PALPITATIONS

Question 1

palpitations key hx: timing

Answer 1

gradual vs acute onset/offset
context (exertion, caffeine, energy drinks or supplements, anxiety)
duration

Question 2

palpitations key hx: assoc sxs

Answer 2

lightheadedness
LOC
CP
dyspnea
fever
sweating
pale skin
flushing
diarrhea
hyperthyroid sxs

Question 3

palpitations key hx: medhx

Answer 3

hx of bleeding or anemia
hx of heart dz
HTN
diabetes

Question 4

palpitations key PE

Answer 4

VS
endocrine/thyroid exam (exophthalmos, lid retraction, lid lag, gland size, bruit, and tremor)
complete CV exam (JVP, PMI, heart sounds, lower extremities, distal pulses)

Question 5

hypoglycemia ddx

Answer 5

cardiac arrhythmia
angina
hyperthyroidism
hyperventilation episodes
panic attack
pheochromocytoma
carcinoid syndrome

Question 6

hypoglycemia w/u

Answer 6

glucose
CBC
elytes
TSH
ECG
24-hr urine catecholamines
5-HIAA

Question 7

panic attack ddx

Answer 7

GAD
specific phobia
acute stress d/o
hyperthyroidism
substance abuse/dependence
pheo

Question 8

panic attack w/u

Answer 8

CBC
elytes
TSH, FT4
ECG
echocardiography
urine tox
24-hour urinary catecholamines

Question 9

specific phobia ddx

Answer 9

avoidant personality d/o
agoraphobia/specific phobia
panic attack
GAD
substance abuse/dependence
hyperthyroidism

Question 10

specific phobia w/u

Answer 10

CBC
elytes
ECG
TSH, FT4

Question 11

MVP ddx

Answer 11

cardiac arrhythmia
panic attack
pheochromocytoma

Question 12

MVP w/u

Answer 12

ECG
TEE
event monitor
holter monitor
24-hour urinary catecholamines