Exam 2: STEP 2 CS - Practice Cases

Doorway information about patient The patient is a 30-year-old man who comes to the emergency department due to a new-onset seizure. Vital signs Temperature: 37.2 C (99 F) Blood pressure: 120/80 mm Hg Pulse: 82/min, regular Respirations: 18/min Basic differential diagnosis Seizures (secondary to head trauma, infections, drugs, metabolic disorders) Hypoglycemia Syncope Migraine Stroke Psychogenic seizure Space-occupying lesions Alcohol or drug withdrawal

Doorway information about patient The patient is a 23-year-old man who comes to the emergency department due to rectal bleeding. Vital signs Temperature: 38.3 C (101 F) Blood pressure: 110/60 mm Hg Pulse: 90/min Respirations: 18/min Basic differential diagnosis Young patients Anal fistula/fissure Hemorrhoid Inflammatory bowel disease Infectious colitis Neoplasm Vascular ectasia Elderly patients Diverticulosis Angiodysplasia Malignancy/polyp Ischemic colitis Inflammatory bowel disease

Doorway information about patient The patient is a 53-year-old man who comes to the emergency department due to right knee pain and swelling. Vital signs Temperature: 38.3 C (101 F) Blood pressure: 130/60 mm Hg Pulse: 80/min Respirations: 18/min Basic differential diagnosis Osteoarthritis Septic arthritis and bursitis Pseudogout and gout Reactive arthritis Traumatic knee injury Lyme disease Monoarticular rheumatoid arthritis Psoriatic arthritis

Doorway information about patient The patient is a 45-year-old man who comes to the emergency department due to vomiting blood. Vital signs Temperature: 36.7 C (98 F) Blood pressure: 100/60 mm Hg Pulse: 90/min Respirations: 18/min Basic differential diagnosis Peptic ulcer Esophageal and gastric varices Mallory-Weiss tear Gastritis Erosive esophagitis Gastric malignancy Vascular ectasia

Doorway information about patient The patient is a 60-year-old man who comes to the office due to dizziness. Vital signs Temperature: 36.1 C (97 F) Blood pressure: 140/90 mm Hg Pulse: 80/min Respirations: 16/min Basic differential diagnosis Vertigo (benign paroxysmal positional vertigo, labyrinthitis, Ménière disease, posterior circulation stroke) Lightheadedness (hypotension, postural hypotension, arrhythmia, anemia, congestive heart failure) Dysequilibrium (anxiety, autonomic dysfunction) TIA or stroke Medication effect Hypoglycemia

Doorway information about patient The patient is a 60-year-old man who comes to the emergency department due to lower abdominal pain. Vital signs Temperature: 38.3 C (101 F) Blood pressure: 130/84 mm Hg Pulse: 98/min Respirations: 22/min Basic differential diagnosis Diverticulitis Renal colic Appendicitis Ischemic colitis Infectious colitis Abdominal aortic aneurysm Intestinal obstruction

Doorway information about patient The patient is a 45-year-old woman who comes to the office due to acute right upper quadrant abdominal pain. Vital signs Temperature: 38.3 C (101 F) Blood pressure: 130/80 mm Hg Pulse: 100/min Respirations: 20/min Basic differential diagnosis Gastrointestinal Acute cholecystitis Biliary colic Acute hepatitis Peptic ulcer (perforation) Acute pancreatitis (biliary pain) Pulmonary Right lower lobe pneumonia Cardiovascular Myocardial infarction Heart failure with hepatic congestion Miscellaneous Herpes zoster (shingles)

Doorway information about patient The patient is a 50-year-old man who comes to the office due to fatigue and weight loss. Vital signs Temperature: 36.7 C (98.1 F) Blood pressure: 120/76 mm Hg Pulse: 78/min Respirations: 18/min Basic differential diagnosis Infection HIV Tuberculosis Metabolic disorders Diabetes mellitus Thyroid disorder Adrenal insufficiency Malignancy Solid tumor Hematologic malignancy Gastrointestinal Hepatitis Malabsorption Other Depression Eating disorder Medication side effect

Doorway information about patient The patient is a 40-year-old woman who comes to the office due to increased urination. Vital signs Temperature: 36.7 C (98 F) Blood pressure: 110/70 mm Hg Pulse: 86/min Respirations: 16/min Basic differential diagnosis Increased urine volume Diabetes mellitus Diabetes insipidus (central, nephrogenic) Psychogenic polydypsia Diuretic use Hypercalcemia Increased urinary frequency Urinary tract infection Overactive bladder Excess caffeine intake Vaginitis, urethritis

Doorway information about patient The patient is a 50-year-old man who comes to the clinic due to impotence. Vital signs Temperature: 36.7 C (98 F) Blood pressure: 150/80 mm Hg Pulse: 80/min Respirations: 16/min Basic differential diagnosis Cardiovascular Atherosclerotic vascular disease Metabolic/endocrine Diabetes Hypogonadism Hyperprolactinemia Neurologic Spinal cord disorders Psychological Anxiety Depression Alcohol or other substance abuse Other Medications (eg, antihypertensives)

Doorway information about patient The patient is a 70-year-old man with insomnia. Vital signs Temperature: 36.7 C (98.1 F) Blood pressure: 130/90 mm Hg Pulse: 58/min Respirations: 16/min Basic differential diagnosis Depression Post-traumatic stress disorder Anxiety disorder Chronic pain syndromes Adverse effect of medication Age-related sleep changes Thyroid problems Sleep apnea Restless legs syndrome

