Step 2 CS Flashcards
0
Q
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
A
Migraine (complicated)
1
Q
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
A
*Migraines (complicated) * Tension headache Cluster headache Pseudotumor cerebri Trigeminal neuralgia CNS vasculitis Partial seizure Intracranial neoplasm
2
Q
Migraine (complicated)
Workup?
A
CBC ESR CT-head MRI-brain LP
3
Q
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.
A
Cluster headache
4
Q
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.
A
*Cluster headache* Migraine Tension headache Sinusitis Pseudotumor cerebri Trigeminal neuralgia Intracranial neoplasm
5
Q
Cluster headache – workup?
A
CBC ESR CT-head MRI-brain LP
6
Q
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.
A
Temporal arteritis (giant cell arteritis)
7
Q
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.
A
*Temporal arteritis* Migraine Cluster headache Tension headache Meningitis Carotid artery dissection Pseudotumor cerebri Trigeminal neuralgia Intracranial neoplasm
8
Q
Temporal arteritis – workup?
A
CBC ESR CRP Temporal artery biopsy Doppler U/S - carotid MRI-brain
9
Q
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.
A
Sinusitis
10
Q
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.
A
*Sinusitis* Migraine Tension headache Meningitis Intracranial neoplasm
11
Q
Sinusitis - work up?
A
CBC
XR-sinus
CT-sinus
LP
12
Q
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.
A
Tension headache
13
Q
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.
A
*Tension headache* Migraine Depression Caffeine or analgesic withdrawal Hypertension Cluster headache Pseudotumor cerebri Intracranial neoplasm
14
Q
Tension headache - workup?
A
CBC Electrolytes ESR CT-head LP
15
Q
Likely dx?
35 y.o M presents with sudden severe headache, vomitign, confusion, left hemiplegia, and nuchal rigidity.
A
Subarachnoid hemorrhage
16
Q
Ddx?
35 y.o M presents with sudden severe headache, vomitign, confusion, left hemiplegia, and nuchal rigidity.
A
*Subarachnoid hemorrhage* Migraine Meningitis/encephalitis Intracranial hemorrhage Vertebral artery dissection Intracranial venous thrombosis Acute hypertension Intracranial neoplasm
17
Q
Subarachnoid hemorrhage - workup?
A
CT w/o contrast - head LP CBC PT/PRR MRI/MRA - brain
18
Q
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.
A
Meningitis Migraine Subarachnoid hemorrhage Sinusitis/encephalitis Intracranial or epidural abscess
19
Q
Ddx?
25 y.o M presents with high fever, severe headache, confusion, photophobia, and nuchal rigidity. Kernig’s and Brudzinski’s signs are positive.
A
MENINGITIS Migraine Subarachnoid hemorrhage Sinusitis/encephalitis Intracranial anscess or epifural abscess.
20
Q
Meningitis - workup?
A
CBC
CT-head
MRI-brain
LP - CST analyis (cell count, protein, glucose, Gram stain, PCR for antigens, culture)
21
Q
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.
A
Pseudotumor cerebri
22
Q
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.
A
PSEUDOTUMOR CEREBRI Tension headache Migraine Cluster headache Meningitis Intracranial venous thrombosis Intracranial neoplasm
23
Q
Pseudotumor cerebri - workup?
A
Urine hCG
CBC
CT-head
LP - opening pressure and CSF analysis
24
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
25
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
```
26
Trigeminal neuralgia - workup?
CBC
ESR
MRI-brain
27
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
28
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
Hypothyroidism
```
29
Vascular (multi-infarct) dementia - workup?
```
CBC
VDRL/RPR
Serum B12
TSH
MRI-brain
CT-head
LP - CSF analysis (rare)
```
30
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
31
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
```
32
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)
```
33
Likely dx?
72 y.o M presents with memory loss, gait disturbamce, and urinary incontinence for the past 6 months.
Normal pressure hydrocephalus
34
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
```
35
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)
```
36
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
37
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
```
38
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
```
39
Likely dx?
70 y/o insulin-dependent diabetic M presents with episodes of confusion, dizziness, palpation, diaphoresis, and weakness.
Hypoglycemia
40
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
```
41
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
```
42
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
43
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
44
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
45
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
46
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
```
47
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
```
48
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
49
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
50
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
```
51
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
52
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
```
53
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
54
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
55
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
56
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
```
57
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
```
58
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
59
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
```
60
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.
