Term
Orthostatic Hypotension
Light-headedness
Loss of Consciousness
Symptoms from sitting to standing position |
|
Definition
Risks
Trauma/Injury, Alcoholism, Bleeding Disorder
Infants and Elderly - Dehydration
Vomiting and Diarrhea
Drugs - BP lowering
Differential Diagnosis
Blood Loss
Dehydration
Drugs - β-Blockers, Diuretics |
|
|
Term
Low Blood Pressure
Fatigue, Palpitations, Shortness of Breath
Light-headedness and/or Loss of Consciousness
Physical exam
Paleness
Increased HR and RR, Decreased BP
Blood in Stool
Decreased Skin Turgor and Tenting
|
|
Definition
Risk
Trauma/Injury, Alcoholism, Bleeding
Infants and Elderly
Vomiting and Diarrhea
Differential Diagnosis
Acute Blood Loss
Dehydration |
|
|
Term
Low Blood Pressure
Fatigue, Palpitations, Shortness of Breath
Light-headedness and/or Loss of Consciousness
Physical exam
Signs of Infection |
|
Definition
Risks
Elderly
Severe infection
Differential Diagnosis
Sepsis |
|
|
Term
Increased Blood Pressure
No Complaints
Physical Exam
Increased BP
Normal RR and HR |
|
Definition
Risks
Fx Hx high BP
Increased Age, African American, obesity, sedentary life style, high salt diet
Differential Diagnosis
Primary Hypertension
Secondary Hypertension |
|
|
Term
Increased Blood Pressure
Severe headache
Loss of Consciousness
Physical Exam
Increased RR, Decreased HR, Increased BP
Non-responsive
Neurologic deficits |
|
Definition
Risks
Hx of Head injury
Differential Diagnosis
Increased Intracranial Pressure |
|
|
Term
Increased Blood Pressure
Consistent with Stress
Physical Exam
Anxious Look
Increased HR, RR, BP |
|
Definition
Risks
Life Changes
Differential Diagnosis
Anxiety |
|
|
Term
Abnormally Increased Respiratory Rate
Productive Cough
Shortness of Breath
Fever, Chills, Malaise
Physical Exam
Increased RR, HR
Normal BP
Decreased O2 saturation
Abnormal lung sounds |
|
Definition
Risks
Smoking
Lung disease
Differential Diagnosis
Pneumonia |
|
|
Term
Abnormally Increased Respiratory Rate
Wheezing
Shortness of Breath
Physical Exam
↑RR ↑HR
↓ O2 saturation
Wheezing of lung exam
↓ Peak Flow |
|
Definition
Risks
Atopic Dermatitis
Exposure to Triggers
Differential Diagnosis
Asthma |
|
|
Term
Increased Temperature
Fever, Chills, Malaise
Symptoms related to Infection
Physical Exam
Symptoms of Infection
|
|
Definition
Risks
General Risk of infection
Exposure to sick contacts
Differential Diagnosis
Infection |
|
|
Term
Hypothermia
Chills, Cold to Touch, Pale
Physical Exam
Mild increase HR and RR
Moderate Decrease in HR and RR |
|
Definition
Risks
Exposure to Cold
Differential Diagnosis
Hypothermia due to exposure
Sepsis in Elderly |
|
|
Term
Dyspnea
Acute Onset
Productive Cough
Fever
Pleuritic Chest Pain
Rigors
Physical Exam
↑ T, RR, HR
Work of Breathing
Chest Exam:
↓ breath sounds
Dull to percussion
Bronchial Breath Sounds
Egophony, Brochophony, Whispered Pectoriloque |
|
Definition
Risks
>65 YO, Cold and Flu Season, Immunocompromised, Smoking, Alcohol,
Differential Diagnosis
Pneumonia
Plan
CXR
CBC
Sputum gram stain and culture
Blood Cultures |
|
|
Term
Dyspnea
Episodic
Wheeze
Non-Productive Cough
Triggers
Physical Exam
During Exacerbation - ↑ RR, HR
Pulsus Paradoxus
Work of Breathing
"Tripod Position"
Chest Exam: High Pitched Wheeze |
|
Definition
Risks
Personal, Fx Hx atopic dermatitis, asthma
seasonal allergies
Triggers
Differential Diagnosis
Asthma
Exercise or Viral induced
Plan
Pulmonary Function Tests
Methacholin or Exercise challenge if PFTs normal |
|
|
Term
Dyspnea with Exertion
Cough - sputum in morning
Avoids exertion
Physical Exam
↑ RR
Work of Breathing
"Tripod Position"
Chest Exam:
↓ Breath Sounds
Hyperinflation
Prolonged Expiration
Expiratory Wheeze
Crackles |
|
Definition
Risks
Smoking
Occupational/Environmental Exposures
Differential Diagnosis
COPD
Plan
CXR
PFTs
Arterial Blood Gas |
|
|
Term
Acute Dyspnea at Rest
pleurtic chest pain
Cough
> pillow orthopnea
calf or thigh pain/swelling
Physical Exam
↑ RR, HR, ↓BP
DVT symptoms
Chest Exam:
Rales
↓ Breath Sounds
|
|
Definition
Risks
DVT
Differential Diagnosis
Acute Pulmonary Embolus
Plan
VQ scan
Spiral CT
EKG
CBC - Troponin levels
Arterial Blood Gas |
|
|
Term
Dyspnea
Orthopnea, Postural Nocturnal Dyspnea
Lower extremity swelling
Physical Exam
