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
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
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
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
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
6
Q
Patient has dysuria, polyuria, and suprapubic tenderness. Differentials?
A
UTI
Nephrolithiasis
Cystitis
Pyelonephritis
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
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
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
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
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
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
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
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
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
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
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
18
Q
Patient is a 16 y/o M w/sore throat for 1 day.
Possible differentials?
A
viral pharyngitis
bacterial pharyngitis
laryngitis
Mononucleosis
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
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
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
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
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
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
25
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?
Hearing loss due to aspirin toxicity
26
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?
CBC w/diff
Serum salicylate acid level
Audiogram
27
Patient is a 75 y/o M who has sudden onset of slurring speech.
Differential dx?
TIA
Cerebrovascular Accident
Subdural hematoma
Ruptured Aneurysm
Seizure
28
Workup for cerebrovascular accident and TIA differentials
Lipid panel (total cholesterol, LDL, HDL, TGs)
CBC w/diff
electrolytes
EKG
Carotid U/S
CT w/o contrast of head
MRI of brain
29
45 y/o M w. severe headache for the past 4 hours.
Possible Differentials?
Subarachnoid hemorrhage due to rupture aneurysm
Hypertensive crisis
substance-induced hemorrhage
Meningitis
30
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?
Ruptured cerebral aneurysm (SAH)
31
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?
Cocaine-induced hypertensive intracranial hemorrhage
32
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?
Meningitis
33
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?
CBC w/diff
Urine toxicology
CT head w/o contrast
LP
MRI of brain
34
31 y/o F presents w/severe abd pain for the last 5 hrs.
Possible differentials?
Ectopic pregnancy
Appendicitis
Ruptured ovarian cyst
Spontaneous Abortion
Ovarian torsion
35
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?
Pancreatitis
36
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?
Acute cholecystitis
37
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?
Peptic ulcer disease
38
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?
CBC w/diff
Electrolytes, glucose
lipase
AST, ALT, bilirubin, alkaline phos
U/S RUQ abd
CT scan of abd
EGD
39
30 y/o F w. recurrent diarrhea for the past year.
Possible differential?
Crohn's disease
Ulcerative colitis
Celiac disease
Chronic infectious diarrhea
Irritable Bowel Syndrome
40
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?
Crohn's disease
41
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?
Ulcerative colitis
42
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?
chronic infectious diarrhea
43
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?
Rectal exam w/FOBT
CBC w/diff
Electrolytes
stool culture for ova, parasites, fecal leukocytes, stool antigen for E.histolytica
pANCA
Colonoscopy
44
55 y/o M w/ abd pain and yellow skin for the past 2 weeks.
Differential dx?
Viral Hepatitis
Alcoholic hepatitis
Acute pancreatitis
Hepatic failure
45
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?
Alcholic hepatitis
46
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?
Viral hepatitis (B or C)
47
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
Acetaminophen toxicity
48
55 y/o M w/jaundice, choluria, acholic stools, RUQ abd pain, anorexia.
Meds: acetaminophen use daily
PE: hepatomegaly, RUQ abd
Workup?
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
49
66 y/o M w/worsening cough
Possible differential dx?
COPD exacerbation
CHF
PNA
50
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?
lung cancer
51
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?
PNA
52
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?
COPD exacerbation
53
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?
CBC w/diff
Pulmonary function tests
sputum gram stain and culture
ABG
CXR
Blood cultures
EKG
54
60 y/o M w/intermittent blood in urine over the past month.
Possible differentials?
Bladder cancer
Prostate cancer
Urine discoloration due to medication side effect
Nephritis
urethral trauma
55
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?
bladder cancer
56
60 y/o M w/hematuria.
PMH: recent pharyngitis, HTN
Possible dx?
poststreptococcal glomerulonephritis
57
60 y/o M w/hematuria. ROS: nocturia, polyuria, increased urinary urgency, weight loss
FH: dad had prostate cancer
Possible dx?
prostate cancer
58
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?