61
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
```
62
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.
```
63
Likely dx?
35 y.o F presents intermittent episodes of vertigo, tinnitus, nausea, and hearing loss over the past week.
Meniere's disease
64
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
```
65
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
66
Likely dx?
55 y.o F c.o dizziness for the past day. She feels faint and has severe diarrhea that started 2 days ago. She takes furosemide for her hypertension.
Orthostatic hypotension 2/2 dehydration
67
Ddx?
55 y.o F c.o dizziness for the past day. She feels faint and has severe diarrhea that started 2 days ago. She takes furosemide for her hypertension.
```
ORTHOSTATIC HYPOTENSION 2/2 dehydration
Vestibular neuronitis
Labrynthitis
Benign position vertigo
Vertebrobasilar insufficiency
```
68
Workup?
55 y.o F c.o dizziness for the past day. She feels faint and has severe diarrhea that started 2 days ago. She takes furosemide for her hypertension.
Orthostatic vital signs
CBC
Electrolytes
Stool exam (occult blood, fecal leukocytes)
69
Likely dx?
65 y.o M presents with postural dizziness and unsteadiness. He has hypertension and was started on HCT 2 days ago.
Drug induced orthostatic hypotension
70
Ddx?
65 y.o M presents with postural dizziness and unsteadiness. He has hypertension and was started on HCT 2 days ago.
```
DRUG INDUCED HYPOTENSION
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Brain stem or cerebellar tumor
Acute renal failure
```
71
Workup?
65 y.o M presents with postural dizziness and unsteadiness. He has hypertension and was started on HCT 2 days ago.
```
Orthostatic vital signs
CBC
Electrolytes
BUN/Cr
MRI-brain
```
72
Likely dx?
44 y.o. F c/o dizziness on moving her head to the left. She feels that the room is spinning around her head. Tilt test results in nystagmus and nausea.
Benign positional vertigo
73
Ddx?
44 y.o. F c/o dizziness on moving her head to the left. She feels that the room is spinning around her head. Tilt test results in nystagmus and nausea.
BENIGN POSITIONAL VERTIGO
Vestibular neuronitis
Labyrinthitis
Meniere's disease
74
Workup?
44 y.o. F c/o dizziness on moving her head to the left. She feels that the room is spinning around her head. Tilt test results in nystagmus and nausea.
MRI-brain
| Audiogram
75
Likely dx?
55 y.o, F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI 2 days ago and has experienced no hearing loss.
Vestibular neuronitis
76
Ddx?
55 y.o, F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI 2 days ago and has experienced no hearing loss.
```
VESTIBULAR NEURONITIS
Labyrinthitis
Meniere's disease
Benign positional vertigo
Vertigo associated w/ cervical spine disease/injury
Vertebrobasilar insufficiency
```
77
Workup?
55 y.o, F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI 2 days ago and has experienced no hearing loss.
CBC
Electrolytes
Electronystagmography
MRI/MRA-brain
78
Likely dx?
55 yo F c/o dizziness that started this morning and of "not hearing" well. She feels nauseated and has vomited once in the past day. She had a URI 2 days ago.
Labyrinthitis
79
Ddx?
55 y.o, F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI 2 days ago and has experienced no hearing loss.
```
LABYRINTHITIS
Vestibular neuronitis
Meniere's disease
Acoustic neuroma
Vertebrobasilar insufficiency
```
80
Workup?
55 yo F c/o dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI 2 days ago and has experienced no hearing loss.
Audiogram
Electronystagmography
MRI/MRA-brain
81
Likely dx?
26 yo M presents after falling and losing consciousness at work. He had rhythmic movements of the limbs, bit his tongue, and lost control of his bladder. He was subsequently confused (as witnessed by his colleagues)
Seizure, grand mal -- complex tonic-clonic seizure
82
Ddx?
26 yo M presents after falling and losing consciousness at work. He had rhythmic movements of the limbs, bit his tongue, and lost control of his bladder. He was subsequently confused (as witnessed by his colleagues).
```
Complex tonic-clonic seizure
Convulsive syncope
Substance abuse/overdose
Malingering
Hypoglycemia
```
83
Workup?
