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35 Cards in this Set
- Front
- Back
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Chest Pain
-differential |
Pleuritic chest pain: pneumothroax, pneumonia, pulmonary embolism; pericarditis (retrosternal)
Dull central pain: crushing = angina, myocardial infarction tearing interscapular = dissecting aortic aneurysm burning = esophagitis/spasm/tear Chest wall tenderness: trauma, shingles |
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Chest Pain
-associated symptoms |
Dyspnea: PE, pneumonia, pneumothorax, pulmonary edema in cardiac ischemia, hyperventilation in anxiety
Cough: purulent sputum in pneumonia, hemoptysis in PE, frothy pink sputum in pulmonary edema Rigors: lobar pneumonia Calf swelling: PE from DVT Palpitations: angina, cardiac ischemia, PE, pneumonia Clamminess, nausea, vomiting, sweating: MI or PE |
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Chest Pain
-physical exam |
1. Vitals!
2. combined Resp and Cardiac Exam 3. Peripheral Vascular Exam - uneven pulses in dissecting aorta, bruits = CAD, PEs |
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Shortness of Breath
-differential |
Lungs: PE, pneumonia, pneumothorax, intersitital lung disease (pulmonary fibrosis), COPD, asthma, pleural effusion, pulmonary edema, ARDS, cancer, aspiration
Heart: CHF (LVF from CAD, aortic stenosis/regurg, mitral stenosis/regurg, pulmonary stenosis) arrythmia (supra/ventricular tachycardia) Metabolism: thyrotoxicosis, ketoacidosis, sepsis, drug OD Blood: anemia Psych: anxiety, hyperventilation |
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Shortness of Breath
- associated symptoms |
chest pain, cough, orthopnea/PND, wheezing, stridor, allergies, hemoptysis
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Shortness of Breath
-physical exam |
1. Vitals - RR
2. Full Resp exam + Cardiac exam 3. JVP: RHF 4. Abdo: liver for RHF 5. Legs: peripheral edema, DVT |
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Palpitations
-differential |
Heart: arrhythmias, MI?
SNS: drugs, pheochromocytoma, hyperthyroidism, Cushing's?, exercise Blood: anemia Gyn: pregnancy GI: GERD Psych: anxiety |
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Palpitations
-associated symptoms |
chest pain, sweating, heat intolerance (etc), faintness, dizziness, fatigue, drugs!!
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Palpitations
-physical exam |
1. Vitals (HR, temp)
2. General Inspection (jaundice, cyanosis, pallor) 3. Cardiac Exam (Resp for crackles) 4. Peripheral pulses for rate and rhythm, also V and C -JVP for cannon or absent a waves 5. Eyes and Legs for sx of Grave's |
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Cough
-differential |
postnasal drip
URTI pressure on trachea (goiter) croup, laryngitis lower resp tract: asthma, COPD, bronchiectasis, LVF drugs and irritants GERD, pericardial irritation psychogenic cough |
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Hemoptysis
-differential |
acute infections, lobar pneumonia, lung abscesses
bronchiectasis bronchial carcinoma pulmonary TB PE with infarction LVF (pink, frothy sputum) mitral stenosis trauma |
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Cough/Hemoptysis
-physical exam |
1. Vitals
2. Hands: nicotine stains, clubbing, cyanosis 3. Face and Neck: goiter, JVP for prominent a waves in pulm HTN 4. Lungs and Heart 5. Legs: DVT |
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Fever of Unknown Origin
-differential |
Infections, Connective tissue disorders, malignancy, undiagnosed, drugs (rare)
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Blood in Vomit or Stool
-differential |
Upper GI Bleed = hematemesis/melena
- PUD, erosive gastritis, Mallory-Weiss tears after retching from EtOH, esophagitis/hiatus hernia, esophageal varices, vascular abnormalities, ca Lower GI Bleed = hematochezia/melena - diverticulosis, hemorrhoids, mesenteric ischemia, arteriovenous malformations, IBD, radiation colitis, colon ca/polyp |
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Blood in Vomit or Stool
-associated symptoms |
faintness, weakness, dizziness, pallor; constitutional sx; abdo pain; dysphagia/odynophagia; EtOH and drugs; vomiting
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Blood in vomit or stool
-physical exam |
1. Vitals
2. Hands: clubbing 3. Head and Neck: anemia, jaundice, lymphadenopathy 4. Abdo: rigid, masses, tenderness, DRE 5. Skin: bruising (bleeding disorder), slate-grey (hemachromatosis), liver failure s/sx |
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Diarrhea
-ddx |
Infection: inflammatory (bacteria, protozoa) or non inflammatory (bacteria, virus, protozoa)
Malabsorption: Celiac's, lymp obstruction, pancreatic disease (CF, pancreatitis), bacterial overgrowth Osmotic: drugs (antacids, lactulose, laxatives), lactose intolerance Secretory: endocrine (VIPoma, ZE syndrome, ca), villous adenoma, bile salt malabsorption Inflammatory: IBD, ca, radiation |
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Constipation
-ddx |
Patient: low fiber diet, poor bowel habit
Endocrine: hypothyroidism, hyperPTHism Metabolic: hypokalemia, hypercalcemia, uremia CNS: paraplegia, MS IBS Meds, prolonged bedrest, dehydration, psychogenic (depression, anxiety), surgical cause (Stricutres, obstruction, post op pain) |
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Exam for change in bowel habit
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1. Vitals (temp for fever)