↑ Jugular venous Distension
Bilateral Crackles
Displace PMI
S3
Lower extremity Edema |
|
Definition
Risks
Hx or Cardiac Disease
Hypertension
Alcohol Abuse
Differential Diagnosis
Congestive Heart Failure
Plan
CXR
ECHO
Increased Natriuretic Peptide |
|
|
Term
Dyspnea - Hemoptysis
Gradual Onset
Hemoptysis
Chest Pain
Physical Exam
Diastolic Murmur
Splitting of S2 (pulmonary HTN)
Rt ventricular Heave (pulmonary HTN) |
|
Definition
Risks
Hx of rheumatic Fever
Bicuspid valve
Coarctation of aorta
Differential Diagnosis
Valvular Heart Disease
Mitral Stenosis
Plan
ECHO |
|
|
Term
Dyspnea and Heart Failure
Dizziness and syncope
Angina
Physical Exam
Slow rate of rise in Carotid Pulse
Systolic efection murmur heard at aortic area
↓ 2nd heart sound |
|
Definition
Risks
Bicuspid Valve
Rheumatic Fever
Differential Diagnosis
Valvular Heart Disease
Aortic Stenosis
Plan
ECHO |
|
|
Term
Cough
Chronic >3wks
weight loss, fatigue
Fever, night sweats
Physical Exam
Non-specific
Clubbing of Nails
Chest Exam:
Dullness to percussion
Fremitus |
|
Definition
Risks
Immunocompromised
Exposure - healthcare, prisoners, immigrants
Differential Diagnosis
Reactivation
Tuberculosis
Plan
CXR
Acid Fast Bacilli Stain + Culture
Tuberculin Skin Test |
|
|
Term
Cough
Chronic >3wks
weight loss, Fatigue
Anorexia
Physical Exam
Varied
Often Normal |
|
Definition
Risks
Smoking
Radiation Therapy
Exposure to carcinogens
Differential Diagnosis
Lung Cancer
Plan
CXR
CT scan
Tissue Biopsy |
|
|
Term
Cough
Heartburn
Regurgitation
Dysphagia
Bronchospasm
Laryngitis
Physical Exam
Often Normal
Occasional Epigastric Tenderness |
|
Definition
Risks
Smoking
Alcohol
Obesity
Differential Diagnosis
GERD
Plan
Esphagoscopy
Upper GI Barium Swallow Test |
|
|
Term
Chest Pain
Diffuse Retrosternal, Down Lt arm or jaw
Dull, vise-like
minutes
alleviated by rest, nitroglycerin
aggrevated by effort, emotion, eating
Physical Exam
Normal between episodes |
|
Definition
Risks
↑ Age, Obesity, Smoking, ↑ Cholesterol, Fx Hx, Male, HTN, Diabetes
Differential Diagnosis
Coronary Artery Disease
Angina
Transient MI
Plan
EKG
Labs: Troponin, CPK-MB |
|
|
Term
Chest Pain
Severe, Sharp, "Tearing"
Posterior chest or back pain
Acute
Physical Exam
Acute Aortic Insufficiency - Diastolic decrescendo murmur Right Sternal Boarder
>20mmHg difference in systolic BP between arms |
|
Definition
Risks
HTN, Atherosclerosis, Vasculitis, Collagen Disorders
CABG Hx, Cocaine Use
Differential Diagnosis
Aortic Dissection
Plan
CT scan of chest
MRI of chest
Transesophageal or Transthoracic ECHO |
|
|
Term
Chest Pain
Sudden onset
Anterior Chest, sharp, Worse w/ inspiration
Pain Decreased by leaning forward
Fever
Physical Exam
Pericardial Friction Rub |
|
Definition
Differential Diagnosis
Acute Pericarditis
Plan
EKG
CXR
Labs: CBC, Sed Rate, C-reactive Protein
|
|
|
Term
Chest Pain
Substernal
Burning
Cough and ENT Sx
Physical Exam
Weight loss if dysphagia
Wheezing if Aspiration |
|
Definition
Risks
Smoking
Alcohol Consumption
Differential Diagnosis
GERD
Plan
EGD for ulcer disease |
|
|
Term
Chest Pain
Anterior Chest - specific spot
Acute, Sharp, Severe
aggrevated by movement
Physical Exam
Point Tenderness over costochondral Jnx |
|
Definition
Risks
Viral Illness
Differential Diagnosis
Costochondritis
Plan
Rest, NSAIDs |
|
|
Term
Chest Pain
Unilateral Chest
Sharp, Severe
Worse on inspiration/cough
Physical Exam
Increased effort to breath
Splinting of chest
decreased breath sounds
changes to percussion |
|
Definition
Risks
Smoking
Aspiration Risk
COPD
Differential Diagnosis
Pleuritis
Plan
CXR |
|
|
Term
Syncope
Fluid Depleted
Patient warm, still, upright
Physical Exam
↓ BP with bradycardia or vasodilation |
|
Definition
Risks
"Classical Vasovagal Syncope"
Differential Diagnosis
Vasovagal syncope
Neurocardiogenic Syncope
Plan
Rule out other causes
Tilt Table |
|
|
Term
Syncope
After urination, defecation, cough or swallowing
Physical Exam
↓ BP with bradycardia or vasodilation |
|
Definition
Differential Diagnosis
Situational Syncope
Plan
Good History |
|
|
Term
Syncope
Light-headedness and/or Loss of Consciousness
Changes sitting to standing
Physical Exam
Orthostatic Hypotension |
|
Definition
Risks
Trauma/Injury
Alcoholism
Bleeding Disorders
Dehydration
Drugs
