Step 2 Cs: U.w. Cases

Front 1

30yo F c abdominal pain and fever: ddx?

Back 1

1. PID
2. pelvic abscess
3. endometriosis
4. UTI
5. appendicitis
6. rupture/torsion of ovarian cyst
7. acute cholecystitis
8. renal colic
9. ectopic pregnancy
10. abortion
11. acute gastroenteritis
12. inflammatory bowel disease

Front 2

30yo F c abdominal pain and fever: work-up?

Back 2

1. rectal and pelvic exam
2. CBC c diff.
3. urinalysis c C/S
4. pregnancy test
5. u/s abdomen

Front 3

27 yo WF c rash over face and neck: ddx?

Back 3

1. SLE
2. rheumatoid arthritis
3. photodermatitis
4. drug-induced
5. occupational exposure

Front 4

27 yo WF c rash over face and neck: work-up?

Back 4

1. CBC c diff, ESR
2. ANA and anti-ds DNA
3. rheumatoid factor assay
4. skin biopsy
5. skin tests for allergen

Front 5

65yo WF c weakness of R arm and leg: ddx?

Back 5

1. evolving stroke
2. TIA or reversible ischemic neuro deficit
3. subarachnoid hemorrhage

Front 6

65yo WF c weakness of R arm and leg: work-up?

Back 6

1. CBC c diff
2. chem 7
3. 12 lead EKG
4. CT head w/o contrast
5. carotid doppler
6. transesophageal echocardiogram

Front 7

29yo BF c sickle cell anemia, complains of chest pain: ddx?

Back 7

1. sickle cell chest syndrome
2. pneumonia
3. costochondritis
4. pericarditis
5. pulm. thromboembolism
6. salmonella osteomyelitis

Front 8

29yo BF c sickle cell anemia, complains of chest pain: work-up?

Back 8

1. CBC c diff
2. sputum gram stain, C/S
3. blood cx
4. CXR
5. EKG

Front 9

35yo M c recent onset cough & fever: ddx?

Back 9

1. common cold
2. acute sinusitis
3. acute bronchitis
4. allergic rhinitis
5. pneumonia
6. asthma exacerbation
7. meds (ACE I)
8. PE
9. COPD exacerbation
10. CHF

Front 10

35yo M c recent onset cough & fever: work-up

Back 10

1. CBC c differential
2. sputum gram stain, C/S
3. CXR, PA and lateral views

Front 11

50yo M c fatigue and recent wt loss: ddx?

Back 11

1. malignancy
2. hyperthyroidism
3. diabetes mellitus
4. malabsorption
5. depression
6. infx: TB, HIV
7. Addison's disease

Front 12

50yo M c fatigue and recent wt loss: work-up?

Back 12

1. rectal exam and fecal occult blood test
2. CBC c diff
3. TSH
4. LFT's
5. abd. u/s

Front 13

35yo M c acute onset diarrhea: ddx?

Back 13

1. viral gastroenteritis
2. bacterial GE
3. med-induced
4. C. difficile
5. inflammatory bowel disease
6. irritable bowel syndrome
7. malabsorption
8. HIV

Front 14

35yo M acute onset diarrhea: work-up?

Back 14

1. rectal exam and FOBT
2. CBC c diff
3. chem 7
4. stool: C. difficile
5. stool: fecal leukocytes

Front 15

25yo F c sore throat and fever: ddx?

Back 15

1. viral pharyngitis (rhino virus and influenza)
2. bacterial pharyngitis: group A strep., mycoplasma pneumo, N. gonorrhea
3. EBV mononucleosis
4. post-nasal drip 2* to rhinitis
5. chronic tonsillitis
6. 1* HIV

Front 16

25yo F c sore throat and fever: work-up?

Back 16

1. CBC
2. mono spot test
3. rapid streptococcal antigen test

Front 17

56yo M for BP check and med refills: BP complications?

Back 17

1. diastolic CHF
2. CAD (angina)
3. peripheral vascular disease
4. retinopathy
5. medication side effects

Front 18

56yo M for BP check and med refills: work-up?

Back 18

1. urinalysis
2. lipid profile
3. ALT

Front 19

66yo M c/o constipation: ddx?

Back 19

1. functional constipation
2. obstructive lesions (bowel obstruction, carcinoma of colon)
3. metabolic disturbances ( hypothyroidism, DM, hyperCa++)
4. neuro dysfunctions (stroke, autonomic neuropathy, spinal cord trauma, MS, Parkinson's)
5. med induced (iron, opiates, anticholinergics)

Front 20

66yo M c/o constipation: work-up?

