Term
HEADACHE
Key History
Onset (acute vs. chronic), location (unilateral vs. bilateral), quality (dull vs. stabbing), intensity (is it the “worst
headache of their life”?), duration, timing (does it disturb sleep?), presence of associated neurologic symptoms (paresthesias,
visual stigmata, weakness, numbness, ataxia, photophobia, dizziness, auras, neck stiffness); nausea/vomiting,
jaw claudication, recent trauma, dental surgery, sinusitis symptoms; exacerbating factors (stress, fatigue, menses,
exercise, certain foods) and alleviating factors (rest, medications); patient and family history of headache; history of
trauma. |
|
Definition
Key Physical Exam
Vital signs; inspection and palpation of entire head; ENT inspection; complete neurologic exam, including funduscopic
exam. |
|
|
Term
21 yo F presents with several episodes of throbbing
left temporal pain that last for 2–3 hours. Before onset,
she sees flashes of light in her right visual field
and feels weakness and numbness on the right side of
her body for a few minutes. Her headaches are often
associated with nausea and vomiting. She has a family
history of migraine. |
|
Definition
Migraine (complicated)
Tension headache
Cluster headache
Pseudotumor cerebri
CNS vasculitis
Partial seizure
Intracranial neoplasm
*
CBC
ESR
CT—head
MRI—brain
LP—CSF analysis |
|
|
Term
26 yo M presents with severe right temporal headaches
associated with ipsilateral rhinorrhea, eye
tearing, and redness. Episodes have occurred at the
same time every night for the past week and last for
45 minutes. |
|
Definition
Cluster headache
Migraine
Tension headache
Intracranial neoplasm
Pseudotumor cerebri
*
CBC
CT—head
MRI—brain
LP—CSF analysis
ESR |
|
|
Term
65 yo F presents with severe, intermittent right temporal
headache, fever, blurred vision in her right eye,
and pain in her jaw when chewing. |
|
Definition
Temporal arteritis (giant
cell arteritis)
Migraine
Cluster headache
Tension headache
Meningitis
Carotid artery dissection
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
Temporomandibular joint
(TMJ) disorder
*
ESR
CBC
CRP
Temporal artery biopsy
Doppler U/S—carotid
MRI—brain
LP—CSF analysis |
|
|
Term
30 yo F presents with frontal headache, fever, and
nasal discharge. There is pain on palpation of the
frontal and maxillary sinuses. She has a history of
allergies. |
|
Definition
Sinusitis
Migraine
Tension headache
Meningitis
Intracranial neoplasm
*
CBC
XR—sinus
CT—sinus
LP—CSF analysis |
|
|
Term
50 yo F presents with recurrent episodes of bilateral
squeezing headaches that occur 3–4 times a week,
typically toward the end of her work day. She is experiencing
significant stress in her life and recently
decreased her intake of caffeine. |
|
Definition
Tension headache
Migraine
Depression
Caffeine or analgesic
withdrawal
Hypertension
Cluster headache
Pseudotumor cerebri
Intracranial neoplasm
*
CBC
Electrolytes
ESR
CT—head
LP—CSF analysis |
|
|
Term
35 yo M presents with sudden severe headache,
vomiting, confusion, left hemiplegia, and nuchal rigidity. |
|
Definition
Subarachnoid
hemorrhage
Migraine
Meningitis/encephalitis
Intracranial hemorrhage
Vertebral artery dissection
Intracranial venous
thrombosis
Acute hypertension
Intracranial neoplasm
*
Noncontrast CT—head
LP—CSF analysis
CBC
PT/PTT/INR
Urine toxicology |
|
|
Term
25 yo M presents with high fever, severe headache,
confusion, photophobia, and nuchal rigidity. |
|
Definition
Meningitis
Migraine
Subarachnoid hemorrhage
Sinusitis/encephalitis
Intracranial or epidural
abscess
*
CBC
CT—head
MRI—brain
LP—CSF analysis (cell
count, protein, glucose,
Gram stain, PCR for
specific pathogens,
culture) |
|
|
Term
18 yo obese F presents with a pulsatile headache,
vomiting, and blurred vision for the past 2–3 weeks.
She is taking OCPs. |
|
Definition
Pseudotumor cerebri
Tension headache
Migraine
Cluster headache
Meningitis
Intracranial venous
thrombosis
Intracranial neoplasm
*
Urine hCG
CBC
CT—head
LP—opening pressure and
CSF analysis |
|
|
Term
57 yo M c/o daily pain in the right cheek for the past
month. The pain is electric and stabbing in character
and occurs while he is shaving. Each episode lasts
2–4 minutes. |
|
Definition
Trigeminal neuralgia
Tension headache
Migraine
Cluster headache
TMJ disorder
Intracranial neoplasm
*
CBC
ESR
MRI—brain |
|
|
Term
CONFUSION/MEMORY LOSS
Key History
Must include history from family members/caregivers when available. Detailed time course of cognitive deficits
(acute vs. chronic/gradual onset); associated symptoms (constitutional, incontinence, ataxia, hypothyroid symptoms,
depression); screen for delirium (waxing/waning level of alertness); falls, medications (and recent medication
changes); history of stroke or other atherosclerotic vascular disease, syphilis, HIV risk factors, alcohol use, or vitamin
B12 deficiency; family history of Alzheimer’s disease or other neurologic disorders. |
|
Definition
Key Physical Exam
Vital signs; complete neurologic exam, including mini-mental status exam and gait; general physical exam, including
ENT, heart, lungs, abdomen, and extremities. |
|
|
Term
81 yo M presents with progressive confusion for the
past several years accompanied by forgetfulness and
clumsiness. He has a history of hypertension, diabetes
mellitus, and 2 strokes with residual left hemiparesis.
His mental status has worsened after each
stroke (stepwise decline in cognitive function). |
|
Definition
Vascular (“multiinfarct”)
dementia
Alzheimer’s disease
Normal pressure
hydrocephalus
Chronic subdural
hematoma
Intracranial neoplasm
Depression
B12 deficiency
Neurosyphilis
Hypothyroidism
*
CBC
VDRL/RPR
Serum B12
TSH
MRI—brain
CT—head
LP—CSF analysis |
|
|
Term
84 yo F brought by her son c/o forgetfulness (eg,
forgets phone numbers, loses her way back home)
and difficulty performing some of her daily activities
(eg, bathing, dressing, managing money, using the
phone). The problem has progressed gradually over
the past few years. |
|
Definition
Alzheimer’s disease
Vascular dementia
Depression
Hypothyroidism
Chronic subdural
hematoma
Normal pressure
hydrocephalus
Intracranial neoplasm
B12 deficiency
Neurosyphilis
*
CBC
VDRL/RPR
Serum B12
TSH
MRI—brain (preferred)
CT—head
LP—CSF analysis |
|
|
Term
72 yo M presents with memory loss, gait disturbance,
and urinary incontinence for the past 6 months. |
|
Definition
Normal pressure
hydrocephalus
Alzheimer’s disease
Vascular dementia
Chronic subdural
hematoma
Intracranial neoplasm
Depression
B12 deficiency
Neurosyphilis
Hypothyroidism
*
CT—head
MRI—brain
LP—opening pressure and
CSF analysis
Serum B12
VDRL/RPR
TSH |
|
|
Term
55 yo M presents with a rapidly progressive change
in mental status, inability to concentrate, and memory
impairment for the past 2 months. His symptoms
are associated with myoclonus, ataxia, and a startle
response. |
|
Definition
Creutzfeldt-Jakob disease
Vascular dementia
Lewy body dementia
Wernicke’s
encephalopathy
Normal pressure
hydrocephalus
Chronic subdural
hematoma
Intracranial neoplasm
Depression
Delirium
B12 deficiency
Neurosyphilis
*
CBC
Electrolytes, calcium
Serum B12
VDRL/RPR
MRI—brain (preferred)
CT—head
EEG
LP—CSF analysis
Brain biopsy |
|
|
Term
70 yo insulin-dependent diabetic M presents with
episodes of confusion, dizziness, palpitations, diaphoresis,
and weakness. |
|
Definition
Hypoglycemia
Transient ischemic attack
Arrhythmia
Delirium
Angina
*
Glucose
CBC
Electrolytes
CPK-MB, troponin
Echocardiography
ECG
MRI—brain
Doppler U/S—carotid |
|
|
Term
55 yo F presents with gradual altered mental status
and headache. Two weeks ago she slipped, hit her
head on the ground, and lost consciousness for 2
minutes. |
|
Definition
Subdural hematoma
SIADH (causing
hyponatremia)
Creutzfeldt-Jakob disease
Intracranial neoplasm
*
CT—head
CBC
Electrolytes
MRI—brain
LP—CSF analysis |
|
|
Term
LOSS OF VISION
Key History
Acute vs. chronic, progression, ability to see light; associated symptoms (eye pain, discharge, itching, tearing, photophobia,
redness, headache, weakness, numbness, floaters, sparks); history of cardiac, rheumatic, thrombotic, autoimmune,
or neurologic disorders; jaw claudication, medications, trauma. |
|
Definition
Key Physical Exam
Vital signs; cardiovascular, HEENT, funduscopic, and neurologic exams. |
|
|
Term
73 yo M presents with acute loss of vision in his left
eye, palpitations, and shortness of breath. He has a
history of atrial fibrillation and cataracts in his right
eye. He has no eye pain, discharge, redness, or photophobia.
He has not experienced headache, weakness,
or numbness. |
|
Definition
Retinal artery occlusion
Retinal vein occlusion
Acute angle-closure
glaucoma
Retinal detachment
Temporal arteritis (giant
cell arteritis)
*
Fluorescein angiogram
Echocardiography
Doppler U/S—carotid
Intraocular tonometry
ESR
Temporal artery biopsy
CBC |
|
|
Term
DEPRESSED MOOD
Key History
Onset, duration; sleep patterns; appetite and weight change; drug and alcohol use; life stresses, excessive guilt, suicidality,
social function, decreased interest (anhedonia), decreased energy, decreased concentration, psychomotor
agitation or retardation; family history of mood disorders; prior episodes; medications. |
|
Definition
Key Physical Exam
Vital signs; head and neck exam; neurologic exam; mental status exam, including documentation of appearance,
behavior, speech, mood, affect, thought process, thought content, cognition (measured by the 30-point mini-mental
status exam), insight, and judgment. |
|
|
Term
68 yo M presents with a 2-month history of crying
spells, excessive sleep, poor hygiene, and a 15-lb
(6.8-kg) weight loss, all following his wife’s death.
He cannot enjoy time with his grandchildren and
admits to thinking he has seen his dead wife in line
at the supermarket or standing in the kitchen making
dinner. |
|
Definition
Normal bereavement
Adjustment disorder with
depressed mood
Major depressive disorder
with psychotic features
Schizoaffective disorder
Depressive disorder not
otherwise specified
*
Physical exam
TSH
CBC
Urine toxicology
Beck Depression
Inventory |
|
|
Term
42 yo F presents with a 4-week history of excessive
fatigue, insomnia, and anhedonia. She states that
she thinks constantly about death. She has suffered
5 similar episodes in the past, the first in her 20s, and
has made 2 previous suicide attempts. She further
admits to increased alcohol use in the past month. |
|
Definition
Major depressive disorder
Substance-induced mood
disorder
Dysthymic disorder
*
Physical exam
Mental status exam
Beck Depression
Inventory
Blood alcohol level
TSH
CBC
Urine toxicology |
|
|
Term
26 yo F presents with a 6.5-lb (2.9-kg) weight loss in
the past 2 months, accompanied by early-morning
awakening, excessive guilt, and psychomotor retardation.