Differential Diagnosis
Blood Loss
Dehydration
Drugs - BP meds
Plan
Othostatic Hypertension test
CBC |
|
|
Term
Syncope
Dyspnea and Heart Failure
Dizziness
Angina
Physical Exam
Slow rate of rise in carotid pulse
Systolic Ejection Murmur
↓ intensity of 2nd heart sound |
|
Definition
Risks
Bicuspid Valve
Rheumatic Fever
Differential Diagnosis
Aortic Stenosis
Plan
ECHO |
|
|
Term
Syncope
Palpitation
Chest Pain
Physical Exam
Irregular rhythm |
|
Definition
Risks
Cardiac Disease
Fx Hx of sudden death
Caffeine, Alcohol
Differential Diagnosis
Cardiac arrhythmias
2nd/3rd Degree Heart Block
Supraventricular Tachycardia
Sick Sinus Syndrome
Atrial Fibrillation
Plan
EKG |
|
|
Term
Syncope
Jerking, loss of urine or bowel
post-ictal confusion
Physical Exam
Normal with Neurological abnormalities |
|
Definition
Risks
Head Trauma
Hx of Seizures
Brain masses/abscesses
Metabolic disturbances
Differential Diagnosis
Seizure
Plan
EEG
CT of Head |
|
|
Term
Dyspnea
Orthopnea
Postural Nocturnal Dyspnea
Lower Extremity Swelling
Physical Exam
↑ Jugular Distension
Bilateral Crackles
Displaced PMI
S3
Lower Extremity Edema |
|
Definition
Risks
Hx of Cardiac Disease
HTN
Alcohol abuse
Differential Diagnosis
CHF
Plan
CXR
ECHO
Labs: CBC, Brain natriuretic peptide |
|
|
Term
Dyspnea
Gradual Onset
Hemoptysis
cerebral embolism
Chest Pain (infrequent)
Physical Exam
Diastolic Murmur - heard at apex
Splitting of S2 (pulmonary htn)
Rt ventricular heave (pulmonary htn) |
|
Definition
Risks
Hx of Rheumatic Fever
Bicuspid Valve
Coarctation of Aorta
Differential Diagnosis
Mitral Stenosis
Plan
ECHO |
|
|
Term
Dyspnea
Heart Failure
Dizziness
Syncope
Angina
Physical Exam
Slow Rate of Rise in Carotid Pulse
Systolic Ejection Murmur - aortic area
↓ intensity of 2nd heart sound |
|
Definition
Risks
Hx of Rheumatic Fever
Bicuspid Valve
Differential Diagnosis
Aortic Stenosis
Plan
ECHO |
|
|
Term
Dyspnea
at Rest
Pleuritic Pain
Cough
>2 pillow orthopnea
Calf or thigh pain/swelling
Physical Exam
Tachypnea, Tachycardia, Rales, ↓ Breath sounds
DVT symptoms |
|
Definition
Risks
DVT
Differential Diagnosis
Acute Pulmonary Embolus
Plan
Ventilation Perfusion Scan
Spiral CT of Chest
EKG
Troponin levels
ABG |
|
|
Term
Acute Abdominal Pain
Periumbilical, RLQ
Progressively worsening over a few hours
Physical Exam
Flexed Right Leg, Lying Still
Guarding and Rebound Tenderness |
|
Definition
Differential Diagnosis
Appendicitis
Plan
CBC w/ Differential
LFTs, Bilirubin
CT scan with contrast |
|
|
Term
Acute Abdominal Pain
Epigastric, Radiates to Back
alleviated by sitting up leaning forward
Anorexia, Nausea, Vomiting
Physical Exam
Tenderness even to light touch
WITHOUT rebound tenderness |
|
Definition
Risks
Alcoholism, Gallstones, HyperTG, Trauma, Drugs
Differential Diagnosis
Pancreatitis
Plan
CBC with Differential
Electrolytes
LFTs: aminotransferase, Alkaline Phosphatase, Bilirubin
Lipase
Abdominal Ultrasound
CT of abdomen |
|
|
Term
Acute Abdominal Pain
Epigastric (R or L)
Burning, Radiates to Back
Awakens at Night
Better after Eating
Dyspepsia
Melena
Physical Exam
May be Normal
Guaiac positive Stool |
|
Definition
Risks
NSAIDs
Alcohol
Differential Diagnosis
Peptic Ulcer Disease
Plan
Endoscopy
Barium Radiography
H. pylori testing |
|
|
Term
Acute Abdominal Pain
Diffuse
Anorexia, Bloating, Nausea, Vomiting, Constipation
Physical Exam
High Pitched or Absent Bowel Sounds
Distention
Abdominal percussion: tympany |
|
Definition
Risks
Previous Abdominal Surgery
Differential Diagnosis
GI Obstruction
Plan
CBC w/ differential
Electrolytes
LFTs
Lipase
Urinalysis
Pregnancy Test
Abdominal X-ray |
|
|
Term
Acute Abdominal Pain
RUQ, Radiates to back, epigastrium, right shoulder
Fever
Jaundice
Physical Exam
Tenderness in RUQ
Murphy's Sign + |
|
Definition
Risks
Fat, Forty, Fertile, Female
Differential Diagnosis
Acute Cholangitis
Plan
CBC w/ differential
Electrolytes
LFTs
Lipase
Urinalysis
Pregnancy Test
Abdominal Ultrasound
Cholangiopancreatography |
|
|
Term
Acute Abdominal Pain
LLQ (RLQ in Asians)
Blood in Stool
Cramping, Bloating, Flatulence, Irregular defecation
Physical Exam
Stool positive for guaiac or occulat blood positive |
|
Definition
Differential Diagnosis
Diverticular Disease
Plan
CT of Abdomen with Contrast |
|
|