Back 20

1. rectal exam c FOBT
2. CBC c diff
3. serum Ca++
4. fasting BS and HbA1c
5. colonoscopy

Front 21

50yo M c/o impotence: ddx?

Back 21

1. diabetic neuropathy
2. artherosclerotic vascular disease
3. anxiety, other psych issues
4. meds, esp. anti-HTN
5. chronic ETOH abuse
6. pituitary dysfunction
7. spinal cord dysfunction

Front 22

50yo M c/o impotence: work-up?

Back 22

1. rectal and genital exam
2. fasting BS and HbA1c
3. CBC
4. nocturnal penile tumescence testing
5. TSH, serum prolactin, testosterone, as needed

Front 23

1yo baby c fever: ddx?

Back 23

1. respiratory tract infx
2. ear infx
3. other exanthematous diseases
4. meningitis
5. UTI
6. gastroenteritis

Front 24

1yo baby c fever: work-up?

Back 24

1. CBC c differential
2. urinalysis
3. ear exam
4. fundoscopy
5. LP

Front 25

45yo F c acute RUQ abd pain and fever: ddx?

Back 25

1. cholecystitis
2. biliary colic
3. acute hepatitis
4. acute pancreatitis (biliary pain)
5. perforated peptic ulcer
6. MI
7. RLL pneumonia

Front 26

45yo F c acute RUQ abd pain and fever: work-up?

Back 26

1. CBC c differential
2. EKG
3. CXR
4. u/s abdomen
5. LFTs (albumin, AST, ALT, alk phos, TBili, DBili)
6. serum amylase and lipase

Front 27

24yo F comes in for 1st prenatal visit: important Q's?

Back 27

1. LMP
2. how confirmed pregnancy?
3. OB hx
4. Gyn hx
5. problems with current pregnancy?

Front 28

24yo F comes in for 1st prenatal visit: counseling?

Back 28

1. explain findings
2. stop tobacco and ETOH
3. safe sex practices
4. explain need for vitamins, iron supplementation, nutritious diet
5. importance of regular antenatal visits

Front 29

24yo F comes in for 1st prenatal visit: work-up?

Back 29

1. CBC c diff, blood group & type
2. urinalysis
3. u/s abdomen
4. TORCH screen
5. hep B screen
6. HIV screen (consent)

Front 30

60yo M c/o acute SOB: ddx?

Back 30

1. PE
2. CHF
3. COPD exacerbation
4. pneumonia
5. spontaneous pneumothorax
6. bronchial asthma
7. anxiety and panic attacks

Front 31

60yo M c/o acute SOB: work-up?

Back 31

1. CBC c diff
2. CXR
3. 12-lead EKG
4. V/Q scan
5. echocardiogram
6. PFT's if needed

Front 32

40yo F c increased urination: ddx?

Back 32

1. DM
2. central DI
3. nephrogenic DI
4. psychogenic DI
5. cystitis (UTI)
6. diuretics and other drugs
7. hypercalcemia

Front 33

40yo F c increased urination: work-up?

Back 33

1. fasting BS
2. urinalysis
3. chem 6 and Ca++
4. urine and serum osmolality

Front 34

35yo F evaluation for jaundice: ddx?

Back 34

1. infectious hepatitis
2. alcoholic hepatitis
3. drug-induced hepatitis
4. primary biliary cirrhosis
5. malignancy
6. hemolytic jaundice
7. Wilson's disease
8. hemochromatosis

Front 35

35yo F evaluated for jaundice and fever: work-up?

Back 35

1. CBC c diff
2. urine for bile salts
3. anti-mitochondrial antibodies
4. LFT's
5. hepatitis screen

Front 36

35yo F c/o chest pain and fever: ddx?

Back 36

1. pneumonia
2. GERD
3. panic d/o
4. hyperthyroidism
5. pheochromocytoma
6. hyperventilation syndrome
7. angina
8. costochondritis

Front 37

35yo F c/o chest pain and fever: work-up?

Back 37

1. CBC c diff
2. EKG
3. CXR
4. thyroid profiles
5. lipid profile (early arteriosclerosis)
6. urinary catecholamines

Front 38

45yo M c/o RLQ abdominal pain: ddx?

