Term
|
Definition
1) PE: Neck/spine, neurological, extretties
2) Differential
- Disk herniation: increases with movement, radiculopathy
- Cervical fracture: Rapid rotation injury, pain with movement, osteopenia
- Neck muscle strain: Rapid rotation injury
3) W/U: XR c spine, MRI c spine, Nerve conduction. |
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Term
| 48 yo F with abdominal pain |
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Definition
1) PE: Chest, heart, abdomen
2) Differential
- Gallstone pancreatitis
- PUD: History of NSAIDs, pain 2-3h after meals
- Gastritis: NSAID, food associated, N + V
- Cholecystitis: worse with heavy foods, N + V, female of age
3) W/U: rectal exam, CBC, RUQ US, lipase/amylase, H. pylori testing, EGD |
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Term
| 35 yo in ED with Headache |
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Definition
1) PE: Neurological, Cardiac, Pulmonary, HEENT
2) Differential
- Migraine: unilateral, N + V, photophobia
- Mass lesion: N + V, Family history
- Tension: Stress, improves with sleep, chronic
3) W/U: non-con CT head, CBC, LP, CT-sinus |
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Term
| 36 yo F with abnormal menstrual periods |
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Definition
1) PE: Neck (thyroid), CV, Respiratory, Extremities, Neurological
2) Differential
- Pregnancy: sexually active, change in cycles, previous pregnancy
- Anovulatory cycles
- PCOS: oligomenorrhea, weight gain, hirsutism
- Hyperprolactinemia: galactorhea, oligomenorrhea
3) W/U: urine bHCG, breast and pelvic exams, prolactin, TSH, LH/FSH |
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Term
| 28 yo F with pain during sex |
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Definition
1) PE: CV exam, Pulmonary exam, Abdominal exam
2) Differential
- Vulvovaginitis: white discharge, fishy ordor, pruritis
- Cervicitis: White discharge, dyspareunia, sexual activity without barrier
- Endometriosis: Dymenorrhea, dyspareunia
3) W/U: pelvic exam, swabs for GC, RPR with NAAT, wet prep with KOH, possibly laparoscopy |
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Term
| 75 yo M with hearing loss |
|
Definition
1) PE: HEENT, Neurological, CV exam
2) Differential
- Presbycusis: bilateral, progressive, advanced age
- Ototoxicity: ASA or antibiotic use
- Noise-induced hearing loss: prior exposure to loud sounds
- Otosclerosis: bilateral progressive, advanced age
3) W/U: Audiometry, tympanography, ABRs |
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Term
| 5d old male with jaundice |
|
Definition
1) Differential
- Neonatal jaundice (physiological): no changes in feeding, urination or bowel movements (vs. breast feeding jaundice)
- ABO Rh incompatibility: Infant in first week of life, mother and father with different ABO types
- Neonatal Sepsis: History of maternal infection
3) W/U: Bilirubin (total and indirect), blood typing, direct coombs, CRP, CBC, TORCH serology? |
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|
Term
|
Definition
1) PE: none. Ask about seizures, ear pulling, bowel/bladder/feeding changes. Birth history.
2) Differential
- Viral URI: fever, rhinorrhea, contact, day care, RR
- PNA: fever, day care, sibling, RR
- OM: fever, irritability, day care
- Meningitis, UTI, Gastroenteritis, bacteremia
3) W/U: CBC with diff, culture, UA and culture, CXR, respiratory viral panel, pneumatic otoscopy. |
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|
Term
|
Definition
1) PE: Chest, CV exam, Extremeties, HEENT
2) Differential
- GERD
- Asthma
- Acute bronchitis: same
- Post-nasal drip allergy
- URI: recent URI, low-grade fever, persistent cough
- PNA: persistent cough, low grade fever
3) W/U: CXR, CBC diff, Sputum gram stain and culture, HIV and STD tests |
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|
Term
|
Definition
1) PE: HEENT, CV exam, Pulmonary, abdominal, Asterixis, edema, Skin
2) Differential
- Extrahepatic obstruction: pancreatic cancer, cholangiocarcinoma, sphincter of oddi dysfunction): acolic stools, dark urine, prurutis
- Viral hepatitis: blood transfusion and travel
- Acetaminophen toxicity: Frequent use, use with alcohol
3) W/U: Stop alcohol, Tylenol, LFTs, Alk phos, GGT, US, Bilirubin, Viral hepatitis screen |
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Term
| 54 yo M in ED with dizziness |
|
Definition
1) PE: HEENT, CV exam, Neurological, get orthostatics
2) Differential
- Meniere’s: Hearing loss, vertigo
- Syncope
- BPV: Vertigo, positional, 20-30 min duration
- Orthostasis: Diarrhea, antihypertensive medication
3) W/U: Audiometry, dix hallpike, MRI brain, VDRL/RPR (can cause meniere’s), ABRs |
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|
Term
|
Definition
1) PE: Neurlogical, Extremeties, CV, Mouth, Abdominal
2) Differential
- RA: morning stiffness, family history, systemic features
- Gout: Monoarticular joint pain, h/x swollen toe, alcohol
- SLE: Systemic features, oral ulcers, history of abortions, raynaud’s
- Infectious arthritis
3) W/U: CBC with diff and potentially culture, joint tap and gram stain/culture/crystals, immunological testing, XR knee |
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|
Term
|
Definition
1) PE: CV, pulmonary, abdominal, extremities, neurological
2) Differential
- Plantar fasciitis: training for marathon, pain is gradual, worsens with activity
- Calcaneal stress fracture: training for marathon, diffuse pain, refractory to conservative management
- Achilles tendinitis
3) W/U: XR foot ankle, bone scan, MRI |
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|
Term
| 18 month old F with fever |
|
Definition
1) Differential
- Acute OM: fever, ear pulling, history of OM
- Meningitis: Rash, fever, difficulty sleep, vomiting
- Scarlett fever: rash, fever, swallowing difficulty
2) W/U: CBC with diff, LP and CSF analysis, urinalysis, throat culture, pneumoatic otoscopy, PT/PTT, d-dimer |
|
|
Term
|
Definition
1) PE: HEENT, CV, Pulmonary, Abdominal, Extremeties
2) Differential
- Depression: SIGECAPS
- Hypothyroidism:
- Chronic Pancreatitis: History of alcohol, smelly stools, worsening with radiation to back.