Term
Blood in Stool
Bright Red
Physical Exam
Guaiac Positive |
|
Definition
Differential Diagnosis
Lower tract pathology:
Anal Fissures
Hemorrhoids |
|
|
Term
Blood in Stool
Melena
Black Tarry Stools
Physical Exam
Guaiac Positive |
|
Definition
Risks
NSAIDS
Alcoholism
Differential Diagnosis
Upper tract Pathology
Peptic Ulcers
Gastritis
Esophageal Varices
Plan
Endoscopy |
|
|
Term
Blood in Stool
Change in Bowel habits
Weight loss
Anemia
Fatigue
Physical Exam
Guaiac Positive
Weight Loss |
|
Definition
Risks
↑ Age
Fam Hx of Bowel Cancer
Polyposis
Differential Diagnosis
Bowel Cancer
Plan
CBC
Stool for occult blood
Colonoscopy, Sigmoidoscopy
Barium enema |
|
|
Term
Vomiting
Early Morning
headache
no abdominal pain
Physical Exam
Focal Neurological deficits |
|
Definition
Differential Diagnosis
Brain Tumor
Plan
CT of head |
|
|
Term
Vomiting
Nausea
Physical Exam
Enlarged Uterus |
|
Definition
Risks
Sexually active female
Differential Diagnosis
Pregnancy
Plan
Urine Pregnancy Test
Ultrasound |
|
|
Term
Vomiting
Fever, Diarrhea
non bilious stomach contents
Physical Exam
↑ T and HR
Dehydration
Epigastric Tenderness
Active Bowel Sounds |
|
Definition
Risks
Exposure to sick contacts
Recent Antibiotics
Differential Diagnosis
Gastroenteritis
Plan
Stool for Leuckocytes
Culture of stool |
|
|
Term
Vomiting
Diffuse Pain
Anorexia, Bloating, Nausea, constipation
Bilious or feculent
Physical Exam
High Pitched or absent bowel sounds
Distention
Abdominal percussion: Tympany |
|
Definition
Risks
Previous Abdominal Surgery
Differential Diagnosis
GI Obstruction
Plan
CBC with Differentials
Electrolytes
LFTs
Lipase
Urinalysis
Pregnancy Test
Abdominal X-ray |
|
|
Term
Vomiting
Epigastric Pain radiating to Back
Alleviated by sitting up leaning forward
Anorexia, Nausea
Physical Exam
Abdominal Tenderness with light touch
WITHOUT rebound tenderness |
|
Definition
Risks
Alcoholism, Gallstones, HyperTG, Trauma, Drugs
Differential Diagnosis
Pancreatitis
Plan
CBC with differentials
Electrolytes
LFTs
Lipase
Abdominal ultrasound
CT of abdomen |
|
|
Term
Jaundice
Fatigue, Malaise, Nausea, Vomiting, Light colored stool
Physical Exam
Jaundice
Hepatomegly |
|
Definition
Risks
Travel to Endemic Area
IV Drug Use
Risky Sexual Behavior
Blood Transfusion
Differential Diagnosis
Hepatitis A, E, B, C
Plan
IgM for Hep A, E
Ab for Hep B surface Ag and core Ag
Hep C antigen, viral Load
LFTs
Liver Biopsy
|
|
|
Term
Jaundice
ascites
Puritus
Confusion
Physical Exam
Spider angiomata
Palmer erythema
Nail Changes
Gyncomastia
Testicular atrophy
Caput medusa
Splenomegly
Ascites
Asterixis |
|
Definition
Risks
Alcohol
Hepatitis B or C
Differential Diagnosis
Liver Cirrhosis
Plan
LFTs
PTT
CBC
ultrasound
Liver biopsy |
|
|
Term
Ear Pain
Hearing Loss
No Fever
Pruritus
Discharge
Physical Exam
Tenderness of tragus and/or pinna
TM normal
Erythema and/or exudate in canal
Conductive Hearing Loss |
|
Definition
Risks
Swimming
Diabetes Mellitus
Differential Diagnosis
External otitis
(Swimmer's ear) |
|
|
Term
Ear Pain
Fever
Decreased Hearing
Physical Exam
TM - dull, erythematous, no landmarks or light reflex, immobile
Mastoid Tenderness (Alert) |
|
Definition
Risks
Prededing URI
Lack of immunizations
Differential Diagnosis
Otitis Media
Mastoiditis (Alert)
Plan
Treatment for improvement |
|
|
Term
Hearing Loss
Gradual, Progressive, Bilateral
Tinnitus
Physical Exam
Decreased Acuity in Affected ears
AC>BC
Weber lateralizes to UNAFFECTED ear |
|
Definition
Risks
Congenital, Aging
ototoxic drugs, noise esposure, menigitis, Hx of Meniere's disease, diabetes
Differential Diagnosis
Sensorineural hearing Loss
(presbycusis with aging)
Plan
Audiogram |
|
|
Term
Hearing Loss
Sudden, Unilateral
Painful
Physical Exam
Obstruction
Decreased acuity in affected ear
AC>BC
Weber lateralizes to AFFECTED Ear |
|
Definition
Risks
Trauma, Infection, Upper Airway congestion
Cerumen
Differential Diagnosis
Conductive hearing Loss
(otitis media, external otitis) |
|
|
Term
Hearing Loss
Sudden Onset
Unilateral
Physical Exam
Decreased acuity in affected ear
AC>BC
Weber lateralizes to UNAFFECTED ear |
|
Definition
Risks
Underlying disease - cardiac disease or autoimmune
Differential Diagnosis
Sudden sensorineural hearing loss |
|
|
Term
