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uworld cases 07 (zoobs) Flashcards

1
Q

30yo F c abdominal pain and fever: ddx?

A
  1. PID
  2. pelvic abscess
  3. endometriosis
  4. UTI
  5. appendicitis
  6. rupture/torsion of ovarian cyst
  7. acute cholecystitis
  8. renal colic
  9. ectopic pregnancy
  10. abortion
  11. acute gastroenteritis
  12. inflammatory bowel disease
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2
Q

30yo F c abdominal pain and fever: work–up?

A
  1. rectal and pelvic exam
  2. CBC c diff.
  3. urinalysis c C/S
  4. pregnancy test
  5. u/s abdomen
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3
Q

27 yo WF c rash over face and neck: ddx?

A
  1. SLE
  2. rheumatoid arthritis
  3. photodermatitis
  4. drug–induced
  5. occupational exposure
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4
Q

27 yo WF c rash over face and neck: work–up?

A
  1. CBC c diff, ESR
  2. ANA and anti–ds DNA
  3. rheumatoid factor assay
  4. skin biopsy
  5. skin tests for allergen
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5
Q

65yo WF c weakness of R arm and leg: ddx?

A
  1. evolving stroke
  2. TIA or reversible ischemic neuro deficit
  3. subarachnoid hemorrhage
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6
Q

65yo WF c weakness of R arm and leg: work–up?

A
  1. CBC c diff
  2. chem 7
  3. 12 lead EKG
  4. CT head w/o contrast
  5. carotid doppler
  6. transesophageal echocardiogram
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7
Q

29yo BF c sickle cell anemia, complains of chest pain: ddx?

A
  1. sickle cell chest syndrome
  2. pneumonia
  3. costochondritis
  4. pericarditis
  5. pulm. thromboembolism
  6. salmonella osteomyelitis
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8
Q

29yo BF c sickle cell anemia, complains of chest pain: work–up?

A
  1. CBC c diff
  2. sputum gram stain, C/S
  3. blood cx
  4. CXR
  5. EKG
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9
Q

35yo M c recent onset cough & fever: ddx?

A
  1. common cold
  2. acute sinusitis
  3. acute bronchitis
  4. allergic rhinitis
  5. pneumonia
  6. asthma exacerbation
  7. meds (ACE I)
  8. PE
  9. COPD exacerbation
  10. CHF
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10
Q

35yo M c recent onset cough & fever: work–up

A
  1. CBC c differential
  2. sputum gram stain, C/S
  3. CXR, PA and lateral views
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11
Q

50yo M c fatigue and recent wt loss: ddx?

A
  1. malignancy
  2. hyperthyroidism
  3. diabetes mellitus
  4. malabsorption
  5. depression
  6. infx: TB, HIV
  7. Addison’s disease
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12
Q

50yo M c fatigue and recent wt loss: work–up?

A
  1. rectal exam and fecal occult blood test
  2. CBC c diff
  3. TSH
  4. LFT’s
  5. abd. u/s
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13
Q

35yo M c acute onset diarrhea: ddx?

A
  1. viral gastroenteritis
  2. bacterial GE
  3. med–induced
  4. C. difficile
  5. inflammatory bowel disease
  6. irritable bowel syndrome
  7. malabsorption
  8. HIV
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14
Q

35yo M acute onset diarrhea: work–up?

A
  1. rectal exam and FOBT
  2. CBC c diff
  3. chem 7
  4. stool: C. difficile
  5. stool: fecal leukocytes
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15
Q

25yo F c sore throat and fever: ddx?

A
  1. viral pharyngitis (rhino virus and influenza)
  2. bacterial pharyngitis: group A strep., mycoplasma pneumo, N. gonorrhea
  3. EBV mononucleosis
  4. post–nasal drip 2* to rhinitis
  5. chronic tonsillitis
  6. 1* HIV
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16
Q

25yo F c sore throat and fever: work–up?

A
  1. CBC
  2. mono spot test
  3. rapid streptococcal antigen test
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17
Q

56yo M for BP check and med refills: BP complications?

A
  1. diastolic CHF
  2. CAD (angina)
  3. peripheral vascular disease
  4. retinopathy
  5. medication side effects
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18
Q

56yo M for BP check and med refills: work–up?

A
  1. urinalysis
  2. lipid profile
  3. ALT
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19
Q

66yo M c/o constipation: ddx?

A
  1. functional constipation
  2. obstructive lesions (bowel obstruction, carcinoma of colon)
  3. metabolic disturbances ( hypothyroidism, DM, hyperCa++)
  4. neuro dysfunctions (stroke, autonomic neuropathy, spinal cord trauma, MS, Parkinson’s)
  5. med induced (iron, opiates, anticholinergics)
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20
Q

66yo M c/o constipation: work–up?

