Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
71 Cards in this Set
- Front
- Back
40 yo F
CC: Rt shoulder/mid-back pain Character: burning/ stabbing, 0-9/10 - 3/10 on avg, dur 2-4 hours, aggr by eating, worse at night ROS - pertinent POS: bloating, nausea, belching ROS - pertinent NEG: UE weakness, CP, pain w/motion, F/C, abdo pain, vomiting PE: POS Murphy, NEG: RUQ TTP, rebound, jaundice, icterus, shoulder special tests (empty can, etc.) |
DDx: cholecystitis, pancreatitis, angina, somatic dysfunction Workup: CMP, abdominal U/S, lipid panel, EKG, osteo exam Tx: consider surg cs, consider stress test/ echo, OMT for somatic dysfxn |
|
35 yo M CC: Lt wrist pain, `dur: 1 week s/p fwd FOOSH, pain 3-6/10 (avg 5/10) dull throbbing, waxes/ wanes, better w/ibuprofen, worse w/mvmt, loc: lat aspect of palm at base of thenar eminence, radiates into forearm and hand ROS - pertinent POS: pain w/mvmt, TTP, swelling ROS - pertinent NEG: weakness, paresthesia, bruising PE: UE strength & sensation, wrist carpal bones, forearm/ elbow/ radial head, interosseous membrane, DTRs, Tinel, (Reverse/)Phalen, Finkelstein |
DDx: de Quervain tenosynovitis, carpal tunnel, somatic dysfxn
Workup: wrist x-ray, osteo exam Tx: consider ortho cs, bracing, ibuprofen 600 mg TID, ice 20 mins x 2-4x/day, PT, OMT (avoid HVLA & mainpulation of wrist) |
|
45 yo F CC: Lt knee pain Char.: 2 weeks ago, no inciting event, began in AM. 1-6/10 (avg.: 5/10) achy to sharp, pulling sensation (only when turning to Rt.), constant - waxes and wanes, loc: front of knee, worse w/jogging. MHx: psoriasis ROS - pertinent POS: pain w/mvmt, TTP ROS - pertinent NEG: no LE weakness PE: skin around knee (nml), knee exam, LE strength/ sensation/ DTRs (nml), gait (nml), Appley compression/ distraction (neg), patellofemoral grind (POS) Osteo exam: TART, innominate, fibular head, tibia on talus |
DDx: patellofemoral syndrome, psoriatic arthritis, Lyme, meniscal/ lig tear, somatic dysfxn, gonococcal arthritis
Workup: x-ray of knee, CRP, ESR, Lyme titer, MRI, osteo exam, CBC, consider synovial fluid Cx Tx: PT, ibuprofen 600 mg TID, Abx if Cx positive, consider ortho consult, OMT |
|
30 yo F CC: Rt. Leg pain Char.: Onset: few days ago, no inciting event. 3-6/10 (avg. 3/10) dull achy, constant, locn: Rt calf muscle MHx, FHx, SurgHx, meds: NS/ND/no IVDU. Ortho-Evra. Other: recent long flight from CA ROS - pertinent POS: Pain w/mvmt, TTP ROS - pertinent NEG: NO SOB/ CP/ Palps/ LE weakness PE: cardio, pulm, Rt calf swollen, Thompson squeeze (NEG), LE strength/ sensation/ DTRs (nml) Osteo exam: TART, fibular head, tibia on talus |
DDx: DVT, superficial thrombophlebitis, Bakers cyst, muscle/ tendon rupture, somatic dysfxn
Workup: LE Doppler U/S Tx: heparin |
|
34 yo F CC: Rt hip pain Char.: onset: "few mos. ago" - no inciting event. 2-6/10 (avg. 3/10) achy/ stiff/ tight, Rt hip into groin, better w/rest, worse w/long periods of standing or walking. Ibuprofen minimal relief. MHx, FHx, SurgHx: asthma, appy, tonsillectomy ROS - pertinent POS: as above ROS - pertinent NEG: NO paresthesias, radiation, weakness, neuro chgs Other: computer programmer, tends to sit w/left foot tucked under her PE: abdo, leg length (R leg short), FAIR, FABERE, impingement test, LE strength/ sensation/ DTRs (nml), NO cerebellar signs, limping gait Osteo exam: sacrum, innominates |
DDX: piriformis, torn acetabular labrum, short leg syndrome, RA, GI/ GU, somatic dysfxn
