Shared Flashcard Set

Details

CC, Symptoms, PE / Risks, DDx, Plan
DRS
114
Other
Graduate
03/10/2012

Additional Other Flashcards

 


 

Cards

Term

Orthostatic Hypotension


 

Light-headedness

Loss of Consciousness

 

Symptoms from sitting to standing position

Definition

Risks


Trauma/Injury, Alcoholism, Bleeding Disorder

Infants and Elderly - Dehydration

Vomiting and Diarrhea

Drugs - BP lowering


Differential Diagnosis


Blood Loss

Dehydration

Drugs - β-Blockers, Diuretics

Term

Low Blood Pressure


Fatigue, Palpitations, Shortness of Breath

Light-headedness and/or Loss of Consciousness


Physical exam


Paleness

Increased HR and RR, Decreased BP

Blood in Stool

Decreased Skin Turgor and Tenting

 

Definition

Risk


Trauma/Injury, Alcoholism, Bleeding

Infants and Elderly

Vomiting and Diarrhea


Differential Diagnosis


Acute Blood Loss

Dehydration

Term

Low Blood Pressure


Fatigue, Palpitations, Shortness of Breath

Light-headedness and/or Loss of Consciousness


Physical exam


Signs of Infection

Definition

Risks


Elderly

Severe infection


Differential Diagnosis


Sepsis

Term

Increased Blood Pressure


No Complaints


Physical Exam


Increased BP

Normal RR and HR

Definition

Risks


Fx Hx high BP

Increased Age, African American, obesity, sedentary life style, high salt diet


Differential Diagnosis


Primary Hypertension

Secondary Hypertension

Term

Increased Blood Pressure


Severe headache

Loss of Consciousness


Physical Exam


Increased RR, Decreased HR, Increased BP

Non-responsive

Neurologic deficits

Definition

Risks


Hx of Head injury


Differential Diagnosis


Increased Intracranial Pressure

Term

Increased Blood Pressure


Consistent with Stress


Physical Exam


Anxious Look

Increased HR, RR, BP

Definition

Risks


Life Changes


Differential Diagnosis


Anxiety 

Term

Abnormally Increased Respiratory Rate


Productive Cough

Shortness of Breath

Fever, Chills, Malaise


Physical Exam


Increased RR, HR

Normal BP

Decreased O2 saturation

Abnormal lung sounds

Definition

Risks


Smoking

Lung disease


Differential Diagnosis


Pneumonia

Term

Abnormally Increased Respiratory Rate


Wheezing

Shortness of Breath


Physical Exam


↑RR ↑HR

↓ O2 saturation

Wheezing of lung exam

↓ Peak Flow

Definition

Risks


Atopic Dermatitis

Exposure to Triggers


Differential Diagnosis


Asthma

Term

Increased Temperature


Fever, Chills, Malaise

Symptoms related to Infection


Physical Exam


Symptoms of Infection

 

Definition

Risks


General Risk of infection

Exposure to sick contacts


Differential Diagnosis


Infection

Term

Hypothermia


Chills, Cold to Touch, Pale


Physical Exam


Mild increase HR and RR

Moderate Decrease in HR and RR

Definition

Risks


Exposure to Cold


Differential Diagnosis


Hypothermia due to exposure

Sepsis in Elderly

Term

Dyspnea


Acute Onset

Productive Cough

Fever

Pleuritic Chest Pain

Rigors


Physical Exam


↑ T, RR, HR

Work of Breathing

Chest Exam:

↓ breath sounds

Dull to percussion

Bronchial Breath Sounds

Egophony, Brochophony, Whispered Pectoriloque

Definition

Risks


>65 YO, Cold and Flu Season, Immunocompromised, Smoking, Alcohol, 


Differential Diagnosis


Pneumonia


Plan


CXR

CBC

Sputum gram stain and culture

Blood Cultures

Term

Dyspnea


Episodic

Wheeze

Non-Productive Cough

Triggers


Physical Exam


During Exacerbation - ↑ RR, HR

Pulsus Paradoxus

Work of Breathing

"Tripod Position"

Chest Exam: High Pitched Wheeze

Definition

Risks


Personal, Fx Hx atopic dermatitis, asthma

seasonal allergies

Triggers


Differential Diagnosis


Asthma

Exercise or Viral induced


Plan


Pulmonary Function Tests

Methacholin or Exercise challenge if PFTs normal

Term

Dyspnea with Exertion


Cough - sputum in morning

Avoids exertion


Physical Exam


↑ RR

Work of Breathing

"Tripod Position"

Chest Exam:

Breath Sounds

Hyperinflation

Prolonged Expiration

Expiratory Wheeze

Crackles

Definition

Risks


Smoking

Occupational/Environmental Exposures


Differential Diagnosis


COPD


Plan


CXR

PFTs

Arterial Blood Gas

Term

Acute Dyspnea at Rest


pleurtic chest pain

Cough

> pillow orthopnea

calf or thigh pain/swelling


Physical Exam


↑ RR, HR, ↓BP

DVT symptoms

Chest Exam:

Rales

↓ Breath Sounds

 

