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160 Cards in this Set
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Headache
-Throbbing pain -lasts 2-3 hours -sees flashes of light -unilateral -weakness & numbness -family history of migraines |
Migraine*
Tension Headache Cluster headache Psuedotumor Cerebri trigeminal neuralgia Partial Seizure Intracranial Neoplasm |
CBC
ESR CT-Head MRI-Brain LP |
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Headache
- ipsilateral rhinorrhea -eye tearing & redness - last 45 mins |
Cluster Headache*
Migraine Tension headache Sinusitis trigeminal neuralgia Partial Seizure Intracranial Neoplasm |
CBC
ESR CT-Head MRI-Brain LP |
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Headache
-severe, intermittent right temporal headache - blurred vision in one eye - pain in jaw when chewing |
Temporal arteritis*
Migraine Cluster headache Tension headache Meningitis Carotid Dissection Pseudotumor Cerebri Trigeminal Neuralgia Intracranial Neoplasm |
CBC
ESR Temporal Artery Biopsy Doppler U/S Carotid MRI - brain |
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Frontal Headache
-fever -nasal discharge -pain with palpation of frontal & maxillary sinuses -Hx of sinusiits |
Sinusitis*
Migraine Tension headache Meningitis Depression Caffeine Withdrawal Hypertension Cluster headache Pseudotumor Cerebri Intracranial Neoplasm |
CBC
Electrolytes ESR CT- head LP |
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Headache
-sudden, severe -vomiting -confusion -left hemiplegia -nuchal rigidity |
Subarachnoid Hemorrhage*
Migraine Meningitis/Encephalitis Intracranial Hemorrhage Vertebral Artery Dissection Intracranial Venous Thrombus Acute Hypertension Intracranial Neoplasm |
CT - without contrast - head
LP CBC PT/PTT MRI/MRA - brain |
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Headache
-high fever -severe headache -confusion - photophobia - Nuchal rigidity Positive Kernig Positive Brudzinski |
Meningitis *
Migraine Subarachoid Hemorrhage Sinusitis/Encephalitis Intracranial or Epidrual Abscess |
CBC
CT - head MRI- brain LP - CSF analysis - cell count, protein, glucose, Gram stain, PCR for antigens |
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18 yo obese F presents with a pulsatile
headache, vomiting, and blurred vision for the past 2–3 weeks. She is taking OCPs. |
Pseudotumor cerebri*
Tension headache Migraine Cluster headache Meningitis Intracranial venous thrombosis Intracranial neoplasm |
Urine hCG
CBC CT—head LP—opening pressure and CSF analysis |
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57 yo M c/o daily pain in the right cheek
over the past month. The pain is electric and stabbing in character and occurs while he is shaving. Each episode lasts 2–4 minutes. |
Trigeminal neuralgia*
Tension headache Migraine Cluster headache TMJ dysfunction Intracranial neoplasm |
CBC
ESR MRI—brain |
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85 y/o M
Confusion -Progressive confusion over years -Forgetfulness -clumsiness Hx: HTN, DM, 2 strokes with hemiparesis Mental status declined with each stroke |
Vascular (“multi-infarct”)
dementia Alzheimer’s disease Normal pressure hydrocephalus Chronic subdural hematoma Intracranial tumor Depression B12 defi ciency Neurosyphilis Hypothyroidism |
CBC
VDRL/RPR Serum B12 TSH MRI—brain CT—head LP—CSF analysis (rare) |
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84 y/o F
Forgetfulness -forgets to do daily activities -difficulty performing some daily tasks Problem progressed over years |
Alzheimer’s disease*
Vascular dementia Depression Hypothyroidism Chronic subdural hematoma Normal pressure hydrocephalus Intracranial neoplasm B12 defi ciency Neurosyphilis |
CBC
VDRL/RPR Serum B12 TSH MRI—brain (preferred) CT—head LP—CSF analysis (rare) |
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72 y/o M
- Memory Loss - Gait disturbance - Urinary Incontinence |
Normal pressure hydrocephalus*
- wet, wacky, wobbly Alzheimer’s disease Vascular dementia Chronic subdural hematoma Intracranial neoplasm Depression B12 defi ciency Neurosyphilis Hypothyroidism |
CT—head
LP—opening pressure and CSF analysis Serum B12 VDRL/RPR TSH |
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55 y/o M
Rapidly Progressive change in mental status - inability to concentrate - memory impairment for 2 months - myoclonus - ataxia |
Creutzfeldt-Jakob disease*
Vascular dementia Lewy body dementia Wernicke’s encephalopathy Normal pressure hydrocephalus Chronic subdural hematoma Intracranial neoplasm Depression Delirium B12 defi ciency Neurosyphilis |
CBC, electrolytes, calcium
Serum B12 VDRL/RPR MRI—brain (preferred) CT—head EEG LP—CSF analysis Brain biopsy |
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70 y/o Diabetic Male
Confusion Dizziness Palpitations Diaphoresis Weakness |
Hypoglycemia*
Transient ischemic attack Arrhythmia Delirium Angina |
Glucose
CBC, electrolytes Echocardiography ECG MRI—brain Doppler U/S—carotid |
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55 y/o F
Gradual Altered mental status - Headache Hx: 2 weeks ago, tripped and hit head |
Subdural hematoma*
SIADH (causing hyponatremia) Creutzfeldt-Jakob disease Intracranial neoplasm |
Electrolytes
CT—head MRI—brain LP |
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68 y/o M
2 month hx of: crying spells, excessive sleep, poor hygiene, 7kg weight loss, after wife's death - cannot enjoy time with grandkids - thinks he sees his wife at supermarket or in kitchen |
Normal bereavement*
Adjustment disorder with depressed mood Major depressive disorder with psychotic features Schizoaffective disorder Depressive disorder not otherwise specifi ed (NOS) |
Physical exam
Mental status exam TSH CBC Urine toxicology |
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42 y/o F
4 week history of: excessive fatigue, insomnia, anhedonia - constantly thinks about death - 5 similar episodes in the past - first episode in 20s - 2 suicide attempts -increased alcohol use in last month |
Major depressive disorder*
Substance-induced mood disorder Dysthymic disorder |
Physical exam
Mental status exam Blood alcohol level TSH CBC Urine toxicology |
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26 y/o F
- 3 kg weight loss in last month - early morning awakening - excessive guilt - psychomotor retardation - no trigger for depressive episodes - several weeks of increased energy, sexual promiscuity, irresponsible spending, racing thoughts |
Bipolar I disorder*
Bipolar II disorder Cyclothymic disorder Major depressive disorder Schizoaffective disorder |
Physical exam
Mental status exam Urine toxicology |
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19 y/o M
receiving msgs from television set - not many friends in high school - suspects roommate is bugging phone - stopped going to class because believes professors are saying horrible things about him & nobody noticed - hearing voices from TV telling him to guard against the evil empire |
Schizophrenia*
Schizoid or schizotypal personality Schizophreniform disorder Substance-induced psychosis Depression with psychotic features Psychotic disorder d/t medical condition |
Mental status exam
Urine toxicology TSH CBC Electrolytes |
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28 y/o F
Bugs crawling on her bed - Hearing loud voices when she's alone in her room - never experienced this before - recently ingested unknown substance |
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 |
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48 y/o F
1 week hx of auditory hallucinations: stating "I am worthless & "I should kill myself" - 2 week history of weight loss - decreased motivation - feelings of guilt |
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 |
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35 yo F presents with intermittent
episodes of vertigo, tinnitus, nausea, and hearing loss over the past week. |
Ménière’s disease*
Vestibular neuronitis Labyrinthitis Benign positional vertigo Acoustic neuroma |
CBC
VDRL/RPR (syphilis is a cause of Ménière’s disease) MRI—brain |
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55 yo F c/o dizziness for the past day.