Back 38

1. appendicitis
2. Meckel's diverticulitis
3. perforated viscus or peptic ulcer
4. intestinal obstruction
5. Yersinia enterocolitica
6. pancreatitis
7. urolithiasis
8. acute cholecystitis

Front 39

45yo M c/o RLQ abdominal pain: work-up?

Back 39

1. CBC c diff
2. abd. x-ray
3. abd. u/s
4. pancreatic enzymes
5. upper GI endoscopy

Front 40

55yo M c bilateral leg pain: ddx?

Back 40

1. thromboangiitis obliterans (Buerger's Disease)
2. atherosclerotic vascular disease
3. lumbar spinal stenosis
4. diabetic polyneuropathy
5. radiculopathy due to spinal disease
6. meds (eg. statins)
7. trauma

Front 41

55yo M c bilateral leg pain: work-up?

Back 41

1. creatinine kinase (statin-induced myopathy)
2. blood sugar and HbA1c
3. lipid profile
4. doppler u/s of LE arteries
5. duplex venous u/s of LE (?DVT)
6. CBC (?infx)
7. MRI (?spinal stenosis)

Front 42

40yo M c hematemesis: ddx?

Back 42

1. peptic ulcer disease
2. gastric erosions
3. esophageal varices
4. Mallory-Weiss tears
5. esophagitis
6. duodenitis
7. malignancy (esophageal & gastric)

Front 43

40yo M c hematemesis: work-up?

Back 43

1. postural BP and HR measurements
2. CBC c diff
3. PT/INR (coag studies)
4. chem 6
5. upper GI endoscopy
6. LFT's (albumin, ALT, AST, alk phos, TBili, DBili)

Front 44

55yo M c/o chest pain: ddx?

Back 44

1. MI
2. unstable angina
3. PE
4. costochondritis
5. pleuritis
6. pericarditis
7. aortic dissection
8. GERD
9. esophageal perforation

Front 45

55yo M c/o chest pain: work-up?

Back 45

1. CBC c diff
2. cardiac enzymes
3. EKG and CXR
4. echocardiogram
5. coronary angiogram & lipid profile

Front 46

70yo M c/o frequent falls: ddx?

Back 46

1. cerebellar disease (ETOH, tumor)
2. Parkinson's (idiopathic, drug-induced)
3. diabetic neuropathy (sensory ataxia)
4. brain tumor
5. hyperthyroidism
'6. fractured hip
'7. seizure
'8. vertigo

Front 47

70yo M c/o frequent falls: work-up?

Back 47

1. CBC c diff
2. CT or MRI (posterior fossa)
3. serum lytes
4. EKG
5. S. phencyclidine levels
6. TSH, T3, T4

Front 48

35yo M c/o cough, chest pain and fever: ddx?

Back 48

1. pneumonia
2. pleuritic pain
3. pleural effusion
4. pulmonary edema
5. TB
6. PE
7. bronchial CA
8. infective endocarditis or pericarditis
9. GERD

Front 49

35yo M c/o cough, chest pain and fever: work-up?

Back 49

1. CBC c diff, ESR
2. CXR
3. EKG
4. sputum gram stain, culture and sensitivity, cytology
5. blood cultures

Front 50

60yo M c/o lower abd pain and fever: ddx?

Back 50

1. diverticulitis
2. renal colic
3. appendicitis
4. ischemic colitis
5. infectious colitis
6. leaking aneurysm
7. intestinal obstruction from stangulated or incarcerated hernia

Front 51

60yo M c/o lower abd pain and fever: work-up?

Back 51

1. rectal exam, FOBT, genital exam
2. CBC c diff
3. chem 6 and Ca++
4. urinalysis
5. EKG
6. abdominal x-ray
7. CT of abdomen and pelvis

Front 52

35yo M c/o fatigue: ddx?

Back 52

1. depression
2. anemia
3. hypo/hyperthyroidism
4. HIV or AIDS
5. malingering
6. hypochondriasis
7. PTSD
8. chronic fatigue

Front 53

35yo M c/o fatigue: work-up?

Back 53

1. CBC c diff
2. TSH, T3, T4
3. ESR
4. chem 6 panel

Front 54

65yo F c/o loss of hearing: 2 types of pathology?

Back 54

1. conducting hearing loss
2. sensorineurial hearing loss

Front 55

list the ddx for conducting hearing loss.

Back 55

1. cerumen impaction
2. otitis media c effusion
3. tympanic membrane perforation
4. otosclerosis
5. foreign body in ear canal
6. cholesteatoma
7. tympanosclerosis
8. tumor of ear canal or middle ear

Front 56

list the ddx for sensorineurial hearing loss.

