CASES - PEx

Question 1

Case 1 — Chest pain:

Answer 1

1. Neck ==> JVD, carotid.
2. CV.
3. Pulmonary.
4. Abdo.
5. Extremities ==> Pulses, BP, edema/cyanosis.

Question 2

Case 2 — Bloody urine:

Answer 2

1. Abdo.
2. CV.
3. Pulmonary.
4. Extremities ==> inspection.

Question 3

Case 3 — Back pain:

Answer 3

1. MSK (back) ==> Inspection, palpation, ROM.
2. Extremities ==> Inspection, pulses, hip exam.
3. Neuro ==> Motor, DTRs, babinski, gait (toe-to-heel), passive straight leg raising, sensory exam.

Question 4

Case 4 — MVA:

Answer 4

1. CV.
2. Pulmonary.
3. Abdo.
4. HEENT.
5. Neuro ==> Mental status, motor/sensory, CNs.
6. Skin ==> inspection.

Question 5

Case 5 — Positive pregnancy test:

Answer 5

1. Abdominal.
2. HEENT ==> inspection, palpation of thyroid.
3. CV
4. Lungs.
5. Skin ==> rashes, pallor, pigmentation.

Question 6

Case 7 — Right arm pain:

Answer 6

1. Head and neck exam ==> Bruises, neck movements.
2. MSK ==> both arms in terms of strength, ROM (shoulder, elbow, wrist), joint stability, DTRs, pulses.
3. CV.
4. Lungs.

Question 7

Case 8 — 56yo DM f/u:

Answer 7

1. HEENT ==> Fundoscopy.
2. CV.
3. Neuro ==> DTRs, babinski, strength, sharp and dull sensations, vibration sense, position sense in lower extremities.
4. Pulmonary.
5. Abdo.

Question 8

Case 9 — 25yo F assaulted:

Answer 8

1. HEENT ==> inspection/palpation.
2. CV ==> auscultation.
3. Lungs.
4. Abdo.
5. MSK ==> Inspection/palpation.
6. Neuro ==> mental status, CNs, gross motor.

Question 9

Case 10 — 35yo F right calf pain:

Answer 9

1. Joint exam ==> Inspection, palpation, ROM.
2. Extremities ==> Inspection, palpation, checked for Homan’s sign.
3. CV/pulmonary exam.
4. Neuro ==> Sensory, motor, reflexes.

Question 10

Case 11 — Hoarseness:

Answer 10

1. HEENT ==> conjunctivae, sclerae, mouth, and throat. Palpated LNs + thyroid.
2. Pulmonary.
3. CV.
4. Abdo.
5. Extremities ==> Inspection, DTRs.

Question 11

Case 12 — Neck pain:

Answer 11

1. Neck ==> Inspection, palpation, ROM, Lhermitte sign, Spurling test.
2. Neuro ==> Motor, DTRs, sensory, Kernig, Brudzinski.
3. MSK ==> Inspection, palpation of peripheral pulses, ROM.

Question 12

Case 13 — Abdo pain:

Answer 12

1. Abdo.

2. CV/lungs.

Question 13

Case 14 — Headache:

Answer 13

1. HEENT ==> Palpation (sinuses, TMJ), fundoscopy, inspected nose, mouth, throat.
2. Neck ==> Inspection, palpation.
3. Neuro ==> CNs, muscle strength, DTRs.
4. CV/lungs.

Question 14

Case 15 — Amenorrhea:

Answer 14

1. Neck ==> thyroid.
2. Extremities ==> Inspection.
3. Neuro ==> Visual fields, EOMI, DTRs.
4. CV/lungs.

Question 15

Case 16 — Dyspareunia:

Answer 15

1. Abdo.

2. CV/Lungs.

Question 16

Case 17 — Hearing loss:

Answer 16

1. HEENT ==> Tested hearing by speaking with back turned/ inspected sinuses, nose, mouth, and throat. Fundoscopic exam and otoscopy. Rinne/weber and whisper test.
2. Neuro ==> CNs, sensation/motor, reflexes, cerebellar—finger to nose, heel to shin.
3. CV/lungs.

Question 17

Case 20 — Cough:

Answer 17

1. Lungs.
2. CV.
3. HEENT ==> mouth, LNs, throat.
4. Extremities ==> Inspection.

Question 18

Case 21 — Yellow eyes and skin 52yo:

Answer 18

1. HEENT ==> sclerae + under the tongue.
2. Abdo ==> I + A + P (Murphy), percussion, liver span, palpation or percussion for splenomegaly, fluid wave for shifting dullness.
3. Skin ==> telangiectasias, palmar erythema.
4. CV/lungs.
5. Extremities ==> asterixis, edema.

Question 19

Case 22 — Dizziness:

Answer 19

1. HEENT ==> nystagmus, fundoscopy, otoscopy, assessed hearing, Rinne/weber, mouth and throat.
2. CNs, motor, DTRs, gait, Romberg, Dix-Hallpike maneuver.
3. CV.

Question 20

Case 23 — Knee pain:

Answer 20

1. MSK ==> Inspection and palpation (both knees, including ROM). Examined other joints.
2. Mouth ==> ulcers.
3. CV/lungs.
4. Hair and skin ==> Inspection.
5. Abdo.