Sore Throat
Acute
Fever, Runny Nose, Cough
Physical Exam
Pharyngeal erythema, exudate, edema
Rhinorrhea |
|
Definition
Risks
Exposure to contagious persons
Differential Diagnosis
Viral Pharyngitis
Plan
Throat Culture (negative) |
|
|
Term
Sore Throat
Acute
Fever, Swollen glands
No URI symptoms, No Cough
Physical Exam
Pharyngeal erythema, exudate, edema, petechiae
Cervical Adenopathy
Skin - diffuse erythema, "sand papery" rash |
|
Definition
Risks
Exposure to contagious persons
Differential Diagnosis
Group A Streptococcal pharyngitis
Plan
Rapid Strept Test
Throat Culture |
|
|
Term
Sore Throat
Chronic
Dysphagia or difficulty swallowing
Physical Exam
Cachectic
Pharyngeal erythema, Mass |
|
Definition
Risks
Smoking, alcohol, older age
Differential Diagnosis
Cancer - Squamous Cell
Plan
CT scan
Biopsy |
|
|
Term
Rhinorrhea
Acute
Cough, Body Aches, Fever, Vomiting, Diarrhea
Physical Exam
Clear Rhinorrhea
No Sinus Tenderness
|
|
Definition
Risks
Wintertime
Exposure to people who are ill
Differential Diagnosis
Viral illness
|
|
|
Term
Rhinorrhea
Several Days
Nasal Discharge, Congestion
Cough, Fever, Headache, Facial Pain
Physical Exam
Purulent Rhinitis
Posterior pharygeal exudate
Facial Tenderness |
|
Definition
Risks
Cocaine Usage by Nose
Differential Diagnosis
Bacterial Sinusitis |
|
|
Term
Rhinorrhea
Chronic or Seasonal
Sneezing
Physical Exam
Clear rhinorrhea
Allergic shiners or nasal crease |
|
Definition
Risks
Environmental Triggers
Differential Diagnosis
Allergic rhinitis |
|
|
Term
Visual Loss/Changes
Sudden, Painless
Floaters or Cobweb
Loss of visual field in one eye
Physical Exam
Decreased visual acuity, fields
Retinal Tear on fundoscopic or slitlamp exam |
|
Definition
Risks
Myopia
Cataract surgery
Differential Diagnosis
Retinal Detachment
Plan
Visual Acuity and Field Test
Slitlamp biomicroscopy
Dilated retinal exam |
|
|
Term
Visual Loss/Changes
Decreased vision
Halos around lights
Headache
Severe Eye Pain (Deep brow ache)
Nausea and Vomiting
Physical Exam
"Steamy" cornea
Watery discharge
pupil may be non-reactive
|
|
Definition
Risks
Family Hx, >40-50 YO
Hyperopia, pseudoexfoliation
Differential Diagnosis
Narrow angle glaucoma
Plan
Visual Acuity, Pupil evaluation, Intraocular pressure
Slit Lamp Exam, Visual Fields, Undilated fundus exam |
|
|
Term
Visual Loss/Changes
Painless eyes
Headache and other neurologic symptoms
Physical Exam
Hemianopsias
Neurological deficits |
|
Definition
Risks
Stroke - ↑ Age, DM, hypercholesterolemia
Differential Diagnosis
Stroke with acute onset
Brain Tumor with gradual onset
Plan
CT of head
MRI of Brain |
|
|
Term
Visual Loss/Changes
Progressive, Painless
Initially presents w/ difficulty w/ night driving
Physical Exam
Darkened Red reflex
White Opacity of lens |
|
Definition
Risks
Age, Smoking, Alcohol, Sunlight, Low Education, Poor Lifestyle, Metabolic Syndrome, DM
Differential Diagnosis
Cataracts
Plan
Visual Acuity
Fundoscopic Exam |
|
|
Term
Visual Loss/Changes
Double vision
Physical Exam
Dilated pupil if CN3 involved
EOM abnormality |
|
Definition
Differential Diagnosis
Palsy of CN 4, 3, or 6
Plan
Check Extraocular Movements |
|
|
Term
Visual Loss/Changes
Loss of Vision
Physical Exam
Cupping on fundoscopic exam
Decreased Visual Fields
Increased Ocular Pressure |
|
Definition
Risks
Increased Ocular Pressure
Increased Age
African American, Family Hx
Differential Diagnosis
Primary Open Angle Glaucoma
Plan
Visual Field, Acuity
Fundoscopic Exam
Intraocular Pressure |
|
|
Term
Visual Loss/Changes
Asymptomatic until Late
Curtain Falling, Floaters
Physical Exam
Cotton-Wool spots, intraretinal hemorrhages, hard exudates, microaneurysms
neovascularization |
|
Definition
Risks
Diabetes
Hyperglycemia
Pregnancy
Differential Diagnosis
Diabetic Retinopathy
Plan
Visual Acuity
Ophthalmoscopy on dilated fundus |
|
|
Term
Red Eye or Eye Pain
Sudden onset, bilateral or unilateral
Gritty feeling in eyes
Discharge
Physical Exam
Vision - Normal
Cornea - Clear, pupils reactive
Purulent or Watery Discharge
Preauricular adenopathy |
|
Definition
Risks
Exposure to another with red eye
Differential Diagnosis
Conjuncivitis - viral or bacterial
Plan
Diagnosis of Exclusion
Look for Red Flags |
|
|
Term
Red Eye or Eye Pain
