CDM Midterm questions and answers(latest update)

Acute cough differential diagnosis Acute bronchitis Influenza Pneumonia CHF Allergic rhinitis Environmental Chronic cough differential diagnosis Chronic allergic rhinitis/PND Asthma GERD COPD Bronchiectasis Lung CA Rx rxn ex. ACEi Idiopathic/psychological MCC of chronic cough GERD PND Acute bronchitis Sx: Cough x 5 days, pleuritic CP, URI sx Wheezing/rhonchi Clinical dx CAP Sx: F/C, cough, SOB, pleuritic CP Decreased breath sounds Dx: CXR, sputum cx Tx: Ceftriaxone/Azithromycin (inpatient), Azithromycin (outpatient) PCP pneumonia PNA in immunocompromised patients ex. HIV Sx: Dry cough, slowly progressing Tx: Bactrim CHF Sx: cough w. pink/frothy sputum, edema, SOB, CP, palpitations JVD, peripheral edema, rales/decreased breath sounds Dx: CXR, BNP, Echo Tx: diuretics, ACEi/ARB Bronchiectasis Cough most days with sputum production with 1 or more exacerbations/year Sx: Productive cough, sinusitis, dyspnea, pleuritic CP Crackles/wheezing, clubbing Dx: CXR, CT Pulmonary emboli Sx: Sudden onset SOB, pleuritic CP, risk factors Unilateral leg swelling, hypotension, tachycardia, tachypnea NO ABNORMAL BREATH SOUNDS Dx: CTA Tx: Anticoags Pleural effusion Sx: SOB, CP, fever, cough Diminished breath sounds at the base of the lungs Dx: CXR, thoracentesis Transudative vs. exudative Sick sinus syndrome Varied heart arrhythmia Sx: CP/angina, AMS, syncope, dizziness, fatigue, palps Rib fracture Sx: Subcutaneous emphysema, tenderness Dx: XR Costochondritis Sx: Pain worse w. deep breaths, reproducible Clinical dx Pericarditis MCC idiopathic or viral illness Sx: Sharp/stabbing CP, worse with lying down and improved when leaning forward, fever, malaise, cough Friction rub, cardiac tamponade risk Beck's triad: low BP, JVD, muffled heart sounds Dx: EKG, Echo Myocarditis RECENT VIRAL ILLNESS Sx: CP, fatigue, fever, dyspnea, arrhythmia Heart failure & abnormal heart rhythms Dx: Echo, EKG Bowel obstruction SBO: Colicky pain w. spasms lasting a few minutes, central mid-abd pain LBO: Lower abd pain, longer spasms Pain decreases s/p vomiting Risks: Hx of prior obstruction and surgery Hyperactive = early Hypoactive bowel sounds = late disease Dx: XR w. dilated loops of bowel, CT w. contrast Cholecystitis Sx: RUQ abd pain, pain can radiate to the shoulder, N/V, fever Risks: Female, obese, > 40 y/o, pregnant Murphy's sign Dx: Amylase/AST/ALT, US initially, HIDA is definitive Choledocolithiasis Stones in the common bile duct Sx: Biliary colic, N/V, JAUNDICE Dx: Elevated LFTs, ERCP Ascending cholangitis Stone obstructing the common bile duct w. infection Charcot's triad: Fever > 40, RUQ pain, jaundice Peptic ulcer NSAID/steroid use or H. pylori infection Sx: Melena, coffee ground emesis, pain relieved w. food Dx: EGD, urea breath test Pancreatitis Sx: epigastric abd pain that can radiate to the back, N/V, fever, flank pain Cullen's sign = bruising Hx of ETOH abuse, gallstones, HLD Dx: Lipase, CT w. contrast (on the slides but maybe w/o from the review??) IBS Sx: long hx of abd pain relieved w. defecation, diarrhea/constipation No visible changes to the bowels on exam Mesenteric ischemia Hx of CAD, PVD, A fib. Sx: acute severe abd pain out of proportion to the PE, diffuse abd pain Dx: Angiogram Tx: surgery Ischemic colitis MC age > 60 y/o Sx: cramping abd pain, bright red/maroon stool, urgency to move bowels, diarrhea Dx: Colonoscopy Hepatitis Etiology: Acute hepatitis can be rx induced, ETOH, autoimmune ex. viral (MC) Sx: Malaise, anorexia, nausea, dark urine, icterus/jaundice Dx: ALT>AST Esophageal varices Sx: hematemesis, black/tarry stools, shock Icterus, spider nevi, ascites...