A
  1. rectal exam c FOBT
  2. CBC c diff
  3. serum Ca++
  4. fasting BS and HbA1c
  5. colonoscopy
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21
Q

50yo M c/o impotence: ddx?

A
  1. diabetic neuropathy
  2. artherosclerotic vascular disease
  3. anxiety, other psych issues
  4. meds, esp. anti–HTN
  5. chronic ETOH abuse
  6. pituitary dysfunction
  7. spinal cord dysfunction
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22
Q

50yo M c/o impotence: work–up?

A
  1. rectal and genital exam
  2. fasting BS and HbA1c
  3. CBC
  4. nocturnal penile tumescence testing
  5. TSH, serum prolactin, testosterone, as needed
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23
Q

1yo baby c fever: ddx?

A
  1. respiratory tract infx
  2. ear infx
  3. other exanthematous diseases
  4. meningitis
  5. UTI
  6. gastroenteritis
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24
Q

1yo baby c fever: work–up?

A
  1. CBC c differential
  2. urinalysis
  3. ear exam
  4. fundoscopy
  5. LP
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25
Q

45yo F c acute RUQ abd pain and fever: ddx?

A
  1. cholecystitis
  2. biliary colic
  3. acute hepatitis
  4. acute pancreatitis (biliary pain)
  5. perforated peptic ulcer
  6. MI
  7. RLL pneumonia
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26
Q

45yo F c acute RUQ abd pain and fever: work–up?

A
  1. CBC c differential
  2. EKG
  3. CXR
  4. u/s abdomen
  5. LFTs (albumin, AST, ALT, alk phos, TBili, DBili)
  6. serum amylase and lipase
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27
Q

24yo F comes in for 1st prenatal visit: important Q’s?

A
  1. LMP
  2. how confirmed pregnancy?
  3. OB hx
  4. Gyn hx
  5. problems with current pregnancy?
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28
Q

24yo F comes in for 1st prenatal visit: counseling?

A
  1. explain findings
  2. stop tobacco and ETOH
  3. safe sex practices
  4. explain need for vitamins, iron supplementation, nutritious diet
  5. importance of regular antenatal visits
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29
Q

24yo F comes in for 1st prenatal visit: work–up?

A
  1. CBC c diff, blood group & type
  2. urinalysis
  3. u/s abdomen
  4. TORCH screen
  5. hep B screen
  6. HIV screen (consent)
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30
Q

60yo M c/o acute SOB: ddx?

A
  1. PE
  2. CHF
  3. COPD exacerbation
  4. pneumonia
  5. spontaneous pneumothorax
  6. bronchial asthma
  7. anxiety and panic attacks
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31
Q

60yo M c/o acute SOB: work–up?

A
  1. CBC c diff
  2. CXR
  3. 12–lead EKG
  4. V/Q scan
  5. echocardiogram
  6. PFT’s if needed
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32
Q

40yo F c increased urination: ddx?

A
  1. DM
  2. central DI
  3. nephrogenic DI
  4. psychogenic DI
  5. cystitis (UTI)
  6. diuretics and other drugs
  7. hypercalcemia
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33
Q

40yo F c increased urination: work–up?

A
  1. fasting BS
  2. urinalysis
  3. chem 6 and Ca++
  4. urine and serum osmolality
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34
Q

35yo F evaluation for jaundice: ddx?

A
  1. infectious hepatitis
  2. alcoholic hepatitis
  3. drug–induced hepatitis
  4. primary biliary cirrhosis
  5. malignancy
  6. hemolytic jaundice
  7. Wilson’s disease
  8. hemochromatosis
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35
Q

35yo F evaluated for jaundice and fever: work–up?

A
  1. CBC c diff
  2. urine for bile salts
  3. anti–mitochondrial antibodies
  4. LFT’s
  5. hepatitis screen
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36
Q

35yo F c/o chest pain and fever: ddx?

A
  1. pneumonia
  2. GERD
  3. panic d/o
  4. hyperthyroidism
  5. pheochromocytoma
  6. hyperventilation syndrome
  7. angina
  8. costochondritis
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37
Q

35yo F c/o chest pain and fever: work–up?

A
  1. CBC c diff
  2. EKG
  3. CXR
  4. thyroid profiles
  5. lipid profile (early arteriosclerosis)
  6. urinary catecholamines
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38
Q

45yo M c/o RLQ abdominal pain: ddx?