26 yo M presents after falling and losing consciousness at work. He had rhythmic movements of the limbs, bit his tongue, and lost control of his bladder. He was subsequently confused (as witnessed by his colleagues)
```
CBC, electrolytes, glucose
Urine toxicology
EEG
MRI-brain
CT-head
LP-CSF analysis
ECG
```
84
Likely dx?
55 yo c/o falling after feeling dizzy and unsteady. He experienced transient LOC. He has hypertnesion and is on numerous anti-BP deugs.
Drug-induced hypotension (causing syncope)
85
Ddx?
55 yo c/o falling after feeling dizzy and unsteady. He experienced transient LOC. He has hypertnesion and is on numerous anti-BP drugs.
```
DRUG-INDUCED ORTHOSTATIC HYPOTENSION
Cardiac arrhythmia
Syncope (vasovagal, other cuases)
Stroke
MI
Pulmonary embolism
```
86
Workup?
55 yo c/o falling after feeling dizzy and unsteady. He experienced transient LOC. He has hypertnesion and is on numerous anti-BP drugs.
```
Orthostatic vital signs
CBC
Electrolytes
CT-head
ECG
V/Q scan
CT- chest w/ IV contrast
```
87
Likely dx?
65 yo M presents after falling and LOC for a few seconds. He had no warning prior to passing out but recently had palpitations. His past hx includes coronary artery bypass grafting (CABG).
Cardiac arrhythmia (causing syncope)
88
Ddx?
65 yo M presents after falling and LOC for a few seconds. He had no warning prior to passing out but recently had palpitations. His past hx includes coronary artery bypass grafting (CABG).
```
CARDIAC ARRHYTHIMA (CAUSING SYNCOPE)
Severe aortic stenosis
Syncope (other causes)
Seizure
Pulmonary embolism
```
89
Workup?
65 yo M presents after falling and LOC for a few seconds. He had no warning prior to passing out but recently had palpitations. His past hx includes coronary artery bypass grafting (CABG).
```
ECG
Holter monitoring
CBC, electrolytes
Glucose
Echocardiography
CT-head
```
90
Likely dx?
68 yo M presents following a 20 minute episode of slurred speech, R facial drooping and numbness, and R hand weakness. His sx had totally resolved by the time he got to the ER. Has a hx of HTN, DM, and heavy smoking.
Transient ischemic attack (TIA)
91
Ddx?
68 yo M presents following a 20 minute episode of slurred speech, R facial drooping and numbness, and R hand weakness. His sx had totally resolved by the time he got to the ER. Has a hx of HTN, DM, and heavy smoking.
```
TIA
Hypoglycemia
Seizure
Stroke
Facial nerve palsy
```
92
Workup?
68 yo M presents following a 20 minute episode of slurred speech, R facial drooping and numbness, and R hand weakness. His sx had totally resolved by the time he got to the ER. Has a hx of HTN, DM, and heavy smoking.
```
CBC
Glucose
Electrolytes
ECG
CT-head
MRI-brain
Doppler U/S - carotid
Echocardiography
EEG
```
93
Likely dx?
68 yo M presents with slurred speech, R facial drooping and numbness and R hand weakness. Babinski's sign is (+) on the right. Has hx of HTN, DM, and heavy smoking.
Stroke
94
Ddx?
68 yo M presents with slurred speech, R facial drooping and numbness and R hand weakness. Babinski's sign is (+) on the right. Has hx of HTN, DM, and heavy smoking
```
STROKE
TIA
Seizure
Intracranial neoplasm
Subdural or epidural hematoma
```
95
Workup?
68 yo M presents with slurred speech, R facial drooping and numbness and R hand weakness. Babinski's sign is (+) on the right. Has hx of HTN, DM, and heavy smoking.
```
CBC
Electrolytes
PT/PTT
CT-head
MRI-brain (preferred)
Doppler U/S - carotid
Echocardiography
```
96
Likely dx?
33 yo F presents with ascending loss of strength in lower legs over the past 2 weeks. She had a recent URI.
Guillain- Barre syndrome
97
Ddx?
33 yo F presents with ascending loss of strength in lower legs over the past 2 weeks. She had a recent URI.
```
GUILLAIN BARRE SYNDROME
Multiple sclerosis
Polymyositis
Myasthenia gravis
Peripheral neuropathy
Tumor in the vertebral canal
```
98
Workup?
33 yo F presents with ascending loss of strength in lower legs over the past 2 weeks. She had a recent URI.
