Step 2 CS Flashcards
Likely dx?
21 y.o F presents w/ multiple episodes of L throbbing temporal pain lasting for 2-3 hrs. Prior to onset, she sees flashes of light in her R visual field and feels weakness and nubness on R side of body for few minutes. H/As associated w. nausea & vomiting. Has fam hx of migraines
Migraine (complicated)
Ddx?
Likely dx?
21 y.o F presents w/ multiple episodes of L throbbing temporal pain lasting for 2-3 hrs. Prior to onset, she sees flashes of light in her R visual field and feels weakness and nubness on R side of body for few minutes. H/As associated w. nausea & vomiting. Has fam hx of migraines
*Migraines (complicated) * Tension headache Cluster headache Pseudotumor cerebri Trigeminal neuralgia CNS vasculitis Partial seizure Intracranial neoplasm
Migraine (complicated)
Workup?
CBC ESR CT-head MRI-brain LP
Likely dx?
26 y.o M presents with severe R temporal h/a associated with ipsilateral rhinorrhea, eye tearing, and redness. Episodes have occurred at the same time at night for past week and last for 45 minutes.
Cluster headache
Ddx?
26 y.o M presents with severe R temporal h/a associated with ipsilateral rhinorrhea, eye tearing, and redness. Episodes have occurred at the same time at night for past week and last for 45 minutes.
*Cluster headache* Migraine Tension headache Sinusitis Pseudotumor cerebri Trigeminal neuralgia Intracranial neoplasm
Cluster headache – workup?
CBC ESR CT-head MRI-brain LP
Likely dx?
65 y.o F presents with severe, intermittent R temporal h/a, fever, blurred vision in her R eye and pain in her jaw when chewing.
Temporal arteritis (giant cell arteritis)
Ddx?
26 y.o M presents with severe R temporal h/a associated with ipsilateral rhinorrhea, eye tearing, and redness. Episodes have occurred at the same time at night for past week and last for 45 minutes.
*Temporal arteritis* Migraine Cluster headache Tension headache Meningitis Carotid artery dissection Pseudotumor cerebri Trigeminal neuralgia Intracranial neoplasm
Temporal arteritis – workup?
CBC ESR CRP Temporal artery biopsy Doppler U/S - carotid MRI-brain
Likely dx?
30 y.o F presents with frontal headache, fever, and nasal discharge. There is pain on palpation of frontal and maxillary sinuses. She has a hx of sinusitis.
Sinusitis
Ddx?
30 y.o F presents with frontal headache, fever, and nasal discharge. There is pain on palpation of the frontal and maxillary sinuses. She has a history of sinusitis.
*Sinusitis* Migraine Tension headache Meningitis Intracranial neoplasm
Sinusitis - work up?
CBC
XR-sinus
CT-sinus
LP
Likely dx?
50 y.o F presents with recurrent episodes of b/l squeezing headaches that occur 3-4 times a week, typically toward the end of her workday. She is experiencing significant stress in her life.
Tension headache
Ddx?
50 y.o F presents with recurrent episodes of b/l squeezing headaches that occur 3-4 times a week, typically toward the end of her workday. She is experiencing significant stress in her life.
*Tension headache* Migraine Depression Caffeine or analgesic withdrawal Hypertension Cluster headache Pseudotumor cerebri Intracranial neoplasm
Tension headache - workup?
CBC Electrolytes ESR CT-head LP
Likely dx?
35 y.o M presents with sudden severe headache, vomitign, confusion, left hemiplegia, and nuchal rigidity.
Subarachnoid hemorrhage
Ddx?
35 y.o M presents with sudden severe headache, vomitign, confusion, left hemiplegia, and nuchal rigidity.
*Subarachnoid hemorrhage* Migraine Meningitis/encephalitis Intracranial hemorrhage Vertebral artery dissection Intracranial venous thrombosis Acute hypertension Intracranial neoplasm
Subarachnoid hemorrhage - workup?
CT w/o contrast - head LP CBC PT/PRR MRI/MRA - brain
Likely dx?
25 y/o M presents with high fever, severe headache, confusion, photophobia, and nuchal rigidity. Kernig’s and Brudzinki’s signs are positive.
Meningitis Migraine Subarachnoid hemorrhage Sinusitis/encephalitis Intracranial or epidural abscess
Ddx?
25 y.o M presents with high fever, severe headache, confusion, photophobia, and nuchal rigidity. Kernig’s and Brudzinski’s signs are positive.
MENINGITIS Migraine Subarachnoid hemorrhage Sinusitis/encephalitis Intracranial anscess or epifural abscess.
Meningitis - workup?