A
  1. appendicitis
  2. Meckel’s diverticulitis
  3. perforated viscus or peptic ulcer
  4. intestinal obstruction
  5. Yersinia enterocolitica
  6. pancreatitis
  7. urolithiasis
  8. acute cholecystitis
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39
Q

45yo M c/o RLQ abdominal pain: work–up?

A
  1. CBC c diff
  2. abd. x–ray
  3. abd. u/s
  4. pancreatic enzymes
  5. upper GI endoscopy
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40
Q

55yo M c bilateral leg pain: ddx?

A
  1. thromboangiitis obliterans (Buerger’s Disease)
  2. atherosclerotic vascular disease
  3. lumbar spinal stenosis
  4. diabetic polyneuropathy
  5. radiculopathy due to spinal disease
  6. meds (eg. statins)
  7. trauma
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41
Q

55yo M c bilateral leg pain: work–up?

A
  1. creatinine kinase (statin–induced myopathy)
  2. blood sugar and HbA1c
  3. lipid profile
  4. doppler u/s of LE arteries
  5. duplex venous u/s of LE (?DVT)
  6. CBC (?infx)
  7. MRI (?spinal stenosis)
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42
Q

40yo M c hematemesis: ddx?

A
  1. peptic ulcer disease
  2. gastric erosions
  3. esophageal varices
  4. Mallory–Weiss tears
  5. esophagitis
  6. duodenitis
  7. malignancy (esophageal & gastric)
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43
Q

40yo M c hematemesis: work–up?

A
  1. postural BP and HR measurements
  2. CBC c diff
  3. PT/INR (coag studies)
  4. chem 6
  5. upper GI endoscopy
  6. LFT’s (albumin, ALT, AST, alk phos, TBili, DBili)
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44
Q

55yo M c/o chest pain: ddx?

A
  1. MI
  2. unstable angina
  3. PE
  4. costochondritis
  5. pleuritis
  6. pericarditis
  7. aortic dissection
  8. GERD
  9. esophageal perforation
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45
Q

55yo M c/o chest pain: work–up?

A
  1. CBC c diff
  2. cardiac enzymes
  3. EKG and CXR
  4. echocardiogram
  5. coronary angiogram & lipid profile
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46
Q

70yo M c/o frequent falls: ddx?

A
  1. cerebellar disease (ETOH, tumor)
  2. Parkinson’s (idiopathic, drug–induced)
  3. diabetic neuropathy (sensory ataxia)
  4. brain tumor
  5. hyperthyroidism

‘6. fractured hip

‘7. seizure

‘8. vertigo

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47
Q

70yo M c/o frequent falls: work–up?

A
  1. CBC c diff
  2. CT or MRI (posterior fossa)
  3. serum lytes
  4. EKG
  5. S. phencyclidine levels
  6. TSH, T3, T4
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48
Q

35yo M c/o cough, chest pain and fever: ddx?

A
  1. pneumonia
  2. pleuritic pain
  3. pleural effusion
  4. pulmonary edema
  5. TB
  6. PE
  7. bronchial CA
  8. infective endocarditis or pericarditis
  9. GERD
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49
Q

35yo M c/o cough, chest pain and fever: work–up?

A
  1. CBC c diff, ESR
  2. CXR
  3. EKG
  4. sputum gram stain, culture and sensitivity, cytology
  5. blood cultures
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50
Q

60yo M c/o lower abd pain and fever: ddx?

A
  1. diverticulitis
  2. renal colic
  3. appendicitis
  4. ischemic colitis
  5. infectious colitis
  6. leaking aneurysm
  7. intestinal obstruction from stangulated or incarcerated hernia
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51
Q

60yo M c/o lower abd pain and fever: work–up?

A
  1. rectal exam, FOBT, genital exam
  2. CBC c diff
  3. chem 6 and Ca++
  4. urinalysis
  5. EKG
  6. abdominal x–ray
  7. CT of abdomen and pelvis
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52
Q

35yo M c/o fatigue: ddx?

A
  1. depression
  2. anemia
  3. hypo/hyperthyroidism
  4. HIV or AIDS
  5. malingering
  6. hypochondriasis
  7. PTSD
  8. chronic fatigue
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53
Q

35yo M c/o fatigue: work–up?

A
  1. CBC c diff
  2. TSH, T3, T4
  3. ESR
  4. chem 6 panel
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54
Q

65yo F c/o loss of hearing: 2 types of pathology?

A
  1. conducting hearing loss

2. sensorineurial hearing loss

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55
Q

list the ddx for conducting hearing loss.

