study Flashcards
What should you do when you first enter the room?
- Confirm that it is the patient
- introduce yourself
- Remove the clip board off the seat
- Drape the patient
How should you start the conversation with the patient?
Open ended question like, what brought you in today?
What pneumonic should you use to gather information?
FORDPAPP
frequency, onset, relieving factors, duration, precipitating factors, associated symptoms, past episodes, progression
What is the differential for a patient complaining of HA?
Migraine, tension, cluster, psuedotumor cerebri, giant cell arteritis, intracranial neoplasm, sinusitis, subarachnoid hemorrhage, trigeminal neuralgia
What is the workup for a patient with HA?
CBC, ESR, CT of head, MRI of brain, LP for CSF analysis
Patient presents with frontal HA, fever, and nasal discharge. There is pain on palpation of the frontal and maxillary sinuses. History of allergies. What is the differential?
Sinusitis migraine tension HA meningitis Intracranial neoplasm
What is the workup for a patient suspected of sinusitis?
CBC, XR or CT of sinusis
Patient presents daily pain in the right cheek for the past month. The pain is electric and stabbing in nature and occurs while the patient is shaving. Pain last for 2-4min. What is the differential diagnosis?
Trigeminal neuralgia tension HA migraine cluster HA TMJ disorder Intracranial neoplasm
What is the workup for a patient with trigemial neuralgia?
CBC, ESR, MRI of brain
Patient presents with sudden severe HA, vomiting, confusion, left hemiplegia, and nuchal rigidity. What is the differential?
Subarachnoid hemorrhage migraine meningitis intracranial hemorrage vetebral artery dissection acute HTN Intracranial neoplasm
What is the workup for a patient with subarachnoid hemorrhage?
Noncontrast CT of head, LP, CBC, PT/PTT/INR, urine toxicology
Patient presents with high fever, severe HA, confusion, photophobia, and nuchal rigidity. What is the differential?
Meningitis Migraine Subarachnoid hemorrhage sinusitis intracranial abscess
What is the workup for a patient with meningitis?
LP, CBC, CT head
Young patient presents with pulsatile HA, vomiting and blurred vision for the past 2-3 wks. She is also taking OCPs. What is the differential?
Pseudotumor cerebri TensionHA Migraine Cluster HA Meningitis
What is the workup for a patient suspected of pseudotumor cerebri?
CBC, LP for opening pressure, CT of head, urine for hCG
Patient presents with severe right temporal HA associated with ipsilateral rhinorrhea, eye tearing, and redness. What is the differential?
Cluster HA
Tension HA
Migraine HA
Intracranial neoplasm
Patient presents with progressive confusion for the past several years accompanied by forgetfullness and clumsiness. History of HTN, diabetes and 2 strokes. Mental status has worsened after each stroke. What is the differential diagnosis?
Vascular dementia Alzheimer disease Normal pressure hydrocephalus Intracranial neoplasm B12 deficiency Hypothyroidism
What is the workup for a patient suspected of dementia?
CBC, serum B12, TSH, MRI of brain, CT of head
Patient presents with forgetfullness and difficulty performing some of her daily activities. Problem has progressed gradually of the past years. What is the differential diagnosis?
Alzheimers vascular dementia Depression Hypothyroidism Chronic subdural hematoma
Patient presents memory loss, gait disturbance, and urinary incontinence for the past 6 months. What is the differential diagnosis?
Normal pressure hydrocephalus Alzheimers disease Vascular dementia Chronic subdural hematoma Intracranial neoplasm
Patient presents with a rapid progressive change in mental status, inability to concentrate and memory impairment for the past 2 months. Symptoms associated with myoclunus, ataxia, and a startle response. What is the differential?
Creutzfeldt-Jakob disease
Vascular dementia
Lewy body dementia
Wernicke’s encehalopathy
Insulin dependent patient presents with confusion, dizziness, palpitations, diaphoresis and weakness. What is the differential?
Hypoglycemia TIA Arrhythmia Delerium Angina
Patient presents with gradual altered mental status and headache. 2 wks ago they slipped hit their head on the ground and lost consciousness for 2 minutes. What is the differential?
