mikenakhla's version from 2016-08-19 20:38


Question Answer
• Labs you’d order if suspecting alcoholism?LFT, GGT, CBC
• Differential for chest pain?MI, GERD, PE, Anxiety, aortic dissection, chostocondritis, pericarditis
• Differential for chronic coughAsthma, GERD, allergies, sinusitis with postnasal drip, COPD, TB, secondary to exposure at work, lung cancer, ACE inhibitor use,
• Differential for chronic diarrhea?IBD, osmotic diarrhea (malabsorption), secretory diarrhea (infectious), fatty diarrhea (celiac’s), hypothyroid
• Differential for confusion?dementia, depression, delirium, head trauma, hypothyroid, electrolyte abnormalities, hypoglycemia, meds, TIA, vascular dementia, NPH (if gait and incontinence), neurosyphillis, B12 deficiency, Hallucinations think Lewy Body dementia, Myoclonus/startle response think Creutzfeld Jakob
• Dark urine differentialrabdo, glomerulonephritis, medication, kidney/bladder stones, UTI
• Differential for depressionanemia, major depression, hypothyroid
• Differential for dizzinesselectrolyte abnormality, orthostatic hypotension due to volume depletion, hypoglycemia, thyroid problem, anemia, arrhythmia, TIA,
• Differential for Forgetfullnessdepression, ADHD, hypothyroid, alzheimer’s, NPH, B12 deficiency, chronic subdural hematoma
• Differential for loss of visionretinal artery occlusion (acute, no pain), temporal arteritis, Retinal detachment (floaters/acute loss of vision), Acute angle closure glaucoma (painful, hard eyeball, loss of peripheral vision first)
• Workup for acute angle closure glaucoma?intraocular tonometry
• Differential for headachesmigraine, tension headache, trauma, Subarachnoid hemorrhage, meningitis, temporal arteritis, sinus headache, cluster headache, pseudotumor cerebri, analgesic withdrawal, sinusitis, TMJ
• Differential for heel painplantar fasciitis, calcaneal periostitis, calceaneal bone spurs, bone tumor, reactive arthritis or other spondyloarthritidies.
• Differential for hemoptysisTB, pneumonia, lung cancer, bleeding abnormality, bronchitis, lung abscess, Goodpastures/Lupus, PE, pseudohemoptysis (hematemesis)
• Differential for insomniadepression, medication reaction, thyroid dysfunction, RLS, Obstructive sleep apnea
• Differential for hot flashesmenopause, hyperthyroidism, pheochromocytoma, carcinoid syndrome, medication induced (vasodilators)
• Differential for night sweatshyperthyroid, cancer, TB, HIV, pheochromocytoma, medication induced (antidepressants, cholinergic agonists, hypoglycemic agents)
• Differential for obesityhypothyroidism, obesity, cushing’s syndrome
• Differential for palpitationshyperthyroidism, electrolyte abnormalities, arrhythmia, anxiety/panic attacks, valvular disease, Pheochromocytoma, anemia, hypoglycemia (diabetics)
• Differential for shoulder painrotator cuff tear, subacromial bursitis, frozen shoulder (adhesive capsulitis), shoulder dislocation or fracture, referred diaphragmatic/splenic pain
• Differential for numbness/weakness?TIA, stroke, seizure, ascending weakness think Guillan barre, MS, polymyositis, droopy eyes at the end of day (myasthenia), hypocalcemia, hypothyroidism
• Differential for fainting spells/loss of consciousnessorthostatic hypotension, vasovagal syncope, TIA, brain tumor, arrhythmia, seizure, structural heart disease (aortic disease or HCM or something), hypoglycemia, hypovolemia (get orthostatics)
• Differential for 5 year old vomiting (will likely be on the phone)gastroenteritis, meningitis, medication/toxins, increased intracranial pressure (aka intracranial hypertension), adrenal insufficiency, intussusception, gastroparesis)
• Differential for vaginal bleedingregular menses, pregnancy, ectopic , molar pregnancy, abortion, endometriosis if with pain, if older think adenomyosis, leiomyoma
• Differential for vomiting in an adultsgasteroenteritis, bowel obstruction, pregnancy, medication/toxin induced, meningitis, pancreatitis, hepatitis, cholecystitis, pyelonephritis
• What counseling would you give to an alcoholic patient?risks of alcohol, patient’s responsibility to reduce/stop drinking, set up a drinking diary, motivate patient by discussing available resources/support group, schedule a follow up appointment
• What lab tests would you order for an alcoholism case?CBC, Liver function tests (AST/ALT, Alk phos) and GGT
• What physical exam findings would you be watching out for in an alcoholism case?HEENT – pallor and oral stuff, skin jaundice/telangeiectasias, ascites/caput medusa, percuss abdomen for shifting dullness if ascites present, check hepatogmegaly/hepatic tenderness
• Suggest this for someone with chronic back painrange of motion exercises
• Workup for chronic back pain?X ray, ESR, consider MRI
• Physical exam things you would do for back pain patient?test motor strength and sensory of lower extremity, reflexes of lower extremity, straight leg test, evaluate gate, PALPATE BACK FOR SPINAL OR PARASPINAL tenderness, evaluate range of motion of lumbar spine, check extremity pulses
• Workup for chest pain?EKG, troponins/CKMB, CXR, echo, fasting lipid panel, V/Q if highly suspicious for PE
• Workup for chronic cough?CBC with diff, CXR, Sputum gram stain and culture, PFT as needed, high res CT as needed
• Workup for chronic diarrhea?FOBT, CBC with diff, CMP, serum TSH, stool studies for WBC, ova, parasites
• Workup for confusion?urinalysis (possible UTI), CT of head, CBC with diff (sepsis), TSH, Basic metabolic panel (liver/kidney function), EKG, Carotid Doppler, CXR, VDRL/RPR (neurosphyilis), B12 level
• Workup for dark urine?UA, CBC with diff, Ck, BMP, cystoscopy possibly, CT scan of abdomen possibly
• Workup for depression?CBC with diff, Serum TSH, CMP (to look for possible electrolytes), Urine tox, Mental status exam. (SIGECAPS)
• Ask a diabetic patient aboutvision changes? When was the last eye exam? Numbness/tingling in legs, problems with sexual intercourse? Urine tested for protein?
