should you check on PE besides a neuro exam?

A

Mental status exam (A+O?, 3 things to remember, no ifs ands or buts)

carotid auscultation (in case TIA)

ORTHOSTATIC VITAL SIGNS

208
Q

37 y/o F comes to the office because she wants help to quit smoking. During the visit, you notice she has a cough. It’s been going on for the last 6 months. She denied any fevers, mucus production, appetite or weight changes.

In working up this patient, what should be included?

A

CBC w/diff (to rule out infection)

CXR (to check her lungs)

209
Q

27 y/o M comes to the ER for seeing writing on a wall.

Possible differential?

A

substance induced psychosis

brief psychotic episode

schizophrenia

schizophreniform disorder

psychosis secondary to a medical condition

narcolepsy

seizure

210
Q

27 y/o M comes to the ER for seeing writing on the wall.

Workup?

A

Urine toxicology

Mini-mental status exam

CBC w/diff

Electrolytes

TSH

AST/ALT

BUN/Cr

EEG

211
Q

Psychosis can be due to a medical condition. Which organ functions should be worked up when this is suspected?

A

Liver (AST, ALT)

Kidney (BUN/Cr)

Thyroid (TSH)

212
Q

When working up a patient who is suspected of either type I or II DM, what should be included?

A

Electrolytes, glucose

U/A

BUN/Cr

Urine microalbumin

HbA1c

Insulin and c-peptide levels

Islet cell antibodies

213
Q

35 y/o F who presents with right calf pain.

Possible differential?

A

DVT

Muscle spasm

Cellulitis/Myositis

Rupture of baker’s cyst

hematoma

rupture of the medial head of the gastrocnemius

214
Q

35 y/o F who presents with right calf pain.

Workup?

A

Doppler U/S of right calf

CBC w/diff

PT, PTT, INR

d-dimer

CPK, myoglobin levels

MRI of right lower extremity

215
Q

31 y/o M w/heel pain.

Possible differential?

A

Achilles tendon rupture

plantar fasciitis

stress fracture

retrocalcaneal bursitis

tarsal tunnel syndrome

ankle sprain

216
Q

31 y/o M w/heel pain.

Workup?

A

X-ray of right heel

MRI of right heel

217
Q

5 day old M w/yellow skin and eyes.

Possible differential?

A

Physiological jaundice

Hemolytic disease of the newborn

neonatal sepsis

cephalohematoma

Breast-feeding jaundice

*early-onset jaundice <1 week

218
Q

5 day old M w/yellow skin and eyes.

Workup?

A

CBC w/diff

Electrolytes

AST,ALT, bilirubin (total and indirect), alk phos

Blood typing

Direct Coombs’ test

219
Q

9 day old M w/ yellow eyes and skin.

Possible differential?

A

Biliary atresia

Duodenal atresia

Gilbert syndrome

Dubin-Johnson syndrome

Breast-milk jaundice

*late-onset jaundice >1week

220
Q

2 y/o F w/noisy breathing.

Possible differential?

A

Croup

Epiglotitis

Foreign body obstruction

laryngitis

retropharyngeal abscess

peritonsillar abscess

angioedema

221
Q

2 y/o F w/noisy breathing.

Workup?

A

CXR

CBC w/diff

x-ray of neck

ABG

222
Q

32 y/o M w/chronic cough. (years)

Possible differential?

A

COPD/Chronic bronchitis

Asthma

GERD

Pulmonary silicosis

Coal-miner pneumoconiosis

223
Q

If a patient is suspected for DVT or PE and she is on birth control pills, what must you do?

A

Advise patient to stop OCPs as they can increase clotting.

224
Q

21 y/o F w/ swelling of the right ankle after falling off a curbside one day ago. ROS: + fever, single joint involvement of the right ankle only

Possible differential?

A

fractured right ankle

right ankle sprain

ligament injury to the right ankle

225
Q

21 y/o F w/ swelling of the right ankle after falling off a curbside one day ago. ROS: + fever, single joint involvement of the right ankle only

Workup?

A

CBC w/diff

X-ray of right ankle

MRI of right ankle (if suspected ligament tear)

226
Q

35 y/o M with lower back pain more on the lateral right side.

PMH: kidney stone 5 years ago

Possible differential?

A

renal colic due to nephrolithiasis

lower back muscular strain

lumbosacral disc disease

227
Q

35 y/o M with lower back pain more on the lateral right side.

PMH: kidney stone 5 years ago

Workup?

A

U/A

MRI of lower back

CT of abd

228
Q

When a patient comes to the ER from any kind of accident or trauma, which questions are important to ask?

A

How did the patient get to the hospital/clinic/ER?

What is the mechanism of the present injury?

Did the patient experience any loss of consciousness?

229
Q

Any time there has been head trauma or injury, what must be in the workup?

A

CT scan of head without contrast

230
Q

59 y/o M involved in a motor vehicle accident. He was recently started on coumadin. What should be included in the counseling for this patient?

A

He needs to be observed for 24 hrs in the hospital to make sure he doesn’t have any intracranial bleeding.

231
Q

22 y/o F coming to the clinic for positive pregnancy test. To start the encounter, what two topics should be at the beginning?

A

LMP and menstrual history

Sexual history (always preface this with personal info and confidentiality)

232
Q

If a patient has a positive pregnancy test, at the end of the encounter, what should be encouraged for counseling?

A

Patient will need regular follow up and prenatal apts to keep track of the pregnancy and the health of the baby.

*smoking and alcohol should be a given if the patient has a history of using these.

233
Q

40 y/o F w/ vaginal bleeding.

Possible differential?

A

abnormal menstrual period

dysfunctional uterine bleeding

spontaneous abortion

cervicitis/endometritis

234
Q

60 y/o F w/vaginal bleeding.

Possible differential?

A

atrophic vaginitis

uterine cancer

ovarian cancer

cervical cancer

235
Q

9 y/o M who has SOB that comes and goes. Mom died in a MVA 18 months ago and is being raised by his grandmother.

Possible differential?

A

Allergies

Asthma

grief-related reaction

236
Q

50 y/o F comes to the office for annual physical exam.

Workup?

A

CBC w/diff

Electrolytes, glucose

rectal exam

pelvic exam

PAP smear

breast exam

mammogram

colonoscopy

237
Q

DEATH SHAFT is a mneumonic to ask about a patient with possible signs of dementia. What does it stand for?

A 
D- dressing
E- eating
A- ambulation
T- toileting
H- hygiene

*is the patient able to do these on his/her own?

S-shopping
H-housework
A- accounting/financial management
F- food preparation (cooking)
T- transportation (driving)
238
Q

A patient comes in with hallucinations. Which organ functions should be include in the work up?

A

liver, kidney, thyroid

239
Q

Plantar fasciitis can be more painful when for a patient?

A

In the morning

240
Q

A patient is on aspirin and is also experiencing hearing loss. What should you talk about at the end of the encounter during the counseling?

A

To stop taking the aspirin until you find out what is exactly causing their hearing loss

241
Q

A patient comes to the clinic for hearing loss. What are some of the questions that you should be asking in terms of ROS?

A

Do you have difficulties understanding speech?

Have you had any trauma to the ears?

Have you experienced dizziness or lightheadedness?

Ear ringing?

Ear pressure?

Ear fullness?

Recent infections? Close contacts sick?

Ear discharge?

Step 2 CS Cases (1 decks)

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