Prostate exam
ASO titers
U/A
Urine culture
PSA
Urine cytology
Cystoscopy
59
1 y/o M w/diarrhea
Possible differentials?
viral gastroenteritis
bacterial gastroenteritis
Giardiasis
Food poisoning
60
1 y/o M w/irritability, blood diarrhea, recent travel hx, vomiting, fever, and sick contacts.
Possible dx?
bacterial gastroenteritis
61
1 y/o M w/irritability, watery diarrhea, low-grade fever, vomiting, daycare exposure
Possible dx?
Viral gastroenteritis
62
1 y/o M w/ irritability, watery/foul-smelling diarrhea, recent travel hx, vomiting
Possible dx?
giardiasis
63
1 y/o M w/irritability, blood diarrhea, recent travel hx, vomiting, fever, and sick contacts.
workup?
CBC w/diff
electrolytes
stool culture, test for ova, parasites, fecal leukocytes
Rotavirus enzyme immunoassay
64
43 y/o w/dizziness.
Possible differential?
BPPV
Acoustic neuroma
Meneiere's disease
Intracranial tumor
65
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?
Meniere's disease
66
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?
Benign paroxysmal positional vertigo
67
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?
acoustic neuroma
68
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?
Dix-Hallpike test
MRI of head
Audiogram
69
52 y/o M w/difficulty swallowing.
Possible differential?
Esophageal stricture
Achalasia
Esophageal cancer
Zenker diverticulum
70
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?
esophageal cancer
71
62 y/o M w/ dysphagia of solids, regurgitation of food, unintentional weight loss
PMH: GERD
Possible dx?
Esophageal stricture
72
62 y/o M w/dysphagia, regurgitation of food at night, and unintentional weight loss.
Possible dx?
achalasia
73
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?
CBC w/diff
Barium esophagram
EGD
Esophageal manometry
74
60 y/o M w/ SOB.
Possible differential?
Pulmonary embolism
MI
COPD exacerbation
Pleural effusion
Cardiac Tamponade
CHF exacerbation
Non-ischemic cardiomyopathy
75
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?
Congestive Heart Failure
76
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?
Non-ischemic cardiomyopathy
77
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?
CBC w/diff
Electrolytes
BNP
EKG
CXR
Echocardiogram
Urine toxicology
78
45 y/o M w/chronic nose bleeds.
Possible differential?
ITP
Substance abuse induced nose bleeds
Immunodeficiency
Hemophilia A
Hemophilia B
Hepatic failure
Nutritional deficiency (vit K or C)
79
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?
hepatic failure
80
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?
nutritional deficiency (such as vit K or vit C)
81
45 y/o M w/recurrent episodes of epistaxis, two episodes of heavy bleeding and easy bruising.
PE: multiple bruises
Possible dx?
ITP
82
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?
CBC w/diff
ASt, ALT, Alk phos, bilirubin, albumin, total protein
PT, PT, INR
U/S of RUQ
Vitamin C level
Acetaminophen level
83
14 y/o girl w/weight loss
Possible differential?
Anorexia Nervosa
Bulimia
Depression
Hyperthyroidism
84
14 y/o f w/ 25 lb intentional weight loss, exercising excessively, distorted body image, amenorrhea, laxative use
Possible dx?
anorexia nervosa
85
14 y/o f w/ 25 lb weight loss, amenorrhea, palpitations, and heat intolerance.
Possible dx?
hyperthyroidism
86
14 y/o f w/ 25 lb weight loss, amenorrhea, palpitations, and heat intolerance.
Workup?
Electrolytes
TSH, FT4, FT3
FSH, LH, prolactin
BUN, Cr
EKG
87
55 y/o M w/decreased energy for the past three years.
Differential?
Hypothyroidism
Depression
OSA
Iron deficiency anemia
88
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?
hypothyroidism
89
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?
iron deficiency anemia
90
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?
rectal exam, FOBT
TSH, FT4
CBC w/diff
peripheral smear
ferritin levels
TIBC levels
serum FE
91
48 y/o F w/ abd pain.