Subdural hematoma
SIADH
Intracranial neoplasm
Patient presents with acute loss of vision in his left eye, palipitations, and shortness of breath. History of A.Fib and cataracts in his right eye. No eye pain, discharge, redness, or photophobia. No headache, weakness or numbness. What is the differential?
Retinal artery occlusion
Retinal vein occlusion
Acute angle closure glaucoma
What is the workup for a patient with retinal artery occlusion?
Fluorescein angiogram
Echo
Doppler of carotids
CBC
Patient presents with 2 month history of crying spells, excessive sleep, poor hygiene and a 15lb weight loss following the death of his wife. What is the diffential?
Normal bearevement
Major Depression
Adjustment disorder with depressed mood
What is the workup for a person with mental health issues?
Physical exam, CBC, TSH, urine toxicology, beck depression inventory
Patient presents with a 6lb weight loss in the past 2 months, accompanied by early morning awakening, excessive guilt, and psychomotor retardation. Reports several wks of increased energy, sexual promiscuity, irresponsible spending and racing thoughts 6 months ago. What is the differential?
Bipolar 1 disorder
Bipolar 2 disorder
Cyclothymic disorder
Patient presents with complaints of receiving messages from his television, having no friends in high school, rarely showers and thinks his friends buged his phone. What is the differential?
Schizophrenia
Schizoid or Schizotypal
Schizophreniform disorder
Patient presents with intermittent episodes of vertigo, tinnitus, nausea, and hearing loss within the past week. What is the differential diagnosis?
Menieres disease
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
What is the workup for a patient with dizziness?
CBC, VDRL/RPR, MRI of brain, Dix-Hallpike maneuver
Patient presents with dizziness for the past day. Patient feels faint and has severe diarrhea that started 2 days ago. Patient takes furosemide for hypertension. What is the differential diagnosis?
Orthostatic hypotension due to dehydration
Vestibular neuronitis
Labyrinthitis
Benign Positional Vertigo
Patient presents with postural dizziness and unsteadiness. Patient has HTN and was started on hydrochlorothiazide 2days ago. What is the differential diagnosis?
Drug induced orthostatic hyopotension
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Patient presents with dizziness on moving their head to the left. Patient feels the room is spinning around their head. Tilt test results in nystagmus and nausea. What is the differential?
Benign positional vertigo
Vestibular neuronitis
Labyrinthitis
Meniere disease
Patient presents with dizziness that started this morning. Patient is nauseated and has vomitied once. Patient had a URI 2 days ago and has experienced no hearing loss. What is the differential diagnosis?
Vestibular neuronitis
Labyrinthitis
Menieres disease
Benign positional vertigo
Patient presents with dizziness that started this morning and not hearing well. Patient feels nauseated and has vomitied once. Patient had a UTI 2 days ago. What is the differential?
Labyrinthitis
Vestibular neuronitis
Menieres disease
Acoustic neuroma
Patient presents after falling and losing consciousness at work. They had rhythmic movements of the limbs, bit their tongue and lost control of their bladder. Subsequently they was confused after regaining consciousness. What is the differential?
Tonic clonic seizure convulsive syncope substance abuse malingering hypoglycemia
Patient complains of feeling dizzy and unsteady and experiencing transient loss of consciousness. Past medical history includes HTN and diabetes. What is the differential?
Drug induced orthostatic hypotension hypoglycemia cardiac arrhythmia syncope stroke MI PE
Patient presents after falling and losing consciousness for a few seconds. There was no warning but there were palpitations. History of coronary artery bypass graft. What is the differential?
Cardiac arrhythmia aortic stenosis syncope seizure PE
Patient presents with slurred speech, right facial drooping and numbness and right hand weakness. Babinski’s sign is present on the right. History of HTN, diabetes and heavy smoking. What is the differential?
Stroke TIA Seizure Intracranial neoplasm Subdural or epidural hematoma
Patient presents with ascending loss of strength in the lower legs over the past 2 weeks. History of recent URI. What is the differential?
Guillian-Barre syndrome
Multiple sclerosis
Polymyositis
Myasthenia Gravis
