CS Keys 2 – Flashcard

DDx: Schizophrenia/Schizophreniform Disorder/Brief Psychotic Disorder Substance-Induced Psychosis Schizoid Personality Disorder Psychosis Secondary to a General Medical Condition Schizoaffective Disorder Depressive Disorder w/Psychotic features Workup: Mental Status Exam CBC electrolytes TSH Beck Depression Inventory

Hx: pos. Sxs (delusions, hallucinations, disorganized thought, catatonic behavior), neg. Sxs (blunted affect, social w/drawal, decreased motivation, decreased speech/thought), paranoia; age at first symptom or hospitalization, prev. psych. medication, alcohol/substance abuse PEx: mental status exam, V/S

DDx: PCOS STI Cervical/Endometrial cancer Endometriosis Pregnancy/Molar pregnancy/Ectopic Pregnancy/Spontaneous abortion Coagulation Disorder Hypothyroidism Atrophic Vaginitis/Endometrium Endometrial Polyps/Hyperplasia Pelvic Inflammatory Disease Ovarian torsion Ruptured Ovarian Cyst Workup: Pelvic Exam, urine/serum hCG, cervical cultures, Pap smear, prolactin, TSH, CBC, electrolytes, TVUS or Pelvic U/S, PT/PTT, endometrial Bx, colposcopy/hysteroscopy

Hx: Duration/Amount, 4P's (menstrual Hx, pregnancy Hx, OCP use, Pap Hx, Partners), associated discharge, associated pain, urinary Sxs, trauma, medications (warfarin), history of easy bleeding PEx: abdominal observation, auscultation, palpation, percuss complete pelvic exam

DDx: Infection(PID, STI - bact. vaginosis, candidal/trhicomonal vag., gono./chlam. cervicitis) trauma (atrophic vaginitis, abuse), neoplasia (cervical/endometrial polyps, hyperplasia, cancer) Workup: pelvic exam, hCG, Pap smear, colposcopy, cervical cultures/G stain, wet mount/KOH prep, pH of vaginal fluid

Hx: Discharge amount/color/odor/consistency/duration/associated burning/itching/recent sexual activity, use of tampos/douche 6P's (partners/sexual activity, Pap Hx, Pregnancy Hx, Period, Pill use, Protection use), status of relationships, Hx of STD/PID PEx: abdominal exam complete pelvic exam

DDx: sexual abuse, atrophic vaginitis, endometriosis, STI/PID, vaginismus, cervical/endometrial cancer Workup: pelvic exam, hCG, wet mount, KOH prep cervical culture/G stain/NAAT, pelvic U/S

Hx: pain association w/discharge, itching, rash, hot flashes, pain onset/duration, association with menstruation/defecation, 5P's (esp. partners-relationship; Hx of Pap/STD); adequacy of lubrication, libido; can ask Hx of endometriosis/PID, SURGICAL Hx PEx: abdominal exam, pelvic exam

Hx: onset, duration, triggers/stressors, SIGECAPS, sleep patterns, family history, prior events, medications PEx: mental status exam (including insight/judgement), Neuro(PERRLA, EOMI, coordination), document behavior/appearance, thought content/process

DDx: MDD, normal bereavement, Schizoaffective, Adjustment disorder, Substance-induced depression, dysthymic disorder, cyclothymic disorder, bipolar disorder, hypothyroidism Workup: CBC, urine toxicology, BAC, mental status exam, TSH

Hx: onset, duration, fever, exudates, difficulty breathing/swallowing, associated cough/phlegm, nausea/vomiting, ear Sxs, eye Sxs, nose Sxs, sick contacts, travel Hx, immuniz. Hx, sexual Hx, occupation, TB exposure, associated rashes, weight/appetite changes, smoking/alcohol Hx PEx: HEENT - LAD, mouth for exudates, swollen glands, thrush, gingiva, redness; eyes for conjunctivitis, PERRLA; ears for pain, redness, exudates, tympanic membrane; nose for dischage, polyps; sinuses for pain Neuro - PERRLA, EOMI, CN's 2-12 Resp - palpation, auscultation, percussion Skin - look for rashes Abd./CV - if have time