```
CBC
Electrolytes
MRI-brain scan
CPK (polymyositis)
LP - CSF analysis
EMG
Nerve conduction studies
Tensilon edrophonium test
Serum B12
```
99
Likely dx?
30 yo F presents w. weakness, loss of sensation, and tingling in her L left leg that started this morning. She also experiencing R eye pain, decreased vision, and double vision. She reports feeling "electric shocks" down her spine upon flexing her hand.
Multiple sclerosis
100
Ddx?
30 yo F presents w. weakness, loss of sensation, and tingling in her L left leg that started this morning. She also experiencing R eye pain, decreased vision, and double vision. She reports feeling "electric shocks" down her spine upon flexing her hand.
```
MULTIPLE SCLEROSIS
Stroke
Conversion disorder
Malingering
CNS tumor
Neurosyphillis
Syringomyelia
CNS vasculitis
```
101
Workup?
30 yo F presents w. weakness, loss of sensation, and tingling in her L left leg that started this morning. She also experiencing R eye pain, decreased vision, and double vision. She reports feeling "electric shocks" down her spine upon flexing her hand.
```
CBC
ESR
VDRL/RPR
MRI-brain, spine
LP-CSF analysis
Retinal evoked potentials
```
102
Likely dx?
55 yo M presents w/ tingling and numbness in his hands and feet (glove and stocking distribution) for the 2 months. He has hx of DM, HTN, and alcoholism. There is a decreased soft touch, vibratory, and position sense in the feet.
Diabetic peripheral neuropathy
103
Workup?
55 yo M presents w/ tingling and numbness in his hands and feet (glove and stocking distribution) for the 2 months. He has hx of DM, HTN, and alcoholism. There is a decreased soft touch, vibratory, and position sense in the feet.
```
DIABETIC PERIPHERAL NEUROPATHY
Alcoholic peripheral neuropathy
B12 deficiency
Hypocalcemia
Hyperventilation
Paraproteinemia/myeloma
```
104
Workup?
55 yo M presents w/ tingling and numbness in his hands and feet (glove and stocking distribution) for the 2 months. He has hx of DM, HTN, and alcoholism. There is a decreased soft touch, vibratory, and position sense in the feet.
```
HBA1C
ESR
Calcium
Serum B12
Urinanalysis
Serum and urine protein electrophoresis
```
105
Likely dx?
40 yo F presents with occasional double vision and droopy eyelids at night with normalization by morning.
Myasthenia gravis
106
Ddx?
40 yo F presents with occasional double vision and droopy eyelids at night with normalization by morning.
```
MYASTHENIA GRAVIS
Horner's syndrome
Multiple sclerosis
Intracranial neoplasm cimpressing CN III, IV, or VI
Amyotrophic lateral sclerosis
```
107
Workup?
40 yo F presents with occasional double vision and droopy eyelids at night with normalization by morning.
```
Tensilon (edrophonium) test
Serum ACH receptor antibodies
CXR
CT-chest
MRI-brain
EMG
```
108
Likely dx?
25 yo M presents with hemiparesis after a tonic-clonic seizure that resolved within a few hours.
Todd's paralysis
109
Ddx?
25 yo M presents with hemiparesis after a tonic-clonic seizure that resolved within a few hours.
```
TODD'S PARALYSIS
TIA
Stroke
Complicated migraine
Malingering
```
110
Workup?
25 yo M presents with hemiparesis after a tonic-clonic seizure that resolved within a few hours.
```
CBC
Electrolytes
EEG
MRI-brain
Doppler U/S - carotid
```
111
Likely dx?
56 yo obese F c/o tingling and numbness of her thumb, index finger, and middle finger for 5 months. Her sx are constant, have progressively worsened, and are relieved with rest. She works as a secretary. She has a hx of fatigue a 20 lb (9 kg) weight gain over the same period.
Carpal tunnel syndrome
112
Ddx?
56 yo obese F c/o tingling and numbness of her thumb, index finger, and middle finger for 5 months. Her sx are constant, have progressively worsened, and are relieved with rest. She works as a secretary. She has a hx of fatigue a 20 lb (9 kg) weight gain over the same period.
CARPAL TUNNEL SYNDROME 2/2 TO HYPOTHYROIDISM
Overuse injury of median nerve
Medial epicondylitis
113
Workup?
