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13 Cards in this Set
- Front
- Back
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Give a DDx for chest pain.
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Cardiovascular causes:
STEMI ACS/unstable angina Angina/CHF Aortic dissection Pericarditis/myocarditis Pulmonary causes: Pneumonia Pneumothorax Pulmonary embolism MSK or soft tissue: Strain/sprain/fracture/contusion (of any thoracic structure) Radiculopathy or neuropathic pain (eg shingles) GI Causes: GERD/esophagitis Esophageal rupture Peptic ulcer disease Biliary/hepatic disease Pancreatitis Anxiety - don't jump to this Dx. |
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Give a DDx for shortness of breath.
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5 Of The Most Common Causes:
Obstructive lung disease (i.e. asthma or COPD) Heart failure/cardiogenic pulmonary edema Pneumonia Angina or myocardial infarction Psychogenic 4 Additional Life Threatening Causes: Upper airway obstruction (angioedema, hemorrhage, foreign body) Pneumothorax/Tension pneumothorax Pulmonary embolism |
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Give a DDx for abdominal pain.
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GI Causes:
Appendicitis Biliary colic/cholecystitis/cholangitis Bowel obstruction Diverticulitis Mesenteric ischemia Pancreatitis Peptic ulcer disease/perforated viscus Urological causes: Urinary retention Cystitis/pyelonephritis Renal colic Gynecological causes: Pelvic inflammatory disease Ovarian torsion Ectopic pregnancy Tubo-ovarian abscess Cardiovascular and other causes: Myocardial ischemia/angina/ACS Ruptured AAA Pneumonia |
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Give a DDx for headache.
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Primary headache syndromes e.g. migraine, tension headache, cluster headache
Medication overuse headache Structural/mechanical causes: Intracranial bleed, e.g. Subarachnoid hemorrhage, subdural hematoma, epidural hematoma Cavernous/venous sinus thrombosis Carotid or vertebral artery dissection Tumor Pseudotumor cerebri Infectious/inflammatory causes: Meningitis, encephalitis Abscess Temporal arteritis Systemic causes: Influenza, malaria, other infections Dehydration Hypoxia, hypoglycemia, altitude sickness, CO poisoning Pre-eclampsia Hypertensive crisis Pheochromocytoma Referred pain: From the ear, e.g. otitis media or mastoiditis From the eye, e.g. glaucoma, iritis, uveitis From the jaw or teeth, e.g. dental abscess, TMJ From the sinuses, e.g. sinusitis |
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Given a patient with suspected sepsis, what is the DDx of possible sources of infection?
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Head and neck: CNS (e.g. meningitis, abscess, etc), ears (e.g. otitis media), sinuses (e.g. sinusitis), mouth (e.g. dental abscess), deep space neck infection.
Chest: Lungs (e.g. pneumonia), heart (e.g. endocarditis). GI: biliary tree (e.g. cholecystitis, cholangitis), appendicitis, diverticulitis, perforated viscus. GU: pyelonephritis, gynecological causes (e.g. septic abortion, tubo-ovarian abscess, endometritis). MSK/skin/soft tissue: e.g. cellulitis, fasciitis, osteomyelitis. Don't forget back infections such as epidural abscess and discitis! |
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Give an approach to shock (with examples).
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Four Types of Shock (and one bonus type!):
1) Hypovolemic, e.g. trauma, GI hemorrhage, fluid loss from DKA 2) Obstructive, e.g. PE, cardiac tamponade, tension pneumothorax 3) Distributive, e.g. sepsis, neurogenic shock, anaphylaxis 4) Cardiogenic, e.g. heart failure, MI, cardiomyopathy, maybe valvular disease? 5) Toxic/metabolic, e.g. acute adrenal insufficiency (aka Addisonian crisis), hypothermia, myxedema coma, cyanide poisoning, toxic ingestion (esp CCB, B-blocker, clonidine, TCAs, many others), electrolyte abnormalities such as K+, Ca++, Mg++ |
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Give a DDx for vomiting.
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GI causes:
gastritis, gastroenteritis, gastric outlet obstruction/gastroparesis, biliary colic, hepatitis, pancreatitis, appendicitis, bowel obstruction (especially small bowel). Non-GI causes originating in the head: Meningitis, traumatic brain injury, stroke, brain tumor, other intracranial pathology; vestibular diseases such as Meniere's, labyrinthitis, etc.; psychogenic. Non-GI causes originating in the chest: Acute coronary syndrome, pneumonia. Non-GI causes originating in the abdomen: Renal colic, pregnancy (and pregnancy complications), testicular torsion, AAA. Systemic causes: Toxic ingestions, metabolic/electrolyte disturbances (especially DKA), sepsis, medication side effects, drug or medication withdrawal. |
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Give an approach to syncope.