CBC
CT-head
MRI-brain
LP - CST analyis (cell count, protein, glucose, Gram stain, PCR for antigens, culture)
Likely dx?
18 y.o obese F presents with a pulsatile headache, vomiting, and blurred vision for the past 2-4 weeks. She is taking OCPs.
Pseudotumor cerebri
Ddx?
18 y.o obese F presents with a pulsatile headache, vomiting, and blurred vision for the past 2-4 weeks. She is taking OCPs.
PSEUDOTUMOR CEREBRI Tension headache Migraine Cluster headache Meningitis Intracranial venous thrombosis Intracranial neoplasm
Pseudotumor cerebri - workup?
Urine hCG
CBC
CT-head
LP - opening pressure and CSF analysis
Likely dx?
57 y/o M c/o daily pain in the R cheek over the past month. The pain is electric and stabbing in character and occurs while is shaving. Each episode lasts 2-4 minutes.
Trigeminal neuralgia
Ddx?
57 y/o M c/o daily pain in the R cheek over the past month. The pain is electric and stabbing in character and occurs while is shaving. Each episode lasts 2-4 minutes.
TRIGEMINAL NEURALGIA Tension headache Migraine Cluster headache TMJ dysfunction Intracranial hypertension
Trigeminal neuralgia - workup?
CBC
ESR
MRI-brain
Likely dx?
81 y.o M presents with progressive confusion over the past several yrs togerther w. forgetfulness and clumsiness. He has a hx of hypertension, DM, and two strokes w/ residual L hemiparesis. His mental status has clearly worsened after each stroke (stepwise decline in cognitive fxn).
Vascular (multi-infarct) dementia
Ddx?
81 y.o M presents with progressive confusion over the past several yrs togerther w. forgetfulness and clumsiness. He has a hx of hypertension, DM, and two strokes w/ residual L hemiparesis. His mental status has clearly worsened after each stroke (stepwise decline in cognitive fxn).
VASCULAR ("multi-infarct") DEMENTIA
Alzheimer's disease
Normal pressure hydrocephalus
Chronic subdural hematoma
Intracranial tumor
Depression
B12 depression
Neurosyphillis
HypothyroidismVascular (multi-infarct) dementia - workup?
CBC VDRL/RPR Serum B12 TSH MRI-brain CT-head LP - CSF analysis (rare)
Likely dx?
84 y.o F brought by her son c/o forgetfulness (e.g. forgets phone numbers, loses her way back home) along w. difficulity performing some of her daily activities (e.g. bathing, dressing, managing money, using the phone). The problem has gradually progressed over the past few years.
Alzheimer’s disease
Ddx?
84 y.o F brought by her son c/o forgetfulness (e.g. forgets phone numbers, loses her way back home) along w. difficulity performing some of her daily activities (e.g. bathing, dressing, managing money, using the phone). The problem has gradually progressed over the past few years.
ALZHEIMER'S DISEASE Vascular dementia Depression Hypothyroidism Chronic subdural hematoma Normal pressure hydrocephalus Intracranial neoplasm B12 deficiency Neurosyphillis
Alzheimer Disease - Workup?
84 y.o F brought by her son c/o forgetfulness (e.g. forgets phone numbers, loses her way back home) along w. difficulity performing some of her daily activities (e.g. bathing, dressing, managing money, using the phone). The problem has gradually progressed over the past few years.
CBC VDRL/RPR (neurosyphillis) Serum B12 (B12 deficiency) TSH (hypothryoidism) MRI - brain (vascular dementia) CT-head LP - CSF analysis (rare)
Likely dx?
72 y.o M presents with memory loss, gait disturbamce, and urinary incontinence for the past 6 months.
Normal pressure hydrocephalus
Ddx?
72 y.o M presents with memory loss, gait disturbamce, and urinary incontinence for the past 6 months
NORMAL PRESSURE HYDROCEPHALUS Alzheimer's disease Vascular dementia Chronic subdural hematoma Intracranial neoplasm Dpression B12 deficiency Neurosyphillis Hypothyroidism
Workup?
72 y.o M presents with memory loss, gait disturbamce, and urinary incontinence for the past 6 months
CT-head LP-opening pressure (NPH) Serum B12 (B12 defic.) VDRL/RPR (neurosyphillis) TSH (hypothyroidism)
Likely dx?
55 y.o M presents w/ rapidly progressive change in mental status, inability to concentrate, and memory impaiment for the past two months. His sx are associated w/ myoclonus and ataxia.
Creutzfelt-Jacob disease
Ddx?
55 y.o M presents w/ rapidly progressive change in mental status, inability to concentrate, and memory impaiment for the past two months. His sx are associated w/ myoclonus and ataxia.
