Usmle Cs Clinical Skills Triage

Front 1

1. Vision Loss

Back 1

1. DM-retinopathy
2. Glaucoma
3. MD macular degeneration
4. Catarcts
5. Presbyopia

Hint 1

1. Dilated eye exam
2. Tonometery Gonioscopy
3. Goldmann perimetry testing
4. Amsler grid chart testing
5. HgbA1c

Front 2

2. Red Eye

Back 2

1. Anterior Uveitis
2. Viral conjunctivitis
3. bacterial conjunctivitis
4. FB or corneal abrasion
5. Closed angle glaucoma

Hint 2

1. Slit lamp and dilated eye exam
2. Florescence eye exam
3. CBCD, renal fctn test
4. HLA-B27
5. Tonometry

Front 3

3. Mental Status Change

Back 3

1. NPH
2. AD
3. Delirium, occult infection
4. MID
5. PD / LBD

Hint 3

1. CBCD
2. MRI - Brain
3. Genital and prostate exam
4. CMP or BMP and renal fctn
5. Urine analysis and culture

Front 4

4. Dizziness

Back 4

1. CVA
2. BPPV
3. labyrintthitis
4. DM-neuropathy
5. Meniere's disease

Hint 4

1. MRI - brain
2. Dix-Hallpike maneuver
3. CBCD
4. BMP
5. HgbA1c

Front 5

5. HA

Back 5

1. Caffeine-related HA
2. Migraine, common type
3. Migraine, menstrual-related
4. Sinusitis
5. Tension type HA-

Hint 5

1. CT - head
2. CT - sinuses
3. CBCD
4. BMP
5.

Front 6

6. Sleep Difficulty

Back 6

1. MDD
2. Dysthymia
3. Adjustment disorder
4. Bereavement
5. Hypothyroid

Hint 6

1. TSH, T4, Chol, CPK,TG
2. CBC
3. BMP
4 EKG
5.

Front 7

7. HA and Stiff Neck

Back 7

1. Meningitis - bacterial
2. Meningitis - viral
3. SAH
4. HA - Vascular type
5. Encephalitis

Hint 7

1. CT - brain
2. LP - OP, GS,Cx,Pro,Glu,Ag
3. CBCD
4. CMP
5.

Front 8

8. Syncope

Back 8

1. O-htn
2. Arrhythmia
3. VV - syncope
4. IHSS, IHCM
5. Sz

Hint 8

1. Bp check vs O-htn (tilt table)
2. CT - head
3. EKG
4. CBC
5. CMP

Front 9

9. Heat - Related Injury

Back 9

1. Heat stroke nephrotoxicity
2. NSAID-induced GN
3. Dehydration-induced renal failure
4. Glomerulonephritis
5. Cerebellar stroke

Hint 9

1. U/A with urine Mgb and Cx
2. Urine Cr, urine Na, plasma Cr,
plasma Na (calculate FENa)
3. Ionized Ca, phosphate, uric acid, CPK level, and
liver function panel with transaminases.
4. ECG
5. MRI brain

Front 10

10. Breast Lump

Back 10

1. Fibroadenoma
2. Breast malignancy or carcinoma in situ
3. Fibrocystic changes
4. Intraductal papilloma
5. Mammary duct ectasia
FA,FCC,BRCA,IDC,MDE
RF-age,race,bbd,phxbrca,fat,sedentary,estrogen,fh,radio,hses

Hint 10

1. Breast ultrasound
2. Needle core biopsy
3. CBC
4. Basic metabolic panel including electrolytes, renal function, and glucose
5. Liver enzyme panel