She does not identify a trigger for the depressive
episode but reports several weeks of increased
energy, sexual promiscuity, irresponsible spending,
and racing thoughts approximately 6 months before
her presentation. |
|
Definition
Bipolar I disorder
Bipolar II disorder
Cyclothymic disorder
Major depressive disorder
Schizoaffective disorder
*
Physical exam
Mental status exam
Urine toxicology |
|
|
Term
PSYCHOSIS
Key History
Positive symptoms (delusions, hallucinations, disorganized thoughts, disorganized or catatonic behavior), negative
symptoms (blunted affect, social withdrawal, decreased motivation, decreased speech/thought), cognitive symptoms
(disorganized speech or thought patterns, paranoia); age at first symptoms and/or hospitalization; previous psychiatric
medications; alcohol and substance use. |
|
Definition
Key Physical Exam
Vital signs; mental status exam; during physical exam, pay particular attention to general appearance (eg, poor
grooming, odd or poorly fitting clothing). |
|
|
Term
19 yo M c/o receiving messages from his television
set. He reports that he did not have many friends
in high school. In college, he started to suspect his
roommate of bugging the phone. He stopped going
to classes because he felt that his professors were
saying horrible things about him that no one else
noticed. He rarely showered or left his room and has
recently been hearing a voice from his television set
telling him to “guard against the evil empire.” |
|
Definition
Schizophrenia
Schizoid or schizotypal
personality disorder
Schizophreniform disorder
Psychotic disorder due
to a general medical
condition
Substance-induced
psychosis
Depression with psychotic
features
*
Mental status exam
Urine toxicology
TSH
CBC
Electrolytes |
|
|
Term
28 yo F c/o seeing bugs crawling on her bed for the
past 2 days and hearing loud voices when she is
alone in her room. She has never experienced anything
similar in the past. She recently ingested an
unknown substance. |
|
Definition
Substance-induced
psychosis
Brief psychotic disorder
Schizophreniform disorder
Schizophrenia
Psychotic disorder due
to a general medical
condition
*
Urine toxicology
Mental status exam
TSH
CBC
Electrolytes, BUN/Cr
AST/ALT |
|
|
Term
48 yo F presents with a 1-week history of auditory
hallucinations that state, “I am worthless” and “I
should kill myself.” She also reports a 2-week history
of weight loss, early-morning awakening, decreased
motivation, and overwhelming feelings of guilt. |
|
Definition
Schizoaffective disorder
Mood disorder with
psychotic features
Schizophrenia
Schizophreniform disorder
Psychotic disorder due
to a general medical
condition
*
Mental status exam
Beck Depression
Inventory
TSH
CBC
Electrolytes |
|
|
Term
DIZZINESS
Key History
Lightheadedness vs. vertigo, ± auditory symptoms (hearing loss, tinnitus), duration of episodes, context (occurs with
positioning, following head trauma); other associated symptoms (visual disturbance, URI, nausea); neck pain or injury;
medications; history of atherosclerotic vascular disease. |
|
Definition
Key Physical Exam
Vital signs; complete neurologic exam, including Romberg test, nystagmus, tilt test (eg, Dix-Hallpike maneuver),
gait, hearing, and Weber and Rinne tests; ENT exam; cardiovascular exam. |
|
|
Term
35 yo F presents with intermittent episodes of vertigo,
tinnitus, nausea, and hearing loss within the
past week. |
|
Definition
Ménière’s disease
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Acoustic neuroma
*
CBC
VDRL/RPR (syphilis is
a cause of Ménière’s
disease)
MRI—brain
Dix-Hallpike maneuver |
|
|
Term
55 yo F c/o dizziness for the past day. She feels faint
and has severe diarrhea that started 2 days ago. She
takes furosemide for hypertension. |
|
Definition
Orthostatic hypotension
due to dehydration
(diarrhea, diuretic use)
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Vertebrobasilar
insufficiency
*
Orthostatic vital signs
CBC
Electrolytes
Rectal exam, stool for
occult blood
Stool leukocytes |
|
|
Term
65 yo M presents with postural dizziness and unsteadiness.
He has hypertension and was started on
hydrochlorothiazide 2 days ago. |
|
Definition
Drug-induced orthostatic
hypotension
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Brain stem or cerebellar
tumor
Acute renal failure
*
Orthostatic vital signs
CBC
Electrolytes
Echocardiography
MRI—brain |
|
|
Term
44 yo F c/o dizziness on moving her head to the left.
She feels that the room is spinning around her head.
A tilt test results in nystagmus and nausea. |
|
Definition
Benign positional vertigo
Vestibular neuronitis
Labyrinthitis
Ménière’s disease
*
Dix-Hallpike maneuver
MRI—brain
Audiogram |
|
|
Term
55 yo F c/o dizziness that started this morning. She
is nauseated and has vomited once in the past day.
She had a URI 2 days ago and has experienced no
hearing loss. |
|
Definition
Vestibular neuronitis
Labyrinthitis
Ménière’s disease
Benign positional vertigo
Vertigo associated with
cervical spine disease or
injury
Vertebrobasilar
insufficiency
*
CBC
Electrolytes
Electronystagmography
MRI/MRA—brain |
|
|
Term
55 yo F c/o dizziness that started this morning and
of “not hearing well.” She feels nauseated and has
vomited once in the past day. She had a URI 2 days
ago. |
|
Definition
Labyrinthitis
Vestibular neuronitis
Ménière’s disease
Acoustic neuroma
Vertebrobasilar
insufficiency
*
Audiogram
Electronystagmography
MRI/MRA—brain |
|
|
Term
LOSS OF CONSCIOUSNESS
Key History
Presence or absence of preceding symptoms (nausea, diaphoresis, palpitations, pallor, lightheadedness), context (exertional,
postural, traumatic; stressful, painful, or claustrophobic experience; dehydration); associated tongue biting
or incontinence, tonic-clonic movements, prolonged confusion; dyspnea or pulmonary embolism risk factors; history
of heart disease, arrhythmia, hypertension, or diabetes; alcohol and drug use. |
|
Definition
Key Physical Exam
Vital signs, including orthostatics; complete neurologic exam; carotid and cardiac exam; lung exam; exam of the
lower extremities. |
|
|
Term
26 yo M presents after falling and losing consciousness
at work. He had rhythmic movements of the
limbs, bit his tongue, and lost control of his bladder.
He was subsequently confused after regaining consciousness
(as witnessed by his colleagues). |
|
Definition
Generalized tonic-clonic
seizure
Convulsive syncope
Substance abuse/overdose
Malingering
Hypoglycemia
*
CBC
Electrolytes, glucose
Urine toxicology
EEG
MRI—brain
CT—head
LP—CSF analysis
ECG |
|
|
Term
55 yo M c/o falling after feeling dizzy and unsteady.
He experienced transient loss of consciousness. His
past medical history is significant for hypertension
and diabetes mellitus. |
|
Definition
Drug-induced orthostatic
hypotension (causing
syncope)
Hypoglycemia
Cardiac arrhythmia
Syncope (vasovagal, other
causes)
Stroke
MI
Pulmonary embolism
*
Orthostatic vital signs
CBC
Electrolytes, glucose
Echocardiography
CT—head
ECG
V/Q scan
CTA—chest with IV
contrast
D-dimer |
|
|
Term
65 yo M presents after falling and losing consciousness
for a few seconds. He had no warning before
passing out but recently had palpitations. His history
includes a coronary artery bypass graft. |
|
Definition
Cardiac arrhythmia
(causing syncope)
Severe aortic stenosis
Syncope (other causes)
Seizure
Pulmonary embolism
*
ECG
Holter monitoring
CBC
Electrolytes, glucose
Echocardiography
CT—head |
|
|
Term
NUMBNESS/WEAKNESS
Key History
Distribution (unilateral, bilateral, proximal, distal), duration, ± progression, pain (especially headache, neck or back
pain); constitutional symptoms, other neurologic symptoms; history of diabetes, alcoholism, atherosclerotic vascular
disease. |
|
Definition
Key Physical Exam
Vital signs; neurologic and musculoskeletal exams; relevant vascular exam. |
|
|
Term
68 yo M presents following a 20-minute episode of
slurred speech, right facial drooping and numbness,
and right hand weakness. His symptoms had totally
resolved by the time he got to the emergency department.
He has a history of hypertension, diabetes
mellitus, and heavy smoking. |
|
Definition
Transient ischemic attack
(TIA)
Hypoglycemia
Seizure
Stroke
Facial nerve palsy
*
CT—head
CBC
Electrolytes, glucose
Fasting lipid panel
ECG
MRI—brain
Doppler U/S—carotid
Echocardiography
EEG |
|
|
Term
68 yo M presents with slurred speech, right facial
drooping and numbness, and right hand weakness.
Babinski’s sign is present on the right. He has a history
of hypertension, diabetes mellitus, and heavy
smoking. |
|
Definition
Stroke
TIA
Seizure
Intracranial neoplasm
Subdural or epidural
hematoma
*
CT—head
CBC
Electrolytes
PT/PTT/INR
Fasting lipid panel
MRI—brain
Doppler U/S—carotid
Echocardiography
ECG |
|
|
Term
33 yo F presents with ascending loss of strength in
her lower legs over the past 2 weeks. She had a recent
URI. |
|
Definition
Guillain-Barré syndrome
Multiple sclerosis
Polymyositis
Myasthenia gravis
Peripheral neuropathy
Tumor in the vertebral
canal
*
CBC
Electrolytes
CPK
LP—CSF analysis
MRI—spine
EMG
Nerve conduction studies
Tensilon (edrophonium)
test
Serum B12 |
|
|
Term
30 yo F presents with weakness, loss of sensation,
and tingling in her left leg that started this morning.
She is also experiencing right eye pain, decreased vision,
and double vision. She reports feeling “electric
shocks” down her spine upon flexing her head. |
|
Definition
Multiple sclerosis
Stroke
Conversion disorder
Malingering
CNS tumor
Neurosyphilis
Syringomyelia
CNS vasculitis
*
CBC
ESR
VDRL/RPR
MRI—brain, spine
LP—CSF analysis
Retinal evoked potentials |
|
|
Term
55 yo M presents with tingling and numbness in his
hands and feet (glove-and-stocking distribution)
for the past 2 months. He has a history of diabetes
mellitus, hypertension, and alcoholism. There is decreased
soft touch, vibratory, and position sense in
the feet. |
|
Definition
Diabetic peripheral
neuropathy
Alcoholic peripheral
neuropathy
B12 deficiency
Hypocalcemia
Hyperventilation
Paraproteinemia/myeloma
*
HbA1c
ESR
Calcium
Serum B12
UA
Serum and urine protein
electrophoresis |
|
|
Term
40 yo F presents with occasional double vision and
droopy eyelids at night with normalization by morning. |
|
Definition
Myasthenia gravis
Horner’s syndrome
Multiple sclerosis
Intracranial neoplasm
compressing CN III, IV,
or VI
Amyotrophic lateral
sclerosis
*
Tensilon (edrophonium)
test
Serum ACh receptor
antibodies
CXR
CT—chest
MRI—brain
EMG |
|
|
Term
25 yo M presents with hemiparesis after a tonicclonic
seizure that resolved within a few hours. |
|
Definition
Todd’s paralysis
TIA
Stroke
Complicated migraine
Malingering
*
CBC
Electrolytes
EEG
MRI—brain
Doppler U/S—carotid |
|
|
Term
56 yo obese F c/o tingling and numbness of her
thumb, index finger, and middle finger for the past
5 months. Her symptoms are constant, have progressively
worsened, and are relieved with rest. She
works as a secretary. She has a history of fatigue and
a 20-lb (9-kg) weight gain over the same period. |
|
Definition
Carpal tunnel syndrome
secondary to
hypothyroidism
Overuse injury of median
nerve
Medial epicondylitis
*
Phalen’s maneuver and
Tinel’s sign
Nerve conduction studies
TSH
CBC |
|
|
Term
FATIGUE AND SLEEPINESS
Key History
Duration; sleep hygiene, snoring, waking up choking/gasping, witnessed apnea; overexertion; stress, depression, or
other emotional problems; lifestyle changes, shift changes at work; diet, weight changes; other constitutional symptoms;
symptoms of thyroid disease; history of bleeding or anemia; medications; alcohol, caffeine, and drug use. |
|
Definition
Key Physical Exam
Vital signs; ENT exam (conjunctival pallor, oropharynx/palate, lymphadenopathy, thyroid exam); heart, lung, abdominal,
neurologic, and extremity (pallor, coolness at distal extremities) exams; consider rectal exam and occult
blood testing. |
|
|
Term
40 yo F c/o feeling tired, hopeless, and worthless and
of having suicidal thoughts. She lost her job and has
been having fights with her husband about money. |
|
Definition
Depression
Adjustment disorder
Hypothyroidism
Anemia
*
CBC
TSH
HIV/STD testing
Beck Depression
Inventory |
|
|
Term
44 yo M presents with fatigue, insomnia, and nightmares
about a murder that he witnessed in a mall 1
year ago. Since then, he has avoided the mall and
has not gone out at night. |
|
Definition
Posttraumatic stress
disorder
Depression
Generalized anxiety
disorder
Psychotic or delusional
disorder
Hypothyroidism
*
CBC
TSH
Urine toxicology
Beck Depression
Inventory |
|
|
Term
55 yo M presents with fatigue, weight loss, and constipation.