Painful, Sudden Onset, Recurrent, Unilateral
Physical Exam
Photophobia
sluggishly reactive pupils
constricted pupil |
|
Definition
Risks
Inflammatory Diseases - IBD, SLE, RA
Drugs
Differential Diagnosis
Anteriaor Uveitis
Iritis
Plan
Slit Lamp Exam |
|
|
Term
Red Eye or Eye Pain
Exquisite Pain
Unilateral Sensation of a foreign body
Physical Exam
Irregular corneal light reflex
May be Loss of vision |
|
Definition
Risks
Trauma, Contact Lens, Foreign Body
Differential Diagnosis
Corneal Abrasion
Plan
Fluorexcein Exam with Wood's Lamp |
|
|
Term
Headaches
Bilateral head or neck
pressure, tightness
builds up as day wears on
waxes and wanes
Physical Exam
Normal Neurologic Exam
May have muscle tenderness in occipital or TMJ |
|
Definition
Risks
Female, Stress
Differential Diagnosis
Tension
Plan
NSAIDs |
|
|
Term
Headache
Recurrent, moderate-severe
Unilateral, Frontal, Bifrontal, Global
Aura Prior to Pain
Triggers
Naudea, vomiting, photophobia
Physical Exam
Photophobia
Transient Focal Neurological deficits |
|
Definition
Risks
Young Adult, Female, Family Hx
Triggers: alcohol, chocolate, aged cheese, MSG...
Differential Diagnosis
Migraine
Plan
Treat with selective 5-HT1B/1D receptor agonists or Ergot alkaloids
|
|
|
Term
Headaches
Unilateral, around eye or temple
Ipsilateral lacrimation and redness of eye, stuffy nose, rhinorhea, pallor
Physical Exam
Ipsilateral miosis and ptosis |
|
Definition
Risks
Men
Associated with Smoking
Differential Diagosis
Cluster Headache |
|
|
Term
Headache
Danger Signs:
Age <5 or >50
"Worst headache of life"
Max intensity in secons to minutes
Trauma, after strenuous exercise
Physical Exam
Danger Signs:
Change in mental status, level of consciousness
Neuor Deficits |
|
Definition
Risks
Hx of Hypertension
Differential Diagnosis
Subarchnoid or Intracranial Hemorrhage
Plan
CT of head without contrast |
|
|
Term
Headache
Dull and Constant
Worse in AM
AM vomiting
weight loss, fatigue, night sweats
Physical Exam
Hypertension, Papilledema
Focal Neurological Findings
|
|
Definition
Risks
None
Differential Diagnosis
Brain Tumor
Plan
Head CT
Gadolinium inhanced MRI |
|
|
Term
Dementia
Gradual onset
Progressive loss of functions
Physical Exam
Changes in general appearance
disheveled, decreased eye contact
No sensorimotor deficits |
|
Definition
Risks
↑ Age, Family Hx, Certain genes
Differential Diagnosis
Alzheimer's Disease
Plan
Mini Mental Status Exam
CT of Head
Rule out Treatable causes |
|
|
Term
Dementia
Sudden Onset
Physical Exam
Facial Motor abnormalities
Slurred Speech
Upper Motor neuron abnormalities |
|
Definition
Risks
Age >60, Diabetes, HTN, Hyperlipidemia, Smoking
Differential Diagnosis
Stroke
Plan
CT of Head
MRI or Neck
ECHO |
|
|
Term
Dementia
Headache
Gait difficulty, cognitive disturbance, decreased concentration, apathy, urinary incontinence
Physical Exam
Lower extremity spasticity
Hyperreflexia, Extensor Plantar responses
Hand Tremor, Rigidity |
|
Definition
Risks
Hx of Trauma to head
intercranial hemorrhage or infection
Differential Diagnosis
Normal Pressure Hydrocephalus
Plan
CT without contrast
MRI
LP to remove fluid |
|
|
Term
Shoulder Pain
Weakness
Worse with overhead activities
Physical Exam
Weakness with external rotation
Difficulty with abduction of arm |
|
Definition
Risks
Trauma, middle-older age, sports, occupational
Smoking, Obesity
Differential Diagnosis
Rotator Cuff Injury
Plan
X-ray shoulder
Ultrasound
MRI |
|
|
Term
Shoulder Pain
Chronic Pain, Stiffness
Physical Exam
Loss of Range of Motion
|
|
Definition
Risks
Disuse, Diabetes
Differential Diagnosis
Adhesive Capsulitis
(Frozen Shoulder)
Plan
X-ray or shoulder
Ultrasound
MRI |
|
|
Term
Knee Pain
Progressive Pain, Crepitus, weight bearing joints
Morning Stiffness <30mins
No Warmth
Involves DIP joints
Physical Exam
Limitation of ROM
Joint Deformity |
|
Definition
Risks
Advancing Age, Female, Obesity
Differential Diagnosis
Osteoarthritis or knee or hip
Plan
X-ray of knee |
|
|
Term
Knee Pain
Twisting injury with foot fixed
Swelling and Pain Diffuse
Physical Exam
May be Normal
Loss of Smooth motion
|
|
Definition
Risks
Trauma
Differential Diagnosis
Meniscus Tear
Plan
X-ray
Ultrasound
MRI
Diagnostic arthroscopy |
|
|
Term
Knee Pain
Trauma from Lateral Side or Front