Front 11

11. Chest Pain

Back 11

1. Myocardial infarction
2. GERD
3. Pulmonary embolism
4. Dissection of the large vessels
5. Pneumonia

Hint 11

1. ECG
2. Cardiac enzymes (Troponin, CK-MB, CK)
3. CBC with differential
4. CXR (PA/Lat)
5. CT angiogram, chest

Front 12

12. Chronic Cough

Back 12

1. GERD
2. ACE-I medication s/e
3. COPD
4. Post-infectious cough
5. Laryngeal cancer

Hint 12

1. Laryngoscopy
2. 24-hour esophageal pH probe
3.
4.
5.

Front 13

13. SOB - Shortness of Breath

Back 13

1. CHF -exacerbation
2. MI - Myocardial infarction
3. COPD - exacerbation
4. PNA - Pneumonia
5. PE - Pulmonary embolism

Hint 13

1. Chest X-ray
2. CBC with differential, electrolytes, renal
function, glucose
3. Cardiac enzymes (Troponin, CK-MB, CPK)
4. ECG
5. B-type naturetic peptide (BNP)

Front 14

14. Weight Loss and Fatigue

Back 14

1. Diabetes Mellitus -DM
2. Hyperthyroid state -TSH
3. Diabetes Insipidis - DI
4. Cushing’s syndrome -CS/pheochromocytoma -PCC
5. Occult malignancy

Hint 14

1. FSG - Finger-stick glucose level
2. TSH, Free T4
3. CBC with differential
4. Complete metabolic profile
5. Fasting glucose level

Front 15

15. Respiratory Symptoms

Back 15

1. URT-i, viral
2. PNA - Pneumonia
3. COPD exacerbation
4. PE - Pulmonary embolism
5. CHF - Congestive heart failure

Hint 15

1. CBC with differential
2. Chest X-ray-PA/Lateral
3. Sputum gram stain and culture
4. Brain naturetic peptide (BNP)
5.

Front 16

16. Male Abdominal Pain

Back 16

1. GE-V - Viral gastroenteritis
2. GE-B - Bacterial gastroenteritis
3. Diverticulitis
4. Acute pancreatitis
5.

Hint 16

1. CBC with differential
2. Stool for ova/parasites,WBC,Cx
3. Amylase/Lipase, ALKP, AST/ALT, Bili- fx(x/y)
4. BMP
5. CT -Abd with oral and IV contrast.

Front 17

17. Nausea and Vomiting in a Diabetic

Back 17

1. Diabetic ketoacidosis (DKA)
2. Bacterial gastroenteritis
3. Viral gastroenteritis
4. HONK - Hyperosmolar nonketotic state
5. Pregnancy

Hint 17

1. BMP - Electrolytes, BUN/creatinine, glucose
2. ABG - Arterial blood gas
3. Acetone level/Plasma ketones
4. CBC with differential
5. B-HCG

Front 18

18. Nausea and Vomiting

Back 18

1. GE-V - Viral gastroenteritis
2. GE-B - Bacterial gastroenteritis
3. Pregnancy
4. Cholecystitis
5. Acute pancreatitis

CC,CL,BC,CDCL,BD,PANC

Hint 18

1. CBC with differential
2. B-HCG
3. Stool for ova/parasites, WBC,Cx
4. U/S upper abdomen
5. Amylase/Lipase, ALKP, AST/ALT,
bilirubin (fractionated)

Front 19

19. Female Abdominal Pain

Back 19

1. Ectopic pregnancy
2. Pelvic inflammatory disease
3. Ovarian cyst
4. Spontaneous abortion
5. Diverticulitis

Hint 19

1. Pelvic exam
2. B-HCG
3. Chlamydia and gonococchal antigen testing.
4. CBC with differential
5. Abdominal/transvaginal ultrasound

Front 20

20. Anterior Knee Pain

Back 20

1. Bursitis
2. Cellulitis
3. Gonococcal arthritis
4. Patellofemoral syndrome
5. Gout

Hint 20

1. CBC with differential
2. Synovial fluid aspiration, fluid analysis and culture
3. Knee X-ray (weight bearing)
4.
5.

Front 21

21. Wrist Pain

Back 21

1. Scaphoid fracture
2. Scapholunate ligament dissociation
3. Hook of hamate fracture
4. Radial styloid fracture
5.

Hint 21

1. Wrist X-rays (PA, lateral, grip, and scaphoid views)
2.
3.
4.
5.

Front 22

22. Joint Pain

Back 22

1. Gout
2. PG - Pseudogout
3. OA - Osteoarthritis
4. RA - Rheumatoid arthritis
5. IA - Infective arthritis

Hint 22

1. Weight-bearing knee X-rays
2. Knee aspiration with synovial fl uid analysis for gram
stain, culture, cell differential, and crystal refraction
3. CBC with differential
4. RF - Rheumatoid factor
5.