Also, provide high risk features that may suggest a need to admit a syncope patients. |
Approach to syncope: HEAD, HEART, and VESSELS
Head: Hypoxia, hypoglycemia, SAH, vertebrobasilar insufficiency, seizure (syncope mimic) Heart: ACS, pulmonary embolism, aortic stenosis, HOCM, bradyarrhythmias such as sick sinus syndrome, and tachyarrhythmias such as those precipitated by long QT syndrome (Torsades de pointes), Brugada syndrome (Vfib), and pre-excitation syndromes such as WPW (atrial tachyarryhthmias). Vessels: Vasovagal syncope, hypovolemia, situational syncope (e.g. micturition, defecation, Valsalva), subclavian steal, orthostatic hypotension, antihypertensive medication side effect, autonomic dysfunction. High risk features of syncope - on history: Age > 65 Hx of cardiovascular disease Lack of prodrome Chest pain with episode Episode related to exertion Palpitations preceding event FHx of sudden cardiac death High risk features of syncope - on physical exam: Abnormal vital signs Systolic BP < 90 Abnormal ECG Clinical evidence of CHF |
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Give an approach to dizziness.
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The initial goal is to determine whether it was (pre)syncope, vertigo, or disequilibrium.
One stepwise approach is as follows: QUESTION 1: Was there loss of consciousness? IF YES --> Stop, work up as syncope. IF NO --> Go to question 2. QUESTION 2: Is there true vertigo (i.e. sensation of movement, room spinning, etc)? IF YES --> Go to question 3. IF NO --> Work up as non-specific dizziness with history, physical, and labs as indicated. Consider cardiac or structural in elderly or patients with risk factors, consider psychogenic/watch and wait in young and healthy. QUESTION 3: Was there any evidence of CNS impairment (now or at the time) - e.g. weakness, numbness, dysarthria, etc.? IF YES, BUT NOW RESOLVED --> Consider TIA, seizure, or migraine. IF YES, AND IT PERSISTS --> consider stroke, structural lesion, or MS. IF NO --> Go to question 4. QUESTION 4: Are the symptoms triggered by sudden head movements, resolving when motionless? IF YES --> BPPV. Confirm with Dix-Hallpike and cure with Epley's maneuver. IF NO --> Go to question 5. QUESTION 5: Is there hearing loss? IF YES --> Go to question 6. IF NO --> Vestibular neuritis, a post-viral syndrome which causes severe persistent peripheral vertigo with nausea and vomiting. Symptomatic Tx and time. QUESTION 6: Is there tinnitus? IF YES --> Consider labyrinthitis (which is just vestibular neuritis plus hearing problems), or Meniere's disease (a condition which causes recurrent episodes of vertigo, hearing loss, and tinnitus). IF NO --> Consider acoustic neuroma. |
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DDx of hemoptysis.
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Infectious:
- Bronchitis - Pneumonia - TB Structural: - Lung cancer - Foreign body - Bronchiectasis - Congenital AVM - Aorto-tracheal fistula Vascular/other: - PE - Vasculitis (e.g. Wegener's, Goodpasture's) - Coagulopathy/anticoagulation therapy |
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Give an approach to the sick neonate.
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The mnemonic is SCAMS.
1) S - SEPSIS. Initiate treatment for sepsis on all sick neonates. - Intubate - 20 cc/kg fluid bolus - Amp and Cefotax - Draw cultures/labs/VBG - DO NOT LP if unstable 2) C- CARDIAC - most of these will be SVT or ductal-dependent lesions. - First, intubate, give antibiotics, draw labs/cultures/VBG - ECG - 4 limb BPs - If not SVT, and O2 sats persistently low despite intubation and 100% O2, give prostoglandin E1 0.1mcg/kg/min - side effects are apnea and hypotension. 3) A - ABUSE - Always start with intubate, give fluid, give antibiotics, draw labs/cultures/VBG - then consider history, look at fundi, skeletal survey - CT head? 4) M - METABOLIC - If hypoglycemic give 5cc/kg of D10W, and measure VBG, ammonia and critical labs. - If not coming around give hydrocortisone 1mg/kg 5) S - SURGICAL - Diaphragmatic hernia - Intestinal malrotation - Volvulus - Duodenal atresia - NEC |
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Give a DDx for altered mental status.
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Intracranial vs Extracranial - IS IT-MEAT
Intracranial causes: Infectious Structural Ischemic Traumatic Extracranial Causes: Metabolic Endocrine Anoxia Toxins/withdrawal |
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Give a DDx for fever in the returning traveler.
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Malaria
Dengue fever Typhoid fever Yellow fever and a bunch of other stuff I will never remember. |