Question 21

Case 24 — Heel pain:

Answer 21

1. Extremities ==> Inspection of both feet and ankles — non-weight bearing/weight bearing, and with ampulation.
   Palpation of medial calcaneal tuberosity, Achilles tendon, plantar fascia, retrocalcaneal bursae.
   Passive ROM and general strength of ipsilateral knee and hip.
   Ankle dorsiflexion and great toe extension and passive ROM.
   Strength testing of ankle dorsiflexion and plantar flexion.
2. Neuro ==> Sensation to light touch for dermatomes of foot and ankle. Assessed Achilles tendon reflex.
3. CV ==> +Distal pulses, cap refill of the toes.
4. Lungs.
5. Abdo.

Question 22

Case 26 — Persistent cough:

Answer 22

1. HEENT ==> inspection of mouth/throat/palpation of neck LNs.
2. Lungs ==> A + P + P.
3. CV.
4. Abdo.
5. Extremities ==> inspection.

Question 23

Case 27 — Fatigue:

Answer 23

1. HEENT ==> Inspection of conjunctivae, mouth, and throat. Inspection and palpation of LNs and thyroid gland.
2. Abdo ==> A + P + P (incl rebound tenderness and Murphy).
3. CV.
4. Lungs.
5. Extremities ==> Inspection, palpation.

Question 24

Case 28 — HTN f/u:

Answer 24

1. HEENT ==> Fundoscopic exam, carotid auscultation.
2. CV ==> + palpation.
3. Neuro ==> DTRs, Babinski, sensation + motor in bil lower extremities.
4. Lungs.
5. Abdo ==> A + P.
6. Extremities ==> Inspection, palpation of peripheral pulses.

Question 25

Case 29 — Sleeping problems:

Answer 25

1. HEENT ==> Inspection + palpation + auscultation of thyroid for LAN. 2. CV. 3. Extremities ==> Check tremor on outstreched fingertips — looked for edema. 4. Lungs. 5. Abdo ==> I + A + P. 6. Skin ==> Inspection. 7. Neuro ==> Brisk tendon reflexes.

Question 26

Case 31 — Abdo pain:

Answer 26

1. Abdo ==> Inspection + A + Palpation + Percussion. Psoas, obturator, Rovsing, CVA. 2. CV/Lungs.

Question 27

Case 32 — Forgetfulness and confusion:

Answer 27

1. Neuro ==> MMSE + CNs + motor + DTRs + gait + sensory. 2. CV/Lungs. 3. Abdo ==> Palpation. 4. Neck ==> carotid auscultation. 5. Eye ==> Inspected pupils, fundus.

Question 28

Case 33 — Fatigue:

Answer 28

1. HEENT ==> Inspected conjunctivae, mouth, and throat, LNs. Examined thyroid gland. 2. Lungs/CV. 3. Abdo ==> A + P + P. 4. Extremities ==> Inspection + DTRs.

Question 29

Case 34 — Fatigue:

Answer 29

1. HEENT ==> Inspected conjunctivae, mouth and throat, LNs. Examined thyroid. 2. CV/Lungs. 3. Abdo ==> A + P + P. 4. Extremities ==> Inspection + motor + DTRs. 5. Skin ==> Inspection for bruises + signs of injury.

Question 30

Case 35 — Strange writing on the wall:

Answer 30

1. Eye exam ==> Pupils, checked for reactivity. 2. Neuro ==> MMSE, CNs, motor—sensory, DTRs, gait. 3. CV/lungs. 4. Abdo ==> palpation.

Question 31

Case 36 — Pre-employment medical checkup:

Answer 31

1. CV ==> A. 2. Lungs ==> A + P + P. 3. HEENT ==> Inspected mouth, throat, palpated LNs. 4. Abdo ==> A + P. 5. Extremities ==> Inspection. 6. Neuro ==> CNs, motor, DTRs, gait.

Question 32

Case 37 — Bloody stool:

Answer 32

1. Abdo ==> A + P + P. | 2. CV/lungs.

Question 33

Case 38 — Tremor:

Answer 33

1. Neuro ==> Mental status, CNs, motor (including muscle tone), sensory, cerebellar, gait. 2. CV/Lungs.

Question 34

Case 39 — Weight gain:

Answer 34

1. Neck ==> Palpated LNs, thyroid. 2. Abdo ==> A + P + P. 3. Extremities ==> Inspected for abnormal dryness in skin, edema, checked DTRs. 4. CV/lungs. 5. Head ==> Inspected hair, conjunctivae, mouth and throat.

Question 35

Case 43 — Sore throat:

Answer 35

1. HEENT ==> Examined nose, mouth, throat, LNs. Checked for sinus tenderness. 2. Abdo ==> A + P + P. 3. Skin/LNs ==> Rashes, lesions, lymphadenopathy. 4. CV/Lungs.

Question 36

Case 44 — Loss of consciousness:

Answer 36

1. Neuro ==> Mental status, CNs (+fundoscopic exam), motor/sensory, DTRs, cerebellar, gait, Romberg. 2. CV ==> P + A + Orthostatic VS. 3. HEENT. ==> Inspection (head, mouth), carotid auscultation and palpation, thyroid exam. 4. Lungs. 5. Extremities ==> Peripheral pulses.