Possible diff?
acute cholecystitis
acute pancreatitis
appendicitis
Peptic ulcer disease
Gastritis
92
48 y/o F w/diffuse abd pain w/hx of NSAID use and burning epigastric pain that is relieved by antacids.
Possible dx?
Peptic ulcer disease
93
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?
rectal exam, FOBT
U/S of RUQ
EGD
Urea breath test
AST, ALT, bilirubin
Lipase
94
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?
Pelvic exam
Urine hCG
U/A
CBC w/diff
U/S of abd/pelvis
Cervical cultures
95
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?
ectopic pregnancy
spontaneous abortion
appendicitis
PID
ruptured ovarian cyst
96
74 y/o M w/right arm pain in the upper and middle sections.
Possible differential?
humeral fracture
shoulder dislocation
elder abuse
rotator cuff tear
osteoporosis
97
74 y/o M w/right arm pain in the upper and middle sections.
Workup?
X-ray of affected area
MRI of shoulder
DEXA scan
98
46 y/o M w/ chest pain.
Possible differential?
MI
PE
Costochondritis
Pericarditis
Cardiac tamponade
Gerd
Esophageal spasm
99
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?
MI secondary to comorbid conditions
MI secondary to cocaine use
Aortic dissection
100
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?
Electrolytes
ECG
CXR
Echocardiogram
Troponins, CKMB
urine tox
101
7 month old child w/fever.
Possible differentials?
Croup
Meningitis
Viral URI
Otitis media
102
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?
Viral URI
PNA
Meningitis
UTI
103
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?
CBC w/diff
Blood culture
CXR
LP w/CSF analysis
U/A
Urine culture
104
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?
Otitis media recurrent
Scarlet Fever
Parvovirus B19
Roseola
Rocky Mountain Spotty Fever
Meningococcal meningitis
Varicella
105
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?
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
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?
Viral URI
Acute bronchitis
PNA
107
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?
CBC w/diff
CXR
Sputum gram stain and culture
blood culture
PPD test
108
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?
TB
Lung cancer
Lung abscess
PNA
109
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?
CBC w/diff
Electrolytes
CXR
PPD test
Sputum gram stain and culture
blood cultures
110
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?
Choledocholithiasis
Pancreatic cancer
Cholangiocarcinoma
Hepatic toxicity due to Acetaminophen use
Alcoholic Hepatitis
Hepatitis A
Primary biliary cirrhosis
111
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?
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
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?
Vascular dementia
Alzheimer's dementia
Subdural hematoma
Pseudodementia
Vit B12 deficiency
113
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?
CBC w/diff
Electrolytes, calcium, BUN/Cr, glucose
CT w/o contrast of head
MRI of brain
TSH, FT4, FT3
B12, VDRL test
114
56 y/o M comes to the clinic for diabetic f/u. What are some questions you should ask this patient?
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
60 y/o M w/ type II DM w/numbness and tingling.
Workup for f/u?
CBC w/diff
Electrolytes, glucose
HbA1c
U/A
albumin to Cr ratio
BUN/Cr
Nerve conduction studies
116
When a patient presents w/ tinnitus, difficulty hearing, and dizziness, what should you rule out since it can cause Meniere's disease?
Neurosyphilis, which can be ruled via VDRL test
117
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?
Brain Stem Auditory Evoked Potentials
118
46 y/o M w/fatigue.
Possible differential?
Cancer
Depression
Hypothyroidism
Iron deficiency Anemia
Sleep disorder
119
When a patient presents w/ sadness, which questions should you ask on ROS?
Sig e caps
```
Sleep
Interest
Guilt
Energy levels
Concentration/focus
Appetite
Psychomotor retardation
Suicide (Any thoughts of wanting to hurt yourself or others)
```
120
Patient w/ depression should also be ruled out for hypothyroidism. Which questions should be asked on ROS?