- feels faint - severe diarrhea for 2 days - takes furosemide for her hypertension. |
Orthostatic hypotension due
to dehydration (diarrhea, diuretic use)* Vestibular neuronitis Labyrinthitis Benign positional vertigo Vertebrobasilar insuffi ciency |
Orthostatic vital signs
CBC Electrolytes Stool exam (occult blood, fecal leukocytes) |
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65 yo M
Postural dizziness & unsteadiness - has hypertension - started on hydrochlorothiazide 2 days ago |
Drug-induced orthostatic
hypotension* Vestibular neuronitis Labyrinthitis Benign positional vertigo Brain stem or cerebellar tumor Acute renal failure |
Orthostatic vital signs
CBC Electrolytes BUN/Cr MRI—brain |
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44 yo F c/o dizziness on moving her
head to the left. - feels that the room spinning around her head. - Tilt test results in nystagmus & nausea . |
Benign positional vertigo*
Vestibular neuronitis Labyrinthitis Ménière’s disease |
MRI—brain
Audiogram |
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55 yo F c/o
Dizziness - started today - nausea & vomiting for 1 day - URI - 2 days ago - no hearing loss |
Vestibular neuronitis*
Labyrinthitis Ménière’s disease Benign positional vertigo Vertigo associated with cervical spine disease/injury Vertebrobasilar insuffi ciency |
CBC
Electrolytes Electronystagmography MRI/MRA—brain |
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55 yo F c/o
dizziness - started this morning and of “not hearing well.” - Nausea & vomiting 1 day - URI 2 days ago |
Labyrinthitis*
Vestibular neuronitis Ménière’s disease Acoustic neuroma Vertebrobasilar insuffi ciency |
Audiogram
Electronystagmography MRI/MRA—brain |
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26 y/o M
Falling & LOC - rhythmic movements of the limbs - bit his tongue, - voided bladder & bowels - subsequently confused (as witnessed by his colleagues). |
Seizure, grand mal (complex tonic-clonic seizure)*
Convulsive syncope Substance abuse/overdose Malingering Hypoglycemia |
CBC, electrolytes, glucose
Urine toxicology EEG MRI—brain CT—head LP—CSF analysis ECG |
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55 yo M c/o falling after feeling dizzy
and unsteady. - transient LOC - Hx of HTN - on multiple HTN drugs |
Drug-induced orthostatic hypotension (causingsyncope)*
Cardiac arrhythmia Syncope (vasovagal) Stroke MI Pulmonary embolism |
Orthostatic vital signs
CBC Electrolytes CT—head ECG V/Q scan CT—chest with IV contrast |
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65 yo M
Falling and LOC for a few seconds. - no warning prior to passing out - had palpitations - PMH: Coronary artery bypass grafting (CABG) |
Cardiac arrhythmia (causing syncope)*
Severe aortic stenosis Syncope (other causes) Seizure Pulmonary embolism |
ECG
Holter monitoring CBC, electrolytes Glucose Echocardiography CT—head |
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68 yo M
20 min episode of: - slurred speech - right facial - drooping and numbness - right hand weakness. Sx resolved by time reached ER Hx: HTN, DM, Heaving smoking |
Transient ischemic attack (TIA)*
Hypoglycemia Seizure Stroke Facial nerve palsy |
CBC
Glucose Electrolytes ECG CT—head MRI—brain Doppler U/S—carotid Echocardiography EEG |
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68 yo M
- slurred speech, - right facial drooping and numbness, - right hand weakness. Babinski’s sign is present on the right. Hx: HTN, DM, Heaving smoking |
Stroke*
TIA Seizure Intracranial neoplasm Subdural or epidural hematoma |
CBC, electrolytes
PT/PTT CT—head MRI—brain (preferred) Doppler U/S—carotid Echocardiography |
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33 yo F
- Ascending loss of strength in her lower legs over the past two weeks. - had a recent URI. |
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 study Tensilon test Serum B12 |
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30 yo F
1 day hx of: - weakness - loss of sensation, - tingling in her left leg - right eye pain, decreased vision, & double vision. - feeling “electric shocks” down her spine upon flexing her head. |
Multiple sclerosis*
Stroke Conversion disorder Malingering CNS tumor Neurosyphilis Syringomyelia CNS vasculitis |
CBC, ESR
VDRL/RPR MRI—brain LP—CSF analysis Retinal evoked potentials |
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55 yo M
2 month hx of: - tingling and numbness in the hands and feet (glove and-stocking distribution) - decreased soft touch, vibratory, and position sense in the feet. Hx: DM, HTN, alcoholism |
Diabetic peripheral neuropathy*
Alcoholic peripheral neuropathy B12 defi ciency Hypocalcemia Hyperventilation Paraproteinemia/myeloma |
HbA1c
ESR Calcium Serum B12 Serum and urine protein electrophoresis |
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40 yo F
- occasional double vision - droopy eyelids at night with normalization by morning. |
Myasthenia gravis*
Horner’s syndrome Multiple sclerosis Intracranial tumor compressing CN III, IV, or VI Amyotrophic lateral sclerosis |
Tensilon test
ACh receptor antibodies (in serum) CXR CT—chest MRI—brain EMG |
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25 yo M
hemiparesis (after a tonic-clonic seizure) that resolves over a few hours. |
Todd’s paralysis*
TIA Stroke Complicated migraine Malingering |
CBC, electrolytes
EEG MRI—brain Doppler U/S—carotid |
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40 yo F
Feeling tired, hopeless, and worthless and of having suicidalthoughts. - recently found out her husband is gay |
Depression*
Adjustment disorder Hypothyroidism Anemia |
CBC
TSH HIV/STD testing (given husband’s possible risk factors) |
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44 yo M
Fatigue, insomnia,and nightmares about a murder that he witnessed 1 year ago. - avoids the mall & going out at night |
Post-traumatic stress disorder
(PTSD)* Depression Generalized anxiety disorder Psychotic or delusional disorder Hypothyroidism |
CBC
TSH Calcium Urine toxicology |
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55 yo M
Fatigue, weight loss, and constipation. - family history of colon cancer. |
Colon cancer*
Hypothyroidism Renal failure Hypercalcemia Depression |
Rectal exam, stool for occult blood
CBC, electrolytes, calcium, BUN/Cr, AST/ALT, TSH Colonoscopy Barium enema |
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40 yo F
