UWorld Sample Cases Flashcards
vomiting hx
projectile, blood, how often, sick contacts/food
abdo, back pain
diarrhea, constipation
b sx: fever, chills, headaches
gu sx: burning with urination, menstrual period, preggers
vomiting ex
orthostatic hypotension (vitals)
heent (fundi for increased icp, orophyrx for dry mucous membranes)
cardio: m/g/r
abdo: denstension, +bs, percuss for bowel gas pattern, tenderness/rebound, cva tenderness
vomiting ddx
gastroentero, obstruction (sbo), pregs, med/tox, meningitis, pancreatiis, hepatitis, cholecystitis, pyelonephr
vomiting ix
cbc (w/differential), euc, preg test/urine hcg, ua, urine culture
axr after neg preggers, amylase, lipase, liver function panel (alt, ast, ggt, alp), abdo u/s, stool studies
diarrhea hx
times/day, how often, volume amt, acute v chronic, continuous v intermittent (normal mvmts in between?), blood/pus/mucus in stool, greasy diarrhea/clay colored/dark,
abdo pain (ibd, ibs), weight loss (malabsorption, cancer), milk or lactose intolerence, increased stress better/worse factors, recent ravel, sick contacts, fever, chills, radiation exposure
diarrhea ex
heent: lesions orophayrnx (ie bulemic eating diet pills), enlarged cervical lymph nodes, thyromegaly, masses ie lipomas/dermoid cysts
heart, lungs, abdo (+bs, percuss for bowel gas patterns, palpate superficial and deep)
diarrhea wu
cbc, fobt, cmp/euc, tsh, stool (wbc, o&p)
diarrhea ddx
secretory diarrhea (bacteria/toxins, ileal bile acid malabsoprtion, endocrine diarrhea) osmotic diarrhea(laxatives, carb malabsorption) inflam diarrhea (ibd, giiardia) fatty dirrhea (celiac, short bowel syndrome)
vag bleed hx
gradual/sudden, bright red / dark, clots, tissue ish (molar pregnancy), continous flow/spotting, triggers (sex, sleep, trauma), assoc sx (n&v, abdo pain, fever), drugs (cocaine can cause bleeds)
preggers before/ g/p/a, lmp, heavy flow, pads per day, period length, irregular/reg, abortions, stds, PMHx bleeding/hospitalization due to that, bleeding disorders, multiple abortions
sexual hx: marriage/relationship state, contraception, last sexual contact (& protection)
vag bleed ex
nose, gums etc bleeding; orthostatic hypothension
abdo: hepatospleno, +bs, palpate, rebound
state: will do pelvic ex
vag bleed wu
pelvic ex, preg test, cbc, transvaginal us, serum r-hcg, tsh
vag bleed ddx
regular menses, abortion, preg, ectopic, hyadatiform mole
dark urine hx ex
blood, same color throughout day, decrease/increase, pain with urination, abdo/back, b sx, diarrhea, food (beets/ artificial colors/berries), trauma, heavy exercies (rhabdo), sore throat (poststrep glom), kidney probs
heent, cardiac, abdo including cva tenderness
dark urine wu
ua, cbc, cpk, bmp/euc, cystoscopy (bladder), ct abdo
dark urine ddx
glomerulo, benign familial hematuria, exercise-induced / rhabdo, atn, med or food induced, KUB stones, UTI, kidney/bladder tumors
abuse
look for bruises, palpate tenderness. hx suicide, weapen, children, sexual abuse, emergency plan (friends/family)
assure confidentiality (no records released without her permission), assure your role in her safety, encurage to get away Before she goes, ASK if safe for her, offer domestic violence counselor
confusion hx ex
hx: weak/tingle/numb, dizziness, jerky mvmts, seizures, headaches, trauma, systemic, adls
ex: lymphadeno, thyroid, pallor, heart, lungs, abdo (masses for ca). neuro: MSE, cranial nerves, reflexes, power&sensory super quick, gait, balance
confusion ix
cbc, ua, bmp, tsh, ecg, ct head, carotid doppler, cxr
confusion ddx
tia, multiinfarct dementia, alz, euc abnormalities, med side effects (polypharmacy)
depression hx ex
sig e caps, weight change/apetite. thyroid: cold, hair loss, constipation/bowel movements, sob. hallucinations. counselor (& if they want one)
ex: thyroid, hla, reflexes (delayed relaxation phase of hypothyroid), MMSE.
depression ix ddx
tsh, cbc, cmp, peripheral smear (anemia types)
depression, hypothyroid, anemia
diziness
fall to specific side, feelings of panic, hearing difficulty/ringing/buzzing, double/blurry vision, weak/numb in face/arm/leg, bowel and bladder, loss of consciousness, warning signs, headaches, n&v, sob, palps
vitals-orthostatic hypo, heent-gross/rinne/weber & otoscopic (esp if tinnitus, ear discharge), thyroid, carotid bruits. neuro: dix-hallpike nystagmus, gait /romberg, dysmetria/dysdiadocho etc for cerebellar
diziness ddx
bpv, tia/stroke, postural/orthostatic hypo, arrhythmia, cns tuors/meniere’s, polypharmacy/meds, peripheral neuropathy, thyroid abnormal, anemia, hypoglycemia or other metabolic, nonspecific dizziness
dizz ix
cbc, euc, tsh/t4, ecg/24 hr holter monitor, carotid doppler for stroke/mr, mri brain for acoustic neuroma etc
forgetting hx ex
onset, timecourse, sleeping, walking, adls, depression (sad/lonely), dizzy spells/falls, hypothyroidism (cold), weight loss. diarrhea/constipation, urination
ex: fundi, mmse. full neuro: power, reflex, sensation (touch, position, vibration), rombergs/get up n go
counsel: home environ, stairs, bathroom safety, support
forget ddx
alz, vascular dementia, nph, vita b12, hypothyroid, depression (atypical), chronic subdural
forget ix
cbc, ncct, tsh/b12/thiamin, bmp, syphilis (rpr/vdrl)
passout
hx: seizure qs (jerky, tongue biting, bowel/bladder incontinence), n&v, cardio & neuro stuff, blurry vision.
ex: orthostatic hypo, carotid bruits ,neuro
ddx: arrythmia, vasovagal syncope, orthostatic hypotension, heard dz (aortic, ie coarctation, takayasus), seizures, tia/stroke
ix: cbc, bmp/euc, ecg, echo, holter/event monitor, get up n go, tilt table, ct/mri/eeg
terminal ca
hx: socrates, weight/appetite, morphine and other pain meds, all systemic, mood/sleep/depression. ex: edema, pallor. discuss: home situ, hospice, advanced directives
smoking cessation
assess motivation to quit, awareness of dz, why (stress, depression, social/triggers with etoh), cough, sob, previous attempts and with what methods