Cold/Heat intolerance
Skin/hair changes
Bowel changes- constipation/diarrhea?
121
If a patient admits to having thoughts of suicide but does not want to act on it, what you must counsel w/the patient?
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
Diagnostic workup for obstructive sleep apnea?
Ambulatory nocturnal pulse ox
Polysomnography
123
Work up for iron deficiency anemia?
CBC w/diff
Fe serum level
Ferritin level
TIBC level
serum B12
Electrolytes
124
35 y/o F w/ a headache.
Possible differential?
Migraine
Tension Headache
Meningitis
SAH
Intracranial tumor
Pseudotumor cerebri
125
Patient suspected of pseudotumor cerebri should have what in the diagnostic workup?
LP- CSF analysis; open pressure will be increased
126
35 y/o M has one episode of hematuria and dysuria.
PE: +CVA on right side
Possible dx?
urolithiasis
127
Workup for urolithiasis?
Genital exam
Rectal exam
U/A
Urine culture
Urine cytology
Bun/Cr
Renal U/S
128
What is the classic triad for renal cell carcinoma?
hematuria
flank pain
palpable mass
129
65 y/o M presenting for f/u w/HTN. Which questions should be asked?
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
Patient has erectile dysfunction. Which questions should be asked during the interview?
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
What should be checked on PE in a patient w/HTN?
fundoscopic exam
Carotid auscultation- looking bruits
Listen to heart and lungs
Palpate for PMI
Listen and palpate abd
132
Workup for erectile dysfunction?
Free testosterone level
genital exam
rectal exam
LH/FSH levels
Prolactin levels
TSH levels
Electrolytes, glucose
133
Propanolol can cause which significant side effect in male patients?
erectile dysfunction
134
Workup for HTN f/U?
U/A
Bun/Cr
electrolytes, glucose
total cholesterol, LDL, HDL, TGs
ECG
135
33 y/o F w/knee pain.
Possible differential?
Rheumatoid arthritis
osteoarthritis
SLE
Meniscal tear
gout
pseudogout
Reiter syndrome
Gonoccocal arthritis
136
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?
RA
SLE
Gonoccocal septic arthritis
Nongonoccocal septic arthritis
137
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?
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
66 y/o M w/tremor
Differential?
Parkinson's disease
Alcohol withdrawal
anxiety
essential tremor
pheochromocytoma
hyperthyroidism
139
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?
Parkinson's disease
Essential tremor
Physiological tremor
psychogenic tremor
140
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?
Electrolytes
MRI-brain
heavy metal screen
141
58 y/o M w/ chest pain for one hr.
VS: tachycardic, tacypnea
Possible differential?
MI
PE
Angina
Esophageal spasm
142
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?
Acute MI
143
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?
Angina pectoris
144
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?
esophageal spasm
145
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?
troponins, CKMB
EKG
CXR
Echocardiogram
146
68 y/o M w/ +prostate biopsy for adenocarcinoma of the prostate. In order to go on to treatment, what tests should be ordered?
Bone scan
CT scan of abd/pelvis
147
60 y/o M w/ difficulty urinating, weak stream, getting worse over time, nocturia, and hesitancy when urinating.
Possible differential?
BPH
Prostate Cancer
UTI
148
24 y/o F w/ weakness for the last 2 months.
Possible differential?
Multiple Sclerosis
Myasthenia Gravis
Botulism
Guillian-Barre Syndrome
Chronic fatigue syndrome
Depression
Hypothyroidism
149
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?
Myasthenia Gravis
150
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?
Guillain-Barre Syndrome
151
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?
Botulism
152
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?
AcH receptor antibodies
anti-SM ab
Botulinum toxin blood test
FVC
Tensilon test
EMG
CXR
153
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
Pancreatic cancer
Alcoholic hepatitis
Hepatocarcinoma
Chronic pancreatitis
154
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
Pancreatic cancer or chronic pancreatitis
155
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?