Front 23

23. Back Pain

Back 23

1. Paraspinal muscle spasm
2. Vertebral fracture
3. Intervertebral disc herniation
4. Spondylosis
5. Ankylosing spondylitis

Hint 23

1. Plain lumbar X-ray, PA, oblique, and lateral
2.
3.
4.
5.

Front 24

24. Back Pain in an Elderly Patient

Back 24

1. Mets CA to the lumbar spine
2. Pathologic Fx-fracture
3. DJD and spondylosis
4. IVDH or rupture
5. OP fx- Osteoporotic fracture
METZ-LL,METZ-FX,DJDOA,DJD-FX,IVDH/IVDH-R

Hint 24

1. Prostate/digital rectal exam
2. PSA
3. MRI back
4. Electrolytes, Renal fctn , LFT, ALKP
5. CBC with manual differential

Front 25

25. Shoulder Pain

Back 25

1. Rotator cuff tendonopathy
2. Impingement syndrome
3. Tear of the glenoid labrum (SLAP lesion)
4. Osteoarthritis
5. Biceps tendonitis
RCT,IS,BT,LT,OA

Hint 25

1.
2.
3.
4.
5.

Front 26

26. Lower Leg Pain

Back 26

1. Deep Vein Thrombosis (DVT)
2. Cellulitis
3. Contact dermatitis
4. superfi cial thrombophlebitis
5. Envenomation

Hint 26

1. Doppler compression ultrasound
2. CBC with differential
3. D-dimer
4.
5.

Front 27

27. Fatigue and Bruising

Back 27

1. Leukemia (CLL, CML, AML)
2. Warfarin medication effect
3. Multiple myeloma
4. Lymphoma
5. Thrombotic thrombocytopenic purpura (TTP)

Hint 27

1. CBC with differential
2. Coagulation panel (PT, aPTT, INR)
3. BMP inc electrolytes,
renal function, and glucose.
4. LFT with LDH
5. OBT - Stool occult blood testing

Front 28

28. Fever in Pregnancy

Back 28

1. Pyelonephritis
2. UTI - Urinary tract infection
3. BV or Trichomonas
4. Vaginal yeast infection
5. Pneumonia

Hint 28

1. Pelvic exam with gonorrhea/Chlamydia DNA
probes, KOH and wet prep mounts
2. CBC with differential
3. Urine analysis and culture
4.
5.

Front 29

29. Hematuria

Back 29

1. Prostatic bleeding
2. Urinary tract infection
3. Urolithiasis
4. Glomerulonephritis
5. Bladder malignancy

Hint 29

1. Genital and digital rectal (prostate) exam
2. Urine analysis and culture
3. CT scan abdomen/pelvis
4. Cystoscopy
5. Basic metabolic panel (BUN, creatinine, sodium,potassium, chloride, bicarbonate, glucose)

Front 30

30. Testicular Mass

Back 30

1. Sperm granuloma
2. Testicular malignancy
3. Hydrocele
4. Varicocele
5. Hernia

Hint 30

1. Genital exam, including inguinal hernia exam
2. Testicular ultrasound
3. B-hCG
4. A-fetoprotein
5.

Front 31

31. Irregular Menses

Back 31

1. Pregnancy
2. Spontaneous abortion
3. Infection of the cervix or vagina
4. PCOS - Polycystic ovarian syndrome
5. Hyperprolactinemia