DDx: Infectious mononucleosis, strep. pharyngitis, viral pharyngitis, HIV, hepatitis (if abd. Sxs/weight loss present) Workup: CBC, throat cultures/G stain, sputum culture/G stain, Monospot test, anti-EBV antibody test, CMV serology, antistreptolysin titers, CD4 count, HIV antibody titers, peripheral smear, AST/ALT/ALP/Bilirubin, rapid strep Ag test

Hx: gradual vs acute onset, duration, intermittency, associated dizziness, LOC, n/v, sweating, dyspnea, chest pain; prior episodes, context/possible triggers (caffeine, anxiety, exertion), cardiac Hx/risk factors, stroke history, recent infections/illnesses, history of anemia/bleeding, fatigue PEx: CV: auscultation, palpation, auscultate carotids, JVD HEENT: palpate thyroid, inspect for lid retraction/exophtal. Neuro: PERRLA, EOMI, CN's 2-12, mental status, sensation/motor, DTR's Resp: auscultation Limbs: inspect for tremor

DDx: cardiac arrhythmia, anemia, hyperthyroidism, hypoglycemia, panic/anxiety disorder, agoraphobia/social phobia, Pheochromocytoma, Substance-induced palpitations Workup: CBC, TSH/fT4, urine toxicology, electrolytes, urine metanephrines, glucose, insulin/C-peptide, ECG, Holter monitor, Echocardiography

What to cover in medical history: 1. associated complications - eyes: visual changes (blurred, difficult), last eye checkup - periph. neuro: numbness/tingling anywhere, infections - sexual function: ED - renal: edema, quality/freq. - comorbidities: cholesterol, HTN, stroke 2. medical management - monitoring: how? frequency? what are the levels? HbA1c taken/when/result?/last checkup with doctor? - medication: which? method? associated Sxs? - diet/exercise: describe both - counsel on any of the above as necessary 3. PEx - check 4 limbs for sensation, strength, pulses, gait - check eyes for retinopathy (fundoscope), Snellen chart - check heart for auscultation, PMI heave, carotid bruits

Hx: OPQRST, history of trauma, history of easy bleeding, fever, fatigue, photosensitivity, involvement of other joints, morning Sxs, oral ulcers, sexual activity PEx:

DDx: hemarthrosis, septic arthritis, osteoarthritis, gout/pseudogout, RA, SLE, trauma, tenosynovitis, IBD arthritis, psoriatic arthritis

Hx: location, onset, progression, alleviation, exacerbation, quality, radiation, severity, timing, bowel changes, fever, urinary changes, urinary sxs/signs, weight, appetite, n/v, surgical history, medications, allergies, drugs PEx: full abdominal - look for masses, rebound/guarding CVA tenderness Extremities - edema CV - cardiac, carotid Rectal Exam, pelvic exam

Hx: establish confidentiality, empathy/is pt ok, describe the event, oral/genital penetration, condom use, does pt know the attacker/recognized them, was there ejaculation, previous episodes, foreign object use, OCP's, has pt reported event, is there pain, dizziness/LOC, head trauma, vaginal bleeding/discharge, anxiety Sxs Counsel: does pt have safe place to go, encourage pt to report, offer emergency contraceptive PEx: examine skin for lacerations/bruising Neuro - full if trauma occurred (CN's, gross motor/sensory, minimental, PERRLA, EOMI) HEENT - full (bruising, mouth) MSK - inspect and palpate for tenderness Abd. - full Resp - full CV - if Sxs present Workup: skeletal survey, bhCG, CBC, CXR, cervical cultures, wet mount KOH, HIV/VDRL/HBV, pelvic exam *for Domestic Abuse: - do they have safe place, fear/safety, backup plan, Hx of frequent falls, mental illness, drug abuse, firearms in house, are kids at home/have they been abused, encourage them to report

What to cover in medical Hx: When were they Dx? When was their last f/u? What is the course of their disease? Monitoring of BP: at home? how often? what are the level? Compliance: what meds? how often taking? having S/E? Diet/Exercise, weight/appetite HTN Complications: headaches. change in vision, LOC, confusion, loss of sensation, claudication, ED, chest pain, SOB, palpitations Associated Diseases: cholesterol levels, DM status, CV Hx (IHD, stroke) PEx: HEENT - fundoscopic, carotid auscultation