Back 56

1. presbycusis (age related)
2. ototoxicity (meds)
3. noise-induced
4. Meniere's disease
5. diabetes
6. acoustic neuroma

Front 57

65yo F c/o loss of hearing: work-up?

Back 57

1. CBC and ESR
2. chem 7
3. audiometry
4. FTA, absorbed (if needed)
5. MRI brain (if needed)
6. Lyme titers (if needed)

Front 58

53yo M with R knee pain, swelling and fever: ddx?

Back 58

1. osteoarthritis
2. septic arthritis
3. pseudogout and gout
4. reactive arthritis
5. traumatic knee injury
6. Lyme disease
7. monoarticular rheumatoid arthritis
8. psoriatic arthritis

Front 59

53yo M with R knee pain, swelling and fever: work-up?

Back 59

1. CBC c diff
2. PT/INR before aspiration
3. joint aspiration
4. knee X-ray
5. ESR, ANA, Rheumatic Factor
6. MRI of joint for hx of trauma
7. Lyme titers of rhx of tick bite or travel to NE U.S.

Front 60

In case of knee trauma, what Q's do you ask? consult or advice?

Back 60

1. what were you doing when pain began?
2. any noises at the time of injury? (pop = ACL injury)
3. did the knee buckle or is it unstable?
4. is there locking and unlocking of joint?
5. do Lachman's maneuver, Drawer's test for CL injury
6. McMurray's maneuver
7. advise orthopedics consult for possible meniscal or CL injury

Front 61

50yo M c blurry vision: ddx?

Back 61

1. DM
2. cataracts
3. HTN retinopathy
4. glaucoma
5. macular degeneration
6. brain lesions
7. hyperviscosity syndrome (polycythemia)
8. illegal drugs
9. temporal arteritis
10. trauma or infx to eye (if unilateral)

Front 62

50yo M c blurry vision: work-up?

Back 62

1. CBC c diff
2. fasting BS and HbA1c
3. urinalysis for microscopic proteinuria
4. lipid profile
5. doppler of carotids

Front 63

32yo F c multiple bruises: ddx?

Back 63

1. accident
2. physical assault
3. spousal abuse
4. bleeding d/o
5. collagen vascular d/o

Front 64

32yo F c multiple bruises: work-up?

Back 64

[really depends on HPI]

1. PT/INR coags
2. ESR

Front 65

20yo F c burning on urination and fever: ddx?

Back 65

1. cystitis
2. pyelonephritis
3. urethritis
4. vulvovaginitis
5. PID
6. non-inflammatory dysuria (trauma, irritant, allergy)

Front 66

20yo F c burning on urination and fever: work-up?

Back 66

1. pelvic exam
2. CBC c diff
3. urine culture
4. urinalysis

Front 67

50yo M c difficulty swallowing: 2 categories of dysphagia?

Back 67

1. oropharyngeal dysphagia
2. esophageal dysphagia

Front 68

list the ddx for oropharyngeal dysphagia.

Back 68

1. neuromuscular (CVA, Parkinsonism, multiple sclerosis)
2. mechanical obstruction (Zenker diverticulum, thyromegaly)
3. skeletal muscle d/o (myasthenia gravis, muscular dystrophies, polymyositis)
4. miscellaneous (meds, radiation)

Front 69

list the ddx for esophageal dysphagia.

Back 69

1. mechanical obstruction (esophageal CA, benign structures, webs and rings)
2. achalasia cardia (achalasia, scleroderma)
3. GERD
4. miscellaneous (DM, alcoholism)

Front 70

what is the work-up for this ddx?
1. esophagial CA
2. achalasia cardia
3. reflux esophagitis
4. stricture

Back 70

1. CBC
2. barium swallow
3. esophagoscopy
4. CXR

Front 71

30yo M HIV pt comes in for med refill. what infx do you look out for?

Back 71

1. PCP
2. Candida
3. CMV retinitis
4. esophagitis

Front 72

30yo M HIV pt comes in for med refill. work-up?

Back 72

1. CBC c diff
2. CD4 count
3. viral load (HIV RNA PCR)
4. CXR
5. LFT's (Zidovudine toxicity)

Front 73

which can present with amenorrhea, hypo- or hyperthyroidism?

Back 73

BOTH!

Front 74

16yo F presents c amenorrhea: ddx?