Physical Exam
Tenderness and Swelling
Joint Instability - laxity
Drawer Test - Forward mobility
Abnormal medial motion |
|
Definition
Risks
Trauma in an adult
Differential Diagnosis
MCL tear - Blow to Lateral Side
ACL tear - Blow to Front
LCL - Varus Stress
Plan
MRI
X-ray |
|
|
Term
Knee Pain
Recurrent Attacks
Synovial Effusion
MCP joints and Knees
Physical Exam
Exquisitiely tender joints with erythema and edema |
|
Definition
Risks
Trauma, Surgery, fatty foods, dehydration, diuretics, low dose aspirin, beer or spirits
Differential Diagnosis
Gout - MSU crystals
Pseudo Gout - CPPD crystals
Plan
Synovial Fluid aspiration
|
|
|
Term
Pain in Knee
Fever, Fatigue, Stiffness worse in Morning
MCP, PIP joints
> 6 weeks
Physical Exam
Swollen Tender Joints
Limited Joint movement
Rheumatoid Nodules |
|
Definition
Risks
> in women, Smoking
Differential Diagnosis
Rheumatoid Arthritis
Plan
Labs: ANA, C-reactive protein, ESR, Rh Factor
X-ray - hand, wrist, feet
|
|
|
Term
Knee Pain
Fever, Chills, Fatigue, Malaise
Red, Hot, Swollen Joint
Physical Exam
Red, Warm, Swollen Joint |
|
Definition
Risks
Trauma
Differential Diagnosis
Septic Arthritis
Plan
Gram stain and culture of joint fluid |
|
|
Term
Lower Back Pain
Back Pain
Physical Exam
Decreased Range of Motion
Negative Straight leg test |
|
Definition
Risks
Smoking, Obesity, ↑ Age, Femal, Strenuous work, sedentary, Worker's Comp
Differential Diagnosis
Sprained muscle
Plan
X-ray
CT or MRI |
|
|
Term
Lower Back Pain
Radiating Pain, Numbness
Tingling or Muscle Weakness
Physical Exam
Decreased ROM
Straight Leg raise elicits Pain
Sitting Knee Extension elicits Pain |
|
Definition
Risks
Smoking, Obesity, ↑ age, Female
Differential Diagnosis
Radiculapathy
Plan
X-ray
CT or MRI |
|
|
Term
Lower Back Pain
Bowel or Bladder dysfunction
Saddle anesthesia
Bilateral Leg Weakness and Numbness
Physical Exam
Neurological Dysfunction |
|
Definition
Risks
Smoking, Obesity, ↑ Age, Female
Differential Diagnosis
Cauda Equina Syndrome
Plan
Emergent MRI
Emergent neurosurgeon or ortho consult |
|
|
Term
Rash with Fever
Severe and Acute, or Subacute with URI deterioration
Headaches, irritability
Neck stiffness
Physical Exam
Fever, Tachycardia, tachypnea, ill appearing,
poor perfusion
Petechial/Purpuric Rash |
|
Definition
Risks
Dorms or Barracks
Mid-Winter
Unvaccinated
Differential Diagnosis
Meningococcemia
Plan
Start Antibiotics
LP and skin biopsy |
|
|
Term
Rash with Fever
Headache, Myalgias
Physical Exam
Fever
Petechial Rash on palms and Soles |
|
Definition
Risks
Tick Bite 5-10 days prior
Southwestern US, Summertime
Differential Diagnosis
Rocky Mountain Spotted Fever
Plan
Skin Biopsy
Serological Testing
Antibiotics |
|
|
Term
Rash with Fever
Chills, night sweats
loss of appetite and weight
fatigue and malaise
Bone pain, Limp
Physical Exam
Generalized Lymphadenopathy
Organomegaly
Petechiae/Purpura |
|
Definition
Risks
Any Age, Exposure to benzene and ionizing radiation
Differential Diagnosis
Leukemia with Fever
Plan
Blood Smear
Chemotherapy |
|
|
Term
Rash With Fever
malaise, pharyngitis, loss of appetite
Followed by:
Generalized vesicular pruritc Rash
Physical Exam
Vesicular lesions on erythematous base in different stages |
|
Definition
Risks
Unvaccinated Children
Worse in adults
Differential Diagnosis
Varicella
Plan
PCR
Direct Fluorescent Antibody Viral Culture
Acyclovir |
|
|
Term
Rash with Fever
cough, coryza, conjunctivitis
Physical Exam
Blanching "red brick" maculopapular rash on head and neck, spreading to trunk and extremities |
|
Definition
Risks
Unvaccinated Children
Immunocompromised
Differential Diagnosis
Measles
Plan
Anti-measles IgM and IgG
Vitamin A
Contact isolation |
|
|
Term
Rash with Fever
3-4 days of fever
Rash after Fever breaks on trunk and spreads
Spares Face
Physical Exam
Maculopapular rash |
|
Definition
Risks
Childhood Disease
Differential Diagnosis
Roseola
Plan
Symptomatic Treatment |
|
|
Term
Rash with Fever
Low Grade Fever
malaise, pharyngitis, loss of appetite
headache, weight loss, rash
Physical Exam
Macular or Papular Rash
Trunk, Extremities, Palms/Soles
Generalized Lymphadenopathy
|
|
Definition
Risks
Risky sexual behavior
Differential Diagnosis
Secondary Syphilis
Plan
Penicillin
VRDL, RPR, FTA-ABS |