Fatigue, weight gain, sleepiness, cold intolerance, constipation, and dry skin. |
Hypothyroidism*
Depression Diabetes Anemia |
TSH, FT3, FT4
CBC Glucose, HbA1c |
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50 yo obese F
Fatigue and daytime sleepiness. - Snores heavily - Naps 3–4 times per day but never feels refreshed - Hx: HTN |
Obstructive sleep apnea*
Hypothyroidism Chronic fatigue syndrome Narcolepsy |
CBC
TSH Nocturnal pulse oximetry Polysomnography ECG |
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20 yo M presents with fatigue, thirst,
increased appetite, and polyuria. |
Diabetes mellitus*
Atypical depression Primary polydipsia Diabetes insipidus |
Glucose tolerance test, HbA1c
UA CBC, electrolytes, glucose BUN/Cr |
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30 yo M presents with night sweats,
cough, and swollen glands of one month’s duration. |
Tuberculosis*
Acute HIV infection Lymphoma Leukemia Hyperthyroidism |
PPD
CBC CXR Sputum Gram stain, acid-fast stain, and culture HIV antibody TSH, FT4 |
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25 yo F
3-week history: - difficulty falling asleep. - sleeps 7 hrs w/o nightmares or snoring - began college recently - having trouble with boyfriend - drinks 3-4 cups of coffee/day |
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 |
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55 yo obese M
Severalmonths of poor sleep and daytime fatigue. His wife reports that he snores loudly. |
Obstructive sleep apnea*
Daytime fatigue in primary hypersomnia Insomnia with circadian rhythm sleep disorder Insomnia related to major depressive disorder |
CBC
TSH Polysomnography ECG |
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33 yo F
3 weeks of fatigue & trouble sleeping. - falls asleep easily but wakes up at 3 am and cannot return to sleep - unintentional weight loss: 3.5kg - lost of interest cannot return to sleep. She also reports an unintentional weight loss of 3.5 kg along with an inability to enjoy the things she once liked to do. |
Insomnia related to major
depressive disorder* Primary hypersomnia Insomnia with circadian rhythm sleep disorder |
Mental status exam
TSH CBC Polysomnography |
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26 yo F
Sore throat, fever, severe fatigue, and loss of appetite for 1 week - Epigastric and LUQ discomfort - Cervical lymphadenopathy & rash. - boyfriend has similar symptoms |
Infectious mononucleosis*
Hepatitis Viral or bacterial pharyngitis Acute HIV infection Secondary syphilis |
CBC, peripheral smear
Monospot test Throat culture AST/ALT/bilirubin/alkaline phosphatase HIV antibody and viral load Anti-EBV antibodies VDRL/RPR |
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26 yo M
Sore throat, fever, rash, and weight loss. - IV drug abuse and sharing needles. |
HIV*
Infectious mononucleosis Hepatitis Viral pharyngitis Streptococcal tonsillitis/ scarlet fever Secondary syphilis |
CBC
Peripheral smear HIV antibody and viral load CD4 count Monospot test Throat culture VDRL/RPR AST/ALT/bilirubin/alkaline phosphatase |
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46 yo F presents with fever and sore
throat. |
Pharyngitis (bacterial or viral)
Mycoplasma pneumonia Acute HIV infection Infectious mononucleosis |
Throat swab for culture and rapid
streptococcal antigen Monospot test CBC HIV antibody and viral load |
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30 yo M
shortness of breath, cough, and wheezing - worsen in cold air. - several episodes over 4 months |
Asthma
GERD Bronchitis Pneumonitis Foreign body |
CBC
CXR Peak fl ow measurement PFTs Methacholine challenge test |
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56 yo F
Shortness of breath Productive cough for 3 months each year for last 2 years - heavy smoker |
COPD—chronic bronchitis*
Bronchiectasis Lung cancer Tuberculosis |
CBC
Sputum Gram stain and culture CXR PFTs CT—chest PPD |
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58 yo M
Pleuritic chest pain - Fever & chills - Cough with purulent yellow sputum - heavy smoker with COPD. |
Pneumonia*
Bronchitis Lung abscess Lung cancer Tuberculosis Pericarditis |
CBC
Sputum Gram stain and culture CXR CT—chest ECG PPD |
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25 yo F
Non-productive cough - 2 weeks Sore throat & runny nose - 3 weeks |
Atypical pneumonia*
Reactive airway disease URI-associated (“postinfectious”) Postnasal drip GERD |
CBC
Sputum Gram stain and culture CXR IgM detection for Mycoplasma pneumoniae Urine Legionella antigen |
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65 yo M
Worsening cough - 6 months - Hemoptysis - Dyspnea - Weakness - Weight loss - Heavy smoker. |
Lung cancer*
Tuberculosis Lung abscess COPD Vasculitis (i.e., Wegener’s) Interstitial lung disease CHF |
CBC
Sputum Gram stain, culture, cytology CXR CT—chest PPD Bronchoscopy |
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55 yo M
Increased dyspnea & Sputum - 3 days - COPD - stopped using inhaler last week - stopped smoking two days ago. |
COPD exacerbation (bronchitis)
Lung cancer Pneumonia URI CHF |
CBC
CXR PFTs Sputum Gram stain and culture CT—chest |
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34 yo F nurse
Worsening cough - 6 weeks of six - Weight loss - fatigue - night sweats, - fever - Hx of TB contact at work |
Tuberculosis*
Pneumonia Lung abscess Vasculitis Lymphoma Metastatic cancer HIV/AIDS Sarcoidosis |
CBC
PPD Sputum Gram stain, acid-fast stain, and culture CXR CT—chest Bronchoscopy HIV antibody |
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35 yo M
Shortness of breath and cough - Unprotected sex with multiple partners - exposed to person with active TB |
Tuberculosis Pneumonia (including
Pneumocystis jiroveci)* Bronchitis CHF (cardiomyopathy) Asthma Acute HIV infection |
CBC
PPD Sputum Gram stain, acid-fast stain, silver stain, and culture CXR HIV antibody |
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50 yo M
Cough - exacerbated by lying down at night - improved by propping up on 3 pillows - exertional dyspnea. |
CHF*
Cardiac valvular disease GERD Pulmonary fibrosis COPD Postnasal drip |
CBC
CXR ECG Echocardiography PFTs BNP |
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60 yo M
Sudden onset of substernal chest pain - lasted for 30 minutes - radiates to the left arm. The pain is accompanied - dyspnea, diaphoresis, and nausea. Hx: HTN, hyperlipidemia, and smoking. |