Definition

Risks


DVT


Differential Diagnosis


Acute Pulmonary Embolus


Plan


VQ scan

Spiral CT

EKG

CBC - Troponin levels

Arterial Blood Gas

Term

Dyspnea


Orthopnea, Postural Nocturnal Dyspnea

Lower extremity swelling


Physical Exam


↑ Jugular venous Distension

Bilateral Crackles

Displace PMI

S3

Lower extremity Edema

Definition

Risks


Hx or Cardiac Disease

Hypertension

Alcohol Abuse


Differential Diagnosis


Congestive Heart Failure


Plan


CXR

ECHO

Increased Natriuretic Peptide

Term

Dyspnea - Hemoptysis


Gradual Onset

Hemoptysis

Chest Pain


Physical Exam


Diastolic Murmur

Splitting of S2 (pulmonary HTN)

Rt ventricular Heave (pulmonary HTN)

Definition

Risks


Hx of rheumatic Fever

Bicuspid valve

Coarctation of aorta


Differential Diagnosis


Valvular Heart Disease

Mitral Stenosis


Plan


ECHO

Term

Dyspnea and Heart Failure


Dizziness and syncope

Angina


Physical Exam


Slow rate of rise in Carotid Pulse

Systolic efection murmur heard at aortic area

↓ 2nd heart sound

Definition

Risks


Bicuspid Valve

Rheumatic Fever


Differential Diagnosis


Valvular Heart Disease

Aortic Stenosis


Plan


ECHO

Term

Cough


Chronic >3wks 

weight loss, fatigue

Fever, night sweats


Physical Exam


Non-specific

Clubbing of Nails

Chest Exam:

Dullness to percussion

Fremitus

Definition

Risks


Immunocompromised

Exposure - healthcare, prisoners, immigrants


Differential Diagnosis


Reactivation

Tuberculosis


Plan


CXR

Acid Fast Bacilli Stain + Culture

Tuberculin Skin Test

Term

Cough


Chronic >3wks

weight loss, Fatigue

Anorexia


Physical Exam


Varied

Often Normal

Definition

Risks


Smoking

Radiation Therapy

Exposure to carcinogens


Differential Diagnosis


Lung Cancer


Plan


CXR

CT scan

Tissue Biopsy

Term

Cough


Heartburn

Regurgitation

Dysphagia

Bronchospasm

Laryngitis


Physical Exam


Often Normal

Occasional Epigastric Tenderness

Definition

Risks


Smoking

Alcohol

Obesity


Differential Diagnosis


GERD


Plan


Esphagoscopy

Upper GI Barium Swallow Test

Term

Chest Pain


Diffuse Retrosternal, Down Lt arm or jaw

Dull, vise-like

minutes

alleviated by rest, nitroglycerin

aggrevated by effort, emotion, eating


Physical Exam


Normal between episodes

Definition

Risks


↑ Age, Obesity, Smoking, ↑ Cholesterol, Fx Hx, Male, HTN, Diabetes


Differential Diagnosis


Coronary Artery Disease

Angina

Transient MI


Plan


EKG

Labs: Troponin, CPK-MB

Term

Chest Pain


Severe, Sharp, "Tearing"

Posterior chest or back pain

Acute


Physical Exam


Acute Aortic Insufficiency - Diastolic decrescendo murmur Right Sternal Boarder

>20mmHg difference in systolic BP between arms 

Definition

Risks


HTN, Atherosclerosis, Vasculitis, Collagen Disorders

CABG Hx, Cocaine Use


Differential Diagnosis


Aortic Dissection


Plan


CT scan of chest

MRI of chest

Transesophageal or Transthoracic ECHO

Term

Chest Pain


Sudden onset

Anterior Chest, sharp, Worse w/ inspiration

Pain Decreased by leaning forward

Fever


Physical Exam


Pericardial Friction Rub

Definition

Differential Diagnosis


Acute Pericarditis


Plan


EKG

CXR

Labs: CBC, Sed Rate, C-reactive Protein

 

Term

Chest Pain


Substernal

Burning

Cough and ENT Sx


Physical Exam


Weight loss if dysphagia

Wheezing if Aspiration

Definition

Risks


Smoking

Alcohol Consumption


Differential Diagnosis


GERD


Plan


EGD for ulcer disease

Term

Chest Pain


Anterior Chest - specific spot

Acute, Sharp, Severe

aggrevated by movement


Physical Exam


Point Tenderness over costochondral Jnx

Definition

Risks


Viral Illness


Differential Diagnosis


Costochondritis


Plan


Rest, NSAIDs

Term

Chest Pain


Unilateral Chest

Sharp, Severe

Worse on inspiration/cough


Physical Exam


Increased effort to breath

Splinting of chest

decreased breath sounds

changes to percussion

Definition

Risks


Smoking

Aspiration Risk

COPD


Differential Diagnosis


Pleuritis


Plan


CXR

Term

Syncope


Fluid Depleted

Patient warm, still, upright


Physical Exam


↓ BP with bradycardia or vasodilation

Definition

Risks


"Classical Vasovagal Syncope"