A
  1. cerumen impaction
  2. otitis media c effusion
  3. tympanic membrane perforation
  4. otosclerosis
  5. foreign body in ear canal
  6. cholesteatoma
  7. tympanosclerosis
  8. tumor of ear canal or middle ear
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56
Q

list the ddx for sensorineurial hearing loss.

A
  1. presbycusis (age related)
  2. ototoxicity (meds)
  3. noise–induced
  4. Meniere’s disease
  5. diabetes
  6. acoustic neuroma
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57
Q

65yo F c/o loss of hearing: work–up?

A
  1. CBC and ESR
  2. chem 7
  3. audiometry
  4. FTA, absorbed (if needed)
  5. MRI brain (if needed)
  6. Lyme titers (if needed)
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58
Q

53yo M with R knee pain, swelling and fever: ddx?

A
  1. osteoarthritis
  2. septic arthritis
  3. pseudogout and gout
  4. reactive arthritis
  5. traumatic knee injury
  6. Lyme disease
  7. monoarticular rheumatoid arthritis
  8. psoriatic arthritis
59
Q

53yo M with R knee pain, swelling and fever: work–up?

A
  1. CBC c diff
  2. PT/INR before aspiration
  3. joint aspiration
  4. knee X–ray
  5. ESR, ANA, Rheumatic Factor
  6. MRI of joint for hx of trauma
  7. Lyme titers of rhx of tick bite or travel to NE U.S.
60
Q

In case of knee trauma, what Q’s do you ask? consult or advice?

A
  1. what were you doing when pain began?
  2. any noises at the time of injury? (pop = ACL injury)
  3. did the knee buckle or is it unstable?
  4. is there locking and unlocking of joint?
  5. do Lachman’s maneuver, Drawer’s test for CL injury
  6. McMurray’s maneuver
  7. advise orthopedics consult for possible meniscal or CL injury
61
Q

50yo M c blurry vision: ddx?

A
  1. DM
  2. cataracts
  3. HTN retinopathy
  4. glaucoma
  5. macular degeneration
  6. brain lesions
  7. hyperviscosity syndrome (polycythemia)
  8. illegal drugs
  9. temporal arteritis
  10. trauma or infx to eye (if unilateral)
62
Q

50yo M c blurry vision: work–up?

A
  1. CBC c diff
  2. fasting BS and HbA1c
  3. urinalysis for microscopic proteinuria
  4. lipid profile
  5. doppler of carotids
63
Q

32yo F c multiple bruises: ddx?

A
  1. accident
  2. physical assault
  3. spousal abuse
  4. bleeding d/o
  5. collagen vascular d/o
64
Q

32yo F c multiple bruises: work–up?

A

[really depends on HPI]

  1. PT/INR coags
  2. ESR
65
Q

20yo F c burning on urination and fever: ddx?

A
  1. cystitis
  2. pyelonephritis
  3. urethritis
  4. vulvovaginitis
  5. PID
  6. non–inflammatory dysuria (trauma, irritant, allergy)
66
Q

20yo F c burning on urination and fever: work–up?

A
  1. pelvic exam
  2. CBC c diff
  3. urine culture
  4. urinalysis
67
Q

50yo M c difficulty swallowing: 2 categories of dysphagia?

A
  1. oropharyngeal dysphagia

2. esophageal dysphagia

68
Q

list the ddx for oropharyngeal dysphagia.

A
  1. neuromuscular (CVA, Parkinsonism, multiple sclerosis)
  2. mechanical obstruction (Zenker diverticulum, thyromegaly)
  3. skeletal muscle d/o (myasthenia gravis, muscular dystrophies, polymyositis)
  4. miscellaneous (meds, radiation)
69
Q

list the ddx for esophageal dysphagia.

A
  1. mechanical obstruction (esophageal CA, benign structures, webs and rings)
  2. achalasia cardia (achalasia, scleroderma)
  3. GERD
  4. miscellaneous (DM, alcoholism)
70
Q

what is the work–up for this ddx?

  1. esophagial CA
  2. achalasia cardia
  3. reflux esophagitis
  4. stricture
A
  1. CBC
  2. barium swallow
  3. esophagoscopy
  4. CXR
71
Q

30yo M HIV pt comes in for med refill. what infx do you look out for?

A
  1. PCP
  2. Candida
  3. CMV retinitis
  4. esophagitis
72
Q

30yo M HIV pt comes in for med refill. work–up?

A
  1. CBC c diff
  2. CD4 count
  3. viral load (HIV RNA PCR)
  4. CXR
  5. LFT’s (Zidovudine toxicity)
73
Q

which can present with amenorrhea, hypo– or hyperthyroidism?

A

BOTH!