Myocardial infarction (MI)
GERD Angina Costochondritis Aortic dissection Pericarditis Pulmonary embolism Pneumothorax |
ECG
CPK-MB, troponin CXR CBC, electrolytes Echocardiography Cardiac catheterization |
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20 yo African-American F
Acute onset of severe chest pain Hx: Sickle cell disease Multiple hospitalizations for pain and anemia management. |
Sickle cell disease—pulmonary
infarction* Pneumonia Pulmonary embolism MI Pneumothorax Aortic dissection |
CBC, reticulocyte count, LDH,
peripheral smear ABG CXR CPK-MB, troponin ECG CT—chest with IV contrast |
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45 yo F
Retrosternal burning sensation - starts after heavy meals & lying down - relieved by antacids. |
GERD
Esophagitis Peptic ulcer disease Esophageal spasm MI Angina |
ECG
Barium swallow Upper endoscopy Esophageal pH monitoring |
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55 yo M
Retrosternal squeezing pain - lasts for two minutes - Occurs with exercise. - relieved by rest - Not related to food intake. |
Angina
Esophageal spasm Esophagitis |
ECG
CPK-MB, troponin CXR CBC, electrolytes Exercise stress test Upper endoscopy/pH monitor Cardiac catheterization |
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34 yo F
Retrosternal stabbing chest pain - Improves when leans forward - Worsens with deep inspiration - Had a URI one week ago. |
Pericarditis*
Aortic dissection MI Costochondritis GERD Esophageal rupture |
ECG
CPK-MB, troponin CXR Echocardiography CBC Upper endoscopy |
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34 yo F
Retrosternal stabbing chest pain - Relieved with aspirin - Worsens with deep inspiration - Had a URI one week ago. - Chest wall tenderness is noted. |
Costochondritis
Pneumonia MI Pulmonary embolism Pericarditis Muscle strain |
ECG
CPK-MB, troponin CXR CBC |
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70 yo F
Acute onset of shortness of breath - occurs at rest - pleuritic chest pain. - tachycardia, hypotension, tachypnea, and mild fever. - Recovering from hip replacement surgery. |
Pulmonary embolism*
Pneumonia Costochondritis MI CHF Aortic dissection |
ECG
CXR ABG CPK-MB, troponin CBC, electrolytes CT—chest with IV contrast Doppler U/S—legs D-dimer |
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55 yo M
sudden onset of severe chest pain - Radiates to the back. - Hx: uncontrolled hypertension. |
Aortic dissection
MI Pericarditis Esophageal rupture Esophageal spasm GERD Pancreatitis Fat embolism |
ECG, CPK-MB, troponin
CXR CBC, amylase, lipase Transesophageal echocardiography (TEE), MRI/MRA—aorta Aortic angiography Upper endoscopy |
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70 yo diabetic M
Episodes of palpitations and diaphoresis. He is on insulin. |
Hypoglycemia*
Cardiac arrhythmias Angina Hyperthyroidism Hyperventilation episodes Panic attacks Pheochromocytoma Carcinoid |
Glucose
CBC, electrolytes TSH BUN/Cr ECG Holter monitor |
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42 yo F
7-kg weight loss - over 2 months - a fine tremor, and her pulse is 112. |
Hyperthyroidism*
Cancer HIV infection Dieting/diet drugs Anorexia nervosa Malabsorption |
TSH, FT4
CBC, electrolytes HIV antibody Urine toxicology |
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44 yo F
Weight gain of > 11 kg over the past two months. - Quit smoking 3 months ago - Taking Amitriptyline for depression. - Cold intolerance - Constipation. |
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 |
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75 yo M
Dysphagia - Started with solids and progressed to liquids. - Alcoholic - Heavy smoker. - Unintentional weight loss of 7 kg - 4 mo |
Esophageal cancer*
Achalasia Esophagitis Systemic sclerosis Esophageal stricture Amyotrophic lateral sclerosis |
CBC
CXR Endoscopy with biopsy Barium swallow CT—chest |
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45 yo F
Dysphagia - 2 weeks - Fatigue - Craving for ice & clay |
Plummer-Vinson syndrome*
Esophageal cancer Esophagitis Achalasia Systemic sclerosis Mitral valve stenosis |
CBC
Serum iron, ferritin, TIBC Barium swallow Endoscopy |
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48 yo F
Dysphagia for both solid and liquid - progressed over 1 year - regurgitation of undigested food (Esp at night) |
Achalasia*
Plummer-Vinson syndrome Esophageal cancer Esophagitis Systemic sclerosis Mitral valve stenosis Esophageal stricture Zenker’s diverticulum |
CXR
Endoscopy Barium swallow Esophageal manometry |
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38 yo M p
Dysphagia and pain on swallowing solids more than liquids. Exam reveals oral thrush. |
Esophagitis (CMV, HSV, pill-induced)
Systemic sclerosis GERD Esophageal stricture Zenker’s diverticulum |
CBC
Endoscopy Barium swallow HIV antibody CD4 count |
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20 yo F
Nausea, vomiting (esp in the morning), - Fatigue, - Polyuria - LMP - 6 weeks ago - Breasts - full & tender - Sexually active w/ BF. Uses condoms |
Pregnancy
Gastritis Hypercalcemia Diabetes mellitus UTI Depression |
Urine hCG
Pelvic exam U/S—pelvis CBC, electrolytes, calcium, glucose UA, urine culture Baseline Pap smear, cervical cultures, rubella antibody, HIV antibody, hepatitis B surface antigen, and VDRL/ RPR |
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45 yo M
Colicky right-sided flank pain - Sudden onset - Radiates to the testicles Accompanied by nausea, vomiting, hematuria, and CVA tenderness. |
Nephrolithiasis*
Renal cell carcinoma Pyelonephritis GI etiology (e.g., appendicitis) |
Rectal exam
UA Urine culture and sensitivity BUN/Cr CT—abdomen U/S—renal IVP |
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60 yo M
Dull epigastric pain - Radiates to the back - Weight loss - Dark urine - Clay-colored stool - Heavy drinker and smoker. |
Pancreatic cancer*
Acute viral hepatitis Chronic pancreatitis Cholecystitis/choledocholithiasis Abdominal aortic aneurysm Peptic ulcer disease |
Rectal exam
CBC, electrolytes Amylase and lipase AST/ALT/bilirubin/alkaline phosphatase U/S—abdomen CT—abdomen |
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56 yo M
Severe mid-epigastric abdominal pain - radiates to the back - improves when leans forward - anorexia, nausea, and vomiting. - Alcoholic - 3 days binge drinking |