Differential Diagnosis


Vasovagal syncope

Neurocardiogenic Syncope


Plan


Rule out other causes

Tilt Table

Term

Syncope


After urination, defecation, cough or swallowing


Physical Exam


↓ BP with bradycardia or vasodilation

Definition

Differential Diagnosis


Situational Syncope


Plan


Good History

Term

Syncope


Light-headedness and/or Loss of Consciousness

Changes sitting to standing


Physical Exam


Orthostatic Hypotension

Definition

Risks


Trauma/Injury

Alcoholism

Bleeding Disorders

Dehydration

Drugs


Differential Diagnosis


Blood Loss

Dehydration

Drugs - BP meds


Plan


Othostatic Hypertension test

CBC

Term

Syncope


Dyspnea and Heart Failure

Dizziness

Angina


Physical Exam


Slow rate of rise in carotid pulse

Systolic Ejection Murmur

↓ intensity of 2nd heart sound

Definition

Risks


Bicuspid Valve

Rheumatic Fever


Differential Diagnosis


Aortic Stenosis


Plan


ECHO

Term

Syncope


Palpitation

Chest Pain


Physical Exam


Irregular rhythm

Definition

Risks


Cardiac Disease

Fx Hx of sudden death

Caffeine, Alcohol


Differential Diagnosis


Cardiac arrhythmias

2nd/3rd Degree Heart Block

Supraventricular Tachycardia

Sick Sinus Syndrome

Atrial Fibrillation


Plan


EKG

Term

Syncope


Jerking, loss of urine or bowel

post-ictal confusion


Physical Exam


Normal with Neurological abnormalities

Definition

Risks


Head Trauma

Hx of Seizures

Brain masses/abscesses

Metabolic disturbances


Differential Diagnosis


Seizure


Plan


EEG

CT of Head

Term

Dyspnea


Orthopnea

Postural Nocturnal Dyspnea

Lower Extremity Swelling


Physical Exam


↑ Jugular Distension

Bilateral Crackles

Displaced PMI

S3

Lower Extremity Edema

Definition

Risks


Hx of Cardiac Disease

HTN

Alcohol abuse


Differential Diagnosis


CHF


Plan


CXR

ECHO

Labs: CBC, Brain natriuretic peptide

Term

Dyspnea


Gradual Onset

Hemoptysis

cerebral embolism

Chest Pain (infrequent)


Physical Exam


Diastolic Murmur - heard at apex

Splitting of S2 (pulmonary htn)

Rt ventricular heave (pulmonary htn)

Definition

Risks


Hx of Rheumatic Fever

Bicuspid Valve

Coarctation of Aorta


Differential Diagnosis


Mitral Stenosis


Plan


ECHO

Term

Dyspnea


Heart Failure

Dizziness

Syncope

Angina


Physical Exam


Slow Rate of Rise in Carotid Pulse

Systolic Ejection Murmur - aortic area

↓ intensity of 2nd heart sound

Definition

Risks


Hx of Rheumatic Fever

Bicuspid Valve


Differential Diagnosis


Aortic Stenosis


Plan


ECHO

Term

Dyspnea


at Rest

Pleuritic Pain

Cough

>2 pillow orthopnea

Calf or thigh pain/swelling


Physical Exam


Tachypnea, Tachycardia, Rales, ↓ Breath sounds

DVT symptoms

Definition

Risks


DVT


Differential Diagnosis


Acute Pulmonary Embolus


Plan


Ventilation Perfusion Scan

Spiral CT of Chest

EKG

Troponin levels

ABG

Term

Acute Abdominal Pain


Periumbilical, RLQ

Progressively worsening over a few hours


Physical Exam


Flexed Right Leg, Lying Still

Guarding and Rebound Tenderness

Definition

Differential Diagnosis


Appendicitis


Plan


CBC w/ Differential

LFTs, Bilirubin

CT scan with contrast

Term

Acute Abdominal Pain


Epigastric, Radiates to Back

alleviated by sitting up leaning forward

Anorexia, Nausea, Vomiting


Physical Exam


Tenderness even to light touch

WITHOUT rebound tenderness

Definition

Risks


Alcoholism, Gallstones, HyperTG, Trauma, Drugs


Differential Diagnosis


Pancreatitis


Plan


CBC with Differential

Electrolytes

LFTs: aminotransferase, Alkaline Phosphatase, Bilirubin

Lipase

Abdominal Ultrasound

CT of abdomen

Term

Acute Abdominal Pain


Epigastric (R or L)

Burning, Radiates to Back

Awakens at Night

Better after Eating

Dyspepsia

Melena


Physical Exam


May be Normal

Guaiac positive Stool

Definition

Risks


NSAIDs

Alcohol


Differential Diagnosis


Peptic Ulcer Disease


Plan


Endoscopy 

Barium Radiography

H. pylori testing

Term

Acute Abdominal Pain


Diffuse

Anorexia, Bloating, Nausea, Vomiting, Constipation


Physical Exam


High Pitched or Absent Bowel Sounds

Distention

Abdominal percussion: tympany

Definition

Risks


Previous Abdominal Surgery


Differential Diagnosis


GI Obstruction


Plan


CBC w/ differential

Electrolytes

LFTs

Lipase

Urinalysis

Pregnancy Test

Abdominal X-ray

Term

Acute Abdominal Pain


RUQ, Radiates to back, epigastrium, right shoulder

Fever

Jaundice


Physical Exam


Tenderness in RUQ

Murphy's Sign +

Definition

Risks


Fat, Forty, Fertile, Female


Differential Diagnosis


Acute Cholangitis


Plan


CBC w/ differential

Electrolytes

LFTs

Lipase

Urinalysis

Pregnancy Test

Abdominal Ultrasound

Cholangiopancreatography

Term

Acute Abdominal Pain


LLQ (RLQ in Asians)