Back 74

1. 1* amenorrhea
2. 2* amenorrhea
3. pregnancy
4. anorexia nervosa
5. hyperprolactinemia
6. thyroid dysfunction
7. polycystic ovarian syndrome
8. stress
9. post pill amenorrhea
10. hypothalamic pituitary ovarian axis problems

Front 75

16yo F presents c amenorrhea: work-up?

Back 75

1. pelvic and breast exam
2. pregnancy test
3. TSH
4. serum prolactin level
5. u/s abdomen (?ovarian tumor)
6. MRI brain (?prolactinoma)
7. LH and FSH levels (?polycystic ovarian disease)

Front 76

35yo F presents c acute R lumbar and lower abd pain c fever: ddx?

Back 76

1. renal colic
2. ovarian torsion
3. UTI and pyelonephritis
4. PID
5. Mittelschmerz
6. appendicitis
7. threatened abortion
8. ectopic pregnancy
9. dysmenorrhea
10. endometriosis
11. fibroid uterus

Front 77

35yo F presents c acute R lumbar and lower abd pain c fever. ddx includes renal colic, pyelonephritis, PID, appendicitis and fibroid uterus. work-up?

Back 77

1. pelvic exam
2. pregnancy test
3. CBC c diff
4. urinalysis and cultures
5. abd u/s

Front 78

70yo M c insomnia: ddx?

Back 78

1. depression
2. PTSD
3. anxiety d/o
4. chronic pain syndrome
5. drug-induced
6. age-related sleep changes
7. thyroid probs
8. sleep apnea
9. restless leg syndrome
10. occult medical illness

Front 79

70yo M c insomnia: work-up?

Back 79

1. CBC
2. chem 6
3. TSH
4. nocturnal polysomnography
5. upper GI endoscopy

Front 80

65yo M c difficulty urinating: ddx?

Back 80

1. BPH
2. CA of prostate
3. stone in urinary tract
4. urethral strictures
5. CA of bladder
6. sphincter dysfunction
7. infection
8. neuro dysfunction (spinal cord trauma or diabetes)
9. drug-induced (anti-cholinergics)

Front 81

65yo M c difficulty urinating: work-up?

Back 81

1. rectal exam
2. CBC c diff
3. urinalysis and urine cx
4. BUN, Cr
5. fasting BS, HbA1c
6. Prostate Specific Antigen
7. cytoscopy (as needed)
8. u/s (as needed)

Front 82

45yo F c/o breathlessness and anxiety: ddx?

Back 82

1. anxiety 2* to medical condition (hyperthyroidism, arrhythmia, pheochromocytoma)
2. substance abuse
3. panic d/o
4. generalized panic disorder
5. adjustment d/o c anxious mood
6. hypochondriasis
7. malignancy

Front 83

45yo F c/o breathlessness and anxiety: work-up?

Back 83

1. CBC
2. EKG
3. TSH
4. urinalysis
5. urine tox screen

Front 84

53yo M c long hx of epigastric pain: ddx?

Back 84

1. peptic ulcer disease
2. gastritis
3. GERD/esophagitis
4. CA of esophagus, stomach, or pancreas
5. chronic pancreatitis
6. cholecystitis
7. hepatitis

Front 85

53yo M c long hx of epigastric pain: work-up?

Back 85

1. CBC c diff
2. endoscopy
3. serum amylase and lipase
4. LFT's (albumin, Dbili, Tbili, AST, ALT, alk phos)
5. Fecal Occult Blood Test
6. abd u/s or CT (as needed)
7. H. pylori breath test (as needed)

Front 86

45yo M c/o bloody vomiting: ddx?

Back 86

1. gastric ulcer
2. duodenal ulcer
3. esophageal and gastric varices
4. Mallory Weiss tears
5. gastritis
6. erosive esophagitis
7. GI malignancy
8. vascular ectasia

Front 87

45yo M c/o bloody vomiting: work-up?

Back 87

1. CBC c diff
2. chem 6
3. upper GI endoscopy
4. LFTs
5. H. pylori serology

Front 88

60yo M c/o dizziness: ddx?

Back 88

1. TIA or stroke
2. drug-induced
3. CAD
4. autonomic dysfunction
5. postural hypotension
6. CHF
7. arrhythmias
8. hypoglycemia
9. intracranial pathology
10. ear probs
11. anemia

Front 89

60yo M c/o dizziness: work-up?

