OSCE part 2

Stable Angina

Stable Angina

Central chest apin Aggravated by exertion Relieved by rest Not related to food intake History of HTN Dyspnea and DIaphoresis

Myocardial Infarction

Pain radiating to the left arm History of HTN Hyperlipidemia Smoking Associated with dyspnea and diaphoresis

Costochondritis

Stabbing chest pain Pain worsens with inspiration Relieved by aspirin Possibly associated with URI Acute onset Chest wall tenderness upon palpation Difficulty breathing

Pericarditis

Retrosternal sharp stabbing chest pain Pain improves when leaning forward Worsens with deep inspiration/lying down Possibly associated with URI

Acute Coronary Sx

Acute onset Dyspnea Pain radiating to the left shoulder Diagnosis of diabetes/ sickle cell anemia

GERD

Retrosternal burning sensation Pain occurring w/ heavy meals Worsens when lying down relieved by antacadis/ PPIs

Pulmonary Embolism

Acute onset of SOB at rest Pleuritic chest pain Tachycardia Hypotension Tachypnea Mild fever Recorvering from surgery Recent travel history

Aortic Dissection

Sudden onset severe pain radiates to the back hx of uncontrolled HTN

Chest pain plan

EKG Cardiac enzyme Angiography Echocardiography

Asthma

Mucoid Cough Wheezing Intermittent episodes SOB

COPD

Productive cough Cough lasting 3 months for 2 years Heavy Smoker Barrel Chest Edema signs

Pneumonia

pleuritic chest pain fever chills cough w/ purulent sputum heavy smoker pre-existing COPD

Lung Cancer

Worsening cough Hemoptysis Dyspnea Weight Loss Fatigue Heavy Smoking

Tuberculosis

Worsening cough over prolonged period Hemoptysis Dyspnea Weight loss Fatigue Heavy smoking

Pulmonary edema

Cough with pink frothy sputum Worsening dyspnea Cold clammy skin Dyspnea worsens with laying down

Common cold

Cough Fever Sick contact

Plan for Cough

CBC Sputum Culture Chest CT ECG Bronchoscopy

CHF

Dyspnea with cough SOB relieved with sitting up Exertional dyspnea Family history

Lung Cancer

Worsening Cough SOB Hemoptysis Weakness Weight loss

Asthma

Mucoid cough Wheezing Intermittent SOB

COPD

productive cough heavy smoker pursed lips barrel chest edema/cyanosis

Pneumonia

Pleuritic chest pain Fever Chills Purulent yellow sputum Heavy smoker Pre-existing COPD

Pulmonary Edema

Cough with Pink Sputum Worsening dyspnea Cold, clammy skin Dyspnea worsens w/ laying down

Pulmonary embolism

Acute onset SOB @ rest Pleuritic chest pain Tachycardia Hypotension Tachypnea Mild fever

Tuberculosis

Worsening Cough Night sweats, fever, chills, weigh loss Contact w/ Tb patients Unprotected sex

SOB Symptoms

CBC Pulmonary Function test Chest CT Bronchoscopy Echocardiography Sputum Analysis ECG

Deep Vein Thrombosis

Pitting Edema Acute Onset Unilateral leg swelling/pain Recent immobilization Smoker Oral contraceptive use

Cellulitis

Acute onset Unilateral leg swelling Unilateral leg pain Redness Fever Hypotension

Peripheral Artery Disease

Intermittent claudication Pain worsening with exercise Dry skin w/ hair loss older age

Beurger's disease

Smoking Raynaud phenomenon Leg pain with exercise

Popliteal Artery Entrapment

Intermittent claudication Cramping pain in calf w/ exercise Male? female Athletes Younger age

Spinal Stenosis

Age Trauma Pain relieved leaning forward Aggravates moving backward Numbness in lower limb

Plan for Calf pain

D-dimer Bilateral lower limb ultrasound Venogram Ankle Brachial Index

Acute Rhino-Pharyngitis

Acute Onset Sore throat Runny nose Sinus congestion Fever Sick contact

Acute Sinusitis

Acute Onset Runny Nose Sinus congestion

Pharyngitis

Fever Sore Throat Acute Onset

Infectious Mononucleosis

Fever Sore throat Severe fatigue Loss of Apetite Epigastric and LUQ discomfort Cervical Lymphadenopathy Rash

HIV

Fever Sore throat Rash Weigh Loss IVDU

Plan for Sore Throat

CBC Throat Swab Nasal Swab Anti-EBV Abs CD4 Count

Drug Toxicity (ACEI Alpha Blockers, Amino-glycosides, Hypoglycemic Agents)

No vertigo Light- headedness Reflex tachycardia New anti htn medication Hearing Loss

Bening Paroxysmal Vertigo

Intermitted Episodes Symptoms exacerbated by postural changes Tinnitus Vertigo Hearing Loss

Arrythmia

Intermittent Episodes Pre-syncope Palpitations

Dizziness Plan

EKG BMP Dix Hallpike Maneuver

A fib

HTN Binge Drinking Diabetes History of Stroke Older

CHF

SOB Fatigue Pitting Edema JVD Low PerfusioN S3

MI

Chest pain Not Alleviated with Rest Nitroglycerin HTN

Angina

Exertional chest pain Nitroglycerin HTN

Hyperparathyroidism

Sweating Restless Hyperactive Heat Intolerant

Cardio Tests

EKG, Troponin, CKMB, Chest X-ray, TSH, CBC, CMP

Emphysema

Thin, SOB, Sputum Production, Pursd Lips,

Sarcoidosis

SOB, Cough W/O Sputum, Skin Nodules, Dirt In Eyes, Can't chew a cracker, dental carries

Pulmonary Embolism

Stationary for long periods; recent flight or hospital stay, SOB, fatigue, pleuritic chest pain, tachycardia

Pneumonia

Yellow/green sputum, fever, chills, pleuritic chest pain,

Gastroenteritis

poorly cooked food, bad water sources, stomach pains, diarrhea/vomiting,

Celiac disease

triggered by gluten, diarrhea, stomach pain

Ulcer

Pain better with meals= duodenal Pain worse with meals= peptic Chronic NSAID use bad breath

Pyelonephritis

Flank pain, fever, chills, nausea, recent catheter, men older than 50, bph hx, diabetes, pain w/ urination

Kidney stones

Unilaterla Flank pain radiating to the groin, hematuria, dark yellow urine-poor hydration, high sodium diet, gout, hx

Nephrotic syndrome

Edema, weight gain, fatigue, loss of apetite, foamy urine

Nephritis syndrome

bloody casts in urine, decreased urine output, edema, HTN