Acute pancreatitis*
Peptic ulcer disease Cholecystitis/choledocholithiasis Gastritis Abdominal aortic aneurysm Mesenteric ischemia Alcoholic hepatitis Mallory-Weiss tear |
Rectal exam
CBC, electrolytes, BUN/Cr, amylase, lipase, AST/ALT/ bilirubin/alkaline phosphatase U/S—abdomen CT—abdomen Upper endoscopy ECG |
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41 yo obese F
RUQ abdominal pain - Radiates to the right scapula - Nausea, vomiting, - Fever of 101.5°F - Pain starts with fatty food - had similar episodes but less intense that lasted a few hours - positive Murphy’s sign. |
Acute cholecystitis*
Hepatitis Choledocholithiasis Ascending cholangitis Peptic ulcer disease Fitz-Hugh–Curtis syndrome |
Rectal exam
CBC AST/ALT/bilirubin/alkaline phosphatase U/S—abdomen HIDA scan |
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43 yo obese F
RUQ abdominal pain - Fever - Jaundice - Diagnosed with asymptomatic gallstones one year ago. |
Ascending cholangitis*
Acute cholecystitis Hepatitis Choledocholithiasis Sclerosing cholangitis Fitz-Hugh–Curtis syndrome |
Rectal exam
CBC AST/ALT/bilirubin/alkaline phosphatase Viral hepatitis serologies U/S—abdomen MRCP ERCP |
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25 yo M
RUQ pain - fever, - anorexia - nausea & vomiting. - dark urine and clay-colored stool. |
Acute hepatitis
Acute cholecystitis Ascending cholangitis Choledocholithiasis Pancreatitis Acute glomerulonephritis |
Rectal exam
CBC, amylase, lipase AST/ALT/bilirubin/alkaline phosphatase UA Viral hepatitis serologies U/S—abdomen |
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35 yo M
Burning epigastric pain - starts 2–3 hours after meals. - relieved by food and antacids. |
Peptic ulcer disease*
Gastritis GERD Cholecystitis Chronic pancreatitis Mesenteric ischemia |
Rectal exam
Amylase, lipase, lactate AST/ALT/bilirubin/alkaline phosphatase Endoscopy (including H. pylori testing) Upper GI series |
|
|
37 yo M
Severe epigastric pain - nausea, vomiting, - mild fever. - appears toxic - Hx: intermittent epigastric pain that is relieved by food and antacids. - Smokes heavily - Takes aspirin on a regular basis. |
Peptic ulcer perforation*
Acute pancreatitis Hepatitis Cholecystitis Choledocholithiasis Mesenteric ischemia |
Rectal exam
CBC, electrolytes, amylase, lipase, lactate AST/ALT/bilirubin/alkaline phosphatase AXR Upright CXR Endoscopy (including H. pylori testing) |
|
|
18 yo M boxer
Severe LUQ abdominal pain - radiates to the left scapula. - He had infectious mononucleosis 3 wks ago |
Splenic rupture*
Kidney stone Rib fracture Pneumonia Perforated peptic ulcer Splenic infarct |
Rectal exam
CBC, electrolytes CXR CT—abdomen U/S—abdomen |
|
|
40 yo M
Crampy abdominal pain, - vomiting - abdominal distention - inability to pass flatus or stool. Hx: multiple abdominal surgeries. |
Intestinal obstruction*
Small bowel or colon cancer Volvulus of the bowel Gastroenteritis Food poisoning Ileus Hernia |
Rectal exam
CBC, electrolytes AXR CT—abdomen/pelvis CXR |
|
|
70 yo F
Acute onset of severe, crampy abdominal pain. - Vomited - Massive dark bowel movmeent Hx: CHF and atrial fibrillation Meds: Digoxin Pain is out of proportion to exam |
Mesenteric ischemia/infarction*
Diverticulitis Peptic ulcer disease Gastroenteritis Acute pancreatitis Cholecystitis/choledocholithiasis MI |
Rectal exam
CBC, amylase, lipase, lactate ECG, CPK-MB, troponin AXR CT—abdomen Mesenteric angiography Barium enema |
|
|
21 yo F
Acute onset of severe RLQ pain - nausea & vomiting. - no fever, urinary symptoms, or vaginal bleeding - never taken OCP - LMP - regular - No hx of STD H |
Ovarian torsion*
Appendicitis Nephrolithiasis Ectopic pregnancy Ruptured ovarian cyst PID Bowel infarction or perforation |
Pelvic exam
Rectal exam Urine hCG UA CBC Doppler U/S—pelvis CT—abdomen Laparoscopy |
|
|
68 yo M
LLQ abdominal pain - Fever & chills - 3 days - Alternating diarrhea and constipation. - Low fiber, high fat diet |
Diverticulitis
Crohn’s disease Ulcerative colitis Gastroenteritis Abscess |
Rectal exam
CBC, electrolytes CXR AXR CT—abdomen |
|
|
20 yo M
Severe RLQ abdominal pain - nausea, and vomiting. - vague pain around the umbilicus - started yesterday - As the pain worsened, it became sharp and migrated to the RLQ. - McBurney & Psoas sign Positive |
Acute appendicitis*
Gastroenteritis Diverticulitis Crohn’s disease Nephrolithiasis Volvulus or other intestinal obstruction/perforation |
Rectal exam
CBC, electrolytes AXR CT—abdomen U/S—abdomen |
|
|
30 yo F
Periumbilical pain - 6 months - never awakens from sleep. - Relieved by defecation - Worsens when upset. - Alternating constipation/Diarrhea - No nausea, vomiting, weight loss, or anorexia. |
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 CT—abdomen/pelvis Stool for ova and parasitology, Entamoeba histolytica antigen |
|
|
24 yo F
Bilateral lower abdominal pain - Started with 1st day of menstrual period - Pain w/ fever, thick, greenish-yellow vaginal discharge. - Unprotected sex with multiple people |
PID*
Endometriosis Dysmenorrhea Vaginitis Cystitis Spontaneous abortion Pyelonephritis |
Pelvic exam
Rectal exam Urine hCG Cervical cultures CBC/ESR UA, urine culture U/S—pelvis |
|
|
67 yo M
Alternating diarrhea/constipation - decreased stool caliber - blood in the stool - 8 months - unintentional weight loss - low- fiber diet - family history of colon cancer. |
Colorectal cancer*
Irritable bowel syndrome Diverticulosis GI parasitic infection (ascariasis, giardiasis) Infl ammatory bowel disease Angiodysplasia |
Rectal exam
CBC AST/ALT/bilirubin/alkaline phosphatase Colonoscopy Barium enema CT—abdomen/pelvis |
|
|
28 yo M
Constipation (veryhard stool) for the last three weeks. - Mom died 2 months ago - ate only junk food since then |
Low-fiber diet*
Irritable bowel syndrome Substance abuse (e.g., heroin) Depression Hypothyroidism |
Rectal exam
TSH Electrolytes Urine toxicology |
|
|
30 yo F
Alternating constipation/diarrhea - abdominal pain- relieved by defecation - no nausea/vomiting, weight loss or blood in stool |
Irritable bowel syndrome*
Infl ammatory bowel disease Celiac disease Chronic pancreatitis GI parasitic infection (ascariasis, giardiasis) Lactose intolerance |
Rectal exam, stool for occult
blood CBC Electrolytes Stool for ova and parasitology AXR CT—abdomen/pelvis |
|
|
33 yo M
Watery diarrhea, vomiting, diffuse abdominal pain - 1 day history - feels hot - co-workers also sick |
