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ScribeAmerica Training > Class 2 - Diseases > Flashcards

Class 2 - Diseases Flashcards

1
Q

What is the physicain work up (asking the patient questions) designed to do?

A

It will point towards OR away from a particular differential diagnosis.

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2
Q

What are associated symptoms?

What are pertinent negatives?

A

Specific symptoms that RAISE the physicians suspicion for a particular Differential Diagnosis (DDx)

Specific symptoms that are not present which LOWER physicians suspicion for a particular (DDx)

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3
Q

What is the foundation of Pathology? (4)

A

Etiology (The physiological process causing the symptoms)

Risk Factors (What puts the patient at risk?)

Chief Complaint (The typical major symptom)

Associated Symptoms or Sx (Other symptoms that raise the physician’s suspicion for the disease)

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4
Q

What is the TRIIIIIIIPLE THREAT?!

A

Hyperglycaemia

Hypertension

Hyperlipidemia

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5
Q

Describe some of the effects of chronically high blood glucose?

A
  • Diabetic retinopathy - Damage small vessels of the eyes, causing hemorrhage, leading to blurred, nearsightness, or loss of vision.
  • CVA due to damage blood vessels
  • Increasing risk factor for CAD, CHF, and diabetic cardiomyopathy
  • Renal Failure by damaging the glomeruli (strainer of the blood) of the kidneys
  • Peripheral Vascular Disease - damage to blood vessels decreases blood flow to extremities and results in infections, ulcers, and potential amputations
  • Neuropathy - damage to peripheral nervous system causing distal parethesias and extremity pain
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6
Q

Describe some of the effects of chronically high blood pressure?

A
  • Retinopathy
  • CVA
  • Cardiac disease
  • Renal failure
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7
Q

Describe some of the effects of chronically high cholesterol?

A
  • CVA
  • Cardiac Disease
  • Pancreaitis due to free fatty acids in the blood can damage pancreatic cells, leading to inflammation.
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8
Q

Cardiovascular Diseases

Coronary Artery Disease (CAD)

Etiology:
Risk Factors:
Chief Complaint/MF:
Associated Sx:
Medications:
Dx By:

A

Etiology: Narrowing of the coronary arteries causing reduced blood flow to the heart muscle.

Risk Factors: HTN, HLD, DM, Smoking, Family history of CAD/MI < 55 y/o

Chief Complaint: Angina (exterional chest pain or chest pressure)
MF: Worse with exertion, improves with rest and/or NG

Associted Sx: Shortness of breath

Medications: Vasodilators such as NTG/ASA

Dx by: Cardiac catheterization (CAD cannot be dx in the ED)

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9
Q

What type of PMHx determines that a patient has CAD?

A

Angina, MI, CABG, Cardiac Stents, or angioplasty.

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10
Q

Cardiovascular Diseases

Myocardial Infarction (MI)

Etiology:
Risk Factors:
Chief Complaint/MF:
Associated Sx:
Medications:
Dx By:

A

Etiology: Acute blockage of the coronary arteries causing ischemia or infarct to the heart muscle

Risk Factors: HTN, HLD, DM, Smoking, CAD, FHx of CAD <55 y/o

Chief Complaint/MF: Angina
MF: Worse w/ exertion, improved with rest and/or NG

Associated Sx: Diaphoresis, nausea/emesis, shortness of breath

Medication: Vasodilators (ASA or NTG), Thrombolytics (Heparin)

Dx by: STEMI (ST-Segment Elevation Myocardial Infarction) by an ECG/EKG

Non-STEMI: dx by elevated troponin

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11
Q

What is important to document when dealing with MI or suspected MI cases?

A

Many timestamps!

ED arrival time, EKG time, ASA time, cath lab departure time.

STEMI patients must get to Cath-lab within 90 minutes of arrival.

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12
Q

Cardiovascular Diseases

Congestive Heart Failure (CHF)

Etiology:
Risk Factors:
Associated Sx:
Medications:
Physical Exam:
Dx By:

A

Etiology: The heart becomes enlarged, inefficient, and congested with excess fluid. (thickening of ventricular walls resulting in smaller filling capacity of chambers and ejection of blood.

Risk factors: HTN, HLD, DM, Smoking, Kidney Disease, History of CHF

Chief Complaint: Shortness of Breath
MF: Worse with lying flat (Orthopnea), Worse with exertion (Dyspnea on Exertion), and episodically worse at night - Paroxysmal Nocturnal Dyspnea (PND)

Associated Sx: Bilateral lower extremity swelling, fatigue, cough

Medications: Diuretics (Lasix/Furosemide)

Physical Exam: Rales (Crackles) in lungs, Jugular Vein Distention (JVD), Pedal edema

Dx by: CXR and elevated BNP (B-type Natriuretic Peptide) This peptide can act on the kidneys to excrete more salt and water.

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13
Q

What should you do if a patient has CHF history?

A

Document current dosage of Lasix.

Search echocardiograms and document the cardiac output (EF or ejection fraction) and cardiac valve function)

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14
Q

Cardiovascular Diseases

Atrial Fibrillation (A Fib)

Etiology:
Risk Factors:
Chief Complaint:
Associated Sx
Medications
Physical Exam
Dx By

A

Etiology: Electrical abnormalities in the “wiring” of the heart causes the top of the heart “atria” to quiver abnormally.