Back 89

1. orthostatics
2. CBC
3. doppler carotid study
4. fasting BS and HbA1c
5. chem 6
6. EKG and holter monitor
7. CT scan of head (as needed)

Front 90

30yo M c new onset of seizures: ddx?

Back 90

1. SZ 2* to: head trauma, infx, drugs, metabolic d/o
2. hypoglycemia
3. syncope
4. migraine
5. stroke
6. space occupying lesion
7. alcohol or drug induced

Front 91

30yo M c new onset of seizures: work-up?

Back 91

1. CBC c diff
2. chem 7, Ca++, Mg++
3. LFTs
4. urinalysis and tox screen
5. CT scan of head
6. LP
7. EEG

Front 92

23yo M c rectal bleeding and fever: ddx?

Back 92

remember: young pt c rectal bleeding
1. anal fistula/fissure
2. inflammatory bowel disease
3. infectious colitis
4. neoplasm
5. vascular ectasia
6. gonococcal proctitis
7. hemorrhoids

Front 93

23yo M c rectal bleeding and fever: work-up?

Back 93

1. rectal exam and FOBT
2. CBC and ESR
3. anoscopy
4. sigmoidoscopy/colonoscopy
5. abd x-ray

Front 94

what is the ddx for an elderly person with rectal bleeding and fever?

Back 94

1. diverticulosis
2. angiodysplasia
3. malignancy/polyp
4. ischemic colitis
5. inflammatory bowel disease

Front 95

20yo M c/o dark urine: ddx?

Back 95

1. UTI
2. glomerulonephritis
3. kidney or bladder stones
4. tumors of kidney or bladder
5. acute tubular necrosis
6. ATN
7. medication-induced
8. drug-induced

Front 96

20yo M c/o dark urine: work-up?

Back 96

1. urinalysis
2. urine cx and sensitivity
3. CBC c diff
4. cytoscopy as needed
5. KUB, as needed
6. CT scan of abdomen, as needed

Front 97

pt presents c signs of ETOH abuse: work-up?

Back 97

1. CBC c diff
2. LFT's
3. GGT (gamma glutanyl transpeptidase)

Front 98

pt presents c signs of ETOH abuse: exit Q's and advice?

Back 98

1. how much ETOH and how often?
2. explain risks of alcoholism
3. explain pt's responsibility to stop drinking
4. drinking diary
5. self-motivation; community resources and groups
6. make f/u appt

Front 99

elderly pt >50yo c back pain: ddx?

Back 99

1. disk prolapse
2. osteoporosis c vertebral body fracture
3. muscle strain
4. pathologic fracture
5. degenerative joint disease

Front 100

elderly pt >50yo c back pain: work-up?

Back 100

1. X-ray of lumbar spine
2. DEXA scan
3. Ca, PO4, alk phos, protein electropheresis, acid phosphatase
4. MRI spine, as needed
5. CBC & ESR, as needed

Front 101

pt presents c chronic cough: ddx?

Back 101

1. postnasal drip syndrome and sinusitis
2. asthma
3. GERD
4. chronic bronchitis
5. bronchiectasis
6. cough 2* to ACE inhibitor use
7. malignancy
8. cough 2* to occupational exposure
9. TB (rare in U.S.)

Front 102

pt presents c chronic cough: work-up?

Back 102

1. CBC c diff
2. CXR
3. sputum gram stain/AFB and culture, as needed
4. PFTs, as needed
5. hi-res CT scan
6. ELISA for HIV
7. PPD placement

Front 103

34yo M c chronic diarrhea: ddx?

Back 103

1. secretory diarrhea (bacterial toxins, ileal bile acid malabsorption, endocrine diarrhea)
2. osmotic diarrhea (osmotic laxatives, carbohydrate malabsorption)
3. inflammatory diarrhea (inflammatory bowel disease, infectious disease - Giardia)
4. fatty diarrhea (celiac disease, short bowel syndrome)

Front 104

34yo M c chronic diarrhea: work-up?

Back 104

1. rectal exam and FOBT
2. CBC c diff
3. chem 7
4. stool analysis (wt, pH, fat staining, osmotic gap, laxative screen)
5. stool for fecal leukocytes, ova, and parasites, stool cx

Front 105

45yo M c hemoptysis: ddx?

Back 105

1. bronchiectasis
2. acute or chronic bronchitis
3. pneumonia
4. bronchogenic CA
5. lung abscess
6. TB
7. connective tissue disease (Wegener's, Goodpasture, Lupus)
8. pulmonary embolus
9. pseudo hemoptysis

Front 106

45yo M c hemoptysis: work-up?