Workup: FAIR test, MRA, X-ray of pelvis/ sacrum/ femur, abdominal CT, ESR, CRP, RF, anti-CCP, X-ray, MRI, U/S, osteo exam Tx: PT/ stretching, consider ortho referral, heel lift, NSAIDs, steroids, DMARDs, diet change, consider GI cs, OMT for somatic dysfxn, change sitting habits at work |
|
14 yo F CC: painful periods Char.: onset "a few months ago" 0-10/10 cramping, s/t sharp pain in lower belly radiating to low back, worse w/periods, duration: ~3 days, better after periods, Tylenol = minimal relief, MHx, FHx, SurgHx: seasonal allergies, OBGHx: G0P0, mearche at 12 yo, 28-day cycles x 3-5 days. Not sexually active. Social: NEG tob/ EtOH/ recreational drug use ROS - pertinent POS: fatigue, N/V/D, HA ROS - pertinent NEG: none PE: abdo (nml), GU (nml) Osteo exam: osteo (L1-L2 RSL; TART) |
DDX: dysmenorrhea, ovarian cyst, UTI, pregnancy, somatic dysfxn
Workup: pelvic/ vaginal U/S, UA, pregnancy test, osteo exam Tx: topical heat, exercise, nutritional support, pain jnl, NSAID, OCP, IUD, Abx, cranberry juice, OMT for somatic dysfxn (e.g. sacral rocking) |
|
19 yo M CC: abdominal pain Char.: "about a year ago," 0-8/10 crampy pain, intermittent ~3 days/wk, loc'n whole abdomen, no relief from Tylenol/ Aleve/ Motrin / "grandma's percocet" MHx, FHx, SurgHx: wisdom teeth, Father: CAD @ 59yo Social: College student, occ'l EtOH binge on weekends, denies tobacco, tried marijuana once ROS - pertinent POS: occasional indigestion, freq. bloating/ cramping, occ'l constipation/ straining (nml soft stools), excess flatulence. Stress. ROS - pertinent NEG: depression, SI, HI, weight gain/ loss, dysphagia, N/V/ hematochezia, melena. PE: abdo (nml), GU (nml) Osteo exam: thoracic/ OA, Chapman's pts |
DDX: IBS, IBD, anxiety, constipation, depression, thyroid, somatization, abdominal mass, somatic dysfxn
Workup: C-scope, celiac panel, stool Cx, abdominal flat plate/ CT, CBC, BMP, LFTs, TSH/ T3/ T4, osteo exam Tx: diet change (fiber), exercise, avoid laxatives, counseling, supplement thyroid if needed, consider GI referral, OMT for somatic dysfxn (eg sacral rocking) |
|
66 yo M CC: epigastric abdominal pain Char.: began ~6 mos ago, 4-10/10 intermittent deep ache in epigastrium - no radiation, occurs after eating/ EtOH, worse after eating/ drinking EtOH, ibuprofen (pt not sure), nothing makes it better. Sleeps propped on 3 pillows. MHx, FHx, SurgHx: GERD, HTN. FHx: HLD. Surg: appy, chole Meds: prilosec, HCTZ ROS - pertinent POS: freq. belching, wakes w/sour taste, abdo pain ROS - pertinent NEG: no wt loss/ gain, N/V/D/C, hematochezia / melena, hematuria PE: abdo, GU, UE (pain raising left arm) Osteo exam: thoracic/ OA, Chapman's pt, pre-vertebral ganglion |
DDX: GERD, PUD, compression Fx, angina, muscle spasm, somatic dysfxn
Workup: EKG/ stress test, EGD, abdo U/S, H. pylori breath/ Ab/ breath test, osteo exam Tx:staop Prilosec, start PPI, Abx, consider ortho cs, cardio cs, muscle relaxant , OMT for somatic dysfxn |
|
35 yo F CC: HA Char.: onset: age 14, episodes last 1-2 d., has 2-3 / mo., current episode started yesterday PM, 0-9/10 (avg 6) stabbing sharp pain at base of head radiating to behind right eye, better w/medication, strong coffee (drinks 4-5 cups per day). Worse w/dehydration, stress. Ass'd Sx: photophobia, phonophobia, dry eyes, blurry vision. MHx, FHx, SurgHx: seasonal allergies, HA. Fhx: non-contrib. Meds; Excedrin PM, Nasonex PM ROS - pertinent POS: see above ROS - pertinent NEG: NO N/V, weakness, neuro signs PE: HEENT (normal), CN, UE, cerebellar, LMN, MMSE Osteo exam: cranial, cervical, thoracic, sacrum |