CBC w/diff
Electrolytes, glucose
lipase, AST, ALT, bilirubin
CT abd
156
53 y/o M w/2 day h/o hearing loss in the left ear.
Possible differential?
Meniere's disease
Perilymph fistula
Complete canal obstruction
Otitis externa
chronic otitis media
157
50 y/o M w/gradual loss of hearing in left ear.
Possible differential?
middle ear effusion
otosclerosis
cholesteatoma
158
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?
Acute bronchitis
PNA
Pleural effusion of the right side
PCP PNA
TB
159
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?
CXR
CBC w/diff
HIV screening
PPD test
160
49 y/o M who passed out a couple of hours ago.
Possible differential?
hypoglycemic episode
seizure
vasovagal syncope
arrhythmia
drug-induced orthostatic hypotension
aortic stenosis
161
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?
convulsive syncope
vasovagal syncope
Cardiac arrhythmia
drug-induced orthostatic hypotension
seizure
aortic stenosis
162
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?
CBC
Electrolytes, glucose
CXR
CT of head w/o contrast (since he fell)
ECG and Holter monitoring for 24 hrs
EEG
Echocardiogram
163
30 y/o F w/weight gain.
Possible differential?
Hypothyroidism
Diabetes mellitus
Depression
Normal Pregnancy
164
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?
hypothyroidism
weight gain secondary to smoking cessation
lithium induced weight gain
165
```
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?
TSH, FT4
Urine hCG
Electrolytes, glucose
lithium serum level
166
36 y/o F who has not had a menstrual period recently.
Possible differential?
Normal Pregnancy
Premature ovarian failure
Prolactinoma/Hyperprolactinemia
Hypothyroidism
167
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?
pelvic exam
breast exam
urine bhCG
CBC w/diff
LH/FSH
electrolytes, glucose
TSH, FT4
prolactin
168
28 y/o F w/pain during sexual intercourse.
Possible differential?
Vaginismus
PID
Vulvovaginitis
Cervicitis
Domestic violence
169
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?
Vulvovaginitis
Cervicitis
Endometriosis
Pelvic tumor
170
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?
pelvic exam
cervical culture
wet mount, KOH prep
U/S pelvis
171
51 y/o M w/ back pain.
Possible differential?
muscle sprain
Herniated disc
spinal fracture
Aortic dissection
Metastatic Cancer
Multiple myeloma
172
Patient with back pain who works in construction asks for time off.
What should you do?
Have the patient switch to light duty work for a while.
173
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?
Lumbar muscle Strain
Lumbar herniated disc
Degenerative arthritis
Lumbar spinal stenosis
Metastatic Prostate Cancer
174
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?
Rectal exam
CBC w/diff
Electrolytes
PSA
X-ray of lumbar spine
175
6 month old F w/diarrhea.
Possible differential?
rotavirus
bacterial diarrhea
malabsorption
UTI
intussusception
bactermia
176
6 month old F w/diarrhea.
Workup?
rotavirus enzyme immunosassay
electrolytes
stool sample for leukocytes and ova
U/A
AXR
blood cultures
177
75 y/o M w/ bilateral hearing loss.
Possible differential?
Presbycusis
Cochlear nerve damage due to loud noise
Otosclerosis
Meniere's disease
Ototoxicity
Acoustic neroma
178
75 y/o M w/bilateral hearing loss.
Workup?
audiogram
tympanogram
brain stem evoked potentials
CT scan of head
179
A tympanogram is used for ?
to distinguish middle ear from inner ear dysfunction
180
A tympanogram shows?
represents the conduction of sound in the middle ear
181
8 y/o M w/urinary incontinence.
Possible differential?
UTI
primary enuresis
secondary enuresis due to trauma
182
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?
primary nocturnal enuresis
183
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?
Genital exam
U/A
Urine culture
U/S of kidneys
184
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?
Tension pneumothorax
Hemothorax
Rib fracture
splenic rupture
Pleuritis
185
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?