Infectious diarrhea*
(gastroenteritis)—bacterial, viral, parasitic, protozoal Food poisoning Infl ammatory bowel disease |
Rectal exam, stool for occult
blood Stool leukocytes and culture CBC Electrolytes CT—abdomen/pelvis |
|
|
40 yo F
Watery diarrhea and abdominal cramps. - was on antibiotics last week for UTI |
Pseudomembranous colitis*
(Clostridium difficile) Gastroenteritis Cryptosporidiosis Food poisoning Infl ammatory bowel disease |
Rectal exam
Stool leukocytes, culture, occult blood C. diffi cile toxin in stool Electrolytes |
|
|
25 yo M
Watery diarrhea and abdominal cramps. He was recently in Mexico. |
Traveler’s diarrhea*
Giardiasis Amebiasis Food poisoning Hepatitis A |
Rectal exam
Stool leukocytes, culture, Giardia antigen, Entamoeba histolytica antigen Electrolytes AST/ALT/bilirubin/alkaline phosphatase Viral hepatitis serology |
|
|
30 yo F
Watery diarrhea and abdominal cramping and bloating. - aggravated by milk ingestion - relieved by fasting. |
Lactose intolerance*
Gastroenteritis Infl ammatory bowel disease Irritable bowel syndrome Hyperthyroidism |
Rectal exam
Stool exam Hydrogen breath test TSH |
|
|
33 yo M
Watery diarrhea, diffuse abdominal pain, and weight loss - 3 weeks - has not responded to antibiotics. |
Crohn’s disease*
Gastroenteritis Ulcerative colitis Celiac disease Pseudomembranous colitis Hyperthyroidism Small bowel lymphoma Carcinoid |
Rectal exam
Stool exam and culture CBC, electrolytes TSH CT—abdomen Colonoscopy Small bowel series Urinary 5-HIAA |
|
|
45 yo F
Coffee-ground emesis - 3 days - Stool is dark and tarry. - Intermittent epigastric pain that is relieved by food and antacids. |
Bleeding peptic ulcer
Gastritis Gastric cancer Esophageal varices |
Rectal exam
CBC, electrolytes AST/ALT/bilirubin/alkaline phosphatase Endoscopy (including H. pylori testing if ulcer is confi rmed) |
|
|
40 yo F
Epigastric pain and coffee-ground emesis. Hx: rheumatoid arthritis - taking aspirin - Heavy Alcoholic |
Gastritis*
Bleeding peptic ulcer Gastric cancer Esophageal varices Mallory-Weiss tear |
Rectal exam
CBC, electrolytes AST/ALT/bilirubin/alkaline phosphatase Barium swallow Endoscopy |
|
|
67 yo M
Blood in his stool - weight loss - constipation - family history of colon cancer. |
Colorectal cancer*
Anal fissure Hemorrhoids Diverticulosis Ischemic bowel disease Angiodysplasia Upper GI bleeding Inflammatory bowel disease |
Rectal exam
CBC, PT/PTT AST/ALT/bilirubin/alkaline phosphatase CEA Colonoscopy CT—abdomen/pelvis Barium enema |
|
|
33 yo F
Rectal bleeding and Diarrhea - 1 week - Lower abdominal pain and tenesmus for several months. |
Ulcerative colitis*
Crohn’s disease Proctitis Anal fi ssure Hemorrhoids Diverticulosis Dysentery |
Rectal exam
CBC, PT/PTT AXR Colonoscopy CT—abdomen/pelvis Barium enema |
|
|
58 yo M
Bright red blood per rectum Chronic constipation. Consumes a low-fiber diet. |
Diverticulosis*
Anal fi ssure Hemorrhoids Angiodysplasia Colorectal cancer |
Rectal exam
CBC, PT/PTT Electrolytes Colonoscopy CT—abdomen/pelvis |
|
|
65 yo M
Painless hematuria. - heavy smoker - works as a painter. |
Bladder cancer*
Renal cell carcinoma Nephrolithiasis Acute glomerulonephritis Prostate cancer Coagulation disorder (i.e., factor VIII antibodies) Polycystic kidney disease |
Genitourinary exam
UA, urine cytology BUN/Cr, PSA, CBC, PT/PTT Cystoscopy U/S—renal/bladder CT—abdomen/pelvis IVP |
|
|
35 yo M
Painless hematuria. - family history of kidney problems. |
Polycystic kidney disease*
Nephrolithiasis Acute glomerulonephritis (e.g., IgA nephropathy) UTI Coagulation disorder Bladder cancer |
Genitourinary exam
UA BUN/Cr, PSA, CBC, PT/PTT U/S—renal CT—abdomen/pelvis IVP |
|
|
55 yo M
Flank pain and blood in his urine - without dysuria - weight loss and fever - 2 months |
Renal cell carcinoma*
Bladder cancer Nephrolithiasis Acute glomerulonephritis Pyelonephritis Prostate cancer |
Genitourinary, rectal exam
UA, urine cytology, BUN/Cr, PSA, CBC, PT/PTT U/S—renal CT—abdomen/pelvis IVP |
|
|
60 yo M
Nocturia, urgency, weak stream, and terminal dribbling. - Denies any weight loss, fatigue, or bone pain. - 2 Episodes of urinary retention that required catheterization. |
Benign prostatic hyperplasia (BPH)*
Prostate cancer UTI Bladder stones |
Rectal exam
UA CBC, BUN/Cr, PSA U/S—prostate (transrectal) |
|
|
71 yo M
Nocturia, urgency, weak stream, terminal dribbling, - hematuria & lower back pain - 4 mo - weight loss and fatigue. |
Prostate cancer*
BPH Renal cell carcinoma UTI Bladder stones |
Rectal exam
UA CBC, BUN/Cr, PSA U/S—prostate (transrectal) CT—pelvis IVP |
|
|
18 yo M
Burning sensation during urination and urethral discharge. - Unprotected sex with new partner |
Urethritis*
Cystitis Prostatitis |
Genital ± rectal exam
UA Urine culture Gram stain and culture of urethral discharge Chlamydia and gonorrhea PCR |
|
|
45 yo diabetic F
Dysuria, urinary frequency, fever, chills, and nausea over the past three days. -left CVA tenderness |
Acute pyelonephritis*
Nephrolithiasis Renal cell carcinoma Lower UTI (cystitis, urethritis) |
UA
Urine culture and sensitivity CBC, BUN/Cr U/S—renal CT—abdomen |
|
|
47 yo M
Impotence - 3 months ago - HTN - started on atenolol - DM - on insulin |
Drug-related ED*
ED caused by hypertension ED caused by diabetes mellitus Psychogenic ED Peyronie’s disease |
Genital exam
Rectal exam Glucose CBC |
|
|
40 yo F
Amenorrhea, - morning nausea and vomiting - fatigue, - polyuria - LMP - 6 weeks ago - Breasts are full and tender - Contraception: Rhythm method |
Pregnancy*
Anovulatory cycle Hyperprolactinemia UTI Thyroid disease |
Pelvic exam
Urine hCG U/S—pelvis CBC, electrolytes UA, urine culture Prolactin, TSH Baseline Pap smear, cervical cultures, rubella antibody, HIV antibody, hepatitis B surface antigen, and VDRL/ RPR |
|
|
23 yo obese F
Amenorrhea - 6 months - facial hair, and infertility - 3 years |
Polycystic ovary syndrome*
Thyroid disease Hyperprolactinemia Pregnancy Ovarian or adrenal malignancy Premature ovarian failure |
Pelvic exam
Urine hCG U/S—pelvis LH/FSH, TSH, prolactin Testosterone, DHEAS |
|
|
35 yo F
Amenorrhea - 6 months - galactorrhea, - visual field defects - Headaches |
Amenorrhea secondary to prolactinoma
Pregnancy Thyroid disease Premature ovarian failure Pituitary tumor |
Pelvic and breast exam
Urine hCG Prolactin LH/FSH, TSH MRI—brain |
|
|
48 yo F
Amenorrhea - 6 months - hot flashes, night sweats, emotional lability, and dyspareunia. |
Menopause*