DDX: migraine HA, tension HA, intracranial aneurysm, space-occupying lesion, caffeine tox, somatic dysfxn
Workup: head/ neck MRI/CT, angiogram, osteo exam Tx: triptan, Tylenol/ NSAID PRN, BB or TCA, stretching, stress mgmt, consider neurosurgery, counsel on caffeine reduction/ cessation, OMT for somatic dysfxn |
|
30 yo M CC: chronic neck pain Char.: onset 3 yrs ago post-MVC (rear ended), 4-8/10 (curr 7/10) dull throbbing pain w/occasional electric-like shooting & burning, waxes and eanes, loc'n: back of neck radiating into left shoulder MHx, FHx, SurgHx: appy, Vicodin PRN (3-4x/d.) ROS - pertinent POS: see above ROS - pertinent NEG: NO weakness, neuro signs (incl. saddle anesthesia), no bowel/ bladder changes PE: UE, spurling, LMN, fine motor Osteo exam: cranial, cervical, thoracic, sacrum |
DDX: cervical HNP, stenosis of C-spine, cervical sprain/ strain, space-occupying lesion, MS, somatic dysfxn
Workup: MRI c-spine, head CT/ MRI, osteo exam Tx: pain mgmt (gabapentin, duloxetine), long-acting opioid, PT, massage, TENS unit, cervical traction, accupuncture, trigger point, consider neurosurgery referral, OMT for somatic dysfxn |
|
33 yo M CC: difficulty turning head Char.: started 1 d. ago when woke up, no inciting event. 1-3/10 (curr.: 1) intermittent, pulling sensation on Rt. neck when turns head to right. nothing makes it better/ worse. MHx, FHx, SurgHx: none ROS - pertinent POS: see above ROS - pertinent NEG: no weakness, loss of sensation, paresthesia PE: cervical ROM, UE Osteo exam: cranial, cervical (SCM), thoracic, sacrum |
DDX: spasmodic torticollis, cervical sprain/ strain, cervical HNP, somatic dysfxn
Workup: C-spine X-ray, osteo exam Tx: muscle relaxant, PT, massage, accupuncture, dry needling, TENS unit, cervical traction, trigger point, , OMT for somatic dysfxn (CS) |
|
39 yo M CC: frontal HA Char.: onset 3 weeks ago (had cold prior to HA onset), 2-6/10 (current: 4/10) constant dull throbbing, loc'n above eyes, better with pressure to face, nothing makes it worse, Ass'd Sx; facial pain, thick green nasal discharge. MHx, FHx, SurgHx: non-contrib. ALL: PCN ROS - pertinent POS: fatigue, runny nose, congestion, HA ROS - pertinent NEG: NO F/C, hearing/ vis chgs, cough, CP, SOB PE: HEENT (sinuses tender, lymph nodes, ears TM mnl, pulm, cardio Osteo exam: cranial, cervical, thoracic |
DDX: acute sinusitis, allergic rhinitis, URI, somatic dysfxn
Workup: X-ray, osteo exam Tx:Abx (avoid PCN, ceph), sinus lavage, NSAID, OTC decongestant, antihistamine, nasal steroid, OMT for somatic dysfxn |
|
What is present in every DDx? |
somatic dysfunction
|
|
Shoulder tests?
|
[tbd]
|
|
LE tests? |
[tbd]
|
|
List Dx/ Tx options for musculoskeletal complaints |
Dx: X-ray, MRI, U/S Tx: moist heat, ice, NSAIDs, PT, muscle relaxants (cyclobenzaprine is sedating, metaxalone is non-sedating), tramadol for pain |
|
Important questions for OBGHx? |
Age at menarche, regularity/ heaviness of pds., FDLMP, age at first sex, # partners, STI, last breast/ pelvic exam (& was it nml), Hx of pregnancies (TPAL)
|
|
Important questions for depression screening? |
In last TWO WEEKS, have you felt: down depressed or hopeless? …little interest or pleasure in doing things? (0: not all all; 1: several d. , 2: > 50%; 3: nearly every d.)
|
|
Important questions for MMSE? |
1) AAOx3.