He has a family history of colon cancer. |
|
Definition
Colon cancer
Hypothyroidism
Renal failure
Hypercalcemia
Depression
*
Rectal exam, stool for
occult blood
CBC
Electrolytes, BUN/Cr,
calcium
AST/ALT
TSH
Colonoscopy
Barium enema
CT—abdomen/pelvis |
|
|
Term
40 yo F presents with fatigue, weight gain, sleepiness,
cold intolerance, constipation, and dry skin. |
|
Definition
Hypothyroidism
Depression
Diabetes
Anemia
*
TSH, FT3, FT4
CBC
Fasting glucose
HbA1c |
|
|
Term
50 yo obese F presents with fatigue and daytime
sleepiness. She snores heavily and naps 3–4 times
per day but never feels refreshed. She also has hypertension. |
|
Definition
Obstructive sleep apnea
Hypothyroidism
Chronic fatigue syndrome
Narcolepsy
*
CBC
TSH
Nocturnal pulse oximetry
Polysomnography
ECG |
|
|
Term
20 yo M presents with fatigue, thirst, increased appetite,
and polyuria. |
|
Definition
Diabetes mellitus
Atypical depression
Primary polydipsia
Diabetes insipidus
*
Glucose tolerance test
HbA1c
UA
CBC
Electrolytes, BUN/Cr,
glucose |
|
|
Term
35 yo M policeman c/o feeling tired and sleepy during
the day. He changed to the night shift last week. |
|
Definition
Shift work sleep disorder
Sleep apnea
Depression
Anemia
*
CBC
Nocturnal pulse oximetry
Polysomnography |
|
|
Term
NIGHT SWEATS
Key History
Onset, duration, severity, frequency, timing, patterns (escalating, waxing, waning), precipitants (eg, food, medications);
associated diseases and symptoms (fever, recent URIs, associated cough, hemoptysis, pleuritic chest pain);
lymphadenopathy, rash, malaise, weight loss, itching, diarrhea, nausea/vomiting, early satiety, anorexia; presence of
significant risk factors (eg, traveling to areas with endemic infections, IV drug use); alcohol history, sexual exposure,
sick contacts, exposure to high-risk populations such as prisoners or homeless people; menstrual history, menopausal
status, travel history. |
|
Definition
Key Physical Exam
Vital signs; HEENT exam, including inspection of the throat and other areas for lymphadenopathy; heart and lung
exam; abdominal exam for hepatosplenomegaly; skin exam; musculoskeletal exam for joint pain. |
|
|
Term
30 yo M presents with night sweats, cough, and
swollen glands of 1 month’s duration. He recently
emigrated from the African subcontinent. |
|
Definition
Tuberculosis
Acute HIV infection
Lymphoma
Leukemia
Hyperthyroidism
*
PPD/QuantiFERON Gold
CBC
CXR
Sputum Gram stain, acidfast
stain, and culture
HIV antibody
TSH, FT4 |
|
|
Term
45 yo F presents with excessive sweating, unintentional
weight loss, palpitations, diarrhea, and shortness
of breath. |
|
Definition
Hyperthyroidism
Pheochromocytoma
Carcinoid syndrome
Tuberculosis
*
TSH, FT4
24-hour urinary
catecholamines
5-HIAA
CBC
PPD |
|
|
Term
INSOMNIA
Key History
Primary vs. secondary, duration, description (trouble falling asleep vs. multiple awakenings vs. early-morning awakening);
daytime sleepiness; other medical problems keeping patient awake at night, such as arthritis (pain) or diabetes
(polyuria); evidence of a common sleep disorder (eg, sleep apnea, restless leg syndrome); associated symptoms,
including loud snoring, nightmares, and depression; caffeine, alcohol, medication, and recreational drug use; work
or lifestyle (jet lag or shift work), stressors, sleep hygiene; presence of psychiatric symptoms (eg, grandiose delusions,
irritability). |
|
Definition
Key Physical Exam
Vital signs; mental status exam; thyroid exam. |
|
|
Term
25 yo F presents with a 3-week history of difficulty
falling asleep. She sleeps 7 hours per night without
nightmares or snoring. She recently began college
and is having trouble with her boyfriend. She drinks
3–4 cups of coffee a day. |
|
Definition
Stress-induced insomnia
Caffeine-induced
insomnia
Insomnia with circadian
rhythm sleep disorder
Insomnia related to major
depressive disorder
*
Polysomnography
Mental status exam
Urine toxicology
CBC
TSH |
|
|
Term
55 yo obese M presents with several months of poor
sleep, daytime fatigue, and morning headaches. His
wife reports that he snores loudly. |
|
Definition
Obstructive sleep apnea
Daytime fatigue in primary
hypersomnia
Insomnia with circadian
rhythm sleep disorder
Insomnia related to major
depressive disorder
*
CBC
TSH
Polysomnography
ECG |
|
|
Term
33 yo F c/o 3 weeks of fatigue and trouble sleeping.
She states that she falls asleep easily but wakes up at
3 A.M. and cannot return to sleep. She also reports
an unintentional weight loss of 8 lbs (3.6 kg) and an
inability to enjoy the things she once liked to do. |
|
Definition
Insomnia related to major
depressive disorder
Primary hypersomnia
Insomnia with circadian
rhythm sleep disorder
*
Mental status exam
TSH
CBC
Polysomnography |
|
|
Term
SORE THROAT
Key History
Duration, fever, other ENT symptoms (ear pain, nasal or sinus congestion), odynophagia, swollen glands, ± cough,
rash; sick contacts, HIV risk factors. |
|
Definition
Key Physical Exam
Vital signs; ENT exam, including oral thrush, tonsillar exudate, and lymphadenopathy; lung, abdominal (focusing
on splenomegaly), and skin exams. |
|
|
Term
26 yo F presents with sore throat, fever, severe fatigue,
and loss of appetite for the past week. She
also reports epigastric and LUQ discomfort. She has
cervical lymphadenopathy and a rash. Her boyfriend
recently experienced similar symptoms. |
|
Definition
Infectious mononucleosis
Hepatitis
Viral or bacterial
pharyngitis
Acute HIV infection
Secondary syphilis
*
CBC with peripheral
smear
Monospot test
Throat culture
AST/ALT/bilirubin/
alkaline phosphatase
HIV antibody and viral
load
Anti-EBV antibodies
VDRL/RPR |
|
|
Term
26 yo M presents with sore throat, fever, rash, and
weight loss. He has a history of IV drug abuse and
sharing needles. |
|
Definition
HIV, acute retroviral
syndrome
Infectious mononucleosis
Hepatitis
Viral pharyngitis
Streptococcal tonsillitis/
scarlet fever
Secondary syphilis
*
CBC with peripheral
smear
HIV antibody and viral
load
CD4 count
Monospot test
Throat culture
VDRL/RPR
AST/ALT/bilirubin/
alkaline phosphatase |
|
|
Term
| 46 yo F presents with fever and sore throat. |
|
Definition
Pharyngitis (bacterial or
viral)
Mycoplasma pneumonia
Acute HIV infection
Infectious mononucleosis
*
Throat swab for culture
and rapid streptococcal
antigen
Monospot test
CBC
Serologic test (cold
agglutinin titer) for
Mycoplasma
HIV antibody and viral
load |
|
|
Term
COUGH/SHORTNESS OF BREATH
Key History
Acute/subacute vs. chronic, increased frequency of cough if chronic, timing; presence/description of sputum, presence
of hemoptysis; associated symptoms (constitutional, URI, postnasal drip, dyspnea, wheezing, chest pain, heartburn);
exacerbating and alleviating factors, exposures; smoking history; history of lung disease, posttussive emesis, or
heart failure; allergies; medications (especially ACE inhibitors). |
|
Definition
Key Physical Exam
Vital signs ± pulse oximetry; exam of nasal mucosa, oropharynx, heart, lungs, lymph nodes, and extremities (clubbing,
cyanosis, edema). |
|
|
Term
30 yo M presents with shortness of breath, cough,
and wheezing that worsen in cold air. He has had
several such episodes in the past 4 months. |
|
Definition
Asthma
GERD
Bronchitis
Pneumonitis
Foreign body
*
CBC
CXR
Peak flow measurement
PFTs
Methacholine challenge
test |
|
|
Term
56 yo F presents with shortness of breath and a productive
cough that has lasted for at least 3 months
each year over the past 2 years. She is a heavy
smoker. |
|
Definition
COPD—chronic
bronchitis
Bronchiectasis
Lung cancer
Tuberculosis
*
CBC
Sputum Gram stain and
culture
CXR
PFTs
CT—chest
PPD |
|
|
Term
58 yo M presents with 1 week of pleuritic chest pain,
fever, chills, and cough with purulent yellow sputum.
He is a heavy smoker with COPD. |
|
Definition
Pneumonia
COPD exacerbation
(bronchitis)
Lung abscess
Lung cancer
Tuberculosis
Pericarditis
*
CBC
Sputum Gram stain and
culture
CXR
CT—chest
ECG
PPD |
|
|
Term
25 yo F presents with 2 weeks of nonproductive
cough. Three weeks ago she had a sore throat and a
runny nose. |
|
Definition
Atypical pneumonia
Reactive airway disease
URI-associated cough
(“postinfectious”)
Postnasal drip
GERD
*
CBC
Induced sputum Gram
stain and culture
CXR
IgM detection for
Mycoplasma pneumoniae
Urine Legionella antigen |
|
|
Term
65 yo M presents with worsening cough for the past
6 months accompanied by hemoptysis, dyspnea,
weakness, and weight loss. He is a heavy smoker. |
|
Definition
Lung cancer
Tuberculosis
Lung abscess
COPD
Vasculitis (eg, Wegener’s
granulomatosis)
Interstitial lung disease
CHF
*
CBC
Sputum Gram stain,
culture, and cytology
CXR
CT—chest
PPD
ANCA
Bronchoscopy
Echocardiography |
|
|
Term
55 yo M presents with increased dyspnea and sputum
production for the past 3 days. He has COPD
and stopped using his inhalers last week. He stopped
smoking 2 days ago. |
|
Definition
COPD exacerbation
(bronchitis)
Lung cancer
Pneumonia
URI
CHF
*
CBC
CXR
ABG
PFTs
Sputum Gram stain and
culture
CT—chest
Echocardiography |
|
|
Term
34 yo F nurse presents with worsening cough of 6
weeks’ duration accompanied by weight loss, fatigue,
night sweats, and fever. She has a history of contact
with tuberculosis patients at work. |
|
Definition
Tuberculosis
Pneumonia
Lung abscess
Vasculitis
Lymphoma
Metastatic cancer
HIV/AIDS
Sarcoidosis
*
CBC
PPD/QuantiFERON Gold
Sputum Gram stain, acidfast
stain, and culture
CXR
CT—chest
Bronchoscopy
HIV antibody
Lymph node biopsy |
|
|
Term
35 yo M presents with shortness of breath and cough.
He has had unprotected sex with multiple sexual
partners and was recently exposed to a patient with
active tuberculosis. |
|
Definition
Tuberculosis
Pneumonia (including
Pneumocystis jiroveci)
Bronchitis
Asthma
Acute HIV infection
CHF (cardiomyopathy)
*
CBC
PPD/QuantiFERON Gold
Sputum Gram stain, acidfast
stain, silver stain,
and culture
CXR
HIV antibody
Echocardiography |
|
|
Term
50 yo M presents with a cough that is exacerbated by
lying down at night and improved by propping up on
3 pillows. He also reports exertional dyspnea. |
|
Definition
CHF
Cardiac valvular disease
GERD
Pulmonary fibrosis
COPD
Postnasal drip
*
CBC
CXR
ECG
Echocardiography
PFTs
BNP
CT—chest |
|
|
Term
60 yo M presents with worsening dyspnea of 6 hours’
duration and a cough that is accompanied by pink,
frothy sputum. |
|
Definition
Pulmonary edema
CHF
Mitral valve stenosis
Arrhythmia
Asthma
Pneumonia
*
ECG
CXR
CBC
ABG
PFTs
BNP |
|
|
Term
CHEST PAIN
Key History
Location, quality, severity, radiation, duration, context (exertional, postprandial, positional, cocaine use, trauma);
associated symptoms (sweating, nausea, dyspnea, palpitations, sense of doom, fever); exacerbating and alleviating
factors (especially medications); history of similar symptoms; known heart or lung disease or history of diagnostic
testing; cardiac risk factors (hypertension, hyperlipidemia, smoking, family history of early MI); pulmonary embolism
risk factors (history of DVT, coagulopathy, malignancy, recent immobilization). |
|
Definition
Key Physical Exam
Vital signs ± BP in both arms; complete cardiovascular exam (JVD, PMI, chest wall tenderness, heart sounds, pulses,
edema); lung and abdominal exams; lower extremity exam (inspection for signs of DVT). |
|
|
Term
60 yo M presents with sudden onset of substernal
heavy chest pain that has lasted for 30 minutes and
radiates to the left arm. The pain is accompanied by
dyspnea, diaphoresis, and nausea. He has a history of
hypertension, hyperlipidemia, and smoking. |
|
Definition
Myocardial infarction
(MI)
GERD
Angina
Costochondritis
Aortic dissection
Pericarditis
Pulmonary embolism
Pneumothorax
*
ECG
CPK-MB, troponin × 3
CXR
CBC
Electrolytes
Echocardiography
Cardiac catheterization
D-dimer
Helical CT |
|
|
Term
20 yo African American F presents with acute onset
of severe chest pain for a few hours. She has a history
of sickle cell disease and multiple hospitalizations for
pain and anemia management. |
|
Definition
Sickle cell disease—acute
chest syndrome
Pulmonary embolism
Pneumonia
MI
Pneumothorax
Aortic dissection
*
CBC with reticulocyte
count and peripheral
smear
LDH
ABG
D-dimer
CXR
CPK-MB, troponin
ECG
CTA—chest with IV
contrast |
|
|
Term
45 yo F presents with a retrosternal burning sensation
that occurs after heavy meals and when lying
down. Her symptoms are relieved by antacids |
|
Definition
GERD
Esophagitis
Peptic ulcer disease
Esophageal spasm
MI
Angina
*
ECG
Barium swallow
Upper endoscopy
Esophageal pH monitoring |
|
|
Term
55 yo M presents with retrosternal squeezing pain
that lasts for 2 minutes and occurs with exercise. It
is relieved by rest and is not related to food intake. |
|
Definition
Stable angina
Esophageal spasm
Esophagitis
*
ECG
CPK-MB, troponin
CXR
CBC
Electrolytes
Exercise stress test
Upper endoscopy/pH
monitor
Cardiac catheterization |
|
|
Term
34 yo F presents with retrosternal stabbing chest pain
that improves when she leans forward and worsens
with deep inspiration. She had a URI 1 week ago. |
|
Definition
Pericarditis
Aortic dissection
MI
Costochondritis
GERD
Esophageal rupture
*
ECG
CPK-MB, troponin
CXR
Echocardiography
CBC
Upper endoscopy
ESR |
|
|
Term
33 yo F presents with stabbing chest pain that worsens
with deep inspiration and is relieved by aspirin.