74
Q

16yo F presents c amenorrhea: ddx?

A
  1. 1* amenorrhea
  2. 2* amenorrhea
  3. pregnancy
  4. anorexia nervosa
  5. hyperprolactinemia
  6. thyroid dysfunction
  7. polycystic ovarian syndrome
  8. stress
  9. post pill amenorrhea
  10. hypothalamic pituitary ovarian axis problems
75
Q

16yo F presents c amenorrhea: work–up?

A
  1. pelvic and breast exam
  2. pregnancy test
  3. TSH
  4. serum prolactin level
  5. u/s abdomen (?ovarian tumor)
  6. MRI brain (?prolactinoma)
  7. LH and FSH levels (?polycystic ovarian disease)
76
Q

35yo F presents c acute R lumbar and lower abd pain c fever: ddx?

A
  1. renal colic
  2. ovarian torsion
  3. UTI and pyelonephritis
  4. PID
  5. Mittelschmerz
  6. appendicitis
  7. threatened abortion
  8. ectopic pregnancy
  9. dysmenorrhea
  10. endometriosis
  11. fibroid uterus
77
Q

35yo F presents c acute R lumbar and lower abd pain c fever. ddx includes renal colic, pyelonephritis, PID, appendicitis and fibroid uterus. work–up?

A
  1. pelvic exam
  2. pregnancy test
  3. CBC c diff
  4. urinalysis and cultures
  5. abd u/s
78
Q

70yo M c insomnia: ddx?

A
  1. depression
  2. PTSD
  3. anxiety d/o
  4. chronic pain syndrome
  5. drug–induced
  6. age–related sleep changes
  7. thyroid probs
  8. sleep apnea
  9. restless leg syndrome
  10. occult medical illness
79
Q

70yo M c insomnia: work–up?

A
  1. CBC
  2. chem 6
  3. TSH
  4. nocturnal polysomnography
  5. upper GI endoscopy
80
Q

65yo M c difficulty urinating: ddx?

A
  1. BPH
  2. CA of prostate
  3. stone in urinary tract
  4. urethral strictures
  5. CA of bladder
  6. sphincter dysfunction
  7. infection
  8. neuro dysfunction (spinal cord trauma or diabetes)
  9. drug–induced (anti–cholinergics)
81
Q

65yo M c difficulty urinating: work–up?

A
  1. rectal exam
  2. CBC c diff
  3. urinalysis and urine cx
  4. BUN, Cr
  5. fasting BS, HbA1c
  6. Prostate Specific Antigen
  7. cytoscopy (as needed)
  8. u/s (as needed)
82
Q

45yo F c/o breathlessness and anxiety: ddx?

A
  1. anxiety 2* to medical condition (hyperthyroidism, arrhythmia, pheochromocytoma)
  2. substance abuse
  3. panic d/o
  4. generalized panic disorder
  5. adjustment d/o c anxious mood
  6. hypochondriasis
  7. malignancy
83
Q

45yo F c/o breathlessness and anxiety: work–up?

A
  1. CBC
  2. EKG
  3. TSH
  4. urinalysis
  5. urine tox screen
84
Q

53yo M c long hx of epigastric pain: ddx?

A
  1. peptic ulcer disease
  2. gastritis
  3. GERD/esophagitis
  4. CA of esophagus, stomach, or pancreas
  5. chronic pancreatitis
  6. cholecystitis
  7. hepatitis
85
Q

53yo M c long hx of epigastric pain: work–up?

A
  1. CBC c diff
  2. endoscopy
  3. serum amylase and lipase
  4. LFT’s (albumin, Dbili, Tbili, AST, ALT, alk phos)
  5. Fecal Occult Blood Test
  6. abd u/s or CT (as needed)
  7. H. pylori breath test (as needed)
86
Q

45yo M c/o bloody vomiting: ddx?

A
  1. gastric ulcer
  2. duodenal ulcer
  3. esophageal and gastric varices
  4. Mallory Weiss tears
  5. gastritis
  6. erosive esophagitis
  7. GI malignancy
  8. vascular ectasia
87
Q

45yo M c/o bloody vomiting: work–up?

A
  1. CBC c diff
  2. chem 6
  3. upper GI endoscopy
  4. LFTs
  5. H. pylori serology
88
Q

60yo M c/o dizziness: ddx?

A
  1. TIA or stroke
  2. drug–induced
  3. CAD
  4. autonomic dysfunction
  5. postural hypotension
  6. CHF
  7. arrhythmias
  8. hypoglycemia
  9. intracranial pathology
  10. ear probs
  11. anemia
89
Q

60yo M c/o dizziness: work–up?