2) Apple penny table (reg.) 3) serial 7s (att'n, calc) 4) repeat [apple, penny table]. (recall) 5) name 2 common objects (language) 6) repeat "no ifs ands or buts" (repetition) 7) complex command (draw two pentagrams). |
|
Important questions for GI complaints? |
abdo pain, N/ V/ D/ C, gas/ bloating, heartburn/ reflux, stool changes (color, blood, frequency)
|
|
What does MOTHRR stand for? |
Medications, OMM, Tests, Holistic, Referral, Return
|
|
What are the parts of a social Hx? |
TED C SED LOST
Tobacco, Ethanol, Drugs, Caffeine, Sick contacts, Exercise, Diet, Living, Occupation, Sexual, Travel |
|
When do you ask ass'd Sx/ ROS? |
After HPI
|
|
When do you wash hands? |
2 times: before shaking hands, before PE
|
|
Important questions for stroke? |
Slurred speech, facial droop, difficulty walking, numbness/ tingling/ weakness, falls
|
|
Tests of cerebellar fxn? |
Romberg, pronator drift, finger to nose, RAM, dysdiadocho, heel shin to toe
|
|
Important questions for musculoskeletal injury? |
Bruising, swelling, numbness/ tingling
|
|
Important questions for chest pain? |
Duration/ location of pain, radiation, pain at rest, sweating, N/V, SOB, dyspepsia, cough
|
|
Important physical exam pieces for chest pain?
|
JVD, carotid, reproducibility, PMI, respo, abdo (incl aorta)
|
|
Hospital workup for chest pain? |
Admit. Cardio cs.
HB MOAN: Heparin, beta blocker, morphine, O2, ASA, nitroglycerin. EKG, CXR, labs (CK-MB, troponins, CMP), stress test. |
|
Abx for appendicitis? |
ampicillin-sulbactam(unasyn), piper-taxo (zosyn), ticarcillin-clavulanate (timentin), 3Gceph+metronidazole, FQ+metronidazole, ertapenem
|
|
Abx for sinus infection? PCN allergic? |
amoxicillin (+/ clavulanate). PCN allergic: azithromycin/ erythromycin
|
|
Abx for skin infection? |
*cephalexin* (almost all forms).
PCN ALL: azithro/ clarithro/ clinda. TMP-SMX if MRSA suspected (purulent focus), |
|
How do you hold the otoscope? |
Inverted, with pinkie extended
|
|
Hospital workup for stroke? |
Stat head CT, stroke alert / stroke team, labs (cardiac: CK-MB, trop; coags), EKG, ASA
|
|
DDx for painful periods? |
Dysmenorrhea, ovarian cyst, UTI, pregnancy, tuboovarian cyst, tubal pregnancy
|
|
Name three important things in the neck that you always forget |
1) carotids 2) lymph nodes 3) thyroid
|
|
Workup for UTI |
Urine dip, UA, labs
|
|
Workup for DVT |
ADMIT, pain relief, imaging, labs (coags, CBC, CMP), elevate leg, chest CT, hem/ onc cs
|
|
Plan for woman who wants to get pregnant |
Folate/ prenatal vitamins ASAP, diet/ exercise, tob/ alc/ caffeine cessation, labs, OBG referral, breast & pelvic exams
|
|
Questions for barfing baby? |
color/ texture of spitup, dribble/ shoots out, pain/ irritability, cough, turn blue, spit up blood,
|
|
Range of diagnoses for barfing baby? |
[pyloric stenosis, malrotation, SBO, allergy, diverticulum]
|
|
Questions for knee injury? |
how happened, bruising, swelling, ROM limited, click/ lock, numbness/ tingling
|
|
McMurray's knee test |
[tbd]
|
|
Questions for meningitis? |
Recent cold/ URI, fever, N/ V, confusion, stiff neck, rash, photophobia, immunizations
|
|
Workup for meningitis? |
ADMIT, stat imaging (head CT?), labs, inform familly, ID/ neuro cs
|
|
DDx for fever (non-infectious causes)? |
* Critical: AMI, PE/infarct, ICH, CVA, neuroleptic malignant syn, thyroid storm, acute adrenal insufficiency
* Emergenct: CHF, dehydration, recent sz, SCD, transplant rejection, pancreatitis, DVT * Non-emergent: drug fever, malignancy, gout, sarcoid, Crohn's, postmyocardiotomy syn |
