Worst Case Scenario Presentations Flashcards
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
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
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
cough, chest pain, hemoptysis, dyspnea, weight loss
Lung Cancer
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
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
hx of URI or oropharyngeal trauma, fever, dysphagia
Retropharyngeal abscess
CT is definitive
complications: life-threatening, airway obstruction
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)
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
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
acute or subacute onset of wheeze and respiratory distress; cough, dyspnea, hyperresonance on percussion
Asthma exacerbation
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
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
chest pain, dyspnea, & a sense of apprehension; syncope s/t occurs
PE
- syncope is strongly associated w/ incr. clot burden
- run D-dimer
Virchow’s triad
venous stasis
vessel wall damage
hypercoagulability
INDICATES –> PE
often asx and discovered incidentally, but may present with abdominal pain and/or back pain
AAA
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
palpitations, dyspnea, angina, dizziness/syncope, irregularly irregular rhythm
A-fib
complications: tachycardia induced cardiomyopathy, stroke, death
> 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
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