Blood in Stool

Cramping, Bloating, Flatulence, Irregular defecation


Physical Exam


Stool positive for guaiac or occulat blood positive

Definition

Differential Diagnosis


Diverticular Disease


Plan


CT of Abdomen with Contrast

Term

Blood in Stool


Bright Red


Physical Exam


Guaiac Positive

Definition

Differential Diagnosis


Lower tract pathology:

Anal Fissures

Hemorrhoids

Term

Blood in Stool


Melena

Black Tarry Stools


Physical Exam


Guaiac Positive

Definition

Risks


NSAIDS

Alcoholism


Differential Diagnosis


Upper tract Pathology

Peptic Ulcers

Gastritis

Esophageal Varices


Plan


Endoscopy

Term

Blood in Stool


Change in Bowel habits

Weight loss

Anemia

Fatigue


Physical Exam


Guaiac Positive

Weight Loss

Definition

Risks


↑ Age

Fam Hx of Bowel Cancer

Polyposis


Differential Diagnosis


Bowel Cancer


Plan


CBC

Stool for occult blood

Colonoscopy, Sigmoidoscopy

Barium enema

Term

Vomiting


Early Morning

headache

no abdominal pain


Physical Exam


Focal Neurological deficits

Definition

Differential Diagnosis


Brain Tumor


Plan


CT of head

Term

Vomiting


Nausea


Physical Exam


Enlarged Uterus

Definition

Risks


Sexually active female


Differential Diagnosis


Pregnancy


Plan


Urine Pregnancy Test

Ultrasound

Term

Vomiting


Fever, Diarrhea

non bilious stomach contents


Physical Exam


↑ T and HR

Dehydration

Epigastric Tenderness

Active Bowel Sounds

Definition

Risks


Exposure to sick contacts

Recent Antibiotics


Differential Diagnosis


Gastroenteritis


Plan


Stool for Leuckocytes

Culture of stool

Term

Vomiting


Diffuse Pain

Anorexia, Bloating, Nausea, constipation

Bilious or feculent


Physical Exam


High Pitched or absent bowel sounds

Distention

Abdominal percussion: Tympany

Definition

Risks


Previous Abdominal Surgery


Differential Diagnosis


GI Obstruction


Plan


CBC with Differentials

Electrolytes

LFTs

Lipase

Urinalysis

Pregnancy Test

Abdominal X-ray

Term

Vomiting


Epigastric Pain radiating to Back

Alleviated by sitting up leaning forward

Anorexia, Nausea


Physical Exam


Abdominal Tenderness with light touch 

WITHOUT rebound tenderness

Definition

Risks


Alcoholism, Gallstones, HyperTG, Trauma, Drugs


Differential Diagnosis


Pancreatitis


Plan


CBC with differentials

Electrolytes

LFTs

Lipase

Abdominal ultrasound

CT of abdomen

Term

Jaundice


Fatigue, Malaise, Nausea, Vomiting, Light colored stool


Physical Exam


Jaundice

Hepatomegly

Definition

Risks


Travel to Endemic Area

IV Drug Use

Risky Sexual Behavior

Blood Transfusion


Differential Diagnosis


Hepatitis A, E, B, C


Plan


IgM for Hep A, E

Ab for Hep B surface Ag and core Ag

Hep C antigen, viral Load

LFTs

Liver Biopsy

 

Term

Jaundice


ascites

Puritus

Confusion


Physical Exam


Spider angiomata

Palmer erythema

Nail Changes

Gyncomastia

Testicular atrophy

Caput medusa

Splenomegly

Ascites

Asterixis

Definition

Risks


Alcohol

Hepatitis B or C


Differential Diagnosis


Liver Cirrhosis


Plan


LFTs

PTT

CBC

ultrasound

Liver biopsy

Term

Ear Pain


Hearing Loss

No Fever

Pruritus

Discharge


Physical Exam


Tenderness of tragus and/or pinna

TM normal

Erythema and/or exudate in canal

Conductive Hearing Loss

Definition

Risks


Swimming

Diabetes Mellitus


Differential Diagnosis


External otitis

(Swimmer's ear)

Term

Ear Pain


Fever

Decreased Hearing


Physical Exam


TM - dull, erythematous, no landmarks or light reflex, immobile

Mastoid Tenderness (Alert)

Definition

Risks


Prededing URI

Lack of immunizations


Differential Diagnosis


Otitis Media

Mastoiditis (Alert)


Plan


Treatment for improvement

Term

Hearing Loss


Gradual, Progressive, Bilateral

Tinnitus


Physical Exam


Decreased Acuity in Affected ears

AC>BC

Weber lateralizes to UNAFFECTED ear

Definition

Risks


Congenital, Aging

ototoxic drugs, noise esposure, menigitis, Hx of Meniere's disease, diabetes


Differential Diagnosis


Sensorineural hearing Loss

(presbycusis with aging)