56 yo obese F c/o tingling and numbness of her thumb, index finger, and middle finger for 5 months. Her sx are constant, have progressively worsened, and are relieved with rest. She works as a secretary. She has a hx of fatigue a 20 lb (9 kg) weight gain over the same period.
Phalen's maneuver and Tinel's sign
Nerve conduction studies
TSH
CBC
114
Likely dx?
40 yo F c/o feeling tired, hopeless, and worthless and of having suicidal thoughts. She lost her job and has been having dights with husband about money.
Depression.
115
Ddx?
40 yo F c/o feeling tired, hopeless, and worthless and of having suicidal thoughts. She lost her job and has been having dights with husband about money.
CBC
TSH
HIV/STD testing
Beck Depression Inventory
116
Likely dx?
44 yo M presents with fatigue, insomnia, and nightmares about a murder that he witnessed in a mall 1 year ago. Since then, he has avoided the mall and has not gone out at night.
Posttraumatic stress disorder
117
Ddx?
44 yo M presents with fatigue, insomnia, and nightmares about a murder that he witnessed in a mall 1 year ago. Since then, he has avoided the mall and has not gone out at night.
```
PTSD
Depression
Generalized anxiety disorder
Psychotic or delusional disorder
Hypothyroidism
```
118
Workup?
44 yo M presents with fatigue, insomnia, and nightmares about a murder that he witnessed in a mall 1 year ago. Since then, he has avoided the mall and has not gone out at night.
CBC
TSH
Urine toxicology
Beck Depression Inventory
119
Likely dx?
55 yo M presents with fatigue, weight loss, and constipation. He has fam hx of colon cancer.
Colon cancer.
120
Ddx?
55 yo M presents with fatigue, weight loss, and constipation. He has fam hx of colon cancer
```
COLON CANCER
Hypothyroidism
Renal failure
Hypercalcemia
Depression
```
121
Workup?
55 yo M presents with fatigue, weight loss, and constipation. He has fam hx of colon cancer
```
Rectal exam, stool for occult blood.
CBC
Electrolytes, BUN/Cr, calcium
AST/ALT
Colonoscopy
TSH
Barium enema
CT-abdomen/pelvis
```
122
Likely dx?
40 yo F presents with fatigue, weight gain, sleepiness, cold intolerance, constipation, and dry skin.
HYPOTHYROIDISM
123
Ddx?
40 yo F presents with fatigue, weight gain, sleepiness, cold intolerance, constipation, and dry skin.
Hypothyroidism
Depression
Diabetes
Anemia
124
Workup?
40 yo F presents with fatigue, weight gain, sleepiness, cold intolerance, constipation, and dry skin.
TSH, FT3, FT4
CBC
Fasting glucose
HBA1C
125
Likely dx?
30 yo obese F presents with fatigue and daytime sleepiness. She snores heavily and naps 3-4 time per day but never feels refreshed. She also has hypertension.
Obstructive sleep apnea
126
Ddx?
30 yo obese F presents with fatigue and daytime sleepiness. She snores heavily and naps 3-4 time per day but never feels refreshed. She also has hypertension
OBSTRUCTIVE SLEEP APNEA
Hypothyrodism
Chronic fatigue syndrome
Narcolepsy
127
Workup?
30 yo obese F presents with fatigue and daytime sleepiness. She snores heavily and naps 3-4 time per day but never feels refreshed. She also has hypertension
```
CBC
TSH
Nocturnal pulse oximetry **
Polysomnography
ECG
```
128
Likely dx?
20 yo M presents with fatigue, thirst, increased appetite, and polyuria.
Diabetes mellitus
129
Ddx?
20 yo M presents with fatigue, thirst, increased appetite, and polyuria.
DIABETES MELLITUS
Atypical depression
Primary polydipsia
Diabetes insipidus
130
Workup?
20 yo M presents with fatigue, thirst, increased appetite, and polyuria.
```
Glucose tolerance test
HBA1C
UA
CBC
Electrolytes, BUN/Cr, glucose
```
131
Likely dx?
35 yo M policeman c/o feeling tired and sleepy during the day. He changed to the night shift last week.
Shift work sleep disorder
132
Ddx?
35 yo M policeman c/o feeling tired and sleepy during the day. He changed to the night shift last week
SHIFT WORK SLEEP DISORDER
Sleep apnea
Depression
Anemia
133
Workup?