• What exam parts should you make sure you do for diabetic patients?examin g fundus, listen for bruits, check distal pulses and sensory exam – make sure they have socks/shoes off
• Workup for diabetic patient?CBC, urine protein/creatinine ratio, HbA1C, BUN and creatinine, lipid profile
• What exams would you want to do for a dizziness case?look for bruits, hearing test, look at ears/membrane. Rinne/Weber test, examine thyroid, check gait/romber sign, check for dysmetria and dysdiadochokinesia, look for nystagmus with dix-halpike maneuver
• Vestibular neuronitis vs labyrinthitis?both have dizziness, N/V after URI with inflamed inner ear. Vestibular neuronitis has NO hearing loss, Labyrnthitis DOES have hearing loss
• Workup for dizziness?CBC with diff, electrolytes, thyroid function tests, carotid Doppler if relevant history for stroke/TIA, MRI of brain for suspected CNS tumor or acoustic neuroma, 24 hour Holter monitor if patient has palpitations/cardiac hx
• Ask these questions about suspected domestic violence caseever been attacked by a weapon? How long have you been in this abusive relationship? Have you ever been assaulted sexually? Does this person use alcohol or drugs? Have you thought of harming yourself? Do you have an emergency plan? Are your friends/family aware of your situation?
• Counseling for any abuse caseassure patient that you’ll do everything possible to keep her safe, will treat medically as needed without doing anything against her will, her children (if she has them) will be cared for. Assure confidentiality, tell her that violence is LIKELY TO ESCALATE and won’t just go away – the only way to end abuse is to get away from the abuser. Ask her if she has a safe place to go and if she’d like to speak with a domestic violence counselor
• What do you order for bedwetting?UA and urine culture
• If somebody has forgetfulness, what should you ask them?difficulty walking (thinking stroke), felt sad or lonely (thinking depression), feeling cold if everybody else feels comfortable (hypothyroid) – problems urinating, diarrhea/constipation. Any problems taking care of yourself?
• Forgetfullness, what parts of exam should you do?HEENT – look at fundi, Neuro – Mini mental status, check strength/reflexes/sensation in legs.
• Workup for forgetfulness case?CBC with diff, CT of the head, Serum TSH, B12 level, BMP – Na,K,Cl,BUN,creatinine,Calcium, Seruum RPR
• Workup for headache?CBC with diff, CT without contrast, Sinus X ray
• Workup for heel pain?ESR, X ray of foot and Ankle in 3 views (if needed)
• Workup for hemoptysisCBC with diff, sputum acid fast culture and gram stain, CXR, BMP, Urinalysis, CT of chest possibly
• Workup for insomnia?TSH, Free T4, CBC, basic metabolic panel, polysomnography
• Counseling for insomnia?educate on sleep hygine, limit/stop nicotine, caffeine and alcohol, don’t exercise late, try to avoid naps. Maintain sleep diary to record sleep patterns, keep regular sleep schedule through weekends
• Workup for menopause?TSH, CBC, Serum FSH/LH if menopause is doubtful.
• Questions you should ask in HPI for menopause casesask about pain with sex, mood changes, weight loss/headahces, LMP, how often hot flashes occur, burning/pain with urinating.
• Workup for night sweatsCBC with diff, ESR, blood cultures, CXR/PPD, Elisa for HIV, TSH, CT scan of chest/abdomen looking for lymphoma
• Workup for obesity/weight gain?CBC with diff, Fasting sugars, TSH, urine cortisol, fasting lipid profile
• Workup for palpitations?CBC with diff, EKG, Serum TSH/Free T4, BMP, Transthoracic echo if needed
• Workup for shoulder pain?ESR, X ray of shoulder, CXR in a smoker to rule out lung cancer involving brachial plexus, MRI of shoulder pending results above
• Workup for syncope/spellsCBC, BMP, EKG, event monitor, echo, CT/MRI of brain, possibly EEG
• For a telephone encounter if kid is sick or something, explain that the next step in the workup isbringing the kid in to clinic/hospital. If very sick, needs to be seen for assessment and to assess volume status
• Discuss these things with a terminal cancer case as part of the “counseling” shit you have to dodiscuss pain medications, discuss their living situation (home, assisted living), ask If they’ve considered hospice and explain what that is. Discuss advanced directives
• Workup for vaginal bleedingpelvic exam, pregnancy test, CBC with diff, Transvaginal ultrasound, Serum TSH
• Workup for vomitingCBC with diff, electrolytes, PREGNANCY TEST, UA/culture, Abd x ray after negative pregnancy test, serum amylase/lipase, Liver function panel, abdominal ultrasound, stool studies

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