CREUTZFELDT-JAKOB DISEASE Vascular dementia Lewy body dementia Wernicke's encephalopathy Normal pressure hydrocephalus Chronic subdural hematoma Intracranial neoplasm Depression Delirium B12 deficiency Neurosyphillis
Workup?
55 y.o M presents w/ rapidly progressive change in mental status, inability to concentrate, and memory impaiment for the past two months. His sx are associated w/ myoclonus and ataxia.
CBC, electrolytes, calcium Serum B12 - B12 deficiency VDRL/RPR - neurosyphillis MRI-brain (preferred) CT-head EEG LP-CSF analysis Brain biopsy
Likely dx?
70 y/o insulin-dependent diabetic M presents with episodes of confusion, dizziness, palpation, diaphoresis, and weakness.
Hypoglycemia
Ddx?
70 y.o insulin-dependent diabetic M presents w/ episodes of confusion, dizziness, palpation, diaphoresis, and weakness.
HYPOGLYCEMIA Transient ischemic attack Arrhythmia Delirium Angina
Workup?
55 y.o M presents w/ rapidly progressive change in mental status, inability to concentrate, and memory impaiment for the past two months. His sx are associated w/ myoclonus and ataxia.
Glucose CBC, electrolytes Echocardiography ECG MRI-brain Doppler U/S - carotid
Likely dx?
55 y.o F presents with gradual altered mental status and headache. Two weeks ago she slipped, hit her head on the ground, and lost consciousness for two minutes.
Subdural hemotoma
Ddx?
55 y.o F presents with gradual altered mental status and headache. Two wks ago she slipped, hit her head on the ground, and lost consciousness for two minutes.
SUBDURAL HEMATOMA
SIADH (causing hyponatremia)
Creutzfeldt-Jakob disease
Intracranial neoplasm
Workup?
55 y.o F presents with gradual altered mental status and headache. Two wks ago she slipped, hit her head on the ground, and lost consciousness for two minutes.
Electrolytes (hyponatremia)
CT-head
MRI-brain
LP
Likely dx?
68 y.o M presents with a two-month hx of cring spells, excessive sleep, poor hygiene, and a 7 kg weight loss, all following wife’s death. He can’t enjoy time with his grandchildren and reluctanly admits to thinking he has seen his dead wife in line at supermarker or standing in the kitchen making dinner.
Normal bereavement
Ddx?
68 y.o M presents with a two-month hx of cring spells, excessive sleep, poor hygiene, and a 7 kg weight loss, all following wife’s death. He can’t enjoy time with his grandchildren and reluctanly admits to thinking he has seen his dead wife in line at supermarker or standing in the kitchen making dinner.
NORMAL BEREAVEMENT Adjustment disorder w/ depressed mood Major depressive disorder w/ psychotic featurs Schizofaffective disorder Depressive disorder NOS
Workup?
68 y.o M presents with a two-month hx of crying spells, excessive sleep, poor hygiene, and a 7 kg weight loss, all following wife’s death. He can’t enjoy time with his grandchildren and reluctanly admits to thinking he has seen his dead wife in line at supermarker or standing in the kitchen making dinner.
Physical exam Mental status exam TSH (hypothyroidism) CBC Urine tox
Likely dx?
42 y.o F presents with a 4 week hx of excessive fatigue, insomnia, and anhedonia. She states that she thinks constantly about death. She has suffered five similar episodes in past, th first in her 20s, and has made 2 previous suicide attempts. She further admits to increased EtOH use in the past month.
Major depressive disorder
Ddx?
42 y.o F presents with a 4 week hx of excessive fatigue, insomnia, and anhedonia. She states that she thinks constantly about death. She has suffered five similar episodes in past, th first in her 20s, and has made 2 previous suicide attempts. She further admits to increased EtOH use in the past month.
MAJOR DEPRESSIVE DISORDER
Substance-induced mood disorder
Dysthymic disorder
Workup?
42 y.o F presents with a 4 week hx of excessive fatigue, insomnia, and anhedonia. She states that she thinks constantly about death. She has suffered five similar episodes in past, th first in her 20s, and has made 2 previous suicide attempts. She further admits to increased EtOH use in the past month
Physical exam Mental status exam Blood alcohol level TSH CBC Urine toxicology
Workup?
26 y/o F presents with a 3 kg weight loss over past 2 months, accompanied by early morning awakening, excessive guilt, and psychomotor retardation. No triggers for depressive epsde but reports several weeks of increased energy, sexual promiscuity, irresponsible spending, and racing throught approx. 6 mths before her presentation.
Bipolar I disorder
Ddx?