Pregnancy Pituitary tumor Thyroid disease |
Pelvic exam
Urine hCG LH/FSH, TSH, prolactin, testosterone, DHEAS CBC MRI—brain |
|
|
35 yo F
Amenorrhea - cold intolerance - coarse hair - weight loss - fatigue Hx: abruptio placentae followed by hypovolemic shock and failure of lactation two years ago. |
Sheehan’s syndrome*
Premature ovarian failure Pituitary tumor Thyroid disease Asherman’s syndrome |
Pelvic exam
Urine hCG CBC LH/FSH, prolactin TSH, FT4 ACTH MRI—brain Hysteroscopy |
|
|
18 yo F
Amenorrhea - 4 months - lost 95 pounds - history of vigorous exercise and cold intolerance. |
Anorexia nervosa
|
CBC
TSH FT4 ACTH FSH LH |
|
|
29 yo F
Amenorrhea - 6 months - occasional palpitations and dizziness. - lost her fiancé in a car accident. |
Anxiety-induced amenorrhea
|
CBC
TSH FT4 ACTH Urine cortisol level Progesterone challenge test FSH/LH/estradiol levels |
|
|
17 yo F
prolonged, excessive menstrual bleeding occurring irregularly over the past six months. |
Dysfunctional uterine bleeding*
Coagulation disorders (e.g., von Willebrand’s disease, hemophilia) Cervical cancer Molar pregnancy Hypothyroidism Diabetes mellitus |
Pelvic exam
Urine hCG Cervical cultures, Pap smear CBC, ESR, glucose PT/PTT Prolactin, LH/FSH TSH U/S—pelvis |
|
|
61 yo obese F
Profuse vaginal bleeding - 1 month - LMP - 10 years - Hx: HTN, DM - Nulliparous |
Endometrial cancer*
Cervical cancer Atrophic endometrium Endometrial hyperplasia Endometrial polyps Atrophic vaginitis |
Pelvic exam
Pap smear Endometrial biopsy U/S—pelvis Endometrial curettage Colposcopy Hysteroscopy |
|
|
45 yo G5P5 F
Postcoital bleeding. - cigarette smoker - takes OCPs. |
Cervical cancer
Cervical polyp Cervicitis Trauma (e.g., cervical laceration) |
Pelvic exam
Pap smear Colposcopy and biopsy |
|
|
28 yo F - 8 weeks pregnant
Lower abdominal pain and vaginal bleeding. |
Spontaneous abortion*
Ectopic pregnancy Molar pregnancy |
Pelvic exam
Urine hCG U/S—pelvis CBC, PT/PTT Quantitative serum hCG |
|
|
32 yo F
Left lower abdominal pain - Sudden onset - Radiates to the scapula and back - vaginal bleeding. - LMP: 5 weeks ago - Hx: PID - Does not use protection |
Ectopic pregnancy*
Ruptured ovarian cyst Ovarian torsion PID |
Pelvic exam
Urine hCG Cervical cultures U/S—pelvis Quantitative serum hCG |
|
|
28 yo F
thin, grayish-white, foul-smelling vaginal discharge. |
Bacterial vaginosis*
Vaginitis—candidal Vaginitis—trichomonal Cervicitis (chlamydia, gonorrhea) |
Pelvic exam
Wet mount Cervical cultures KOH prep (“whiff test”) pH of vaginal fl uid |
|
|
30 yo F
Thick, white, cottage cheese–like, odorless vaginal discharge and vaginal itching. |
Vaginitis—candidal*
Bacterial vaginosis Vaginitis—trichomonal |
Pelvic exam
KOH prep (“whiff test”) Wet mount Cervical cultures pH of vaginal fl uid |
|
|
35 yo F
malodorous, profuse, frothy, greenish vaginal discharge - intense vaginal itching and discomfort. |
Vaginitis—trichomonal*
Vaginitis—candidal Bacterial vaginosis Cervicitis (chlamydia, gonorrhea) |
Pelvic exam
Wet mount Cervical cultures pH of the vaginal fl uid KOH prep (“whiff test”) |
|
|
54 yo F
Painful intercourse - LMP: 9 months ago - Hot flashes |
Atrophic vaginitis*
Endometriosis Cervicitis Depression Domestic abuse |
Pelvic exam
Wet mount, KOH prep, cervical cultures U/S—pelvis |
|
|
37 yo F
Dyspareunia, inability to conceive, and dysmenorrhea. |
Endometriosis*
Cervicitis Vaginismus Vulvodynia PID Depression Domestic violence |
Pelvic exam
Wet mount, KOH prep, cervical cultures U/S—pelvis Laparoscopy |
|
|
28 yo F
multiple facial and bodily injuries. - claims she fell down the stairs - hospitalized for physical injuries seven months ago. - Presents with husband |
Domestic violence*
Osteogenesis imperfecta Substance abuse Consensual violent sexual behavior |
XR—skeletal survey
CT—maxillofacial Urine toxicology CBC |
|
|
30 yo F
Multiple facial and physical injuries. - Was attacked and raped by two men. |
Rape
|
Pelvic exam
Urine hCG Wet mount, KOH prep, cervical cultures XR—skeletal survey CBC HIV antibody Viral hepatitis serologies |
|
|
30 yo F
Wrist pain and a black eye after tripping, falling, and hitting her head on the edge of a table. - looks anxious and gives an inconsistent story. |
Domestic violence
Factitious disorder Substance abuse |
XR—wrist
CT—head Urine toxicology |
|
|
30 yo F secretary
Wrist pain - sensation of numbness and burning in her palm and the first, second, and third fingers of her right hand. - pain worsens at night - relieved by loose shaking of the hand. - Sensory loss in the same fingers. - Positive Tinel’s sign. |
Carpal tunnel syndrome*
Median nerve compression in forearm or arm Radiculopathy of nerve roots C6 and C7 in cervical spine |
Nerve conduction study
EMG |
|
|
28 yo F
Pain in the interphalangeal joints of hands - hair loss - butterfly rash on her face. |
Systemic lupus erythematosus (SLE)*
Rheumatoid arthritis Psoriatic arthritis Parvovirus B19 infection |
ANA, anti-dsDNA, ESR, C3,
C4, rheumatoid factor (RF), CBC XR—hands UA |
|
|
28 yo F
metacarpophalangeal joint pain in both hands. - Left knee - painful and red - Morning joint stiffness - last 1 hour - FHx: mother had rheumatoid arthritis. |
Rheumatoid arthritis*
SLE Disseminated gonorrhea Arthritis associated with inflammatory bowel disease Osteoarthritis |
ANA, anti-dsDNA, ESR, RF,
CBC XR—hands, left knee Cervical culture Arthrocentesis and synovial fluid analysis |
|
|
18 yo M
Interphalangeal joint pain of both hands - scaly, salmon-pink lesions on extensor surface of his elbows and knees. |
Psoriatic arthritis*
Rheumatoid arthritis SLE |
RF, ANA, ESR
CBC XR—hands XR—pelvis/sacroiliac joints Uric acid |
|
|
65 yo F
Unable to use Left leg or bear weight on it - Tripped on carpet - Menopause 20 years ago - No HRT or Calcium supplements - Left leg is externally rotated, shortened, and adducted, and there is tenderness in her left groin. |
Hip fracture*
Hip dislocation Pelvic fracture |
XR—hip/pelvis
CT or MRI—hip CBC Serum calcium and vitamin D Bone density scan (DEXA) |
|
|
40 yo M
Right groin pain - after a motor vehicle accident - Right leg is flexed at the hip, adducted, and internally rotated. |
Hip dislocation—traumatic*
Hip fracture |
XR—hip
CT or MRI—hip CBC PT/PTT Blood type and cross-match Urine toxicology and blood alcohol level |
|
|
56 yo obese F
Right knee stiffness - Pain that increases with movement. - Worsened over 10 years. - Swelling and deformity of joint - Difficulty walking. |
Osteoarthritis*