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
25 y/o F who presents to the ER after being sexually assaulted. ROS: SOB, left sided chest pain
Possible differential?
Rib/bone fracture
Pneumothorax
Hemothorax
Cervicitis
Vulvovaginitis
HIV
Normal Pregnancy
187
25 y/o F who presents to the ER after being sexually assaulted. ROS: SOB, left sided chest pain
Workup?
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
When a patient comes in regarding pregnancy test, what should be the start of the conversation?
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
30 y/o F w/positive pregnancy test.
Possible differential?
Normal pregnancy
Ectopic pregnancy
Molar pregnancy
190
30 y/o F w/positive pregnancy test.
Workup?
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
20 y/o F w/difficulty sleeping.
Possible differential?
insomnia secondary to anxiety
insomnia secondary to depression
adjustment insomnia
caffeine-induced insomnia
hyperthyroidism
sleep/wake cycle disorder
192
20 y/o F w/difficulty sleeping.
Workup?
CBC w/diff
TSH, FT4
Polysomnogram
193
Screening tool for depression?
Beck Depression Inventory
194
If you are concerned that the patient has depression, at the end of the interview, ask the patient what?
if they can be screened for depression. Medical assistant or nurse will administer it.
195
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?
Type II DM
OSA
Hypothyroidism
UTI
196
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?
CBC w/diff
U/A
BUN/Cr
electrolytes, glucose
HbA1c
Polysomnogram
197
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?
Subdural hematoma
Wernicke's encephalopathy
Alcohol withdrawal syndrome
Hepatic encephalopathy
198
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?
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
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?
CHF
Renal insufficiency
Drug-induced cough
200
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?
U/A
BUN/CR
Electrolytes
BNP
CXR
TSH, FT4, FT3
albumin
lipid panel (total cholesterol, HDL, LDL, TGs)
EKG
201
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?
Rhabdomyolysis
202
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?
U/A
urine cytology
urine myoglobin
BUN. CR, albumin
CBC w/diff
Electrolytes
Cystoscopy
U/S renal
203
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?
Colorectal carcinoma
Diverticulitis
204
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?
Parkinson's disease
Essential tremor
Physiological tremor
Mid-brain lesion
Drug-induced tremor
205
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?
CBC w/diff
MRI of brain
heavy metal screening
206
Asking about handwriting changes and gait changes are important for which diagnosis?
Parkinson's disease
207
Any time someone mentions that they have passed out, which things should you check on PE besides a neuro exam?
Mental status exam (A+O?, 3 things to remember, no ifs ands or buts)
carotid auscultation (in case TIA)
ORTHOSTATIC VITAL SIGNS
208
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?
CBC w/diff (to rule out infection)
CXR (to check her lungs)
209
27 y/o M comes to the ER for seeing writing on a wall.
Possible differential?
substance induced psychosis
brief psychotic episode
schizophrenia
schizophreniform disorder
psychosis secondary to a medical condition
narcolepsy
seizure
210
27 y/o M comes to the ER for seeing writing on the wall.
Workup?
Urine toxicology
Mini-mental status exam
CBC w/diff
Electrolytes
TSH
AST/ALT
BUN/Cr
EEG
211
Psychosis can be due to a medical condition. Which organ functions should be worked up when this is suspected?
Liver (AST, ALT)
Kidney (BUN/Cr)
Thyroid (TSH)
212
When working up a patient who is suspected of either type I or II DM, what should be included?
Electrolytes, glucose
U/A
BUN/Cr
Urine microalbumin
HbA1c
Insulin and c-peptide levels
Islet cell antibodies
213
35 y/o F who presents with right calf pain.
Possible differential?
DVT
Muscle spasm
Cellulitis/Myositis
Rupture of baker's cyst
hematoma
rupture of the medial head of the gastrocnemius
214
35 y/o F who presents with right calf pain.
Workup?