35 yo M policeman c/o feeling tired and sleepy during the day. He changed to the night shift last week
CBC
Nocturnal pulse oximetry
Polysomnography
134
Likely dx?
30 yo M presents with night sweats, cough, and swollen glands of 1 month's duration. He recently emigrated from the African subcontinent.
Tuberculosis
135
Ddx?
30 yo M presents with night sweats, cough, and swollen glands of 1 month's duration. He recently emigrated from the African subcontinent.
```
Tuberculosis
Acute HIV infection
Lymphoma
Leukemia
Hyperthyroidism
```
136
Workup?
30 yo M presents with night sweats, cough, and swollen glands of 1 month's duration. He recently emigrated from the African subcontinent.
```
PPD/Quantiferon Gold
CBC
CXR
Sputum Gram stain, acid fast stain, and culture
HIV antibody
TSH, FT4
```
137
Likely dx?
45 yo F presents w/ excessive sweating, unintentional weight loss, palpitations, diarrhea, and shortness of breath.
Hyperthyroidism
138
Ddx?
45 yo F presents w/ excessive sweating, unintentional weight loss, palpitations, diarrhea, and shortness of breath.
HYPERTHYROIDISM
Pheochromocytoma
Carcinoid syndrome
Tuberculosis
139
Workup?
45 yo F presents w/ excessive sweating, unintentional weight loss, palpitations, diarrhea, and shortness of breath.
```
TSH, FT4
24 hr urinary catecholamines (pheochromocytoma)
5-HIAA (carcinoid)
CBC
PPD
```
140
Likely dx?
25 yo F presents with a 3 week hx of difficulty falling asleep. She sleeps 7 hrs per night w/o nightmares or snoring. She recently began college and is having trouble w/ her boyfriend. She drinks 3-4 cups of coffee a day.
Stress-induced insomnia
141
Ddx?
25 yo F presents with a 3 week hx of difficulty falling asleep. She sleeps 7 hrs per night w/o nightmares or snoring. She recently began college and is having trouble w/ her boyfriend. She drinks 3-4 cups of coffee a day.
STRESS INDUCED INSOMNIA
Caffeine induced insomnia
Insomnia w/ circadiam rhythm sleep disorder
Insomnia related to major depressive dsorder
142
Workup?
25 yo F presents with a 3 week hx of difficulty falling asleep. She sleeps 7 hrs per night w/o nightmares or snoring. She recently began college and is having trouble w/ her boyfriend. She drinks 3-4 cups of coffee a day.
```
Polysomnography
Mental status exam
Urine toxicology
CBC
TSH
```
143
Likely dx?
26 yo F presents with sore throat, fever, severe fatigue, and loss of appeitite for the past week. She also reports epigastric and LUQ discomfort She has cervical lymphadenopathy and a rash. Her boyfriend recently experienced similar sx.
Infectious mononucleosis
144
Ddx?
26 yo F w/ sore throat, fever, severe fatigue, and loss of appetite for the past week. She also reports epigastric and LUQ discomfort. She has a cervical lymphadenopathy and a rash. Her boyfriend recently exprienced similar sx.
```
INFECTIOUS MONONUCLEOSIS
Hepatitis
Viral or bacterial pharyngitis
Acute HIV infection
Secondary syphillis
```
145
Workup?
26 yo F w/ sore throat, fever, severe fatigue, and loss of appetite for the past week. She also reports epigastric and LUQ discomfort. She has a cervical lymphadenopathy and a rash. Her boyfriend recently exprienced similar sx.
```
CBC w. peripheral smear
Monospot test
Throat cx
AST/ALT/bilirubin/Alkaline phosphotase
HIV antibody and viral load
Anti-EBV antibodies
VDRL/RPR
```
146
Likely dx?
26 yo M presents with sore throat, fever, rash, and weight loss. Has a hx of IV drug abuse and sharing needles.
HIV, acute retroviral syndrome
147
Ddx?
26 yo M presents with sore throat, fever, rash, and weight loss. Has a hx of IV drug abuse and sharing needles.
```
HIV - acute retroviral syndrome
Infectious mononucleosis
Hepatitis
Viral pharyngitis
Streptococcal tonsillitis/scarlet fever
Secondary syphilis
```
148
Workup?
26 yo M presents with sore throat, fever, rash, and weight loss. Has a hx of IV drug abuse and sharing needles.