A
  1. orthostatics
  2. CBC
  3. doppler carotid study
  4. fasting BS and HbA1c
  5. chem 6
  6. EKG and holter monitor
  7. CT scan of head (as needed)
90
Q

30yo M c new onset of seizures: ddx?

A
  1. SZ 2* to: head trauma, infx, drugs, metabolic d/o
  2. hypoglycemia
  3. syncope
  4. migraine
  5. stroke
  6. space occupying lesion
  7. alcohol or drug induced
91
Q

30yo M c new onset of seizures: work–up?

A
  1. CBC c diff
  2. chem 7, Ca++, Mg++
  3. LFTs
  4. urinalysis and tox screen
  5. CT scan of head
  6. LP
  7. EEG
92
Q

23yo M c rectal bleeding and fever: ddx?

A

remember: young pt c rectal bleeding
1. anal fistula/fissure
2. inflammatory bowel disease
3. infectious colitis
4. neoplasm
5. vascular ectasia
6. gonococcal proctitis
7. hemorrhoids

93
Q

23yo M c rectal bleeding and fever: work–up?

A
  1. rectal exam and FOBT
  2. CBC and ESR
  3. anoscopy
  4. sigmoidoscopy/colonoscopy
  5. abd x–ray
94
Q

what is the ddx for an elderly person with rectal bleeding and fever?

A
  1. diverticulosis
  2. angiodysplasia
  3. malignancy/polyp
  4. ischemic colitis
  5. inflammatory bowel disease
95
Q

20yo M c/o dark urine: ddx?

A
  1. UTI
  2. glomerulonephritis
  3. kidney or bladder stones
  4. tumors of kidney or bladder
  5. acute tubular necrosis
  6. ATN
  7. medication–induced
  8. drug–induced
96
Q

20yo M c/o dark urine: work–up?

A
  1. urinalysis
  2. urine cx and sensitivity
  3. CBC c diff
  4. cytoscopy as needed
  5. KUB, as needed
  6. CT scan of abdomen, as needed
97
Q

pt presents c signs of ETOH abuse: work–up?

A
  1. CBC c diff
  2. LFT’s
  3. GGT (gamma glutanyl transpeptidase)
98
Q

pt presents c signs of ETOH abuse: exit Q’s and advice?

A
  1. how much ETOH and how often?
  2. explain risks of alcoholism
  3. explain pt’s responsibility to stop drinking
  4. drinking diary
  5. self–motivation; community resources and groups
  6. make f/u appt
99
Q

elderly pt >50yo c back pain: ddx?

A
  1. disk prolapse
  2. osteoporosis c vertebral body fracture
  3. muscle strain
  4. pathologic fracture
  5. degenerative joint disease
100
Q

elderly pt >50yo c back pain: work–up?

A
  1. X–ray of lumbar spine
  2. DEXA scan
  3. Ca, PO4, alk phos, protein electropheresis, acid phosphatase
  4. MRI spine, as needed
  5. CBC & ESR, as needed
101
Q

pt presents c chronic cough: ddx?

A
  1. postnasal drip syndrome and sinusitis
  2. asthma
  3. GERD
  4. chronic bronchitis
  5. bronchiectasis
  6. cough 2* to ACE inhibitor use
  7. malignancy
  8. cough 2* to occupational exposure
  9. TB (rare in U.S.)
102
Q

pt presents c chronic cough: work–up?

A
  1. CBC c diff
  2. CXR
  3. sputum gram stain/AFB and culture, as needed
  4. PFTs, as needed
  5. hi–res CT scan
  6. ELISA for HIV
  7. PPD placement
103
Q

34yo M c chronic diarrhea: ddx?

A
  1. secretory diarrhea (bacterial toxins, ileal bile acid malabsorption, endocrine diarrhea)
  2. osmotic diarrhea (osmotic laxatives, carbohydrate malabsorption)
  3. inflammatory diarrhea (inflammatory bowel disease, infectious disease – Giardia)
  4. fatty diarrhea (celiac disease, short bowel syndrome)
104
Q

34yo M c chronic diarrhea: work–up?

A
  1. rectal exam and FOBT
  2. CBC c diff
  3. chem 7
  4. stool analysis (wt, pH, fat staining, osmotic gap, laxative screen)
  5. stool for fecal leukocytes, ova, and parasites, stool cx
105
Q

45yo M c hemoptysis: ddx?

A
  1. bronchiectasis
  2. acute or chronic bronchitis
  3. pneumonia
  4. bronchogenic CA
  5. lung abscess
  6. TB
  7. connective tissue disease (Wegener’s, Goodpasture, Lupus)
  8. pulmonary embolus
  9. pseudo hemoptysis
106
Q

45yo M c hemoptysis: work–up?