Pseudogout Gout Meniscal or ligament damage |
XR—knee
CBC ESR Knee arthrocentesis and synovial fl uid analysis (cell count, Gram stain, culture, crystals) MRI—knee |
|
|
45 yo M
Right knee pain with swelling and redness. |
Septic arthritis*
Gout Pseudogout Lyme arthritis Trauma Reiter’s arthritis |
CBC
Knee arthrocentesis and synovial fl uid analysis (see above) Blood, urethral cultures XR—knee Uric acid Lyme antibody |
|
|
65 yo M
Right foot pain. - been training for a marathon. |
Stress fracture*
Plantar fasciitis Foot sprain or strain |
XR—foot
Bone scan—foot MRI—foot |
|
|
65 yo M
Heel pain on right foot - worse w/ 1st few steps - improved with continued walking - no known trauma |
Plantar fasciitis*
Heel fracture Splinter/foreign body |
XR—heel
Bone scan |
|
|
55 yo M
Elbow Pain - when plays tennis - grip impaired b/c of pain - Tenderness over lateral epicondyl - Pain on resisted wrist dorsiflexion (Cozen’s test) with the elbow in extension. |
Tennis elbow (lateral epicondylitis)*
Stress fracture |
XR—arm
Bone scan MRI—elbow |
|
|
27 yo F
Painful wrists and elbows - Swollen & hot knee joint- painful on flexion - Rash on her limbs - Vaginal discharge - Sexually active w/ multiple partners - occasionally uses condoms. |
Disseminated gonorrhea*
Rheumatoid arthritis SLE Psoriatic arthritis Reiter’s arthritis |
Knee arthrocentesis and
synovial fl uid analysis (cell count, Gram stain, culture) ANA, anti-dsDNA, ESR, RF, CBC Blood, cervical cultures XR—knee |
|
|
60 yo F
Bilateral leg pain - Induced by walking - Relieved by rest - Hx: cardiac bypass surgery - 6 mo - Heavy Smoker |
Peripheral vascular disease*
(intermittent claudication) Leriche’s syndrome (aortoiliac occlusive disease) Lumbar spinal stenosis (pseudoclaudication) Osteoarthritis |
Ankle-brachial index
Doppler U/S—lower extremity Angiography MRI—lumbar spine |
|
|
45 yo F
Right calf pain - Calf is tender, warm, red, and swollen compared to the left side. - Started OCP for dysfunctional uterine bleeding - 2 months ago |
DVT*
Baker’s cyst rupture Myositis Cellulitis Superfi cial venous thrombosis |
Doppler U/S—right leg
CBC CPK D-dimer PT, aPTT, fi brinogen XR—right leg |
|
|
60 yo F
Left arm pain - started when swimming - relieved by rest. |
Angina/MI*
Tendonitis Osteoarthritis Shoulder dislocation |
CPK-MB, troponin, ECG
CBC ESR XR—shoulder CXR Echocardiography Stress test |
|
|
50 yo M
Right shoulder pain - FOOSH when skiing - Deformity of his shoulder - Has to hold his right arm |
Shoulder dislocation*
Fracture of the humerus Rotator cuff injury |
XR—shoulder
XR—arm MRI—shoulder |
|
|
55 yo M
Crampy bilateral thigh and calf pain, - fatigue - dark urine - simvastatin and clofibrate for hyperlipidemia. |
Rhabdomyolysis due tosimvastatin or clofibrate*
Polymyositis Inclusion body myositis Thyroid disease |
CBC
CPK Aldolase UA Urine myoglobin TSH |
|
|
45 yo F
Low back pain - radiates to lateral aspect of left foot. - Straight leg raising is positive. - Patient is unable to tiptoe. |
Disk herniation*
Lumbar muscle strain Tumor in the vertebral canal |
XR—L-spine
MRI—L-spine |
|
|
45 yo F
Low back pain - started after she cleaned her house. - pain does not radiate - no sensory deficit or weakness in legs. - Paraspinal muscle tenderness and spasm |
Lumbar muscle strain*
Disk herniation Abdominal aortic aneurysm Vertebral compression fracture |
XR—L-spine
|
|
|
45 yo M
Pain in the lower back and legs during prolonged standing and walking. - Relieved by sitting and leaning forward |
Lumbar spinal stenosis*
Lumbar muscle strain Tumor in the vertebral canal Peripheral vascular disease |
XR—L-spine
MRI—L-spine (preferred) CT—L-spine Ankle-brachial index |
|
|
17 yo M
Low back pain - Radiates to the left leg - Began after fell on his knee during gym class. - loss of sensation in left foot. - The pain and sensory loss do not match any known distribution. - Insists on requesting a week off from school because of his injury. |
Malingering*
Lumbar muscle strain Disk herniation Knee or leg fracture Ankylosing spondylitis |
XR—L-spine/knee
MRI—L-spine |
|
|
20-day-old M
Fever, - decreased breast-feeding, - lethargy - born at 36 weeks as a result of premature rupture of membranes. |
Neonatal sepsis*
Meningitis Pneumonia UTI |
Physical exam
CBC, electrolytes UA Urine culture Blood culture CXR LP—CSF analysis |
|
|
3 yo M
Fever & Pulling right ear - 2 days - Otherwise healthy - Immunizations UTD - Attends daycare - Older sister had a cold |
Acute otitis media*
URI Meningitis UTI |
Physical exam (including
pneumatic otoscopy) CBC UA |
|
|
12-month-old M
Fever - 2 days - Maculopapular rash on face &body - Did not receive MMR vaccine |
Measles (or other viral exanthem)*
Rubella Roseola Fifth disease Varicella Scarlet fever Meningitis |
Physical exam
CBC Viral antibodies/titers Throat swab for culture LP |
|
|
4 yo M
Fever - Diarrhea & vomiting, - Lethargy & weaknes - Attends daycare - multiple kids with similar symptoms |
Gastroenteritis (viral, bacterial,
parasitic)* Food poisoning UTI URI Volvulus Intussusception |
Physical exam
Stool exam and culture CBC Electrolytes UA, urine culture AXR |
|
|
9 yo M
Angry Outburst - 2 years - at home & school - runs around "as if driven by motor" - does not sit down in class - interrupts classmates - trouble making friends |
Attention-deficit hyperactivity disorder (ADHD)*
Oppositional defiant disorder Manic episode Conduct disorder |
Physical exam
Mental status exam |
|
|
12 yo F
2 Month history of: - Fighting in School, - Truancy - Breaking curfew - Recently divorced parents - recently moved to new school district - was average student before divorce |
Adjustment disorder*
Substance intoxication/abuse/ dependence Manic episode Oppositional defi ant disorder Conduct disorder |
Physical exam
Mental status exam Urine toxicology |
|
|
15 yo M
1 year history of: - Failing grades - School absenteeism - Legal problems, including shoplifting. spends most of his time alone in his room - when he goes out, its with a new group of friends |
Substance abuse*
Conduct disorder Oppositional defi ant disorder Adjustment disorder |
Urine toxicology
Mental status exam |
|
|
5 yo M
6 Month history: -Temper tantrums - last 5–10 minutes that follows disappointment or a discipline. - No problems sleeping - No change in appetite - Does not display behavior when at day care |
Age-appropriate behavior
ADHD Oppositional defi ant disorder |
Physical exam
Mental status exam |