```
CBC w/ peripheral smear
HIV antibody and viral load
CD4 count
Monospot test
Throat cx
VDRL/RPR
AST/ALT/Bilirubin/Alk Phosphotase
```
149
Likely dx?
46 yo F presents with fever and sore throat.
Pharyngitis (viral or bacterial)
150
Ddx?
46 yo F presents with fever and sore throat.
PHARYNGITIS (VIRAL OR BACTERIAL)
Mycoplasma pneumonia
Acute HIV infection
Infectious mononucleosis
151
Workup?
46 yo F presents with fever and sore throat.
Throat swab for culture and rapt streptococcus antigen
Monospot test (mono)
CBC
Serological test (cold agglutinin test for Mycoplasma pneumonia)
HIV antibody and viral load
152
Likely dx?
30 yo M presents with SOB, cough, and wheezing that worsen in cold air. He has had several such episodes in the past 4 months.
Asthma
153
Ddx?
30 yo M presents with SOB, cough, and wheezing that worsen in cold air. He has had several such episodes in the past 4 months.
```
ASTHMA
GERD
Bronchitis
Pneumonitis
Foreign body
```
154
Workup?
30 yo M presents with SOB, cough, and wheezing that worsen in cold air. He has had several such episodes in the past 4 months.
```
CBC
CXR
Peak flow measurement
PFTs
Metacholine challenge test (asthma vs bronchitis)
```
155
Likely dx?
56 yo F presents with SOB and productive cough that has lasted for at least 3 months for over the past 2 years.
COPD-chronic bronchitis
156
Ddx?
56 yo F presents with SOB and productive cough that has lasted for at least 3 months for over the past 2 years.
COPD - CHRONIC BRONCHITIS
Bronchiectasis
Lung cancer
Tuberculosis
157
Workup?
56 yo F presents with SOB and productive cough that has lasted for at least 3 months for over the past 2 years.
```
CBC
Sputum gram stain and culture
CXR
PFTs
CT-chest
PPD
```
158
Likely dx?
58 yo M presents with 1 week of pleuritic chest pain, fevers, chills, and cough with purulent yellow sputum. He is a heavy smoker with COPD.
Pneumonia
159
Ddx?
58 yo M presents with 1 week of pleuritic chest pain, fevers, chills, and cough with purulent yellow sputum. He is a heavy smoker with COPD.
```
PNEUMONIA
COPD-exacerbation (bronchitis)
Lung abscess
Lung cancer
Tuberculosis
Pericarditis
```
160
Workup?
58 yo M presents with 1 week of pleuritic chest pain, fevers, chills, and cough with purulent yellow sputum. He is a heavy smoker with COPD.
```
CBC
Sputum gram stain and cx
CXR
CT-chest
ECG
PPD
```
161
Likely dx?
35 yo F presents with 2 wks of nonproductive cough. Three weeks agoshe had a sore throat and a runny nose.
Atypical pneumonia
162
Ddx?
25 yo F presents with 2 wks of nonproductive cough. Three weeks agoshe had a sore throat and a runny nose.
```
ATYPICAL PNEUMONIA
Reactive airway disease
URI-associated cough ("postinfectious)
Postnasal drip
GERD
```
163
Ddx?
25 yo F presents with 2 wks of nonproductive cough. Three weeks agoshe had a sore throat and a runny nose.
```
CBC
Induced sputum gram stain and cx
CXR
IgM detection for Mycoplasma pneumonia
Urine Legionella antigen
```
164
Likely dx?
65 yo M presents with worsening cough for the past 6 months accompanied by hemoptysis, dyspnea, weakness, and weight loss. Heavy smoker.
Lung cancer
165
Ddx?
65 yo M presents with worsening cough for the past 6 months accompanied by hemoptysis, dyspnea, weakness, and weight loss. Heavy smoker.
```
LUNG CANCER
Tuberculosis
Lung abscess
COPD
Vasculitis (eg Wegener's granulomatosis)
Interstitial lung disease
CHF
```
166
Workup?
65 yo M presents with worsening cough for the past 6 months accompanied by hemoptysis, dyspnea, weakness, and weight loss. Heavy smoker.
```
CBC
Sputum gram stain, cx, and cytology
CXR
CT-chest
PPD
ANCA
Bronchoscopy
Echocardiography
```