She had a URI 1 week ago. Chest wall tenderness is
noted. |
|
Definition
Costochondritis
Pneumonia
MI
Pulmonary embolism
Pericarditis
Pleurisy
Muscle strain
*
ECG
CPK-MB, troponin
CXR
CBC |
|
|
Term
70 yo F presents with acute onset of shortness of
breath at rest and pleuritic chest pain. She also presents
with tachycardia, hypotension, tachypnea, and
mild fever. She is recovering from hip replacement
surgery. |
|
Definition
Pulmonary embolism
Pneumonia
Costochondritis
MI
CHF
Aortic dissection
*
D-dimer
ECG
CXR
ABG
CPK-MB, troponin
CBC
Electrolytes, BUN/Cr,
glucose
CTA—chest with IV
contrast
Doppler U/S—legs |
|
|
Term
55 yo M presents with sudden onset of severe chest
pain that radiates to his back. He has a history of
uncontrolled hypertension. |
|
Definition
Aortic dissection
MI
Pericarditis
Esophageal rupture
Esophageal spasm
GERD
Pancreatitis
Fat embolism
*
ECG
CPK-MB, troponin
CXR
CBC
Amylase, lipase
CTA—chest with IV
contrast
Transesophageal
echocardiography
(TEE)
MRI/MRA—aorta
Aortic angiography
Upper endoscopy |
|
|
Term
PALPITATIONS
Key History
Gradual vs. acute onset/offset, context (exertion, caffeine, anxiety); associated symptoms (lightheadedness, loss of
consciousness, chest pain, dyspnea, fever, sweating, pale skin, flushing, diarrhea); hyperthyroid symptoms; history of
bleeding or anemia; history of heart disease, hypertension, or diabetes. |
|
Definition
Key Physical Exam
Vital signs; endocrine/thyroid exam, including exophthalmos, lid retraction, lid lag, gland size, bruit, and tremor;
complete cardiovascular exam. |
|
|
Term
70 yo diabetic M presents with episodes of palpitations
and diaphoresis. He is on insulin. |
|
Definition
Hypoglycemia
Cardiac arrhythmia
Angina
Hyperthyroidism
Hyperventilation episodes
Panic attack
Pheochromocytoma
Carcinoid syndrome
*
Glucose
CBC
Electrolytes
TSH
ECG
Holter monitor
24-hour urinary
catecholamines
5-HIAA |
|
|
Term
35 yo M presents with several episodes of palpitations,
sweating, and rapid breathing. Episodes occur
unexpectedly, and he does not recall any triggers. He
has had 4–5 episodes per month for several months.
Each episode lasts 2–3 minutes. He does not have
any history of psychiatric illness except for separation
anxiety as a child. |
|
Definition
Panic attack
Generalized anxiety
disorder
Acute stress disorder
Specific phobia
Hyperthyroidism
Agoraphobia
Substance abuse/
dependence
Mitral valve prolapse
Pheochromocytoma
*
CBC
Electrolytes
TSH, FT4
ECG
Echocardiography
Urine toxicology
24-hour urinary
catecholamines |
|
|
Term
19 yo F presents with episodic palpitations, especially
during presentations in front of her class. Episodes
include heart pounding, facial blushing, and hand
tremor. She also experiences excessive sweating and
rapid breathing. She complains of intense worry and
trouble sleeping for days or weeks before an upcoming
social situation. Now she avoids all social events
because she is afraid of humiliating herself. |
|
Definition
Social phobia
Avoidant personality
disorder
Agoraphobia/specific
phobia
Panic attack
Generalized anxiety
disorder
Substance abuse/
dependence
Hyperthyroidism
*
CBC
Electrolytes
ECG
Echocardiography
TSH, FT4
Mental status exam |
|
|
Term
34 yo F presents with episodic palpitations accompanied
by lightheadedness and sharp, atypical chest
pain. |
|
Definition
Mitral valve prolapse
Cardiac arrhythmia
Panic attack
Pheochromocytoma
*
ECG
Echocardiography
Holter monitor
24-hour urinary
catecholamines |
|
|
Term
WEIGHT LOSS
Key History
Amount, duration, ± intention; diet and exercise history; body image, anxiety or depression; other constitutional
symptoms; hyperthyroid symptoms (palpitations, tremor, diarrhea); family history of thyroid disease; HIV risk factors;
tobacco, alcohol, and drug use; medications; history of cancer; blood in urine or stool. |
|
Definition
Key Physical Exam
Vital signs; complete physical. |
|
|
Term
42 yo F presents with a 15.5-lb (7-kg) weight loss
within the past 2 months. She has a fine tremor, and
her pulse is 112. |
|
Definition
Hyperthyroidism
Cancer
HIV infection
Dieting/diet drugs
Anorexia nervosa
Malabsorption
*
TSH, FT4
CBC
Electrolytes
HIV antibody
Urine toxicology |
|
|
Term
WEIGHT GAIN
Key History
Amount, duration, timing (relation to medication changes, smoking cessation, depression); diet history; hypothyroid
symptoms (fatigue, constipation, skin/hair/nail changes); menstrual irregularity, hirsutism; medical history; alcohol
and drug use. |
|
Definition
Key Physical Exam
Vital signs; complete exam, including signs of Cushing’s syndrome (hypertension, central obesity, moon face, buffalo
hump, supraclavicular fat pads, purple abdominal striae); edema resulting from water retention in renal disease. |
|
|
Term
44 yo F presents with a weight gain of > 25 lbs (11.3
kg) within the past 2 months. She quit smoking 3
months ago and is on amitriptyline for depression.
She also reports cold intolerance and constipation. |
|
Definition
Smoking cessation
Drug side effect
Hypothyroidism
Cushing’s syndrome
Polycystic ovary syndrome
Diabetes mellitus
Atypical depression
*
CBC
Electrolytes, glucose
TSH
24-hour urine free cortisol
Dexamethasone
suppression test |
|
|
Term
30 yo F presents with weight gain over the past 3
months. She also reports tremor, palpitations, anxiety,
and hunger that is relieved by eating. She exhibits
proximal muscle weakness and easy bruising. |
|
Definition
Insulinoma
Reactive postprandial
hypoglycemia
Cushing’s syndrome
*
Blood glucose and plasma
insulin
Glucose tolerance test
24-hour urine free cortisol |
|
|
Term
DYSPHAGIA
Key History
Solids or liquids vs. both solids and liquids, ± progression, occurring at the beginning or middle of swallow; constitutional
symptoms (especially weight loss); hoarseness, drooling, regurgitation of liquids vs. undigested food, odynophagia,
GERD symptoms; medications; HIV risk factors; history of anxiety, smoking, Raynaud’s phenomenon. |
|
Definition
Key Physical Exam
Vital signs; head and neck exam; heart, lung, and abdominal exams; skin exam (for signs of scleroderma/CREST). |
|
|
Term
75 yo M presents with dysphagia that started with
solids and progressed to liquids. He is an alcoholic
and a heavy smoker. He has had an unintentional
weight loss of 15 lbs (6.8 kg) within the past 4
months. |
|
Definition
Esophageal cancer
Achalasia
Esophagitis
Systemic sclerosis
Esophageal stricture
Amyotrophic lateral
sclerosis
*
CBC
CXR
Upper endoscopy with
biopsy
Barium swallow
CT—chest |
|
|
Term
45 yo F presents with dysphagia for 2 weeks accompanied
by mouth and throat pain, fatigue, and a
craving for ice and clay. |
|
Definition
Plummer-Vinson
syndrome
Esophageal cancer
Esophagitis
Achalasia
Systemic sclerosis
Mitral valve stenosis
*
CBC
Serum iron, ferritin, TIBC
Barium swallow
Upper endoscopy
Video fluoroscopy |
|
|
Term
48 yo F presents with dysphagia for both solids and
liquids that has slowly progressed in severity within
the past year. It is associated with difficulty belching
and regurgitation of undigested food, especially
at night. She has lost 5.5 lbs (2.5 kg) in the past 2
months. |
|
Definition
Achalasia
Plummer-Vinson
syndrome
Esophageal cancer
Esophagitis
Systemic sclerosis
Mitral valve stenosis
Esophageal stricture
Zenker’s diverticulum
*
CXR
Upper endoscopy
Barium swallow
Esophageal manometry
XR—neck |
|
|
Term
38 yo M presents with dysphagia and pain on swallowing
solids more than liquids. Exam reveals oral
thrush. |
|
Definition
Esophagitis (CMV, HSV,
HIV, pill-induced)
Systemic sclerosis
GERD
Esophageal stricture
Zenker’s diverticulum
*
CBC
Upper endoscopy
Barium swallow
HIV antibody and viral
load
CD4 count |
|
|
Term
NECK MASS
Key History
Onset, size, location, mobility, pain, movement with swallowing; obstructive symptoms (dysphagia, shortness of
breath); other masses; associated symptoms (constitutional, hematologic, GI, endocrine, pulmonary); ill contacts. |
|
Definition
Key Physical Exam
Vital signs; HEENT exam; exam of lymph nodes, spleen, and tonsils; heart, lung, and abdominal exams. |
|
|
Term
39 yo F presents with a single 2-cm mass on the
right side of her neck along with night sweats, fever,
weight loss, loss of appetite, and early satiety. The
mass is painless and movable and has not changed
in size. She does not report heat intolerance, tremor,
palpitations, hoarseness, cough, difficulty breathing,
difficulty swallowing, or abdominal pain. Her husband
was recently discharged from prison, and her
mother has a history of gastric cancer. |
|
Definition
Hodgkin’s/non-
Hodgkin’s lymphoma
Tuberculosis
Thyroid nodule
Gastric carcinoma
*
CBC with differential
Electrolytes
ESR, CRP
Lymph node biopsy
PPD
CXR
TSH
U/S—thyroid
Upper endoscopy |
|
|
Term
NAUSEA/VOMITING
Key History
Acuity of onset, ± abdominal pain, relation to meals, sick contacts, possible food poisoning, possible pregnancy;
neurologic symptoms (headache, stiff neck, vertigo, focal numbness or weakness); urinary symptoms; other associated
symptoms (GI, chest pain); exacerbating and alleviating factors; medications; history of prior abdominal surgery. |
|
Definition
Key Physical Exam
Vital signs; ENT; consider funduscopic exam (increased intracranial pressure); complete abdominal exam; consider
heart, lung, and rectal exams. |
|
|
Term
20 yo F presents with nausea, vomiting (especially in
the morning), fatigue, and polyuria. Her last menstrual
period was 6 weeks ago, and her breasts are
full and tender. She is sexually active with her boyfriend,
and they occasionally use condoms for contraception. |
|
Definition
Pregnancy
Gastritis
Hypercalcemia
Diabetes mellitus
UTI
Depression
*
Urine hCG
Pelvic exam
U/S—pelvis
CBC
Electrolytes, calcium,
glucose
UA, urine culture
HIV antibody |
|
|
Term
ABDOMINAL PAIN
Key History
Location, quality, intensity, duration, radiation, timing (relation to meals); associated symptoms (constitutional,
GI, cardiac, pulmonary, renal, pelvic); exacerbating and alleviating factors; history of similar symptoms; history of
abdominal surgeries, trauma, gallstones, renal stones, atherosclerotic vascular disease; medications (eg, NSAIDs,
corticosteroids); alcohol and drug use; domestic violence, stress/anxiety, sexual history, pregnancy history. |
|
Definition
Key Physical Exam
Vital signs; heart and lung exams; abdominal exam, including tenderness, guarding, rebound, Murphy’s sign, psoas
and obturator signs, and CVA percussion; bowel sounds, aortic bruits; rectal exam; pelvic exam (women). |
|
|
Term
45 yo M presents with sudden onset of colicky rightsided
flank pain that radiates to the testicles, accompanied
by nausea, vomiting, hematuria, and CVA
tenderness. |
|
Definition
Nephrolithiasis
Renal cell carcinoma
Pyelonephritis
GI etiology (eg,
appendicitis)
*
UA, urine culture and
sensitivity, urine
cytology
BUN/Cr
CT—abdomen
U/S—renal
KUB
IVP
Blood culture |
|
|
Term
60 yo M presents with dull epigastric pain that radiates
to the back, accompanied by weight loss, dark
urine, and clay-colored stool. He is a heavy drinker
and smoker. He appears jaundiced on exam. |
|
Definition
Pancreatic cancer
Cholangiocarcinoma
Acute viral hepatitis
Acute alcoholic hepatitis
Chronic pancreatitis
Cholecystitis/
choledocholithiasis
Abdominal aortic
aneurysm
Peptic ulcer disease
*
CBC
Electrolytes
Amylase, lipase
AST/ALT/bilirubin/
alkaline phosphatase
CT—abdomen
U/S—abdomen |
|
|
Term
56 yo M presents with severe midepigastric abdominal
pain that radiates to the back and improves when
he leans forward. He also reports anorexia, nausea,
and vomiting. He is an alcoholic and has spent the
past 3 days binge drinking. |
|
Definition
Acute pancreatitis
Peptic ulcer disease
Cholecystitis/
choledocholithiasis
Gastritis
Abdominal aortic
aneurysm
Mesenteric ischemia
Alcoholic hepatitis
Boerhaave syndrome
*
CBC
Electrolytes, BUN/Cr
Amylase, lipase
AST/ALT/bilirubin/
alkaline phosphatase
U/S—abdomen
CT—abdomen
Upper endoscopy
ECG |
|
|
Term
41 yo obese F presents with RUQ abdominal pain
that radiates to the right scapula and is associated
with nausea, vomiting, and a fever of 101.5°F. The
pain started after she ate fatty food. She has had similar
but less intense episodes that lasted a few hours.