- GERD/PUD
- Pancreatic Cancer: smoking, weight loss, foul-smelling stools
3) W/U: CBC, stool blood, glucose, fecal fat, amylase/lipase, AST/ALT/bilirubin, CT abdomen |
|
|
Term
| 54 yo M with HTN follow-up |
|
Definition
1) PE: blood pressure, HEENT, CV, abdominal, extremeties, neurological impotence?
2) W/U: Genital/rectal exams, glucose, testosterone, prolactin, TSH, LH/FSH, ferritin, Doppler U/S of penis |
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|
Term
| 20 yo F with sleeping problems |
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Definition
| W/U: CBC, TSH, FT3, FT4, Urine toxicity, Polysomnography |
|
|
Term
| 2 yo female with noisy, strange breathing |
|
Definition
1) Differential
- RSV
- Croup
- Foreign Body
- Eppiglottitis
- PTA
2) W/U: AGB, CXR, XR neck, CBC, Bronchoscopy, Direct Laryngoscopy |
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|
Term
| 21 yo F with RLQ abdominal pain |
|
Definition
1) PE: CV, pulmonary, abdominal exam
2) Differential
- Appendicitis
- Ectopic pregnancy
- Renal urolithiasis
- STD/PID
3) W/U: urine bHCG, pelvic US, CBC with differential, CT- abdominal pelvis, cervical cultures, pelvic exam |
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|
Term
| 65 yo F with forgetfulness and confusion |
|
Definition
1) PE: Eyes, neck, CV, pulmonary, abdominal, neurological
2) Differential
- Alzheimer’s: Steady cognitive decline, memory impairment, executive function
- Vascular: Previous CVA, coronary, HTN, impaired executive function
- Dementia syndrome of depression
3) W/U: CT, MRI, CBC, Serum B12, TSH, RPR, Electrolytes |
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Term
| 27 yo M in ED for seeing strange writing on the wall |
|
Definition
1) PE: Eyes, CV, pulmonary, Abdominal, Neurological
2) Differential
- Drugs (PCP, substance-induced psychosis)
- Brief psychotic disorder
- Schizophrenia
3) W/U: urine tox screen, electrolytes, CPK, urine myoglobin, MSE |
|
|
Term
| 55 yo M with blood in stool |
|
Definition
1) PE: CV, pulmonary, abdominal
2) Differential
- Colon cancer
- Diverticulosis/AVM
- C. dif colitis
- Hemorrhoids
3) W/U: CBC, rectal exam (occult blood), colonoscopy, Stool culture for C. dif, fecal leukocytes, Anoscopy |
|
|
Term
|
Definition
1) PE: CV, pulmonary, neurologic
2) Differential
- Essential
- Parkinson’s
- Physiological
3) W/U: MRI brain |
|
|
Term
|
Definition
1) PE: Head, neck, CV, pulmonary, abdominal, extremeties
2) Differential
- PCOS
- Hypothyroidism
- Pregnancy
- Drug-induced
3) W/U: bHCG, TSH, FSH/LH, Prolactin, Lithium level, HLD, cholesterol, fasting glucose |
|
|
Term
| 6 month old F with diarrhea |
|
Definition
1) Differential
- Viral gastroenteritis: watery diarrea, low-grade fever, day care
- Bacterial diarrhea: acute, day care, fever
- Malabsorption: watery diarrhea, dry mouth, too much juice?