2. Hands: clubbing 3. Head & Neck: anemia, thyroid sx, flushing (ca), rashes, lymphadenopathy 4. Abdom: distension, masses, tenderness, bowel sounds, hernias, DRE |
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Weight Loss
-ddx |
Psych: anorexia nervosa, sepression, catatonia, schizophrenia, drug abuse, anxiety, neglect
Patient: dieting, smoking, exercise Endo: uncontrolled DM, hyperthyroid, Addison's, pheochromocytoma, hypopituitarism Drugs! Infections: TB, HIV Heart & Lung: cardiac cachexia in advanced HF, COPD, CT diseases Cancer GI: PUD/mesenteric ischemia, dysphagia, malabsorption CNS Renal: chronic renal failure, uremia |
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Weight Loss
-associated symptoms |
diet, exercise, drugs, EtOH, smoking
GI: diarrhea, constipation, vomiting, blood, nausea, pain Constitutional Sx Renal: anorexia, bruising, polyuria, nocturia, vomiting, hiccups, asterixis Cardiac: palpitations, PND/orthopnea |
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Jaundice
-ddx |
Prehepatic
-hemolytic anemia, Hepatic -liver failure, cirrhosis, hepatitis, hepatocarcinoma, drugs (acetominophen), EtOH, pregnancy, autoimmune, shock Posthepatic -biliary obstruction, gallstones, pancreatitis/ca, sepsis |
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Jaundice
-associate sx |
pruritis, dark urine, pale stools = cholestasis
abdo pain: RUQ colic = gallstones; dull epigastric, radiating to back = pancreatic cancer fevers/rigors = cholangitis encephalopathy |
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Jaundice
-physcial exam |
1. Vitals
2. Hands: leukonychia, palmar erythema, Pupuytren's contracture, asterixis 3. Head and Neck: scleral icteris, anemia, fetor hepaticus, xanthelasmata, drowsiness, constructional apraxia 4. Chest and arms: scratch marks, spider nevi, gynecomastia, loss of body hair, brusing, needle marks, tattoos 5. abdomen: hepatomegaly, splenomegaly, ascites, palpable gallbladder, caput medusae 6. lower half: testicular atrophy, peripheral edema |
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Epigastric Abdominal Pain
-ddx |
stomach ulcer, gastritis
pancreatitis, malignancy lower esophagitis, malignancy |
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RUQ pain ddx
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biliary tree: biliary colic, cholecystitis, cholangitis
liver: hepatitis, malignancy, abscess, RVF subphrenic space: abscess |
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LUQ pain ddx
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spleen: traumatic rupture, infarction (sickle cell), splenic vein thrombosis
pancreas: pancreatitis, malignancy subphrenic space: abscess |
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central abdo pain ddx
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pancreas: pancreatitis, malignancy
S/LB: obstruction, perforation, intussusception, ischemia, Crohn's disease, lymphoma, IBS, adhesions Lymph nodes: mesenteric adenitits, lymphoma Abdomina aorta: ruptured |
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RLQ pain ddx
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terminal ileum: Crohn's disease, infection (TB), diverticulum
appendix: appendicitis, carcinoid syndrome, tumor cecum/ascending colon: ca, diverticulitis, paracolic abscess, UC, ovary/fallopian tubes: ca, ectopic pregnancy, PID, cyst (bleeding or torsion) |
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LLQ pain ddx
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sigmoid/descending colon: ca, diverticulitis, paracolic abscess, UC
ovary/fallopian tubes: ca, ectopic pregnancy, PID, cyst (bleeding or torsion) |
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flank/groin pain ddx
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kidneys: ca, pyelonephritis, polycystic disease
ureters: colic from stone/clot |
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suprapubic pain ddx
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bladder: UTI, acute urinary retention
uterus/adnexae: PID, endometriosis |
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polyuria ddx
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Diabetes insipidus: idiopathic, hypothalamic/pituitary axis damage (insufficient ADH), trauma/surgery/radiation to PG
renal defects Osmotic Diuresis: DM, hypercalcemia in CRF, IV sugar solutions Drugs, psychogenic polydipsia Acute/Chronic Renal Failure |
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polyuria P/E
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1. Vitals (HTN from nephropathy)
2. Hands: pigmentaiton (addison's), clubbing, tremor, brown arcs on nails (CRF) 3. Head and Neck: anemia, visual field defects, DM eye changes 4. Heart: tachycardia 5. Kidneys, Bladder 6. Skin: yellow-brown in uremia, infections in diabetes 7. PVD for legs |
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hypertension ddx
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Essential HTN = no underlying cause
Secondary: *Lifestyle = obesity, EtOH, no exercise, high salt intake *Renal = renal parenchymal disease (chronic pyelonephritis, glomerulonephritis, polycystic disease, tumor, TB) renal artery disease, obstructive uropathy (hydronephrosis due to stone or tumor) Cardiovascular: coarctation of the aorta Drugs: OCP, NSAIDS, etc Endocrine: pheochromocytoma, secondary hyperaldosteronism, Cushing's, hyperthyroid, hypercalcemia increased ICP, obstructive sleep apnea |