Exam reveals a positive Murphy’s sign. |
|
Definition
Acute cholecystitis
Choledocholithiasis
Hepatitis
Ascending cholangitis
Peptic ulcer disease
Fitz-Hugh–Curtis
syndrome
Acute subhepatic
appendicitis
*
CBC
AST/ALT/bilirubin/
alkaline phosphatase
U/S—abdomen
CT—abdomen
Blood culture |
|
|
Term
43 yo obese F presents with RUQ abdominal pain,
fever, and jaundice. She was diagnosed with asymptomatic
gallstones 1 year ago. She is found to be hypotensive
on exam. |
|
Definition
Ascending cholangitis
Acute gallstone
cholangitis
Acute cholecystitis
Hepatitis
Sclerosing cholangitis
Fitz-Hugh–Curtis
syndrome
*
CBC
AST/ALT/bilirubin/
alkaline phosphatase
Blood culture
Viral hepatitis serologies
U/S—abdomen
MRCP
ERCP |
|
|
Term
25 yo M presents with RUQ pain, fever, anorexia,
nausea, and vomiting. He has dark urine and claycolored
stool. |
|
Definition
Acute hepatitis
Acute cholecystitis
Ascending cholangitis
Choledocholithiasis
Pancreatitis
Acute glomerulonephritis
*
CBC
Amylase, lipase
AST/ALT/bilirubin/
alkaline phosphatase
Viral hepatitis serologies
UA
U/S—abdomen |
|
|
Term
35 yo M presents with burning epigastric pain that
starts 2–3 hours after meals. The pain is relieved by
food and antacids. |
|
Definition
Peptic ulcer disease
Gastritis
GERD
Cholecystitis
Chronic pancreatitis
Mesenteric ischemia
*
Rectal exam, stool for
occult blood
Amylase, lipase, lactate
AST/ALT/bilirubin/
alkaline phosphatase
Upper endoscopy
(including H pylori
testing)
Upper GI series |
|
|
Term
37 yo M presents with severe epigastric pain, nausea,
vomiting, and mild fever. He appears toxic. He has
a history of intermittent epigastric pain that is relieved
by food and antacids. He also smokes heavily
and takes aspirin on a daily basis. |
|
Definition
Perforated peptic ulcer
Acute pancreatitis
Hepatitis
Cholecystitis
Gallstone cholangitis
Mesenteric ischemia
*
Rectal exam
CBC
Electrolytes
Amylase, lipase, lactate
AST/ALT/bilirubin/
alkaline phosphatase
CXR
KUB
CT—abdomen
Upper endoscopy
(including H pylori
testing)
Blood culture |
|
|
Term
18 yo M boxer presents with severe LUQ abdominal
pain that radiates to the left scapula. He had infectious
mononucleosis 3 weeks ago. |
|
Definition
Splenic rupture
Kidney stone
Rib fracture
Pneumonia
Perforated peptic ulcer
Splenic infarct
*
CBC
Electrolytes
CXR
CT—abdomen
U/S—abdomen (if
hemodynamically
unstable) |
|
|
Term
40 yo M presents with crampy abdominal pain, vomiting,
abdominal distention, and inability to pass flatus
or stool. He has a history of multiple abdominal
surgeries. |
|
Definition
Intestinal obstruction
Small bowel or colon
cancer
Volvulus
Gastroenteritis
Food poisoning
Ileus
Hernia
*
Rectal exam
CBC
Electrolytes
AXR
CT—abdomen/pelvis with
contrast
Colonoscopy |
|
|
Term
70 yo F presents with acute onset of severe, crampy
abdominal pain. She recently vomited and had a
massive dark bowel movement. She has a history
of CHF and atrial fibrillation, for which she has received
digitalis. Her pain is out of proportion to the
exam. |
|
Definition
Mesenteric ischemia/
infarction
Diverticulitis
Peptic ulcer disease
Gastroenteritis
Acute pancreatitis
Cholecystitis
*
Rectal exam
CBC
Amylase, lipase, lactate
ECG
AXR
CT—abdomen
Mesenteric angiography
Barium enema |
|
|
Term
21 yo F presents with acute onset of severe RLQ
pain, nausea, and vomiting. She has no fever, urinary
symptoms, or vaginal bleeding and has never
taken OCPs. Her last menstrual period was regular,
and she has no history of STDs. She has been told
that she had a cyst on her right ovary. |
|
Definition
Ovarian torsion
Appendicitis
Nephrolithiasis
Ectopic pregnancy
Ruptured ovarian cyst
Pelvic inflammatory
disease
Bowel infarction or
perforation
*
Pelvic exam
Urine hCG
Doppler U/S—pelvis
Rectal exam
UA
CBC
CT—abdomen
Laparoscopy
Chlamydia and gonorrhea
testing, VDRL/RPR |
|
|
Term
68 yo M presents with LLQ abdominal pain, fever,
and chills for the past 3 days. He also reports recent
onset of alternating diarrhea and constipation. He
consumes a low-fiber, high-fat diet. |
|
Definition
Diverticulitis
Crohn’s disease
Ulcerative colitis
Gastroenteritis
Abscess
*
Rectal exam
CBC
Electrolytes
CXR
AXR
CT—abdomen
Blood culture |
|
|
Term
20 yo M presents with severe RLQ abdominal pain,
nausea, and vomiting. His discomfort started yesterday
as a vague pain around the umbilicus. As the
pain worsened, it became sharp and migrated to the
RLQ. McBurney’s and psoas signs are positive. |
|
Definition
Acute appendicitis
Gastroenteritis
Diverticulitis
Crohn’s disease
Nephrolithiasis
Volvulus or other
intestinal obstruction
Perforation
Acute cholecystitis
*
CBC
Electrolytes
CT—abdomen
AXR
U/S—abdomen
Blood culture |
|
|
Term
30 yo F presents with periumbilical pain for 6
months. The pain never awakens her from sleep. It
is relieved by defecation and worsens when she is
upset. She has alternating constipation and diarrhea
but no nausea, vomiting, weight loss, or anorexia |
|
Definition
Irritable bowel syndrome
Crohn’s disease
Celiac disease
Chronic pancreatitis
GI parasitic infection
(amebiasis, giardiasis)
Endometriosis
*
Rectal exam, stool for
occult blood
Pelvic exam
Urine hCG
CBC
Electrolytes
Colonoscopy
CT—abdomen/pelvis
Stool for ova and
parasitology, Entamoeba
histolytica antigen |
|
|
Term
24 yo F presents with bilateral lower abdominal pain
that started with the first day of her menstrual period.
The pain is associated with fever and a thick,
greenish-yellow vaginal discharge. She has had unprotected
sex with multiple sexual partners. |
|
Definition
Pelvic inflammatory
disease
Endometriosis
Dysmenorrhea
Vaginitis
Cystitis
Spontaneous abortion
Pyelonephritis
*
Pelvic exam
Urine hCG
Cervical cultures
CBC
ESR
UA, urine culture
U/S—pelvis |
|
|
Term
CONSTIPATION/DIARRHEA
Key History
Frequency, color, odor, and volume of stools; presence of mucus or flatulence; whether stools float in bowl; duration
of change in bowel habits; associated symptoms (constitutional, abdominal pain, bloating, tenesmus, sense of incomplete
evacuation, melena or hematochezia); thyroid disease symptoms (eg, feeling hot, palpitations, weight loss); diet
(especially fiber and fluid intake); medications (including recent antibiotics); sick contacts, travel, camping, HIV
risk factors; history of abdominal surgeries, diabetes, pancreatitis; alcohol and drug use; family history of colon cancer. |
|
Definition
Key Physical Exam
Vital signs; relevant thyroid/endocrine exam; abdominal and rectal exams; ± female pelvic exam. |
|
|
Term
67 yo M presents with alternating diarrhea and constipation,
decreased stool caliber, and blood in the
stool for the past 8 months. He also reports unintentional
weight loss. He is on a low-fiber diet and has a
family history of colon cancer. His last colonoscopy
was 12 years ago. |
|
Definition
Colorectal cancer
Irritable bowel syndrome
Diverticulosis
GI parasitic infection
(ascariasis, giardiasis)
Inflammatory bowel
disease
*
Rectal exam, stool for
occult blood
CBC
Electrolytes
AST/ALT/bilirubin/
alkaline phosphatase
Colonoscopy
Barium enema
CT—abdomen/pelvis |
|
|
Term
28 yo M presents with constipation (hard stool) for
the past 3 weeks. Since his mother died 2 months
ago, he and his father have eaten only junk food. |
|
Definition
Low-fiber diet
Depression
Substance abuse (eg,
heroin)
Irritable bowel syndrome
Hypothyroidism
*
Rectal exam
TSH
Electrolytes
Urine toxicology |
|
|
Term
30 yo F presents with alternating constipation and
diarrhea accompanied by abdominal pain that is relieved
by defecation. She has no nausea, vomiting,
weight loss, or blood in her stool. |
|
Definition
Irritable bowel syndrome
Inflammatory bowel
disease
Celiac disease
Chronic pancreatitis
GI parasitic infection
(ascariasis, giardiasis)
Lactose intolerance
*
Rectal exam, stool for
occult blood
CBC
Electrolytes
Colonoscopy
Stool for ova and
parasitology
CT—abdomen/pelvis |
|
|
Term
33 yo M presents with watery diarrhea, vomiting,
and diffuse abdominal pain that began yesterday. He
also reports feeling hot. Several of his coworkers are
also ill. |
|
Definition
Infectious diarrhea
(gastroenteritis)—
bacterial, viral,
parasitic, protozoal
Food poisoning
*
Rectal exam, stool for
occult blood
Stool leukocytes and
culture
CBC
Electrolytes
CT—abdomen/pelvis |
|
|
Term
40 yo F presents with watery diarrhea and abdominal
cramps. Last week she was on antibiotics for a UTI. |
|
Definition
Pseudomembranous
(Clostridium difficile)
colitis
Gastroenteritis
Cryptosporidiosis
Food poisoning
Inflammatory bowel
disease
*
Stool for C difficile toxin
Rectal exam, stool for
occult blood
Stool leukocytes and
culture
CBC
Electrolytes |
|
|
Term
25 yo M presents with watery diarrhea and abdominal
cramps. He was recently in Mexico. |
|
Definition
Traveler’s diarrhea
Giardiasis
Amebiasis
Food poisoning
Hepatitis A
*
Rectal exam
Stool leukocytes, culture,
Giardia antigen,
Entamoeba histolytica
antigen
CBC
Electrolytes
AST/ALT/bilirubin/
alkaline phosphatase
Viral hepatitis serologies |
|
|
Term
30 yo F presents with watery diarrhea, abdominal
cramping, and bloating. Her symptoms are aggravated
by milk ingestion and are relieved by fasting. |
|
Definition
Lactose intolerance
Gastroenteritis
Inflammatory bowel
disease
Irritable bowel syndrome
Hyperthyroidism
*
Rectal exam
Stool leukocytes and
culture
Hydrogen breath test
TSH |
|
|
Term
33 yo M presents with watery diarrhea, diffuse abdominal
pain, and weight loss within the past 3
weeks. He has a history of aphthous ulcers. He has
not responded to antibiotics. |
|
Definition
Crohn’s disease
Gastroenteritis
Ulcerative colitis
Celiac disease
Pseudomembranous colitis
Hyperthyroidism
Small bowel lymphoma
Carcinoid syndrome
*
Rectal exam, stool for
occult blood
Stool leukocytes and
culture
CBC
Electrolytes
Colonoscopy
CT—abdomen
TSH
Small bowel series
5-HIAA |
|
|
Term
UPPER GI BLEEDING
Key History
Amount, duration, context (after severe vomiting, alcohol ingestion, nosebleed); associated symptoms (constitutional,
nausea, abdominal pain, dyspepsia); medications (especially blood thinners, NSAIDs, and corticosteroids);
history of peptic ulcer disease, liver disease, abdominal aortic aneurysm repair, easy bleeding. |
|
Definition
Key Physical Exam
Vital signs, including orthostatics; ENT, heart, lung, abdominal, and rectal exams. |
|
|
Term
45 yo F presents with coffee-ground emesis for the
past 3 days. Her stool is dark and tarry. She has a history
of intermittent epigastric pain that is relieved
by food and antacids. |
|
Definition
Bleeding peptic ulcer
Gastritis
Gastric cancer
Esophageal varices
*
Rectal exam
CBC, type and cross
Electrolytes
AST/ALT/bilirubin/
alkaline phosphatase
INR
Upper endoscopy
(including H pylori
testing if ulcer is
confirmed) |
|
|
Term
40 yo F presents with epigastric pain and coffeeground
emesis. She has a history of rheumatoid arthritis
that has been treated with NSAIDs. She is an
alcoholic. |
|
Definition
Gastritis
Bleeding peptic ulcer
Gastric cancer
Esophageal varices
Mallory-Weiss tear
*
Rectal exam
CBC, type and cross
Electrolytes
AST/ALT/bilirubin/
alkaline phosphatase
INR
Upper endoscopy |
|
|
Term
BLOOD IN STOOL
Key History
Melena vs. bright red blood; amount, duration; associated symptoms (constitutional, abdominal or rectal pain, tenesmus,
constipation/diarrhea); menstrual cycle; trauma; history of similar symptoms; prior colonoscopy; medications
(especially blood thinners); history of easy bleeding or atherosclerotic vascular disease, renal disease, aortic valve
disease, liver disease, alcoholism, or abdominal aortic aneurysm repair; family history of colon cancer. |
|
Definition
Key Physical Exam
Vital signs ± orthostatics; abdominal and rectal exams. |
|
|
Term
67 yo M presents with blood in his stool, weight loss,
and constipation. He has a family history of colon
cancer. |
|
Definition
Colorectal cancer
Anal fissure
Hemorrhoids
Diverticulosis
Ischemic bowel disease
Angiodysplasia
Upper GI bleeding
Inflammatory bowel
disease
*
Rectal exam
CBC
AST/ALT/bilirubin/