Plan


Audiogram

Term

Hearing Loss


Sudden, Unilateral

Painful


Physical Exam


Obstruction

Decreased acuity in affected ear

AC>BC

Weber lateralizes to AFFECTED Ear

Definition

Risks


Trauma, Infection, Upper Airway congestion

Cerumen


Differential Diagnosis


Conductive hearing Loss

(otitis media, external otitis)

Term

Hearing Loss


Sudden Onset

Unilateral


Physical Exam


Decreased acuity in affected ear

AC>BC

Weber lateralizes to UNAFFECTED ear

Definition

Risks


Underlying disease - cardiac disease or autoimmune


Differential Diagnosis


Sudden sensorineural hearing loss

Term

Sore Throat


Acute

Fever, Runny Nose, Cough


Physical Exam


Pharyngeal erythema, exudate, edema

Rhinorrhea

Definition

Risks


Exposure to contagious persons


Differential Diagnosis


Viral Pharyngitis


Plan


Throat Culture (negative)

Term

Sore Throat


Acute

Fever, Swollen glands

No URI symptoms, No Cough


Physical Exam


Pharyngeal erythema, exudate, edema, petechiae

Cervical Adenopathy

Skin - diffuse erythema, "sand papery" rash

Definition

Risks


Exposure to contagious persons


Differential Diagnosis


Group A Streptococcal pharyngitis


Plan


Rapid Strept Test

Throat Culture

Term

Sore Throat


Chronic

Dysphagia or difficulty swallowing


Physical Exam


Cachectic

Pharyngeal erythema, Mass

Definition

Risks


Smoking, alcohol, older age


Differential Diagnosis


Cancer - Squamous Cell


Plan


CT scan

Biopsy

Term

Rhinorrhea


Acute

Cough, Body Aches, Fever, Vomiting, Diarrhea


Physical Exam


Clear Rhinorrhea

No Sinus Tenderness

 

Definition

Risks


Wintertime

Exposure to people who are ill


Differential Diagnosis


Viral illness

 

Term

Rhinorrhea


Several Days

Nasal Discharge, Congestion

Cough, Fever, Headache, Facial Pain


Physical Exam


Purulent Rhinitis

Posterior pharygeal exudate

Facial Tenderness

Definition

Risks


Cocaine Usage by Nose


Differential Diagnosis


Bacterial Sinusitis

Term

Rhinorrhea


Chronic or Seasonal

Sneezing


Physical Exam


Clear rhinorrhea

Allergic shiners or nasal crease

Definition

Risks


Environmental Triggers


Differential Diagnosis


Allergic rhinitis

Term

Visual Loss/Changes


Sudden, Painless

Floaters or Cobweb

Loss of visual field in one eye


Physical Exam


Decreased visual acuity, fields

Retinal Tear on fundoscopic or slitlamp exam

Definition

Risks


Myopia

Cataract surgery


Differential Diagnosis


Retinal Detachment


Plan


Visual Acuity and Field Test

Slitlamp biomicroscopy

Dilated retinal exam 

Term

Visual Loss/Changes


Decreased vision

Halos around lights

Headache

Severe Eye Pain (Deep brow ache)

Nausea and Vomiting


Physical Exam


"Steamy" cornea

Watery discharge

pupil may be non-reactive

 

Definition

Risks


Family Hx, >40-50 YO

Hyperopia, pseudoexfoliation


Differential Diagnosis


Narrow angle glaucoma


Plan


Visual Acuity, Pupil evaluation, Intraocular pressure

Slit Lamp Exam, Visual Fields, Undilated fundus exam

Term

Visual Loss/Changes


Painless eyes

Headache and other neurologic symptoms


Physical Exam


Hemianopsias

Neurological deficits

Definition

Risks


Stroke - ↑ Age, DM, hypercholesterolemia


Differential Diagnosis


Stroke with acute onset 

Brain Tumor with gradual onset


Plan


CT of head

MRI of Brain

Term

Visual Loss/Changes


Progressive, Painless

Initially presents w/ difficulty w/ night driving


Physical Exam


Darkened Red reflex

White Opacity of lens 

Definition

Risks


Age, Smoking, Alcohol, Sunlight, Low Education, Poor Lifestyle, Metabolic Syndrome, DM