Back 106

1. CBC c diff, ESR
2. PT, INR, PTT
3. sputum for AFB, gram stain
4. CXR
5. PPD, as needed
6. urinalysis
7. BUN and creatinine
8. CT of chest, as needed, for bronchiectasis

Front 107

22yo M African American c night sweats: ddx?

Back 107

1. malignancy (lymphoma, solid tumor)
2. infections (TB, HIV, endocarditis)
3. endocrine d/o (hyperthyroidism, pheochromocytoma)
4. medications (antidepressants, cholinergic agonists, hypoglycemic agents)

Front 108

22yo M African American c night sweats: work-up?

Back 108

1. CBC c diff
2. ESR
3. blood cx
4. CXR and PPD
5. TSH
6. ELISA for HIV, as needed
7. CT scan of chest and abdomen for lymphoma, as needed

Front 109

25yo F c n/v: ddx?

Back 109

1. gastroenteritis (food poisoning)
2. obstructing d/o
3. inflammatory disease
4. impaired motor function
5. intracranial pathology
6. drugs

Front 110

2 most common Step 2 CS causes of n/v in women?

Back 110

1. pregnancy
2. anorexia nervosa

Front 111

what drugs commonly cause n/v?

Back 111

1. digoxin
2. CA drugs

Front 112

what 2 intracranial pathologies can cause n/v? what do you ask about?

Back 112

1. malignancy and infections

2. ask about fever, HA, quality of vomiting (projectile?

Front 113

what impaired motor functions cause n/v? what do you ask about?

Back 113

1. diabetic gastroparesis
2. DKA
3. GERD

Ask about hx of diabetes

Front 114

what inflammatory diseases can cause n/v? what are the associated sx?

Back 114

1. PID
2. cholecystitis (pain in the R hypochondriac region)
3. acute pancreatitis (severe epigastric pain radiating to the back)
4. appendicitis (initially, periumbilical pain, later to RLQ)
5. pyelonephritis

Front 115

what obstructing d/o will cause n/v? associated sx?

Back 115

1. pyloric obstruction (vomiting 1hr after eating)
2. intestinal obstruction (vomiting late post prandial period)
3. constipation (passing gas?)

Front 116

what is the likely diagnosis if pain is relieved after emesis?

Back 116

small bowel obstruction

Front 117

if you suspect gastroenteritis (food poisoning), what do you ask about?

Back 117

- eaten any food outside?
- travel hx?
- any family members ill with associated sx, like abdominal cramps and diarrhea?

Front 118

there is n/v in 25yo F. what do decreased bowel sounds mean? increased bowel sounds?

Back 118

decr: ileus
incr: obstruction

Front 119

25yo F c n/v: work-up?

Back 119

1. CBC c diff
2. chem 6
3. pregnancy test
4. urinalysis, cx and sensitivity
5. abd X-ray, if not pregnant
6. if needed: amylase and lipase ? acute pancreatitis
7. if needed: LFTs
8. u/s to ?acute cholecystitis
9. glu to ?DM
10. stool studies, fecal leukocytes, stool ova, parasites, C. diff
11. EKG (if risk factors for MI)

Front 120

what type of MI can appear with vomiting?

Back 120

inferior wall MI, especially with diabetics

Front 121

27yo WF c/o headache: ddx?

Back 121

1. migraine
2. cluster HA
3. tension HA
4. SAH or CVA
5. sinusitis
6. brain tumor
7. meningitis, encephalitis, infections
8. temporal arteritis (in elderly pts)
9. refractive errors (if any positive hx and PE)
10. meds, drugs

Front 122

27yo WF c/o headache: work-up?

Back 122

1. CBC c diff
2. ESR
3. if elderly, temporal artery biopsy
4. sinus X-ray
5. CT head w/o contrast
6. LP, if pt appears sick and presents with fever or confusion, then also take blood cx to ?meningitis

Front 123

40yo F c depression: ddx?

Back 123

1. depression
2. hypothyroidism
3. occult carcinoma

Front 124

40yo F c depression: work-up?

Back 124

1. serum TSH
2. CBC c diff
3. urine and serum tox screen

Front 125

52yo F c/o hot flashes: ddx?

Back 125

1. menopause
2. hyperthyroidism
3. occult malignancy
4. factitious d/o
5. chronic fatigue syndrome

Front 126

52yo F c/o hot flashes: work-up?