Doorway information about patient The patient is a 30-year-old woman who comes to the clinic due to abdominal pain. Vital signs Temperature: 38.5 C (101.3 F) Blood pressure: 120/75 mm Hg Pulse: 98/min Respirations: 22/min Basic differential diagnosis Gastrointestinal Appendicitis Acute cholecystitis Pancreatitis Inflammatory bowel disease Irritable bowel syndrome Diverticulitis Bowel obstruction Acute gastroenteritis Urinary Urinary tract infection/pyelonephritis Renal colic Reproductive Pelvic inflammatory disease Pelvic abscess Endometriosis Ovarian cyst/torsion Ectopic pregnancy Spontaneous abortion Miscellaneous Shingles Aortic dissection

Doorway information about patient The patient is a 56-year-old man who comes to the office for a blood pressure check and medication refill. Vital signs Temperature: 36.1 C (97 F) Blood pressure: 150/90 mm Hg Pulse: 80/min Respirations: 16/min Basic differential diagnosis When patients come for follow-up of known conditions, the primary diagnosis is known. However, you should be aware of complications and associated conditions. Congestive cardiac failure Coronary artery disease (angina) Peripheral vascular disease Retinopathy Side effects of the medications

Doorway information about patient The patient is a 66-year-old man who comes to the clinic due to constipation. Vital signs Temperature: 36.7 C (98 F) Blood pressure: 120/70 mm Hg Pulse: 70/min Respirations: 16/min Basic differential diagnosis Functional constipation Obstructive lesions (eg, bowel obstruction, carcinoma of colon) Metabolic disturbances (eg, hypothyroidism, diabetes mellitus, hypercalcemia) Neurologic dysfunction (eg, stroke, autonomic neuropathy, spinal cord trauma, multiple sclerosis, Parkinson disease) Medication-induced (eg, iron preparations, opiates, anticholinergics)

Doorway information about patient The patient is a 25-year-old woman who comes to the clinic due to a sore throat. Vital signs Temperature: 38.3 C (101 F) Blood pressure: 120/70 mm Hg Pulse: 90/min Respirations: 22/min Basic differential diagnosis Viral pharyngitis Bacterial pharyngitis Group A streptococcal pharyngitis Mycoplasma pneumoniaNeisseria gonorrhea Epstein-Barr virus mononucleosis Allergic rhinitis/postnasal drip Chronic tonsillitis Primary HIV

Doorway information about patient The patient is a 45-year-old man who comes to the emergency department due to right lower abdominal pain. Vital signs Temperature: 37.1 C (98.7 F) Blood pressure: 130/80 mm Hg Pulse: 100/min Respirations: 20/min Basic differential diagnosis Appendicitis Meckel diverticulitis Perforated viscus Intestinal obstruction Yersinia enterocolitica Pancreatitis Urolithiasis Acute cholecystitis Herpes zoster (shingles)

Doorway information about patient The patient is a 65-year-old woman who comes to the office due to loss of hearing. Vital signs Temperature: 36.7 C (98.1 F) Blood pressure: 130/86 mm Hg Pulse: 80/min Respirations: 16/min Basic differential diagnosis Conductive hearing loss Cerumen impaction Otitis media with effusion Tympanic membrane perforation Otosclerosis Foreign body in ear canal Cholesteatoma Tympanosclerosis Tumor of the ear canal or middle ear Sensorineural hearing loss Presbycusis (age-related hearing loss) Ototoxicity Noise-induced hearing loss Ménière disease Diabetes Acoustic neuroma

Doorway information about patient The patient is a 27-year-old woman who comes to the office due to a rash. Vital signs Temperature: 36.8 C (98.3 F) Blood pressure: 120/75 mm Hg Pulse: 78/min Respirations: 16/min Basic differential diagnosis Infections Bacterial (eg, cellulitis) Viral (eg, herpes zoster/shingles) Fungal (eg, tinea corporis) Parasitic (eg, scabies) Psoriasis Acne vulgaris Rosacea Immune/autoimmune (eg, systemic lupus erythematosus, erythema multiforme) Allergic/irritant (eg, contact dermatitis, drug rash, photodermatitis, urticaria) Stasis dermatitis Bullous disorders (eg, bullous pemphigoid, dermatitis herpetiformis)

Doorway information about patient The patient is a 32-year-old woman who comes to the emergency department due to multiple bruises. Vital signs Temperature: 37.4 C (99.3 F) Blood pressure: 120/80 mm Hg Pulse: 90/min Respirations: 16/min Basic differential diagnosis Accident Physical assault Spousal abuse Bleeding disorders Collagen vascular disorders

Doorway information about patient The patient is a 16-year-old girl who comes to the office due to amenorrhea. Vital signs Temperature: 36.7 C (98.1 F) Blood pressure: 120/70 mm Hg Pulse: 76/min Respirations: 16/min Basic differential diagnosis Pregnancy Primary amenorrhea Chromosomal disorders Abnormal müllerian development Androgen insensitivity Secondary amenorrhea Eating disorder Hyperprolactinemia Thyroid dysfunction Polycystic ovarian syndrome Functional hypothalamic amenorrhea Postpill amenorrhea Hypothalamic/pituitary mass