|
DDx for fever (infectious causes)? |
* Critical: bacterial PNA w/RF, peritonitis, meningitis, cavernous sinus, thrombosis, sepsis/ septic shock, meningococcemia
* Emergent: bact PNA, peritonsillar abscess, retropharyngeal abscess, epiglottitis, endocarditis, pericarditis, appendicitis, cholecystitis, diverticulitis, intra-abdominal abscess, pyelo, tubo-ovarian abscess, PID, encephalitis, brain abscess, cellulitis, infect decub ulcer, soft tissue abscess * Non-emergent: otitis media, sinusitis, pharyngitis, bronchitis, influenza, TB, colitis/ enteritis, cystitis, epididymitis, prostatitis |
|
DDx for weakness (neuromuscular)? |
* Critical: pot'l respiratory compromise, rabies, botulism, tetanus, organophosphate, myasthenic crisis
* Emergent: Guillain-Barre, transverse myelitis, impingement syn, spinal infarct, electrolytes * Other: Lambert-Eaton, ALS, paraneoplastic syn, diphtheria, porphyria, drug/ tox, tick paralysis, poliomyelitis |
|
DDx for weakness (non-neuromuscular)? |
* Critical: hemodynamic instability, MI, arrhythmia, severe infxn/ sepsis, RF, hyperK+
* Emergent: acute anemia, dehydration, metabolic d/o (eg hypothyroid, DM), electrolyte imbalance * Other: fatigue, psych (anx/ depr), rheum (fibomyalgia, SLE), malignancy, renal/ hepatic dz, metabolic dz, alcoholism/ tox, malingering |
|
DDx for vertigo (central)? |
Vascular: vertebrobasilar insufficiency, cerebellar hemorrhage, occlusion of PICA (Wallenberg syn.), subclavian steal
Other: head/ neck trauma, vetebrobasilar migraine, MS, temporal lobe epilepsy, hypoglycemia |
|
DDx for vertigo (peripheral)? |
BPPV, labyrinthitis, Meniere's, vestibular neuronitis, acoustic neuroma
|
|
DDx for confusion? (note: this is only a partial list) |
Critical: hypoxia (RF, CHF, MI, shock), systemic process (eg hypoglycemia), CNS infxn, HTN encephalopathy, INCR ICP
Emergent: hypoxia (eg severe anemia), systemic dz (lyte/ fluid, thyroid/ adrenal, hepatic failure, nutrition/ Wernicke's), sepsis/ infxn, tox/ withdrawal (sedatives, EtOH, antichol, others), CNS dz (trauma, infxn, stroke, SAH, epilepsy/ sz), neoplasm |
|
DDx for depressed consciousness / coma? (p.106) |
[tbd]
|
|
DDx for seizure? |
Syncope (vasopressive vs dysrhythmic), hyperventilation syndrome, prolonged breath-holding, toxic/ metabolic d/o (EtOH abuse/ wd, hypogly, phencyclidine, strychnine, camphor, extrapyramidal rxn), non-ictal CNS event (TIA, transient global amnesia, hemiparetic migraine, carotid sinus hypersensitivity, narcolepsy), hemiballismus, fugue, panic attacks, pseudosz
|
|
DDx for headache? |
* Critical: SAH, CO tox, temporal arteritis, bact mening/ encephalitis, carotid dissection
* Emergent: shunt failure, traction HA, tumor/ mass, SDH, mountain sickness, glaucoma, sinusitis, brain abscess, anoxic HA, anemia, HTN crisis * Nonemergent: migraine, vascular HA, trigeminal neuralgia, post-traumatic, post-LP, HA, dental/ TMJ, tension HA, cervical strain, cluster/ histamine HA, febrile HA, HTN (rare), effort-dependent/ coital HA, [pseudotumor] |
|
Key hallmarks of emergent forms of HA: SAH, TMJ, sinus/ dental, temp arteritis, acute A-C glaucoma |
* SAH: sudden onset, syncope, "worst HA of my life"
* TMJ: jaw mvmt --> INCR pain * Sinus/ dental: facial pain (esp forehead, maxillary sinus area) * Temp. arteritis: forehead/ temporal/ periorbital/ retroorbital pain * Acute AC glaucoma: periorbital/ retro-orbital pain, blurry, fixed pupil |
|
DDx for dyspnea?