A
  1. CBC c diff, ESR
  2. PT, INR, PTT
  3. sputum for AFB, gram stain
  4. CXR
  5. PPD, as needed
  6. urinalysis
  7. BUN and creatinine
  8. CT of chest, as needed, for bronchiectasis
107
Q

22yo M African American c night sweats: ddx?

A
  1. malignancy (lymphoma, solid tumor)
  2. infections (TB, HIV, endocarditis)
  3. endocrine d/o (hyperthyroidism, pheochromocytoma)
  4. medications (antidepressants, cholinergic agonists, hypoglycemic agents)
108
Q

22yo M African American c night sweats: work–up?

A
  1. CBC c diff
  2. ESR
  3. blood cx
  4. CXR and PPD
  5. TSH
  6. ELISA for HIV, as needed
  7. CT scan of chest and abdomen for lymphoma, as needed
109
Q

25yo F c n/v: ddx?

A
  1. gastroenteritis (food poisoning)
  2. obstructing d/o
  3. inflammatory disease
  4. impaired motor function
  5. intracranial pathology
  6. drugs
110
Q

2 most common Step 2 CS causes of n/v in women?

A
  1. pregnancy

2. anorexia nervosa

111
Q

what drugs commonly cause n/v?

A
  1. digoxin

2. CA drugs

112
Q

what 2 intracranial pathologies can cause n/v? what do you ask about?

A
  1. malignancy and infections

2. ask about fever, HA, quality of vomiting (projectile?

113
Q

what impaired motor functions cause n/v? what do you ask about?

A
  1. diabetic gastroparesis
  2. DKA
  3. GERD

Ask about hx of diabetes

114
Q

what inflammatory diseases can cause n/v? what are the associated sx?

A
  1. PID
  2. cholecystitis (pain in the R hypochondriac region)
  3. acute pancreatitis (severe epigastric pain radiating to the back)
  4. appendicitis (initially, periumbilical pain, later to RLQ)
  5. pyelonephritis
115
Q

what obstructing d/o will cause n/v? associated sx?

A
  1. pyloric obstruction (vomiting 1hr after eating)
  2. intestinal obstruction (vomiting late post prandial period)
  3. constipation (passing gas?)
116
Q

what is the likely diagnosis if pain is relieved after emesis?

A

small bowel obstruction

117
Q

if you suspect gastroenteritis (food poisoning), what do you ask about?

A

– eaten any food outside?

– travel hx?

– any family members ill with associated sx, like abdominal cramps and diarrhea?

118
Q

there is n/v in 25yo F. what do decreased bowel sounds mean? increased bowel sounds?

A

decr: ileus
incr: obstruction

119
Q

25yo F c n/v: work–up?

A
  1. CBC c diff
  2. chem 6
  3. pregnancy test
  4. urinalysis, cx and sensitivity
  5. abd X–ray, if not pregnant
  6. if needed: amylase and lipase ? acute pancreatitis
  7. if needed: LFTs
  8. u/s to ?acute cholecystitis
  9. glu to ?DM
  10. stool studies, fecal leukocytes, stool ova, parasites, C. diff
  11. EKG (if risk factors for MI)
120
Q

what type of MI can appear with vomiting?

A

inferior wall MI, especially with diabetics

121
Q

27yo WF c/o headache: ddx?

A
  1. migraine
  2. cluster HA
  3. tension HA
  4. SAH or CVA
  5. sinusitis
  6. brain tumor
  7. meningitis, encephalitis, infections
  8. temporal arteritis (in elderly pts)
  9. refractive errors (if any positive hx and PE)
  10. meds, drugs
122
Q

27yo WF c/o headache: work–up?

A
  1. CBC c diff
  2. ESR
  3. if elderly, temporal artery biopsy
  4. sinus X–ray
  5. CT head w/o contrast
  6. LP, if pt appears sick and presents with fever or confusion, then also take blood cx to ?meningitis
123
Q

40yo F c depression: ddx?

A
  1. depression
  2. hypothyroidism
  3. occult carcinoma
124
Q

40yo F c depression: work–up?

A
  1. serum TSH
  2. CBC c diff
  3. urine and serum tox screen
125
Q

52yo F c/o hot flashes: ddx?

A
  1. menopause
  2. hyperthyroidism
  3. occult malignancy
  4. factitious d/o
  5. chronic fatigue syndrome
126
Q

52yo F c/o hot flashes: work–up?