Hint 31

1. Pelvic and breast exams
2. B-HCG (qualitative)
3. Gonorrhea/Chlamydia DNA probes and wet
mount and KOH prep from cervical swabs.
4. TSH/free T4
5. Prolactin level

Front 32

32. Fever in a Child

Back 32

1. Otitis media
2. Viral pharyngitis
3. Streptococcal pharyngitis
4. Bronchitis
5. Cystitis

Hint 32

1. RPA - Rapid antigen testing for strep throat
2. Influenza antigen testing.
3. Urine analysis and culture
4.
5.

Front 33

33. Difficult Patient: Fibromyalgia

Back 33

1. Fibromyalgia
2. Major depressive disorder
3. Obstructive sleep apnea
4. Thyroid dysfunction
5. Bereavement

Hint 33

1. TSH, free T4
2. Overnight sleep study
3.
4.
5.

Front 34

34. Difficult Patient: Drug-Seeking

Back 34

1. Drug-seeking behavior
2. Malingering 2.
3. Muscular back spasm
4. Bulging intervertebral disc
5. Ruptured intervertebral disc

Hint 34

1. Lumbar X-rays
2.
3.
4.
5.

Front 35

35. Difficult Patient: Non-English Speaking

Back 35

1. GERD
2. Chronic gastritis
3. Peptic ulcer disease
4. Pancreatitis
5. Stomach malignancy

Hint 35

1. Urea breath test (H.pylori BT)
2. CBC with differential
3. Amylase/Lipase
4. EGD Esophagogastroduodenoscopy
5.

Front 36

36. Telephone Case: Abdominal Pain

Back 36

1. PUD - Peptic ulcer disease
2. Acute gastritis
3. Acute pancreatitis
4. BD - Inflammatory bowel disease (Crohn’s disease)
5. Gallstone disease (cholecystitis,
choledocholithiasis)

Hint 36

1. CBC with differential
2. CXR, upright
3. CT scan, abdomen
4. LFTs panel including: AST/ALT, bilirubin
(fractionated), Amylase/lipase, ALKP
5. BMP - including Ca.

Front 37

37. Telephone Case: Elderly Fall

Back 37

1. Subdural hematoma
2. Epidural hematoma
3. Fracture
4. Cervical spine injury
5. Hemorrhagic stroke.

Hint 37

1. CT scan, head
2. CT scan cervical spine.
3. Plain X-rays—, chest, , bilateral hips, extremities as
indicated
4. CBC, Coagulation profile (pT, aPTT, INR)
5. Electrolytes, renal function, and glucose

Front 38

38. Telephone Case: Labor Check

Back 38

1. Preterm rupture of membranes
2. Prolonged rupture of membranes
3. Preterm labor
4. Braxton-Hicks (false labor) contractions
5. Cervical or vaginal infection

Hint 38

1.Sterile speculum exam (evaluate for pooling of
amniotic fluid, ferning of discharge by microscopy,
and nitrizine testing of discharge)
2. Amniotic fl uid index (ultrasound)
3. Cervical exam
4. Nonstress test (Recording uterine activity and fetal
heart rate for 20 min)
5.

Front 39

39. Telephone Case: Question of Abuse

Back 39

1. Sexual abuse
2. Physical abuse
3. Accidental trauma
4. Urinary tract infection
5. Candidiasis

Hint 39

1. U/A and urine Cx
2. Vaginal, oral, and anal microscopic slides and
culture performed
3. Gonorrhea and Chlamydia antigen testing on
genital and oral samples
4. RPR, HIV antibodies, hepatitis B and C testing
5. Hair and nail samples

Front 40

40. Telephone Case: Toxic Ingestion

Back 40

1. Caustic alkali ingestion
2. Detergent ingestion
3. Orophayrngeal and esophageal injury
4. Aspiration
5. Gastrointestinal perforation

Hint 40

1. ABG - Arterial blood gas
2. BMPElectrolytes and renal fctn
3. CXR, upright, PA/Lat
4. CBC
5.