3) W/U: BMP, Stool leukocytes, culture, O/A, rotavirus PCR |
|
|
Term
| 8 yo child with bet wetting |
|
Definition
1) DIfferential
- Monosymtpomatic primary nocturnal enuresis: family history
- UTI:
- Secondary enuresis
2) W/U: genital exam, UA, urine culture |
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|
Term
| 11 month old female with seizure |
|
Definition
1) Differential
- Simple febrile seizure
- Meningitis
- Hyponatremia
2) W/U: CBC, LP, electrolytes, CT, MRI, EEG |
|
|
Term
| 49 yo M in ED who passed out |
|
Definition
1) PE: Head and neck, CV exam, Pulmonary exam, Extremities, Neurological
2) Differential
- Syncope
- Cardiac arrhythmia
- Seizures
3) W/U: orthostatic vitals, EKG, CBC, electrolytes, CT/MRI, EEG |
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|
Term
|
Definition
1) PE: CV, Extremeties (pulses), HEENT (JVD), Abdominal
2) Differential
- Cocaine
- MI
- GERD
3) W/U
- EKG, CBC, Cardiac enzymes, Urine too screen, Upper endoscopy, TTE |
|
|
Term
|
Definition
1) PE: CV, Pulmonary, Extremeties, Abdominal, CVA tenderness
2) Differential
- Urolithiasis
- Bladder/renal cancer
- STDs
- Exercise
- BPH
3) W/U
- Genital/rectal exams, UA and culture, BUN/Cr, STD screen, CBC, non-con CT, Cytoscopy |
|
|
Term
|
Definition
1) PE: Back exam, gait, Extermeties, neurological
2) Differential
- Herniated Disc
- Spondylolithiasis
- Metastatic disease
- Multiple myeloma
- Lumbar strain
3) W/U: GU exam, Xray/MRI of spine, CBC, Electrophoresis, PSA |
|
|
Term
|
Definition
1) PE: CV, Pulmonary, Abdominal, Extremeties, HEENT, Neurological, Skin
2) Differential
- PTX
- Hemothorax
- Rib fracture
- PNA
3) W/U
- CBC, CXR, Sputum and blood gram stain and culture, urine toxicology |
|
|
Term
| 28 yo F with positive pregnancy test |
|
Definition
1) PE: CV, pulmonary, HEENT (thyroid), abdominal, skin exam
- Take FULL gyne and obstetric history
2) Differential
- Normal, ectopic or molar
3) W/U
- Repeat urine pregnancy, Pelvic US, breast/pelvic exams, ABO, Rh, antibody screen. Screen for Rubella, HIV, Syphilis, HbsAg, GC NAAT |
|
|
Term
| 10 yo F recently diagnosed DM |
|
Definition
1) PE: None
- Ask about vision, GU, depression, glucose control, meds, neurological, birth history, weight, infections, hypoglycemia (fainting, confusion, disorientation)
2) Differential
- T1DM
- T2DM
- Secondary diabetes (Cushing)
3) W/U
- A1C, glucose, BUN/Cr, electrolytes, Insulin and C-peptide levels, Islet cell antibodies, UA and urine micro albumin, 24h free cortisol |
|
|
Term
| 74 yo M with right arm pain |
|
Definition
1) PE: HEENT, Neurological, Extremeties, CV/Resp
**ASK about ADLs in all elderly**
2) Differential
- Humeral fracture
- Shoulder dislocation
- Osteoporosis
- Elder abuse
- DEXA scan
3) W/U
- XR/MRI of arm |
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|
Term
| 56 yo M for diabetes follow up |
|
Definition
1) PE: CV, Pulmonary, Abdominal, Extremeties, Carotid, Neurological
- Ask about eyes, feet, heart, lungs, bowels/bladder
2) Differential
- Insulin-induced hypoglycemia
- Peripheral neuropathy
- Organic erectile dysfunction
3) W/U
- A1C, serum glucose, UA, microalbumin test, Insulin level, C peptide level, BUN/Cr, for ED (penile US, genital exam) |
|
|
Term
|
Definition
1) PE: CV, pulmonary, abdominal, extremity, neurological , MSK, Mouth, Head and neck
- Get menstrual, gyne, pain
2) Differential
- Rib fracture
- STD
- Pregnancy
3) W/U
- Pelvic exam, XR skeletal survey, CXR, STD screening, HIV, RPR, GC, bHCG, Rape Kit |
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|
Term
| 35 yo F with right calf pain |
|
Definition
1) PE: CV, pulmonary, neurological, extremities
2) Differential
- DVT
- Cellulitis
- Ruptured baker's cyst
- PVD
3) W/U
- Dopplers, D-dimer, CBC with diff, Wound and blood cultures, Electrolytes, BUN/Cr, Hypercoag workup |
|
|
Term
| What are the Key ROS for most patients? |
|
Definition
1) Constitutional: Weight loss, fevers, chills, night sweats, appetite changes
2) HEENT: Changes in vision, nasal/ear discharge, ear pain, throat pain, masses
3) CV: Pain, palpitations, swelling,
4) Respiratory: SOB, wheezing, cough
5) ABD: Pain, changes in bowel habits
6) Neurological: Numbness, tingling, dizziness, weakness, tremors, gait disturbance |
|
|
Term
|
Definition
1) PE: HENT, CV pulmonary, abdominal
2) Differential
- Laryngeal cancer
- Laryngitis
- Vocal chord polyp
3) W/U
- CT neck, US neck, ESR, laryngoscopy, CBC with diff, |
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