|
Critical: airway obstruction, PE, noncardiogenic edema, anaphylaxis, ventilatory failure, pulm edema, MI, tamponade, toxin, DKA, epiglottitis, tension PNX, CO tox, acute chest, CVA, intracranial insult, organophosphate tox
Emergent: spont PNX, asthma, cor pulmonale, aspiration, PNA, pericarditis, mechanical interference, hypotension, sepsis, SBO/ LBO, renal failure, lytes, metabolic acidosis, PNA (CAP score > 70), simple PNX, hemothorax, diaphragmatic rupture, anemia, MS, guillain-barre, tick paralysis Non-emergent: pleural effusion, neoplasm, PNA (CAP < 70), COPD, congential heart dz, valvular dz, cardiomyopathy, pregnancy, ascites, obesity, hyperventilation syn, somatization, panic attack, fever, thyroid dz, rib Fx, ALS, polymyositis, porphyria |
|
DDx for CP? |
Critical: AMI, acute coronary ischemia, aortic dissection, tamponade, PE, tension PNX, Boerhaave
Emergent: USA, coronary spasm, Prinzmetal, cocaine (peri/myocarditis), PNX, mediastinitis, Mallory-Weiss tear, cholecystitis, pancreatitis Non-emergent: valvular dz, AS, MVP, HOCM, PNA, pleuritis, lung tumor, pneumomediastinum, esophageal spasm/ reflux, PUD, biliary colic, muscle strain, rib fx, arthritis, tumor, chostochondritis, non-specific chest wall pain, spinal root compression, throacic outlet, zoster, postherpetic neuralgia, psych, hyperventilation |
|
DDx for syncope? (p. 142) |
[tbd]
|
|
DDx for abdo pain? |
"Top to bottom:"
esophagitis gastritis, acute gastroenteritis. Duodenitis. Biliary tree dz. Acute appendicitis. Constipation/ obstipation. Diverticulitis. Catch-all: non-specific/ fxnl abdo pain Wild card: ureteral colic. |
|
Structures of primitive gut & pain location? |
Upper abdominal pain = foregut: stomach, duodenum, liver, pancreas
Periumbilical = midgut: small bowel, proximal colon, appendix Lower abdominal pain = hindgut: distal colon, GU tract |
|
DDx for abdo pain, by quadrants (including diffuse)? |
* Diffuse: peritonitis, pancreatitis, sickle cell crisis, early appendicitis, mesenteric thrombosis, gastroenteritis, aortic aneurysm, intestinal obstruction, DM, IBD, IBS
* RUQ: biliary colic, cholecystitis, gastritis, GERD, hepatic abscess, acute hepatitis, hepatomegaly 2'/2 CHF, perf ulcer, pancreatitis, retrocecal appendicitis, MI, appendicitis in preg, RLL PNA * LUQ: gastritis, pancreatitis, GERD, splenic pathology, MI, pericarditis, myocarditis, LLL PNA, pleural effusion * RLQ: appendicitis, diverticuliutis (Meckel's, cecal), aortic aneurysm, ectopic preg, ovarian cyst, ovarian torsion, tubo-ovarian abscess, PID, endometriosis, UTI, ureteral calculus, psoas abscess, mesenteric adenitis, incarcerated hernia. * LLQ: aortic aneurysm, sigmoid diverticulitis, incarcerated hernia, ectopic preg, ovarian torsion, ovarian cyst, PID, endometriosis, tubo-ovarian abscess, mittelschmerz, ureteral calculus, UTI, psoas abscess |
|
DDx for GI bleed? Most important distinguishing factor(s)? |
* Upper vs. lower. Adult vs. child
* Most common to least common: --Adult lower GI bleed: diverticulosis, angiodysplasia, UPPER GI BLEED, cancer/ polyps, rectal dz, IBD --Adult upper GI bleed: PUD, gastric erosions, varices, Mallory-Weiss, esophagitis, duodenitis (erosion --> rupture --> inflammation) |
