- onset > 50 y/o - first or worst HA - sudden onset - neck pain - hx of head trauma - hx of HIV or CA

Worst Case Scenario Presentations Flashcards by Piper Dobner

dramatic symptomatic even with blurring of vision, painful red eye, HA, N & V

Angle-closure glaucoma

complications: loss of vision, may be permanent; retinal vein occlusion

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reduced visual acuity & red eye - unilateral, sudden onset, painful infx around the eye secondary to sinus infx

Orbital cellulitis

complications: retinal artery or vein thrombosis, retinal damage, brain abscess, meningitis, cavernous sinus thrombosis

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fever, HA, vomiting, nuchal rigidity, one eye is swollen & red first and the other eye is affected w/in 48 hr of sx onset; sequelae of infx from face, sinuses, ears, teeth, or mouth

Cavernous sinus thrombosis (septic)

can also have aseptic CST as a result of trauma, iatrogenic injuries, or prothrombotic conditions
complications: death, CN deficits, meningitis, septic embolism, blindness

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cough, chest pain, hemoptysis, dyspnea, weight loss

Lung Cancer

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deep, aching pain, pulsating sensation, cough, hoarseness, cold feet, trouble swallowing, fever, weight loss, constipation, dizziness (hypotn), fullness

Aortic Aneurysm

complications: risk of rupture, esp. is diameter exceeds 5.5 cm in men or 5.0 cm in women

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rapid onset high fever, sore throat, inability to control secretions, tripod positioning, difficulty breathing, irritability

Epiglottis

if suspected, do NOT exam oral cavity
complications: airway compromise

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hx of URI or oropharyngeal trauma, fever, dysphagia

Retropharyngeal abscess

CT is definitive

complications: life-threatening, airway obstruction

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HA, nausea or vomiting, neck stiffness, fever, change in mental status

Meningitis

viral is usu. self-limiting; bacterial is life-threatening and requires prompt antimicrobial therapy; fungal is progressive and life-threatening (often see in immosuppressed pt)

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sudden sx; weakness/numbness in face, arm, or leg; change in vision in one or both eyes; severe HA; dizziness, loss of coordination/balance, difficulty walking; problem talking or expressing thoughts & words

Stroke

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HA red flags (6)

onset > 50 y/o
first or worst HA
sudden onset
neck pain
hx of head trauma
hx of HIV or CA

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acute or subacute onset of wheeze and respiratory distress; cough, dyspnea, hyperresonance on percussion

Asthma exacerbation

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central chest pain that is classically heavy in nature & has sensation of pressure or squeezing

MI (STEMI often present this way)

*ECG is first-line and should NOT be delayed - will show ST-segment elevation in 2 or more anatomically contiguous leads

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chest pressure/discomfort lasting at least several minutes, at times accompanied by sweating, dyspnea, nausea, and/or anxiety

MI (NSTEMI often present this way)

Note: sx are indistinguishable from unstable angina but can be differentiated by a rise of cardiac biomarkers
ECG is first-line and should NOT be delayed

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chest pain, dyspnea, & a sense of apprehension; syncope s/t occurs

syncope is strongly associated w/ incr. clot burden
run D-dimer

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Virchow’s triad

venous stasis
vessel wall damage
hypercoagulability

INDICATES –> PE

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often asx and discovered incidentally, but may present with abdominal pain and/or back pain

AAA

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Chest pain d/t CAD via evidence based questions (5)

1) PHx vascular dz (PAD, carotids, AAA, DVT)
2) pain < exertion
3) pain not elicited by palpation
4) pt. feels pain is coming from their heart
5) Age: M > 55, F > 65

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palpitations, dyspnea, angina, dizziness/syncope, irregularly irregular rhythm

A-fib

complications: tachycardia induced cardiomyopathy, stroke, death

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> 40 y/o, rectal bleeding, rectal/abdominal mass, change in bowel habits, anemia, abdominal pain, wt loss and anorexia, abdominal distension, palpable LN

Colorectal CA

MC males
often have +FHx

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jaundice, nonspecific upper abd pain/discomfort, wt loss and anorexia, steatorrhea, thirst, polyuria, nocturia, N/V, hepatomegally, petechiae/purpura/bruising

Pancreatic CA

*MC 65-75 y/o

What are Courvoisier sign and Trousseau sign? What are the indicative of?

Courvoisier = indicated by painless palpable GB and jaundice; indicates tumors of biliary tree or pancreatic head (sign of advanced dz)

Trousseau = migratory thrombophlebitis (clot felt as tender nodule); may be the first sign of pancreatic CA

Together they indicated presence of pancreatic CA

Sudden onset of severe ripping or tearing substernal or interscapular pain

Aortic dissection

*MC in men > 50 y/o

abdominal pain & tenderness, vaginal bleeding/amenorrhea, urge to defecate; pain may refer to shoulder

Ectopic pregnancy

+CMT & adnexal tenderness/mass on pelvic exam
hemodynamic instability and CMT may indicate rupture or imminent rupture
Usu. presents 6-8 wks after last normal menses

lower abdominal tenderness, adnexal tenderness, CMT, fever, cervical/vaginal d/c, N/V; sx range from absent to severe

PID

acute abd pain starting in mid abdomen and later localizing to RLQ; fever, anorexia, N/V

Appendicitis

fever, jaundice, & RUQ What condition comes to mind and what triad is this?