26 y/o F presents with a 3 kg weight loss over past 2 months, accompanied by early morning awakening, excessive guilt, and psychomotor retardation. No triggers for depressive epsde but reports several weeks of increased energy, sexual promiscuity, irresponsible spending, and racing throught approx. 6 mths before her presentation.
BIPOLAR I DISORDER Bipolar II disorder Cyclothymic disorder Major depressive disorder Schizoaffective disorder
Workup?
26 y/o F presents with a 3 kg weight loss over past 2 months, accompanied by early morning awakening, excessive guilt, and psychomotor retardation. No triggers for depressive epsde but reports several weeks of increased energy, sexual promiscuity, irresponsible spending, and racing throught approx. 6 mths before her presentation.
Physical exam
Mental status exam
Urine toxicology
Likely dx?
19 y/o M c/o receiving msgs from his TV. He reports that he didn’t have many friends in HS. In college, he started to suspect his roommate of bugging the phone. In the same time frame, he stopped going to classes b/c he felt that his professors were saying horrible things about him that noone else noticed. He rarely showered or left his room and has recently been hearing a voice from his TV set telling him to “guard”against the evil empire.
Schizophrenia
Ddx?
19 y/o M c/o receiving msgs from his TV. He reports that he didn’t have many friends in HS. In college, he started to suspect his roommate of bugging the phone. In the same time frame, he stopped going to classes b/c he felt that his professors were saying horrible things about him that noone else noticed. He rarely showered or left his room and has recently been hearing a voice from his TV set telling him to “guard”against the evil empire.
SCHIZOPHRENIA
Schizoid or schizotypal personality disorder
Schizophreniform disorder
Psychotic disorder 2/2 to general medical condition
Substance induced psychosis
Depression w/ pyschotic features
Workup?
19 y/o M c/o receiving msgs from his TV. He reports that he didn’t have many friends in HS. In college, he started to suspect his roommate of bugging the phone. In the same time frame, he stopped going to classes b/c he felt that his professors were saying horrible things about him that noone else noticed. He rarely showered or left his room and has recently been hearing a voice from his TV set telling him to “guard”against the evil empire.
Mental status exam Urine toxicology TSH CBC Electrolytes
Ddx?
28 y.o F c/o seeing bugs crawling on her bed over the past 2 days and reports hearing loud voices when she is alone in her room. She has never experiened sx such as these in past. Recently ingested unknown substance.
SUBSTANCE INDUCED PSYCHOSIS Brief psychotic disorder Schizophreniform disorder Schixpphrenia Psychotic disorder 2/2 to general medical condition
Likely dx?
28 y.o F c/o seeing bugs crawling on her bed over the past 2 days and reports hearing loud voices when she is alone in her room. She has never experiened sx such as these in past. Recently ingested unknown substance.
Substance induced psychosis
Workup?
28 y.o F c/o seeing bugs crawling on her bed over the past 2 days and reports hearing loud voices when she is alone in her room. She has never experiened sx such as these in past. Recently ingested unknown substance.
Urine toxicology Mental status exam TSH CBC Electrolytes, BUN/Cr, AST/ALT
Likely dx?
48 y.o F presents w/ a 1 week hx of auditory hallucinations, stating, “ I should kill myself”. She also reports 2 weeks hx of weight loss, early morning awakening, decr. motivations and overwhelming feelings of guilt.
Schizoaffective disorder.
Workup?
48 y.o F presents w/ a 1 week hx of auditory hallucinations, stating, “ I should kill myself”. She also reports 2 weeks hx of weight loss, early morning awakening, decr. motivations and overwhelming feelings of guilt.
Mental status exam Beck Depression Inventory TSH CBC Electrolytes
Ddx?
48 y.o F presents w/ a 1 week hx of auditory hallucinations, stating, “ I should kill myself”. She also reports 2 weeks hx of weight loss, early morning awakening, decr. motivations and overwhelming feelings of guilt.
SCHIZOAFFECTIVE DISORDER Mood disorder w/ psychotic fx Schizophrena Schizophreniform disorder Psychotic disorder 2/2/ to a general medical condition.
Likely dx?
35 y.o F presents intermittent episodes of vertigo, tinnitus, nausea, and hearing loss over the past week.
Meniere’s disease
Ddx?
35 y.o F presents intermittent episodes of vertigo, tinnitus, nausea, and hearing loss over the past week.
MENIERE'S DISEASE Vestibular neuronitis Labrynthitis Benign positional vertigo Acoustic neuroma
Workup?
35 y.o F presents intermittent episodes of vertigo, tinnitus, nausea, and hearing loss over the past week.
CBC
VDRL/RPR (syphillis is cause of Meniere’s disease)
MRI-brain
