Step2CS Minicases

Question 1

Throbbing unilateral HA w/ visual aura, N/V, neuro symptoms

Answer 1

Migraine

Question 2

Severe unilateral HA w/ ipsilateral rhinorrhea, ear tearing, redness, with characteristic pattern

Answer 2

Cluster

Question 3

Older woman w/ severe intermittent unilateral temporal HA, fever, blurred vision in her right eye, and pain in her jaw while chewing

Answer 3

Temporal arteritis

W/u: CBC, ESR, CRP, temporal artery biopsy, doppler ultrasound

Question 4

Frontal HA, fever, nasal discharge, & sinus tenderness

Answer 4

sinusitis

Question 5

bilateral squeezing HAs

Answer 5

tension (also caffeine or drug w/d)

Question 6

sudden severe HA, vomiting, confusion, hemiplegia, nuchal rigidly

Answer 6

SAH

W/u: NC head CT, LP

Question 7

High fever, severe HA, confusion, photophobia, nuchal rigidity

Answer 7

Meningitis

W/u LP

Question 8

young, obese F w/ pulsatile HA, N/V, blurred vision, on OCPs

Answer 8

Pseudotumor

W/u LP

Question 9

electric, stabbing pain in R cheek

Answer 9

trigeminal neuralgia

w/u? ddx TMJ

Question 10

step wise decline in cognitive function

Answer 10

vascular dementia

w/u (general for memory loss/delerium): CBC, electrolytes, VDRL/ RPR, serum B12, TSH, HIV?, MRI?

Question 11

Progressive forgetfulness in older person

Answer 11

Alzheimers

Question 12

Common (on boards) HA ddx

Answer 12

Migraine, cluster, tension, GCA, pseudotumor, meningitis, carotid artery dissection (Horner), SAH, subdural, epidural

Question 13

memory loss, ataxia, urinary incontinence

Answer 13

NPH

W/u CT

Question 14

Rapidly progressive AMS, myoclonus, ataxia, +startle

Answer 14

CJD

W/u EEG, general AMS

Question 15

Gradual AMS s/p trauma`

Answer 15

Subdural

Question 16

acute unilateral painless loss of vision, palpitations, SOB, w/ hx of afib

Answer 16

Retinal artery occlusion

Question 17

sudden painless vision loss w/ hx of atherosclerosis

Answer 17

Retinal vein occlusion

Question 18

sudden painful vision loss (?!?!)

Answer 18

Acute angle-closure glaucoma

Question 19

curtain coming down over eye (??!?!)

Answer 19

Retinal detachment vs amargoix fugax??!?!

Question 20

Grief

Answer 20

Normal

W/u: CBC, TSH, utox, beck depression inventory?

Question 21

+4 SIGECAPS > 2weeks

Answer 21

MDD

W/u: CBC, TSH, utox, blood alcohol level?, beck depression inventory?

Question 22

+/- full SIGECAPS

+ 3 DIGFAST x1 time

Answer 22

Bipolar 1

Ddx: Bipolar II (hypomania plus depression, no mania), cyclothymic d/o, schizoaffective, MDD

Question 23

+positive sx: thought broadcasting, delusions of reference, paranoia,
+negative sx: catatonia

Answer 23

schizophrenia

ddx: drugs, brief psychotic, depression w/ psychotic features, schiophreniform, personality d/os, schizoaffective