alkaline phosphatase
INR
Colonoscopy
CEA
CT—abdomen/pelvis |
|
|
Term
33 yo F presents with rectal bleeding and diarrhea
for the past week. She has had lower abdominal pain
and tenesmus for several months. |
|
Definition
Ulcerative colitis
Crohn’s disease
Proctitis
Anal fissure
Hemorrhoids
Diverticulosis
Dysentery
*
Rectal exam
CBC
PT/PTT
Colonoscopy
CT—abdomen/pelvis |
|
|
Term
58 yo M presents with painless bright red blood per
rectum and chronic constipation. He consumes a
low-fiber diet. |
|
Definition
Diverticulosis
Anal fissure
Hemorrhoids
Angiodysplasia
Colorectal cancer
*
Rectal exam
CBC, type and cross
PT/PTT
Electrolytes
Colonoscopy
Tagged RBC scan
CT—abdomen/pelvis |
|
|
Term
HEMATURIA
Key History
Amount, duration, ± clots; associated symptoms (constitutional, renal colic, dysuria, irritative voiding symptoms);
point along the stream (initial vs. terminal vs. throughout); medications; history of vigorous exercise, trauma, smoking,
stones, cancer, or easy bleeding; skin bruising (purpura). |
|
Definition
Key Physical Exam
Vital signs; lymph nodes; abdominal exam; genitourinary and rectal exams; extremities. |
|
|
Term
65 yo M presents with painless hematuria. He is a
heavy smoker and works as a painter. |
|
Definition
Bladder cancer
Renal cell carcinoma
Nephrolithiasis
Acute glomerulonephritis
Prostate cancer
Coagulation disorder (ie,
factor VIII antibodies)
*
Genitourinary exam
UA, urine cytology
BUN/Cr
PSA
CBC
PT/PTT
Cystoscopy
U/S—renal/bladder
CT—abdomen/pelvis
Prostate biopsy |
|
|
Term
35 yo M presents with painless hematuria. He has a
family history of kidney disease. |
|
Definition
Polycystic kidney disease
Nephrolithiasis
Acute glomerulonephritis
(eg, IgA nephropathy)
UTI
Coagulation disorder
Bladder cancer
*
Genitourinary exam
UA, urine cytology
BUN/Cr
PSA
CBC
PT/PTT
U/S—renal
CT—abdomen/pelvis |
|
|
Term
55 yo M presents with flank pain and blood in his
urine without dysuria. He has experienced weight
loss and fever over the past 2 months. Exam reveals
a flank mass. |
|
Definition
Renal cell carcinoma
Bladder cancer
Nephrolithiasis
Acute glomerulonephritis
Pyelonephritis
Prostate cancer
*
Genitourinary, rectal
exams
UA, urine cytology
BUN/Cr
PSA
CBC
PT/PTT
U/S—renal
CT—abdomen/pelvis
Cystoscopy |
|
|
Term
OTHER URINARY SYMPTOMS
Key History
Duration, obstructive symptoms (hesitancy, diminished stream, sense of incomplete bladder emptying, straining,
postvoid dribbling, leakage with cough or sneeze, incontinence), irritative symptoms (urgency, frequency, nocturia),
constitutional symptoms; bone pain; medications; history of UTIs, urethral stricture, or urinary tract instrumentation;
stones, diabetes, alcoholism. |
|
Definition
Key Physical Exam
Vital signs; abdominal exam (including suprapubic percussion to assess for a distended bladder); genital and rectal
exams; focused neurologic exam. |
|
|
Term
60 yo M presents with nocturia, urgency, weak
stream, and terminal dribbling. He denies any weight
loss, fatigue, or bone pain. He has had 2 episodes of
urinary retention that required catheterization. |
|
Definition
Benign prostatic
hypertrophy (BPH)
Prostate cancer
UTI
Bladder stones
*
Rectal exam
UA
CBC
BUN/Cr
Alkaline phosphatase
U/S—prostate
(transrectal)
PSA |
|
|
Term
71 yo M presents with nocturia, urgency, a weak
stream, terminal dribbling, hematuria, and lower
back pain for the past 4 months. He has also experienced
weight loss and fatigue. |
|
Definition
Prostate cancer
BPH
Renal cell carcinoma
UTI
*
Rectal exam
UA
CBC
BUN/Cr
PSA
U/S—prostate
(transrectal)
Prostate biopsy
Alkaline phosphatase
CT—pelvis
MRI—spine
Bladder stones |
|
|
Term
18 yo M presents with a burning sensation during
urination and urethral discharge. He recently had
unprotected sex with a new partner. |
|
Definition
Urethritis
Cystitis
Prostatitis
*
Genital, rectal exams
UA, urine culture
Gram stain and culture of
urethral discharge
Chlamydia and gonorrhea
PCR |
|
|
Term
45 yo diabetic F presents with dysuria, urinary frequency,
fever, chills, and nausea for the past 3 days.
There is left CVA tenderness on exam. |
|
Definition
Acute pyelonephritis
Nephrolithiasis
Lower UTI (cystitis,
urethritis)
Renal cell carcinoma
*
UA, urine culture and
sensitivity
Blood culture
CBC
BUN/Cr
U/S—renal
CT—abdomen |
|
|
Term
55 yo F presents with urinary leakage after exercise.
She loses a small amount of urine when she coughs,
laughs, or sneezes. She also complains of vague low
back pain. She has a history of multiple vaginal deliveries,
and her mother had the same problem after
the onset of menopause. |
|
Definition
Stress incontinence
Mixed incontinence
Urge incontinence
Overflow incontinence
Functional incontinence
UTI
Diabetes mellitus
*
UA, urine culture
BUN/Cr
Urodynamic testing
IVP
Cystourethroscopy |
|
|
Term
33 yo F presents with urinary leakage. She is unable
to suppress the urge to urinate and loses large
amounts of urine without warning. She has a history
of UTIs and a family history of diabetes mellitus.
She drinks 8 cups of coffee per day. She has been under
stress since her sister passed away a few months
ago. |
|
Definition
Urge incontinence
Mixed incontinence
Stress incontinence
Overflow incontinence
Functional incontinence
UTI
Diabetes mellitus
*
CBC
Electrolytes, BUN/Cr,
glucose
UA, urine culture
Urodynamic testing
IVP
Cystourethroscopy |
|
|
Term
ERECTILE DYSFUNCTION (ED)
Key History
Duration, severity, ± nocturnal erections, libido, stress or depression, trauma, associated incontinence; gynecomastia
or loss of body hair; medications (and recent changes); medical history (hypertension, diabetes, high cholesterol,
known atherosclerotic vascular disease, prior prostate surgery, liver disease, thyroid disease, neurologic disease);
smoking, alcohol, and drug use. |
|
Definition
Key Physical Exam
Vital signs; cardiovascular exam; genital and rectal exams. |
|
|
Term
47 yo M presents with impotence that started 3
months ago. He has hypertension and was started on
atenolol 4 months ago. He also has diabetes and is
on insulin. |
|
Definition
Drug-related ED
ED caused by
hypertension
ED caused by diabetes
mellitus
Psychogenic ED
Peyronie’s disease
*
Genital exam
Rectal exam
Glucose
CBC
Testosterone level |
|
|
Term
AMENORRHEA
Key History
Primary vs. secondary, duration, possible pregnancy; associated symptoms (headache, decreased peripheral vision,
galactorrhea, hirsutism, virilization, hot flashes, vaginal dryness, symptoms of thyroid disease); history of anorexia
nervosa, excessive dieting, vigorous exercise, pregnancies, D&Cs, uterine infections; drug use; medications. |
|
Definition
Key Physical Exam
Vital signs; breast exam; complete pelvic exam. |
|
|
Term
40 yo F presents with amenorrhea, morning nausea
and vomiting, fatigue, and polyuria. Her last menstrual
period was 6 weeks ago, and her breasts are full
and tender. She uses the rhythm method for contraception. |
|
Definition
Pregnancy
Anovulatory cycle
Hyperprolactinemia
UTI
Hypothyroidism
*
Urine hCG
U/S—abdomen/pelvis
Pelvic exam
CBC
UA, urine culture
Prolactin, TSH
Baseline Pap smear,
cervical cultures,
rubella antibody, HIV
antibody, hepatitis B
surface antigen, VDRL/
RPR |
|
|
Term
23 yo obese F presents with amenorrhea for 6
months, facial hair, and infertility for the past 3
years. |
|
Definition
Polycystic ovary
syndrome
Thyroid disease
Hyperprolactinemia
Pregnancy
Ovarian or adrenal
malignancy
Premature ovarian failure
*
Urine hCG
LH/FSH, TSH, prolactin
Pelvic exam
Testosterone, DHEAS |
|
|
Term
35 yo F presents with amenorrhea, galactorrhea,
visual field defects, and headaches for the past 6
months. |
|
Definition
Amenorrhea secondary
to prolactinoma
Pregnancy
Thyroid disease
Premature ovarian failure
Pituitary tumor
*
Urine hCG
LH/FSH, TSH, prolactin
MRI—brain
Pelvic and breast exams |
|
|
Term
48 yo F presents with amenorrhea for the past 6
months accompanied by hot flashes, night sweats,
emotional lability, and dyspareunia. |
|
Definition
Menopause
Pregnancy
Pituitary tumor
Thyroid disease
*
Urine hCG
LH/FSH, TSH, prolactin
Testosterone, DHEAS
Pelvic exam
CBC
MRI—brain |
|
|
Term
35 yo F presents with amenorrhea, cold intolerance,
coarse hair, weight loss, and fatigue. She has a history
of abruptio placentae followed by hypovolemic
shock and failure of lactation 2 years ago. |
|
Definition
Sheehan’s syndrome
Premature ovarian failure
Pituitary tumor
Thyroid disease
Asherman’s syndrome
*
Urine hCG
LH/FSH, prolactin
CBC
Pelvic exam
TSH, FT4
ACTH
MRI—brain
Hysteroscopy |
|
|
Term
18 yo F presents with amenorrhea for the past
4 months. She is 5 feet, 6 inches (167.6 cm) and
weighs 90 lbs (40.9 kg). She has a history of exercise
and heat intolerance. |
|
Definition
Anorexia nervosa
Pregnancy
Hyperthyroidism
*
Urine hCG
CBC
TSH, FT4
LH/FSH |
|
|
Term
29 yo F presents with amenorrhea for the past 6
months. She has a history of occasional palpitations
and dizziness. She lost her fiancé in a car accident in
which she was a passenger. |
|
Definition
Anxiety-induced
amenorrhea
Posttraumatic stress
disorder
Depression
Hyperthyroidism
*
CBC
TSH, FT4
Urine cortisol level
Progesterone challenge
test
LH/FSH, estradiol levels |
|
|
Term
VAGINAL BLEEDING
Key History
Pre- vs. postmenopausal status, duration, amount; menstrual history and relation to last menstrual period; associated
discharge, pelvic or abdominal pain, or urinary symptoms; trauma; medications (especially blood thinners, contraceptives);
history of easy bleeding or bruising; history of abnormal Pap smears. |
|
Definition
Key Physical Exam
Vital signs; abdominal exam; complete pelvic exam. |
|
|
Term
17 yo F presents with prolonged, excessive menstrual
bleeding occurring irregularly within the past
6 months. |
|
Definition
Dysfunctional uterine
bleeding
Coagulation disorder
(eg, von Willebrand’s
disease, hemophilia)
Cervical cancer
Molar pregnancy
Hypothyroidism
Diabetes mellitus
*
Urine hCG
Pelvic exam
Cervical culture
Pap smear
CBC
ESR
Glucose
PT/PTT
LH/FSH, TSH, prolactin
U/S—pelvis |
|
|
Term
61 yo obese F presents with profuse vaginal bleeding
for the past month. Her last menstrual period was
10 years ago. She has a history of hypertension and
diabetes mellitus. She is nulliparous. |
|
Definition
Endometrial cancer
Cervical cancer
Atrophic endometrium
Endometrial hyperplasia
Endometrial polyps
Atrophic vaginitis
*
Pelvic exam
Pap smear
Endometrial biopsy
Endometrial curettage
U/S—pelvis
Colposcopy
Hysteroscopy |
|
|
Term
45 yo G5P5 F presents with postcoital bleeding. She
is a cigarette smoker and takes OCPs. |
|
Definition
Cervical cancer
Endometrial cancer
Cervical polyp
Cervicitis
Trauma (eg, cervical
laceration)
*
Pelvic exam
Pap smear
Colposcopy and biopsy
HPV testing
Endometrial biopsy |
|
|
Term
28 yo F who is 8 weeks pregnant presents with lower
abdominal pain and vaginal bleeding. |
|
Definition
Spontaneous abortion
Ectopic pregnancy
Molar pregnancy
*
Urine hCG
Quantitative serum hCG
U/S—abdomen/pelvis
Pelvic exam
CBC
PT/PTT |
|
|
Term
32 yo F presents with sudden onset of left lower abdominal
pain that radiates to the scapula and back
and is associated with vaginal bleeding. Her last
menstrual period was 5 weeks ago. She has a history
of pelvic inflammatory disease and unprotected intercourse. |
|
Definition
Ectopic pregnancy
Ruptured ovarian cyst
Ovarian torsion
Pelvic inflammatory
disease
*
Urine hCG
Quantitative serum hCG
U/S—abdomen/pelvis
Pelvic exam
Cervical cultures |
|
|
Term
VAGINAL DISCHARGE
Key History
Amount, color, consistency, odor, duration; associated vaginal burning, pain, or pruritus; recent sexual activity; onset
of last menstrual period; use of contraceptives, tampons, and douches; history of similar symptoms; history of STDs. |
|
Definition
Key Physical Exam
Vital signs; abdominal exam; complete pelvic exam. |
|
|
Term
28 yo F presents with a thin, grayish-white, foulsmelling
vaginal discharge. |
|
Definition
Bacterial vaginosis
Vaginitis—candidal
Vaginitis—trichomonal
Cervicitis (chlamydia,
gonorrhea)
*
Pelvic exam
Wet mount, KOH prep,