Ascending cholangitis (these 3 sx together are known as Charcot triad) Complications = sepsis w/ shock, vascular collapse, multiorgan failure, death

diarrhea (esp. bloody), abdominal pain, nausea, vomiting, absence of fever, known community outbreak of E. coli

Hemolytic uremic syndrome *MC in children < 5 y/o

nocturia, urinary frequency, urinary hesitancy, dysuria, hematuria, weight loss/anorexia, lethargy, palpable LN, bone pain

Prostate CA *abnl digital rectal exam and elevated PSA

hematuria (gross or microscopic), dysuria, urinary frequency, > 55 y/o

Bladder CA *often see FHx

saddle (perineal) anesthesia, bladder retention (may also see overflow incontinence), and leg weakness

Cauda equina syndrome

vague nonspecific sx in female such as abdominal bloating, early satiety dyspepsia, pelvic pain/pressure, low back pain, urinary urgency

Ovarian CA

postmenopausal bleeding or abnormal menstruation/vaginal bleeding in premenopausal women; uterine mass/fixed uterus/adnexal mass; pain and weight loss; MC in obese individuals

Endometrial CA

firm mass in breast with axillary LN, skin changes, and nipple d/c

Breast CA

acute-onset fever, chills, severe back or flank pain, nausea and vomiting, and costovertebral angle tenderness

Pyelonephritis

HA, dizziness, & nausea --> MI, dysrhythmias, cardiac arrest, stroke-like sx, altered mental status, confusion, coma, syncope 1/3 of severe exposure to this are fatal

CO poisoning *ask about hx of CO exposure

headache, neck and face pain (esp. around the eyes), vision disturbances (double vision or droopy eyelid), pulsatile "whooshing" sound in 1 ear (i.e. pulsatile tinnitus), sudden decrease in sense of taste and/or weakness on one side of the body

Cervical artery dissection *stroke can develop in hours, days, or even a week after these sx begin

sudden onset intense vertigo, nausea, & vomiting PE: may see bilateral or vertical nystagmus, head impulse test negative, pt. usu. cannot stand without support Cerebellar stroke

*1st test = MRI

unilateral hearing loss, dizziness/vertigo, tinnitus PE: may see spontaneous nystagmus

posterior fossa tumor (acoustic neuroma is a posterior fossa tumor - i.e. it compresses the neural tissue in the posterior fossa and internal auditory canal)

fevers & night sweats, weight loss, skin rashes and postinflammatory scars, oral ulcers, angular chelitis, oral thrush, oral hairy leukoplakia, diarrhea, changes in mental status

HIV

genital ulcer, diffuse rash, fatigue, memory impairment/altered mood/confusion/dementia, visual disturbance, Argyll-Robertson pupils, loss of sensation, ataxia, tremor, peripheral neuropathy, hearing loss, peripheral edema

Syphilis (tabes dorsalis) PE = +Romberg sign, diastolic murmur, LN

combination of UMN & LMN s/sx, initially involving 1 segment of neuroaxis (i.e. cranial, cervical, thoracic, or lumbosacral), then spreading progressively to contiguous areas

Amyotrophic lateral sclerosis (ALS) *No cure at this time, eventually results in respiratory failure

hx of neurofibromatosis type 1 & presents with mononeuropathy of UE/LE with tenderness on palpation

Nerve sheath tumor 1st test = EMG & nerve conduction studies

night sweats, fatigue, malaise, fever, lymphadenopathy, pallor, purpura, jaundice, hepasplenomegally, skin nodules, abnl neurologic exam

Lymphoma

hx of malignancy & presents with asymmetric weakness, numbness, and pain that involves multiple nerve roots, trunks, or their temporal branches; weight loss, fatigue, back pain weakness, atrophy, numbness, loss of DTRs

Lumosacral plexopathy (neoplastic compressive) Paraneoplastic immune-mediated attacks also presents this way - and neuropathy is painful & aggressive

skin lesions with loss of sensation to pin pricks or light touch, possible muscle weakness of affected nerve skin lesions are hypopigmented

Leprosy 1st test = EMG, nerve conduction studies, skin smear(+ for acid-fast bacilli)

Dyspnea, decreased exercise tolerance, swelling of legs, fatigue, generalized weakness

CHF, acute exacerbation

hx of otitis media and now there is pain & redness behind the ear

Mastoiditis

may be acute or insidious, with substantial fatigue and weakness associated with mucocutaneous hyperpigmentation, hypotension, and/or postural hypotension, and salt craving

Addison disease *if untx is life-threatening