Back 126

1. CBC c diff
2. serum TSH
3. serum FSH and LH (only in doubtful cases)
4. pap smear (yearly)
5. screening mammogram
6. annual FOBT

Front 127

70yo F c/o forgetfulness: ddx?

Back 127

1. Alzheimer's Disease
2. vascular dementia
3. normal pressure hydrocephalus
4. vitamin B12 deficiency
5. hypothyroidism
6. masked depression
7. chronic subdural hematoma

Front 128

70yo F c/o forgetfulness: work-up?

Back 128

1. CBC c diff
2. CT scan of head
3. serum TSH, vitamin B12 level
4. chem 6 and Ca++
5. syphilis serology

Front 129

50yo M diabetic comes in for med refill: work-up?

Back 129

1. CBC c diff
2. BS
3. HbA1c
4. BUN and serum creatinine
5. lipid profile

Front 130

50yo M diabetic comes in for med refill: questions to ask?

Back 130

1. when dx c DM?
2. taking DM meds? compliant?
3. are the meds working?
4. have you ever taken insulin?
5. do you check BS regularly?

Front 131

20yo F c/o vaginal bleeding: ddx?

Back 131

1. regular menses
2. abortion
3. pregnancy
4. ectopic pregnancy
5. hydatiform mole

Front 132

what illegal drug can cause vaginal bleeding?

Back 132

cocaine

Front 133

20yo F c/o vaginal bleeding: work-up?

Back 133

1. pelvic exam
2. pregnancy test
3. CBC c diff
4. transvaginal u/s
5. serum B-hCG levels
6. serum TSH

Front 134

56yo M presents c shoulder pain: ddx?

Back 134

1. shoulder dislocation
2. shoulder fracture
3. rotator cuff tear
4. subacromial bursitis
5. ligament sprain

Front 135

56yo M presents c shoulder pain: work-up?

Back 135

1. CBC
2. x-ray of shoulder joint 2 views, incl. elbow
3. x-ray hand, 2 views
4. MRI of shoulder
5. ANA and rheumatic factors

Front 136

40yo F presents for obesity eval: common probs associated c obesity?

Back 136

1. type 2 DM
2. heart disease
3. stroke
4. HTN
5. osteoarthritis
6. sleep apnea
7. breathing probs
8. high cholesterol
9. gall bladder disease
10 increase incidence of CA: endometrial, colon, postmenopausal, breast CA
11. menstrual irregularities
12. stress incontinence
13. psych d/o like depression
14. psychosocial difficulties like social stigmatization

Front 137

40yo F presents for obesity eval: ddx?

Back 137

1. obesity
2. hypothyroidism
3. Cushing's syndrome

Front 138

40yo F presents for obesity eval: work-up?

Back 138

1. CBC c diff
2. fasting BS
3. serum TSH
4. urine cortisol levels
5. fasting lipid profile
6. consider annual PAP smear

Front 139

what are the common causes of syncope?

Back 139

1. cardiac: arrhythmias, CAD and ACS, aortic stenosis, hypertrophic obstructive cardiomyopathy
2. vasovagal syncope
3. neuro causes: TIA, stroke, seizures, migraine
4. meds or toxins
5. unexplained syncope
6. psych cause: personality d/o, hyperventilation, conversion d/o

Front 140

recommended work-up for pt c syncope?

Back 140

1. EKG
2. 24hr holter monitor
3. exercise testing: in case of syncope on exertion
4. 2D echo
5. upright tilt table test: neurocardiogenic syncope
6. neuro investigations: CT, MRI, EEG, carotid doppler
7. tox screen if suspect drug abuse
8. BS and metabolic screen (suspect low BS or electrolyte imbalance)
9. FOBT or stook guaiac

Front 141

62yo M c confusion and DM: ddx?

Back 141

1. insulin-induced hypoglycemia
2. TIA
3. multi-infarct dementia
4. electrolyte abnormalities
5. meds
6. alzheimer's dementia

Front 142

what are the ADL's?

Back 142

DEATH:
Dressing
Eathing
Ambulating
Toileting
Hygiene

Front 143

what are the instrumental ADL's?

Back 143

SHAFT:
Shopping
Housekeeping
Accounting
Food prep
Transportation

Front 144

62yo M c confusion and DM: work-up?

Back 144

1. CBC c diff
2. urinalysis
3. serum lytes or basic metabolic profile
4. EKG and 24h Holter monitor if hx of spells
5. carotid doppler
6. CT scan of head
7. CXR