“whiff test”
pH of vaginal fluid
Cervical cultures |
|
|
Term
30 yo F presents with a thick, white, cottage cheese–
like, odorless vaginal discharge and vaginal itching. |
|
Definition
Vaginitis—candidal
Bacterial vaginosis
Vaginitis—trichomonal
*
Pelvic exam
Wet mount, KOH prep,
“whiff test”
pH of vaginal fluid
Cervical cultures |
|
|
Term
35 yo F presents with a malodorous, profuse, frothy,
greenish vaginal discharge with intense vaginal itching
and discomfort. |
|
Definition
Vaginitis—trichomonal
Vaginitis—candidal
Bacterial vaginosis
Cervicitis (chlamydia,
gonorrhea)
*
Pelvic exam
Wet mount, KOH prep,
“whiff test”
pH of vaginal fluid
Cervical cultures |
|
|
Term
DYSPAREUNIA
Key History
Duration, timing; associated symptoms (vaginal discharge, rash, painful menses, GI symptoms, hot flashes); adequacy
of lubrication, menopausal status, libido; sexual history, history of sexual trauma or domestic violence; history of
endometriosis, pelvic inflammatory disease, or prior abdominal/pelvic surgeries. |
|
Definition
Key Physical Exam
Vital signs; abdominal exam; complete pelvic exam. |
|
|
Term
54 yo F c/o painful intercourse. Her last menstrual
period was 9 months ago. She has hot flashes. |
|
Definition
Atrophic vaginitis
Endometriosis
Cervicitis
Depression
Domestic violence
*
Pelvic exam
LH/FSH
Wet mount, KOH prep
Cervical cultures |
|
|
Term
37 yo F presents with dyspareunia, inability to conceive,
and dysmenorrhea. |
|
Definition
Endometriosis
Cervicitis
Vaginismus
Vulvodynia
Pelvic inflammatory
disease
Depression
Domestic violence
*
Pelvic exam
Wet mount, KOH prep
Cervical cultures
U/S—pelvis
Laparoscopy
Endometrial biopsy |
|
|
Term
ABUSE
Key History
Establish confidentiality; directly question about physical, sexual, or emotional abuse and about fear, safety, backup
plan; history of frequent accidents/injuries, mental illness, drug use; firearms in the home. |
|
Definition
Key Physical Exam
Vital signs; complete exam ± pelvic exam. |
|
|
Term
28 yo F c/o multiple facial and bodily injuries. She
claims that she fell on the stairs. She was hospitalized
for physical injuries 7 months ago. She presents
with her husband. |
|
Definition
Domestic violence
Osteogenesis imperfecta
Substance abuse
Consensual violent sexual
behavior
*
XR—skeletal survey
CT—maxillofacial
Urine toxicology
CBC |
|
|
Term
30 yo F presents with multiple facial and physical
injuries. She states that she was attacked and raped
by 2 men. |
|
Definition
Rape
Domestic violence
*Forensic exam (sexual
assault forensic
evidence [SAFE]
collection kit)
Pelvic exam
Urine hCG
Wet mount, KOH prep
Cervical cultures
Chlamydia and gonorrhea
testing
XR—skeletal survey
CBC
HIV antibody
Viral hepatitis serologies |
|
|
Term
JOINT/LIMB PAIN
Key History
Location, quality, intensity, duration, pattern (small vs. large joints; number involved; swelling, redness, warmth);
associated symptoms (constitutional, red eye, oral or genital ulceration, diarrhea, dysuria, rash, focal numbness/weakness,
morning stiffness); exacerbating and alleviating factors; trauma (including vigorous exercise); medications;
DVT risk factors; alcohol and drug use; family history of rheumatic disease. |
|
Definition
Key Physical Exam
Vital signs; HEENT and musculoskeletal exams; relevant neurovascular exam. |
|
|
Term
30 yo F presents with wrist pain and a black eye after
tripping, falling, and hitting her head on the edge of
a table. She looks anxious and gives an inconsistent
story. |
|
Definition
Domestic violence
Factitious disorder
Substance abuse
*
XR—wrist
CT—head
Urine toxicology |
|
|
Term
30 yo F secretary presents with wrist pain and a sensation
of numbness and burning in her palm and the
first, second, and third fingers of her right hand. The
pain worsens at night and is relieved by loose shaking
of the hand. There is sensory loss in the same
fingers. Exam reveals a positive Tinel’s sign. |
|
Definition
Carpal tunnel syndrome
Median nerve
compression in the
forearm or arm
Radiculopathy of nerve
roots C6 and C7 in the
cervical spine
De Quervain’s
tenosynovitis
*
Phalen’s maneuver and
Tinel’s sign
Finkelstein’s test
Nerve conduction studies
EMG |
|
|
Term
28 yo F presents with pain in the interphalangeal
joints of her hands accompanied by hair loss and a
rash on her face. |
|
Definition
Systemic lupus
erythematosus (SLE)
Rheumatoid arthritis
Psoriatic arthritis
Parvovirus B19 infection
*
ANA, anti-dsDNA, ESR,
C3, C4, RF, CCP
CBC
XR—hands
UA
Antibody titers for
parvovirus B19 |
|
|
Term
28 yo F presents with pain in the metacarpophalangeal
joints of both hands. Her left knee is also painful
and red. She has morning joint stiffness that lasts
for an hour. Her mother had rheumatoid arthritis. |
|
Definition
Rheumatoid arthritis
SLE
Disseminated gonorrhea
Arthritis associated with
inflammatory bowel
disease
*
XR—hands, left knee
ANA, anti-dsDNA, ESR,
RF, CCP
CBC
Cervical culture
Arthrocentesis and
synovial fluid analysis |
|
|
Term
18 yo M presents with pain in the interphalangeal
joints of both hands. He also has scaly, salmon-pink
lesions on the extensor surface of his elbows and
knees. |
|
Definition
Psoriatic arthritis
Rheumatoid arthritis
SLE
Gout
*
ANA, ESR, RF, CCP
CBC
XR—hands
XR—pelvis/sacroiliac
joints
Uric acid |
|
|
Term
65 yo F presents with inability to use her left leg or
bear weight on it after tripping on a carpet. Onset of
menopause was 20 years ago, and she did not receive
HRT or calcium supplements. Her left leg is externally
rotated, shortened, and adducted, and there is
tenderness in her left groin. |
|
Definition
Hip fracture
Hip dislocation
Pelvic fracture
*
XR—hip/pelvis
CT or MRI—hip
CBC, type and cross
Serum calcium and
vitamin D
Bone density scan
(DEXA) |
|
|
Term
40 yo M presents with pain in the right groin after a
motor vehicle accident. His right leg is flexed at the
hip, adducted, and internally rotated. |
|
Definition
Hip dislocation—
traumatic
Hip fracture
*
XR—hip
CT or MRI—hip
CBC, type and cross
PT/PTT
Urine toxicology and
blood alcohol level |
|
|
Term
56 yo obese F presents with right knee stiffness and
pain that increases with movement. Her symptoms
have gradually worsened over the past 10 years. She
has noticed swelling and deformity of the joint and
is having difficulty walking. |
|
Definition
Osteoarthritis
Pseudogout
Gout
Meniscal or ligament
damage
*
XR—knee
CBC
ESR
Knee arthrocentesis and
synovial fluid analysis
(cell count, Gram
stain, culture, crystals)
Uric acid
MRI—knee |
|
|
Term
45 yo M presents with fevers and right knee pain
with swelling and redness. |
|
Definition
Septic arthritis
Gout
Pseudogout
Lyme arthritis
Trauma
Reiter’s syndrome
(reactive arthritis)
*
CBC
Knee arthrocentesis and
synovial fluid analysis
(cell count, Gram
stain, culture, crystals)
Blood, urethral cultures
XR—knee
Uric acid
Lyme titers—IgG and IgM |
|
|
Term
65 yo M presents with right foot pain. He has been
training for a marathon. |
|
Definition
Stress fracture
Plantar fasciitis
Foot sprain or strain
*
XR—foot
Bone scan—foot
MRI—foot |
|
|
Term
65 yo M presents with pain in the heel of the right
foot that is most notable with his first few steps and
then improves as he continues walking. He has no
known trauma. |
|
Definition
Plantar fasciitis
Heel fracture
Splinter/foreign body
*
XR—heel
Bone scan—foot |
|
|
Term
55 yo M presents with pain in the elbow when he
plays tennis. His grip is impaired as a result of the
pain. There is tenderness over the lateral epicondyle
as well as pain on resisted wrist dorsiflexion (Cozen’s
test) with the elbow in extension. |
|
Definition
Tennis elbow (lateral
epicondylitis)
Stress fracture
*
XR—arm
Bone scan
MRI—elbow |
|
|
Term
27 yo F presents with painful wrists and elbows, a
swollen and hot knee joint that is painful on flexion,
a rash on her limbs, and vaginal discharge. She is
sexually active with multiple partners and occasionally
uses condoms. |
|
Definition
Disseminated gonorrhea
Rheumatoid arthritis
SLE
Reiter’s syndrome
(reactive arthritis)
*
Knee arthrocentesis and
synovial fluid analysis
(cell count, Gram
stain, culture)
ANA, anti-dsDNA, ESR,
RF, CCP
CBC
Blood, cervical cultures
XR—knee |
|
|
Term
60 yo F presents with pain in both legs that is induced
by walking and is relieved by rest. She had
cardiac bypass surgery 6 months ago and continues
to smoke heavily. |
|
Definition
Peripheral vascular
disease (intermittent
claudication)
Leriche syndrome
(aortoiliac occlusive
disease)
Lumbar spinal stenosis
(pseudoclaudication)
Osteoarthritis
*
Ankle-brachial index
Doppler U/S—lower
extremity
Angiography
MRI—L-spine |
|
|
Term
45 yo F presents with right calf pain. Her calf is tender,
warm, red, and swollen compared to the left
side. She was started on OCPs 2 months ago for dysfunctional
uterine bleeding. |
|
Definition
DVT
Baker’s cyst rupture
Myositis
Cellulitis
Superficial venous
thrombosis
*
Doppler U/S—right leg
CBC
D-dimer |
|
|
Term
60 yo F c/o left arm pain that started while she was
swimming and was relieved by rest. |
|
Definition
Angina/MI
Tendinitis
Osteoarthritis
*
ECG
CBC
XR—shoulder
CXR
Echocardiography
Stress test |
|
|
Term
50 yo M presents with right shoulder pain after falling
onto his outstretched hand while skiing. He noticed
deformity of his shoulder and had to hold his
right arm. |
|
Definition
Shoulder dislocation
Fracture of the humerus
Rotator cuff injury
*
XR—shoulder
XR—arm
MRI—shoulder |
|
|
Term
55 yo M presents with crampy bilateral thigh and
calf pain, fatigue, and dark urine. He is on simvastatin
and clofibrate for hyperlipidemia. |
|
Definition
Rhabdomyolysis due to
statins
Polymyositis
Inclusion body myositis
*
CBC
Phosphate, potassium,
BUN/Cr, glucose,
calcium, uric acid
CPK
Aldolase
UA
Urine myoglobin |
|
|
Term
LOW BACK PAIN
Key History
Location, quality, intensity, radiation, context (moving furniture, bending/twisting, trauma), timing (disturbs sleep);
associated symptoms (especially constitutional, incontinence); exacerbating and alleviating factors; history of cancer,
recurrent UTIs, diabetes, renal stones, IV drug use, smoking. |
|
Definition
Key Physical Exam
Vital signs; neurologic exam (especially L4–S1 nerve roots); back palpation and range of motion (although rarely of
diagnostic utility); hip exam (can refer pain to the back); consider rectal exam. |
|
|
Term
45 yo F presents with low back pain that radiates to
the lateral aspect of her left foot. The straight leg
raise is positive. The patient is unable to tiptoe. |
|
Definition
Disk herniation
Lumbar muscle strain
Tumor in the vertebral
canal
*
XR—L-spine
MRI—L-spine |
|
|
Term
45 yo F presents with low back pain that started after
she cleaned her house. The pain does not radiate,
and there is no sensory deficit or weakness in her
legs. Paraspinal muscle tenderness and spasm are
also noted. |
|
Definition
Lumbar muscle strain
Disk herniation
Vertebral compression
fracture
*
XR—L-spine
MRI—L-spine |
|
|
Term
45 yo M presents with pain in the lower back and
legs during prolonged standing and walking. The
pain is relieved by sitting and leaning forward (eg,
pushing a grocery cart). |
|
Definition
Lumbar spinal stenosis
Lumbar muscle strain
Tumor in the vertebral
canal
Peripheral vascular disease
*
MRI—L-spine (preferred)
XR—L-spine
CT—L-spine
Ankle-brachial index |
|
|
Term
17 yo M presents with low back pain that radiates
to the left leg and began after he fell on his knee
during gym class. He also describes areas of loss of
sensation in his left foot. The pain and sensory loss
do not match any known distribution. He insists on
requesting a week off from school because of his injury. |
|
Definition
Malingering
Lumbar muscle strain
Disk herniation
Knee or leg fracture
Ankylosing spondylitis
*
XR—L-spine/knee
MRI—L-spine |
|
|
Term
CHILD WITH FEVER
No child will be present; the mother will relate the story. When you enter the examination room, you may see a
telephone with instructions to pick up the handset. Upon doing so, you will be speaking to the parent of the child.