Doppler U/S of right calf
CBC w/diff
PT, PTT, INR
d-dimer
CPK, myoglobin levels
MRI of right lower extremity
215
31 y/o M w/heel pain.
Possible differential?
Achilles tendon rupture
plantar fasciitis
stress fracture
retrocalcaneal bursitis
tarsal tunnel syndrome
ankle sprain
216
31 y/o M w/heel pain.
Workup?
X-ray of right heel
MRI of right heel
217
5 day old M w/yellow skin and eyes.
Possible differential?
Physiological jaundice
Hemolytic disease of the newborn
neonatal sepsis
cephalohematoma
Breast-feeding jaundice
*early-onset jaundice <1 week
218
5 day old M w/yellow skin and eyes.
Workup?
CBC w/diff
Electrolytes
AST,ALT, bilirubin (total and indirect), alk phos
Blood typing
Direct Coombs' test
219
9 day old M w/ yellow eyes and skin.
Possible differential?
Biliary atresia
Duodenal atresia
Gilbert syndrome
Dubin-Johnson syndrome
Breast-milk jaundice
*late-onset jaundice >1week
220
2 y/o F w/noisy breathing.
Possible differential?
Croup
Epiglotitis
Foreign body obstruction
laryngitis
retropharyngeal abscess
peritonsillar abscess
angioedema
221
2 y/o F w/noisy breathing.
Workup?
CXR
CBC w/diff
x-ray of neck
ABG
222
32 y/o M w/chronic cough. (years)
Possible differential?
COPD/Chronic bronchitis
Asthma
GERD
Pulmonary silicosis
Coal-miner pneumoconiosis
223
If a patient is suspected for DVT or PE and she is on birth control pills, what must you do?
Advise patient to stop OCPs as they can increase clotting.
224
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?
fractured right ankle
right ankle sprain
ligament injury to the right ankle
225
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?
CBC w/diff
X-ray of right ankle
MRI of right ankle (if suspected ligament tear)
226
35 y/o M with lower back pain more on the lateral right side.
PMH: kidney stone 5 years ago
Possible differential?
renal colic due to nephrolithiasis
lower back muscular strain
lumbosacral disc disease
227
35 y/o M with lower back pain more on the lateral right side.
PMH: kidney stone 5 years ago
Workup?
U/A
MRI of lower back
CT of abd
228
When a patient comes to the ER from any kind of accident or trauma, which questions are important to ask?
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
Any time there has been head trauma or injury, what must be in the workup?
CT scan of head without contrast
230
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?
He needs to be observed for 24 hrs in the hospital to make sure he doesn't have any intracranial bleeding.
231
22 y/o F coming to the clinic for positive pregnancy test. To start the encounter, what two topics should be at the beginning?
LMP and menstrual history
Sexual history (always preface this with personal info and confidentiality)
232
If a patient has a positive pregnancy test, at the end of the encounter, what should be encouraged for counseling?
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
40 y/o F w/ vaginal bleeding.
Possible differential?
abnormal menstrual period
dysfunctional uterine bleeding
spontaneous abortion
cervicitis/endometritis
234
60 y/o F w/vaginal bleeding.
Possible differential?
atrophic vaginitis
uterine cancer
ovarian cancer
cervical cancer
235
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?
Allergies
Asthma
grief-related reaction
236
50 y/o F comes to the office for annual physical exam.
Workup?
CBC w/diff
Electrolytes, glucose
rectal exam
pelvic exam
PAP smear
breast exam
mammogram
colonoscopy
237
DEATH SHAFT is a mneumonic to ask about a patient with possible signs of dementia. What does it stand for?
```
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
A patient comes in with hallucinations. Which organ functions should be include in the work up?
liver, kidney, thyroid
239
Plantar fasciitis can be more painful when for a patient?
In the morning
240
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?
To stop taking the aspirin until you find out what is exactly causing their hearing loss
241
A patient comes to the clinic for hearing loss. What are some of the questions that you should be asking in terms of ROS?
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?