A
  1. CBC c diff
  2. serum TSH
  3. serum FSH and LH (only in doubtful cases)
  4. pap smear (yearly)
  5. screening mammogram
  6. annual FOBT
127
Q

70yo F c/o forgetfulness: ddx?

A
  1. Alzheimer’s Disease
  2. vascular dementia
  3. normal pressure hydrocephalus
  4. vitamin B12 deficiency
  5. hypothyroidism
  6. masked depression
  7. chronic subdural hematoma
128
Q

70yo F c/o forgetfulness: work–up?

A
  1. CBC c diff
  2. CT scan of head
  3. serum TSH, vitamin B12 level
  4. chem 6 and Ca++
  5. syphilis serology
129
Q

50yo M diabetic comes in for med refill: work–up?

A
  1. CBC c diff
  2. BS
  3. HbA1c
  4. BUN and serum creatinine
  5. lipid profile
130
Q

50yo M diabetic comes in for med refill: questions to ask?

A
  1. when dx c DM?
  2. taking DM meds? compliant?
  3. are the meds working?
  4. have you ever taken insulin?
  5. do you check BS regularly?
131
Q

20yo F c/o vaginal bleeding: ddx?

A
  1. regular menses
  2. abortion
  3. pregnancy
  4. ectopic pregnancy
  5. hydatiform mole
132
Q

what illegal drug can cause vaginal bleeding?

A

cocaine

133
Q

20yo F c/o vaginal bleeding: work–up?

A
  1. pelvic exam
  2. pregnancy test
  3. CBC c diff
  4. transvaginal u/s
  5. serum B–hCG levels
  6. serum TSH
134
Q

56yo M presents c shoulder pain: ddx?

A
  1. shoulder dislocation
  2. shoulder fracture
  3. rotator cuff tear
  4. subacromial bursitis
  5. ligament sprain
135
Q

56yo M presents c shoulder pain: work–up?

A
  1. CBC
  2. x–ray of shoulder joint 2 views, incl. elbow
  3. x–ray hand, 2 views
  4. MRI of shoulder
  5. ANA and rheumatic factors
136
Q

40yo F presents for obesity eval: common probs associated c obesity?

A
  1. type 2 DM
  2. heart disease
  3. stroke
  4. HTN
  5. osteoarthritis
  6. sleep apnea
  7. breathing probs
  8. high cholesterol
  9. gall bladder disease

10 increase incidence of CA: endometrial, colon, postmenopausal, breast CA

  1. menstrual irregularities
  2. stress incontinence
  3. psych d/o like depression
  4. psychosocial difficulties like social stigmatization
137
Q

40yo F presents for obesity eval: ddx?

A
  1. obesity
  2. hypothyroidism
  3. Cushing’s syndrome
138
Q

40yo F presents for obesity eval: work–up?

A
  1. CBC c diff
  2. fasting BS
  3. serum TSH
  4. urine cortisol levels
  5. fasting lipid profile
  6. consider annual PAP smear
139
Q

what are the common causes of syncope?

A
  1. cardiac: arrhythmias, CAD and ACS, aortic stenosis, hypertrophic obstructive cardiomyopathy
  2. vasovagal syncope
  3. neuro causes: TIA, stroke, seizures, migraine
  4. meds or toxins
  5. unexplained syncope
  6. psych cause: personality d/o, hyperventilation, conversion d/o
140
Q

recommended work–up for pt c syncope?

A
  1. EKG
  2. 24hr holter monitor
  3. exercise testing: in case of syncope on exertion
  4. 2D echo
  5. upright tilt table test: neurocardiogenic syncope
  6. neuro investigations: CT, MRI, EEG, carotid doppler
  7. tox screen if suspect drug abuse
  8. BS and metabolic screen (suspect low BS or electrolyte imbalance)
  9. FOBT or stook guaiac
141
Q

62yo M c confusion and DM: ddx?

A
  1. insulin–induced hypoglycemia
  2. TIA
  3. multi–infarct dementia
  4. electrolyte abnormalities
  5. meds
  6. alzheimer’s dementia
142
Q

what are the ADL’s?

A

DEATH:

Dressing

Eathing

Ambulating

Toileting

Hygiene

143
Q

what are the instrumental ADL’s?

A

SHAFT:

Shopping

Housekeeping

Accounting

Food prep

Transportation

144
Q

62yo M c confusion and DM: work–up?

A
  1. CBC c diff
  2. urinalysis
  3. serum lytes or basic metabolic profile
  4. EKG and 24h Holter monitor if hx of spells
  5. carotid doppler
  6. CT scan of head
  7. CXR

step 2 cs (1 decks)

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