Differential Diagnosis


Cataracts


Plan


Visual Acuity

Fundoscopic Exam

Term

Visual Loss/Changes


Double vision


Physical Exam


Dilated pupil if CN3 involved

EOM abnormality

Definition

Differential Diagnosis


Palsy of CN 4, 3, or 6


Plan


Check Extraocular Movements

Term

Visual Loss/Changes


Loss of Vision


Physical Exam


Cupping on fundoscopic exam

Decreased Visual Fields

Increased Ocular Pressure

Definition

Risks


Increased Ocular Pressure

Increased Age

African American, Family Hx


Differential Diagnosis


Primary Open Angle Glaucoma


Plan


Visual Field, Acuity

Fundoscopic Exam

Intraocular Pressure

Term

Visual Loss/Changes


Asymptomatic until Late

Curtain Falling, Floaters


Physical Exam


Cotton-Wool spots, intraretinal hemorrhages, hard exudates, microaneurysms

neovascularization

Definition

Risks


Diabetes

Hyperglycemia

Pregnancy


Differential Diagnosis


Diabetic Retinopathy


Plan


Visual Acuity

Ophthalmoscopy on dilated fundus

Term

Red Eye or Eye Pain


Sudden onset, bilateral or unilateral

Gritty feeling in eyes

Discharge


Physical Exam


Vision - Normal

Cornea - Clear, pupils reactive

Purulent or Watery Discharge

Preauricular adenopathy

Definition

Risks


Exposure to another with red eye


Differential Diagnosis


Conjuncivitis - viral or bacterial


Plan


Diagnosis of Exclusion

Look for Red Flags

Term

Red Eye or Eye Pain


Painful, Sudden Onset, Recurrent, Unilateral


Physical Exam


Photophobia

sluggishly reactive pupils

constricted pupil

Definition

Risks


Inflammatory Diseases - IBD, SLE, RA

Drugs


Differential Diagnosis


Anteriaor Uveitis

Iritis


Plan


Slit Lamp Exam

Term

Red Eye or Eye Pain


Exquisite Pain

Unilateral Sensation of a foreign body


Physical Exam


Irregular corneal light reflex

May be Loss of vision

Definition

Risks


Trauma, Contact Lens, Foreign Body


Differential Diagnosis


Corneal Abrasion


Plan


Fluorexcein Exam with Wood's Lamp

Term

Headaches


Bilateral head or neck

pressure, tightness

builds up as day wears on

waxes and wanes


Physical Exam


Normal Neurologic Exam

May have muscle tenderness in occipital or TMJ

Definition

Risks


Female, Stress


Differential Diagnosis


Tension 


Plan


NSAIDs

Term

Headache


Recurrent, moderate-severe

Unilateral, Frontal, Bifrontal, Global

Aura Prior to Pain

Triggers

Naudea, vomiting, photophobia


Physical Exam


Photophobia

Transient Focal Neurological deficits

Definition

Risks


Young Adult, Female, Family Hx

Triggers: alcohol, chocolate, aged cheese, MSG...


Differential Diagnosis


Migraine


Plan


Treat with selective 5-HT1B/1D receptor agonists or Ergot alkaloids

 

Term

Headaches


Unilateral, around eye or temple

Ipsilateral lacrimation and redness of eye, stuffy nose, rhinorhea, pallor


Physical Exam


Ipsilateral miosis and ptosis

Definition

Risks


Men

Associated with Smoking


Differential Diagosis


Cluster Headache

Term

Headache


Danger Signs:

Age <5 or >50

"Worst headache of life"

Max intensity in secons to minutes

Trauma, after strenuous exercise


Physical Exam


Danger Signs:

Change in mental status, level of consciousness

Neuor Deficits

Definition

Risks


Hx of Hypertension


Differential Diagnosis


Subarchnoid or Intracranial Hemorrhage


Plan


CT of head without contrast

Term

Headache


Dull and Constant

Worse in AM

AM vomiting

weight loss, fatigue, night sweats


Physical Exam


Hypertension, Papilledema

Focal Neurological Findings

 

Definition

Risks


None


Differential Diagnosis


Brain Tumor


Plan


Head CT

Gadolinium inhanced MRI

Term

Dementia


Gradual onset

Progressive loss of functions


Physical Exam


Changes in general appearance

disheveled, decreased eye contact

No sensorimotor deficits

Definition

Risks


↑ Age, Family Hx, Certain genes


Differential Diagnosis


Alzheimer's Disease


Plan


Mini Mental Status Exam

CT of Head

Rule out Treatable causes

Term

Dementia


Sudden Onset


Physical Exam


Facial Motor abnormalities

Slurred Speech

Upper Motor neuron abnormalities

Definition

Risks


Age >60, Diabetes, HTN, Hyperlipidemia, Smoking


Differential Diagnosis


Stroke


Plan


CT of Head

MRI or Neck 

ECHO

Term

Dementia


Headache

Gait difficulty, cognitive disturbance, decreased concentration, apathy, urinary incontinence


Physical Exam


Lower extremity spasticity

Hyperreflexia, Extensor Plantar responses

Hand Tremor, Rigidity

Definition

Risks


Hx of Trauma to head

intercranial hemorrhage or infection


Differential Diagnosis


Normal Pressure Hydrocephalus


Plan


CT without contrast

MRI

LP to remove fluid

Term

Shoulder Pain


Weakness

Worse with overhead activities


Physical Exam


Weakness with external rotation

Difficulty with abduction of arm

Definition

Risks


Trauma, middle-older age, sports, occupational

Smoking, Obesity


Differential Diagnosis


Rotator Cuff Injury


Plan


X-ray shoulder

Ultrasound

MRI

Term

Shoulder Pain


Chronic Pain, Stiffness


Physical Exam


Loss of Range of Motion

 

Definition

Risks


Disuse, Diabetes


Differential Diagnosis


Adhesive Capsulitis

(Frozen Shoulder)


Plan


X-ray or shoulder

Ultrasound

MRI

Term

Knee Pain


Progressive Pain, Crepitus, weight bearing joints

Morning Stiffness <30mins

No Warmth

Involves DIP joints


Physical Exam


Limitation of ROM

Joint Deformity

Definition

Risks


Advancing Age, Female, Obesity


Differential Diagnosis


Osteoarthritis or knee or hip


Plan


X-ray of knee

Term

Knee Pain


Twisting injury with foot fixed

Swelling and Pain Diffuse


Physical Exam


May be Normal

Loss of Smooth motion

 