|
DDx for diarrhea |
Infectious: 60% viral , 20% bacterial, 5% parasitic
Non-infectious: |
|
DDx for back pain |
1) Non-specific: 85% - no X-rays, Tx: pain ctrl 2) Vert Fx - H&P: trauma, spinal point tenderness; Dx: X-ray; Cs: ortho/ spine 3) Epidural abscess - Hx: IVDU, fever, spinal point tenderness; Dx: MRI; Tx: IV Abx, Cs neurosurg 4) Cauda Eq. - Hx: saddle anes, loss of bowel/ bladder ctrl; Dx: MRI; Tx: steroids, IMM neuroosurg cs 5) HNP - Hx: sciatica, straight-leg raise 6) AAA rupture - Hx: old male smoker; Dx: U/S, CT-; Tx: emerg surg, T&S 7) Pyelo - Hx: CVAT, urinary Sx; Dx: UA; Tx: cipro x 2 wks, f/u PCP 8) PE - w/u as PE |
|
DDx for cough |
* Acute: 1) PNA - Hx: fever, sputum; Dx: CXR; Tx: Abx 2) Sinusitis - Hx: purulent rhinorrhea, sinus TTPl; Dx: clin.; Tx: nasal spray/ pseudoephedrine, ABx 3) foreign body - Dx: CXR; Tx: bronchoscopy 4) URI - Hx: cong/ rhinor/ aches; Dx: clin.; Tx: reassurance 5) Asthma/ COPD - Hx: wheeze, TOB; Dx: clin.; Tx: nebs/ steroids, COPD: ABx 6) Allergic rhinitis - Dx: seasonal, swollen eyes; DX: clin; Tx: antihistamine/ loratidine * Non-acute: 7) GERD - Hx: food, epig pain; DX: clinical; Tx: GI cocktail, f/u PCP 8) ACE cough - Tx: f/u PCP, dc ACE |
|
DDx for leg pain |
* Trauma: knee Fx, ACL tear, collaterals, meniscus, ankle injury --Dx: X-ray Fx, MRI the rest --Tx: immob, cs ortho * Joint: Septic joint, gout, arthritis --septic & gout are RED JOINTs; tap both --septic: ABx, surg cs
* Other: DVT, abscess/ cellulitis |
|
DDx for fever |
* Real fever: meningitis/ encephalitis, AOM, strep, URI, PNA, PE, UTI/ pyelo, abdominal (app'x, GB, pancreas, SBP, PID, etc.), skin * Hyperthermia: neuroleptic/ serotonin/ MH, heat stroke, cocaine, CNS lesion --NMS... & heat stroke: CPK, Crn --heat stroke & CNS: cooling --NMS... & cocaine: benzos |
|
DDx for weakness |
* Tx: 1) IMMEDIATE EKG & fingerstick 2) Review VS. CHk for orthostasis. 3) Focal or Gen'l * Focal: CVA, MS, Guillain-Barre, transverse myelitis, myashenia gravis * Gen'l: cardiac, anemia, lytes, infxn, med change, hypothyroid, rheum, depression, dehydration 4) PE: HEENT (conjunctiva, PERRLA, EOM), lung (crackles), full neuro, rectal: good tone, guaic neg, brown stool. 5) Workups: cardiac - EKG, trops. Anemia - CBC, coags, T&S. Lytes - BMP, EKG (K+). Infxn: UA, bloodCx, CXR, LP. thyroid - TSH. Rheum - ESR, DEPR - exclude. Dehydration - clinical, BUN/Cr. |
|
DDx for vomiting? |
* IMMEDIATE FINGERSTICK * 3 sources: 1) Head: ACS/ MI, ICH, mening, vertigo 2) Abdo: SBO, DKA, other (acute gastroenteritis, appy, GB, pancr, PUD, perf, etc. - workup as abdo pain) 3) Other: hyperemesis gravidarum, lytes, EtOH/ tox, post-tussive, acute gastroenteritis * Key questions: bilious? bloody? * Pearls/ pitfalls: --Peritoneal signs - rebound, rigid abdomen --> IMM surgery cs --NO REGLAN if SBO suspected; give Zofran bc it does not promote motility --Can't tolerate PO = CAN'T GO HOME --Diarrhea is reassuring, but make sure it's real diarrhea & not soft stool. |