|
|
Term
Rash with Fever
Low Grade Fever, Pruritis
Physical Exam
Eruptions in dependent areas
Generalized
Involve mucus membrane erythema |
|
Definition
Risks
New drug 10-14 days before
Differential Diagnosis
Drug-induced Exanthems
Plan
Histamine Blockers
Steroids |
|
|
Term
Rash with Fever
Intensely pruritic rash
Physical Exam
Circumscribed, raised, and erythematous eruption with central pallor |
|
Definition
Risks
Rash within hours of exposure
Differential Diagnosis
Urticaria
Plan
Histamine Blockers
Steroids |
|
|
Term
"Ugly" Skin Lesion
No Systemic symptoms
"Ugly" changing mole
Physical Exam
Asymmetry, irregular and notched borders
variable color, >6mm in size
Firm regional lymph adenopathy
|
|
Definition
Risks
Fair Skin, Family Hx, Skin Burns, Advancing Age
Differential Diagnosis
Malignant Melanoma
Plan
Skin Biopsy
Excision
Chemotherapy
|
|
|
Term
"Ugly" Skin Lesion
Non healing ulcer
Physical Exam
Scaly, Crusting nodule that can bleed |
|
Definition
Risks
Skin esposed to Sun
Family Hx
Differential Diagnosis
Squamous Cell Carcinom
Plan
Skin Biopsy
Excision
Chemotherapy |
|
|
Term
"Ugly" Skin Lesion
on Face or Trunk
Physical Exam
Pearly, Rolled, Well-defined
Margin with central ulcerated depression |
|
Definition
Risks
Sun Exposure
Higher incidence in Caucasians
Differential Diagnosis
Basel Cell Carcinoma
Plan
Skin Biopsy
Excision
Chemotherapy |
|
|
Term
"Ugly" Skin Lesion
No Systemic Systmes
Physical Exam
Symmetric, Regular Borders
Uniform in Color
<6mm |
|
Definition
Risks
Normal to hae 10-40 over face and body
Differential Diagnosis
Nevi, Normal Mole
Plan
None needed |
|
|
Term
"Ugly" skin lesion
Single or Multiple lesions
Physical Exam
Located in genital, planer, or palmer areas
Flat, Mosaic, or Filiform types |
|
Definition
Risks
Children/Young adults
Occupational risk - meat handlers
Atopic dermatitis
Differential Diagnosis
Wart
HPV 1 planter warts
HPV 6,11 anogenital warts
Plan
Salicylic Acid
Duct Tape
Excision
Cryotherapy |
|
|
Term
Rash
Ichy on face, flexor surfaces, arms, and legs
Physical Exam
Dry scales, plugged hair follicles, inflammation around lips
Increased skin creasing
Darkening of skin around Eye |
|
Definition
Risks
Infants, young children
Differential Diagnosis
Atopic Dermatitis
Plan
Biopsy
Topical steroids
Moistruizers
|
|
|
Term
Rash
Itchy Red Raised
Where contact occurred 12-48hrs prior
Physical Exam
Red Raised Rash |
|
Definition
Risks
Poison Ivy, Nickel, Chromate
Differential Diagnosis
Contact Dermatitis
Plan
Biopsy
Avoid allergen
Topical Streoids |
|
|
Term
Rash
Painful blisters
Physical Exam
Painful Blisters which crust |
|
Definition
Risks
Any Age
Differential Diagnosis
Herpes
Plan
PCR
Direct Fluorescent Antibody Viral Culture
Acyclovir |
|
|
Term
Rash
Acute neuritis
headache, fever, malaise, fatigue
Physical Exam
Starts on erythematous papules that group into vesicles and bullae
Over dermatome area |
|
Definition
Risks
Older Age
Immunocompromised
Differential Diagnosis
Herpes Zoster
Plan
PCR
Direct Fluorescent Antibody
Viral Culture
Acyclovir |
|
|
Term
Generalized Lymphadenopathy
Flu-Like Illness
Physical Exam
Fever, Rash, generalized lymphadenopathy |
|
Definition
Risks
Risky sexual behaviour
blood transfustion
OSHA breech
Differential Diagnosis
HIV: persistent generalized lymphadenopathy
Plan
ELISA and Western Blot Testing
Anti-retroviral treatment
|
|
|
Term
Generalized Lymphadenopathy
Fever, Fatigue and Sore throat for several days
Physical Exam
Exudative pharyngitis
Splenomegaly
Maculupapular rash after ampicillin
Rash over trunk
|
|
Definition
Risks
Adolescent, Young Adults
Kissing
Differential Diagnosis
EBV: mononucleosis
Plan
Mono Spot Test
Symptomatic Treatment |
|
|
Term
Generalized Lymphadenopathy
Chills, night sweats
loss of appetite and weight
fatigue, malaise, bone pain, limp
Physical Exam
organomegaly
petechia/purpura |
|
Definition
Risks
Any Age
Chemical/Radiation Exposure
Differential Diagnosis
Malignancy: Leukemia
Plan
Blood Smear
Chemotherapy |
|
|
Term
Generalized Lymphadenopathy
Rashes, arthralgias, Chest pain, Fatigue
Physical Exam
Fever, Malar Rash
Arthritis |
|
Definition
Risks
Young Adult Female
AA and Hispanic
Drug induced
Differential Diagnosis
Collagen Vascular disease
SLE |
|
|