Definition

Risks


Trauma


Differential Diagnosis


Meniscus Tear


Plan


X-ray

Ultrasound

MRI

Diagnostic arthroscopy

Term

Knee Pain


Trauma from Lateral Side or Front


Physical Exam


Tenderness and Swelling

Joint Instability - laxity

Drawer Test - Forward mobility

Abnormal medial motion

Definition

Risks


Trauma in an adult


Differential Diagnosis


MCL tear - Blow to Lateral Side

ACL tear - Blow to Front

LCL - Varus Stress


Plan


MRI

X-ray

Term

Knee Pain


Recurrent Attacks

Synovial Effusion

MCP joints and Knees


Physical Exam


Exquisitiely tender joints with erythema and edema

Definition

Risks


Trauma, Surgery, fatty foods, dehydration, diuretics, low dose aspirin, beer or spirits


Differential Diagnosis


Gout - MSU crystals

Pseudo Gout - CPPD crystals


Plan


Synovial Fluid aspiration

 

Term

Pain in Knee


Fever, Fatigue, Stiffness worse in Morning

MCP, PIP joints

> 6 weeks


Physical Exam


Swollen Tender Joints

Limited Joint movement

Rheumatoid Nodules

Definition

Risks


> in women, Smoking


Differential Diagnosis


Rheumatoid Arthritis


Plan


Labs: ANA, C-reactive protein, ESR, Rh Factor

X-ray - hand, wrist, feet

 

Term

Knee Pain


Fever, Chills, Fatigue, Malaise

Red, Hot, Swollen Joint


Physical Exam


Red, Warm, Swollen Joint

Definition

Risks


Trauma


Differential Diagnosis


Septic Arthritis


Plan


Gram stain and culture of joint fluid

Term

Lower Back Pain


Back Pain


Physical Exam


Decreased Range of Motion

Negative Straight leg test

Definition

Risks


Smoking, Obesity, ↑ Age, Femal, Strenuous work, sedentary, Worker's Comp


Differential Diagnosis


Sprained muscle


Plan


X-ray

CT or MRI

Term

Lower Back Pain


Radiating Pain, Numbness

Tingling or Muscle Weakness


Physical Exam


Decreased ROM

Straight Leg raise elicits Pain

Sitting Knee Extension elicits Pain 

Definition

Risks


Smoking, Obesity, ↑ age, Female


Differential Diagnosis


Radiculapathy


Plan


X-ray

CT or MRI

Term

Lower Back Pain


Bowel or Bladder dysfunction

Saddle anesthesia

Bilateral Leg Weakness and Numbness


Physical Exam


Neurological Dysfunction

Definition

Risks


Smoking, Obesity, ↑ Age, Female


Differential Diagnosis


Cauda Equina Syndrome


Plan


Emergent MRI

Emergent neurosurgeon or ortho consult

Term

Rash with Fever


Severe and Acute, or Subacute with URI deterioration

Headaches, irritability

Neck stiffness


Physical Exam


Fever, Tachycardia, tachypnea, ill appearing,

poor perfusion

Petechial/Purpuric Rash

Definition

Risks


Dorms or Barracks

Mid-Winter

Unvaccinated


Differential Diagnosis


Meningococcemia


Plan


Start Antibiotics

LP and skin biopsy

Term

Rash with Fever


Headache, Myalgias


Physical Exam


Fever

Petechial Rash on palms and Soles

Definition

Risks


Tick Bite 5-10 days prior

Southwestern US, Summertime


Differential Diagnosis


Rocky Mountain Spotted Fever


Plan


Skin Biopsy

Serological Testing

Antibiotics

Term

Rash with Fever


Chills, night sweats

loss of appetite and weight

fatigue and malaise

Bone pain, Limp


Physical Exam


Generalized Lymphadenopathy

Organomegaly

Petechiae/Purpura

Definition

Risks


Any Age, Exposure to benzene and ionizing radiation


Differential Diagnosis


Leukemia with Fever


Plan


Blood Smear

Chemotherapy

Term

Rash With Fever


malaise, pharyngitis, loss of appetite

Followed by:

Generalized vesicular pruritc Rash


Physical Exam


Vesicular lesions on erythematous base in different stages 

Definition

Risks


Unvaccinated Children

Worse in adults


Differential Diagnosis


Varicella


Plan


PCR

Direct Fluorescent Antibody Viral Culture

Acyclovir

Term

Rash with Fever


cough, coryza, conjunctivitis


Physical Exam


Blanching "red brick" maculopapular rash on head and neck, spreading to trunk and extremities

Definition

Risks


Unvaccinated Children

Immunocompromised


Differential Diagnosis


Measles


Plan


Anti-measles IgM and IgG

Vitamin A

Contact isolation

Term

Rash with Fever


3-4 days of fever

Rash after Fever breaks on trunk and spreads

Spares Face


Physical Exam


Maculopapular rash

Definition

Risks


Childhood Disease


Differential Diagnosis


Roseola


Plan


Symptomatic Treatment

Term

Rash with Fever


Low Grade Fever

malaise, pharyngitis, loss of appetite

headache, weight loss, rash


Physical Exam


Macular or Papular Rash

Trunk, Extremities, Palms/Soles

Generalized Lymphadenopathy

 