Key History
Severity, duration; associated localizing symptoms such as rash, wheezing, cough, and ear discharge; poor appetite,
convulsions, lethargy, sleepiness; sick contacts, day care, immunizations. |
|
Definition
Key Physical Exam
Vital signs; HEENT, neck, heart, lung, abdominal, and skin exams. |
|
|
Term
20-day-old M presents with fever, decreased breastfeeding,
and lethargy. He was born at 36 weeks as a
result of premature rupture of membranes. |
|
Definition
Neonatal sepsis
Meningitis
Pneumonia
Pyelonephritis
*
Physical exam
CBC
Electrolytes
Blood culture
LP—CSF analysis
CXR
UA, urine culture |
|
|
Term
3 yo M presents with a 2-day history of fever and
pulling on his right ear. He is otherwise healthy, and
his immunizations are up to date. His older sister
recently had a cold. The child attends a day care
center. |
|
Definition
Acute otitis media
URI
Meningitis
Pyelonephritis
*
Physical exam (including
pneumatic otoscopy)
CBC
Blood culture
Tympanocentesis culture
LP—CSF analysis
UA, urine culture |
|
|
Term
12-month-old M presents with fever for the past 2
days accompanied by a maculopapular rash on his
face and body. He has not yet received the MMR
vaccine. |
|
Definition
Measles (or other viral
exanthem)
Rubella
Roseola
Fifth disease
Varicella
Scarlet fever
Meningitis
*
Physical exam
CBC
Viral antibodies/titers
Throat swab for culture
LP—CSF analysis |
|
|
Term
4 yo M presents with diarrhea, vomiting, lethargy,
weakness, and fever. The child attends a day care
center where several children have had similar
symptoms. |
|
Definition
Gastroenteritis (viral,
bacterial, parasitic)
Food poisoning
UTI
URI
Volvulus
Intussusception
*
Physical exam
Stool exam and culture
CBC
Electrolytes
UA, urine culture
AXR |
|
|
Term
CHILD WITH GI SYMPTOMS
No child will be present; only the parent will relate the story, either in person or by telephone.
Key History
Onset, location, quality, intensity, duration, radiation, timing (relation to meals); associated symptoms (constitutional,
GI, cardiac, pulmonary, renal, pelvic); changes in weight, skin rash, bloody/mucoid stools, change in stool
color; exacerbating and alleviating factors; history of similar symptoms; history of abdominal surgeries; medications;
sick contacts, day care, immunizations. |
|
Definition
Key Physical Exam
Vital signs; exam for signs of dehydration (BP, heart rate, skin turgor); heart and lung exams; abdominal exam; rectal
exam; pelvic exam (women). |
|
|
Term
1-month-old F is brought in because she has been
spitting up her milk for the last 10 days. The vomiting
episodes have increased in frequency and
forcefulness. Emesis is nonbloody and nonbilious.
The episodes usually occur immediately after breastfeeding.
She has stopped gaining weight. |
|
Definition
Pyloric stenosis
Partial duodenal atresia
GERD
Gastroenteritis
Hepatitis
UTI
Otitis media
*
Physical exam
CBC
Electrolytes
U/S—abdomen
Barium swallow
pH probe
Endoscopy
AST/ALT/bilirubin/
alkaline phosphatase
UA, urine culture
Tympanocentesis culture |
|
|
Term
3 yo M presents with constipation. The child has
had 1 bowel movement per week since birth despite
the use of stool softeners. At birth, he did not pass
meconium for 48 hours. He has poor weight gain.
There is a family history of this problem. |
|
Definition
Hirschsprung’s disease
Low-fiber diet
Anal stenosis
Hypothyroidism
Lead poisoning
*
Physical exam
Rectal exam
Stool exam and culture
Barium enema
Suction rectal biopsy
Anorectal manometry
TSH, FT4
CBC
Electrolytes
Serum lead level |
|
|
Term
8-month-old F presents with sudden-onset colicky
abdominal pain with vomiting. The episodes are 20
minutes apart, and the child is completely well between
episodes. She had loose stools several hours
before the pain, but her stools are now bloody. |
|
Definition
Intussusception
Appendicitis
Meckel’s diverticulum
Volvulus
Gastroenteritis
Enterocolitis
Blunt abdominal trauma
*
Physical exam
Rectal exam, stool for
occult blood
CBC
Electrolytes
Contrast enema
U/S—abdomen
CT—abdomen |
|
|
Term
7 yo M presents with abdominal pain that is generalized,
crampy, worse in the morning, and seemingly
less prominent during weekends and holidays. He
has missed many school days because of the pain.
Growth and development are normal. His parents
recently divorced. |
|
Definition
Somatoform disorder
Malingering
Irritable bowel syndrome
Lactose intolerance
Child abuse
*
Physical exam
CBC
Electrolytes
U/S—abdomen
CT—abdomen
Amylase, lipase
Stool exam |
|
|
Term
2-month-old M presents with persistent crying for
2 weeks. The episodes subside after passing flatus or
eructation. There is no change in appetite, weight,
or growth. There is no vomiting, constipation, or fever. |
|
Definition
Colic
Formula allergy
GERD
Lactose intolerance
Strangulated hernia
Testicular torsion
Gastroenteritis
*
Physical exam
Rectal exam, stool for
occult blood
U/S—abdomen
U/S—testicular |
|
|
Term
CHILD WITH RED EYE
No child will be present; only the parent will relate the story, either in person or by telephone.
Key History
Onset, location, duration, affecting one or both eyes; eye discharge, itching, pain, photophobia, tearing; associated
symptoms (constitutional, dermatologic, GI, cardiac, pulmonary, renal, pelvic, rheumatologic); exacerbating and alleviating
factors; medications; sick contacts, day care, immunizations; history of similar symptoms. |
|
Definition
Key Physical Exam
Vital signs; HEENT exam. |
|
|
Term
3 yo F presents with a 3-day history of “pink eye.” It
began in the right eye but now involves both eyes.
She has mucoid discharge, itching, and difficulty
opening her eyes in the morning. Her mother had
the flu last week. She has a history of asthma and
atopic dermatitis. |
|
Definition
Bacterial conjunctivitis
Viral conjunctivitis
Keratitis
Seasonal allergies
Uveitis
*
Physical exam
Ophthalmoscopic eye
exam
CBC
Electrolytes
Discharge cultures
Slit lamp exam |
|
|
Term
CHILD WITH SHORT STATURE
No child will be present; only the parent will relate the story, either in person or by telephone.
Key History
Associated symptoms (constitutional, GI, cardiac, pulmonary, renal, pelvic, endocrine); medications; prenatal and
birth history, growth history; past medical history; family history; cognitive abilities, school performance. |
|
Definition
Key Physical Exam
Vital signs; height, weight; HEENT, heart, lung, abdominal, and neurologic exams. |
|
|
Term
14 yo M presents with short stature and lack of sexual
development. His birth weight and length were
normal, but he is the shortest child in his class. His
father and uncles had the same problem when they
were young, but they are now of normal stature. |
|
Definition
Constitutional short
stature
Growth hormone (GH)
deficiency
Hypothyroidism
Chronic renal
insufficiency
Genetic causes
Cystic fibrosis
*
Physical exam
CBC
Electrolytes
GH stimulation test
IGF-1, IGFBP-3 levels
TSH, FT4
XR—hand
U/S—renal and cardiac
Sweat chloride testing
BUN/Cr
Karyotype |
|
|
Term
BEHAVIORAL PROBLEMS IN CHILDHOOD
No child will be present; only the parent will relate the story, either in person or by telephone.
Key History
Onset, severity, duration, triggers; physical violence or use of weapons; substance use, developmental history, changes
in environment or school performance; change in personality, anhedonia. |
|
Definition
Key Physical Exam
Vital signs; neurologic exam. |
|
|
Term
9 yo M presents with a 2-year history of angry outbursts
both in school and at home. His mother complains
that he runs around “as if driven by a motor.”
His teacher reports that he cannot sit still in class,
regularly interrupts his classmates, and has trouble
making friends. |
|
Definition
Attention-deficit
hyperactivity disorder
(ADHD)
Oppositional defiant
disorder
Manic episode
Conduct disorder
Hyperthyroidism
*
Physical exam
Mental status exam
TSH, FT4
EEG |
|
|
Term
12 yo F presents with a 2-month history of fighting
in school, truancy, and breaking curfew. Her parents
recently divorced, and she just started school in a
new district. Before her parents divorced, she was an
average student with no behavioral problems. |
|
Definition
Adjustment disorder
Substance intoxication,
abuse, or dependence
Manic episode
Oppositional defiant
disorder
Conduct disorder
*
Physical exam
Mental status exam
Urine toxicology |
|
|
Term
15 yo M presents with a 1-year history of failing
grades, school absenteeism, and legal problems, including
shoplifting. His parents report that he spends
most of his time alone in his room, adding that when
he does go out, it is with a new set of friends. |
|
Definition
Substance abuse
Conduct disorder
Oppositional defiant
disorder
Adjustment disorder
*
Urine toxicology
Mental status exam
Physical exam |
|
|
Term
5 yo M presents with a 6-month history of temper
tantrums that last 5–10 minutes and immediately
follow a disappointment or a discipline. He has no
trouble sleeping, has had no change in appetite, and
does not display these behaviors when he is at day
care. |
|
Definition
Age-appropriate behavior
ADHD
Oppositional defiant
disorder
*
Physical exam
Mental status exam |
|
|