Definition

Risks


Risky sexual behavior


Differential Diagnosis


Secondary Syphilis


Plan


Penicillin

VRDL, RPR, FTA-ABS

Term

Rash with Fever


Low Grade Fever, Pruritis


Physical Exam


Eruptions in dependent areas

Generalized

Involve mucus membrane erythema

Definition

Risks


New drug 10-14 days before


Differential Diagnosis


Drug-induced Exanthems


Plan


Histamine Blockers

Steroids

Term

Rash with Fever


Intensely pruritic rash


Physical Exam


Circumscribed, raised, and erythematous eruption with central pallor

Definition

Risks


Rash within hours of exposure


Differential Diagnosis


Urticaria 


Plan


Histamine Blockers

Steroids

Term

"Ugly" Skin Lesion


No Systemic symptoms

"Ugly" changing mole


Physical Exam


Asymmetry, irregular and notched borders

variable color, >6mm in size

Firm regional lymph adenopathy

 

Definition

Risks


Fair Skin, Family Hx, Skin Burns, Advancing Age


Differential Diagnosis


Malignant Melanoma


Plan


Skin Biopsy

Excision

Chemotherapy

 

Term

"Ugly" Skin Lesion


Non healing ulcer


Physical Exam


Scaly, Crusting nodule that can bleed

Definition

Risks


Skin esposed to Sun

Family Hx


Differential Diagnosis


Squamous Cell Carcinom


Plan


Skin Biopsy

Excision

Chemotherapy

Term

"Ugly" Skin Lesion


on Face or Trunk


Physical Exam


Pearly, Rolled, Well-defined

Margin with central ulcerated depression

Definition

Risks


Sun Exposure

Higher incidence in Caucasians


Differential Diagnosis


Basel Cell Carcinoma


Plan


Skin Biopsy

Excision

Chemotherapy

Term

"Ugly" Skin Lesion


No Systemic Systmes


Physical Exam


Symmetric, Regular Borders

Uniform in Color

<6mm

Definition

Risks


Normal to hae 10-40 over face and body


Differential Diagnosis


Nevi, Normal Mole


Plan


None needed

Term

"Ugly" skin lesion


Single or Multiple lesions


Physical Exam


Located in genital, planer, or palmer areas

Flat, Mosaic, or Filiform types

Definition

Risks


Children/Young adults

Occupational risk - meat handlers

Atopic dermatitis


Differential Diagnosis


Wart

HPV 1 planter warts

HPV 6,11 anogenital warts


Plan


Salicylic Acid

Duct Tape

Excision

Cryotherapy

Term

Rash


Ichy on face, flexor surfaces, arms, and legs


Physical Exam


Dry scales, plugged hair follicles, inflammation around lips

Increased skin creasing

Darkening of skin around Eye

Definition

Risks


Infants, young children


Differential Diagnosis


Atopic Dermatitis


Plan


Biopsy

Topical steroids

Moistruizers

 

Term

Rash


Itchy Red Raised

Where contact occurred 12-48hrs prior


Physical Exam


Red Raised Rash

Definition

Risks


Poison Ivy, Nickel, Chromate


Differential Diagnosis


Contact Dermatitis


Plan


Biopsy

Avoid allergen

Topical Streoids

Term

Rash


Painful blisters


Physical Exam


Painful Blisters which crust

Definition

Risks


Any Age


Differential Diagnosis


Herpes


Plan


PCR

Direct Fluorescent Antibody Viral Culture

Acyclovir

Term

Rash


Acute neuritis

headache, fever, malaise, fatigue


Physical Exam


Starts on erythematous papules that group into vesicles and bullae

Over dermatome area 

Definition

Risks


Older Age

Immunocompromised


Differential Diagnosis


Herpes Zoster


Plan


PCR

Direct Fluorescent Antibody

Viral Culture

Acyclovir

Term

Generalized Lymphadenopathy


Flu-Like Illness


Physical Exam


Fever, Rash, generalized lymphadenopathy

Definition

Risks


Risky sexual behaviour

blood transfustion

OSHA breech


Differential Diagnosis


HIV: persistent generalized lymphadenopathy


Plan


ELISA and Western Blot Testing

Anti-retroviral treatment

 

Term

Generalized Lymphadenopathy


Fever, Fatigue and Sore throat for several days


Physical Exam


Exudative pharyngitis

Splenomegaly

Maculupapular rash after ampicillin

Rash over trunk 

 

Definition

Risks


Adolescent, Young Adults

Kissing


Differential Diagnosis


EBV: mononucleosis


Plan


Mono Spot Test

Symptomatic Treatment

Term

Generalized Lymphadenopathy


Chills, night sweats

loss of appetite and weight

fatigue, malaise, bone pain, limp


Physical Exam


organomegaly

petechia/purpura

Definition

Risks


Any Age

Chemical/Radiation Exposure


Differential Diagnosis


Malignancy: Leukemia


Plan


Blood Smear

Chemotherapy

Term

Generalized Lymphadenopathy


Rashes, arthralgias, Chest pain, Fatigue


Physical Exam


Fever, Malar Rash

Arthritis

Definition

Risks


Young Adult Female

AA and Hispanic

Drug induced


Differential Diagnosis


Collagen Vascular disease

SLE

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