Risk Factors: Paroxysmal A Fib, Chronic A Fib, Alcoholism

Chief Complaint: Palpitations (fast, pounding, irregular)

Associated Sx: Global Weakness, Fatgue, Lightheadedness

Medications: Anticoagulants (warfarin/coumadin) and Digoxin (slows heart down to allow ventricles to fill more with blood)

Physical Exam: Irregularly irregular rhythm

Dx By: ECG/EKG

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15
Q

What is emergency department concern with Afib?

A

Rapid Ventricular Response (RVR) which is Afib with a rate greater than 100 bpm.

Patients who has Afib are at increased risk for developing blood clots and often take a anticoagulent aka blood thinner.

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16
Q

Respiratory Diseases

Pulmonary Embolism (PE)

Etiology
Risk Factors
Chief Complaint
Associated Sx
Dx By (screening tool as well)

A

Etiology: A blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs

Risk Factors: Known DVT (and/or PMHx/FHx of one or PE), Afib, Recent Surgery, Cancer, Immobility, Pregnancy, BCPs (Birth Control Pills), Smoking

Chief Complaint: Chest Pain
MF: Worst with deep breaths (pleuritic)

Associated Sx: Shortness of Breath. Patients often are hypoxic (low oxygen sat <92%), tachycardic (elevated heart ate)

Dx By: Screening tool D-Dimer (blood test that assesses for fibrin degradation fragments aka protein fragments from a blood clot) Can produce false positives when pt has other issues

Dx tool: CTA Chest (CT Chest w/ IV Contrast)

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17
Q

What does a PE share with a DVT?

A

Risk factors

DVTs or Deep Vein Thrombosis is a blood clot in the legs (not the lungs) and can result in a PE. Symptoms of a DVT is extremity pain and swelling. A DVT is dx by an ultrasound of that extremity.

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18
Q

Respiratory Diseases

Pneumonia (PNA)

Etiology
Cheif Complaint
Associated Sx
Medications
Physical Exam
Dx By

A

Etiology: Infiltrate (bacterial infection) and inflammation inside the lungs around alveoli that help with gas exchange

Risk Factors: Elderly, Bedridden, Immunocompromised, Recent chest injury, recent surgery

Chief Complaint: Productive Cough

Associated Sx: Shortness of breath, fever, chest pain

Medications: Antibiotics - Rocephin and Zithromax

Physical Exam: Rhonchi (continous gurgling or bubbling sounds typically heard during both inhalationa and exhalation

Dx By: Chest X-Ray (CXR)

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19
Q

What does it mean when community acquired pnemonia is suspected?

A

When multiple patients come from the same place with the same disease or malady. A hospital will generate best practice/methods to streamline treatment.

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20
Q

Respiratory Diseases

Chronic Obstructive Pulmonary Disease (COPD)

Etiology
Risk Factors
Chief Complaint
Associated Sx
Treatment/Meds
Physical Exam
Dx By

A

Etiology - Long-term damage to the lung’s alveoli (emphysema) along with inflammation and muscus production (chronic bronchitis)

Risk Factors - Single greatest risk factor is smoking (80-90% of all cases)

Chief Complaint - Shortness of breath

Associated Sx - Wheezing, Cough, Chest Tightness

Treatment - Bronchodilators, Supplemental oxygen, corticosteroids, ventilatory support

Physical Exam - Decreased breath sounds, wheezes

Dx By - Acute infections are a very common cause for a COPD Exacerbation. For this reason, a CXR may be ordered to rule out PNA. Otherwise, COPD is not dx in ED.

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21
Q

What must a scribe document in the case of dealing with a COPD pt?

A

Pt’s baseline O2 requirement

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22
Q

Respiratory Diseases

Asthma

Etiology
Risk Factors
Chief Complaint
Associated Sx
Treatment
Physical Exam

A

Etiology - Constricting of the airway due to inflammation and muscular contraction of the bronchioles, known as a “bronchospasm”

Risk Factors - PMHs, FMHs, smoking, occupational exposure, obesity, allergies

Chief Complaint - Shortness of breath
MF: Improved w/ “breathing treatments”, exacerbated by certain triggers

Associated Sx: Wheezing

Treatment: Bronchidilators, Corticosteroids, Inhalers (Inhaled corticosteroids) or nebulizers

Physical Exam: Wheezes (Inspiratory or Expiratory)

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23
Q

What should be documented in an asthma case in which the patient becomes hypoxic and requires supplmented oxygen or additional interventions?

A

The pt’s oxygen saturation

24
Q

What are the two types of strokes that cause permanent brain damage and what is it known as?

A

Cerebrovascular Accident (CVA)

The two CVAs that cause irreversible damage:
- Ischemic CVA
- Hemorrhagic CVA

25
Q

What is a “mini-stroke” that DOES NOT cause permanent brain damage referred as?

A

Transient Ischemic Attack (TIA)

26
Q

What happens when the brain suffers an injury and what term is used to describe the effects?

A

Damage typically affects a focal region of the brain. Focal Neurological Deficit (FNDs) are specfic deficits and dysfunction dependent on the area of the brain that was injured and the function that area of the brain performs.

27
Q

Neurological Diseases

Ischemic Cerebrovascular Accident (CVA)

Etiology
Risk Factors
Chief Complaint
Medications
Physical Exam
Dx By

A

Etiology: Blockage of the arteries supplying blood to the brain resulting in permanent brain damage

Risk Factors: HTN, HLD, DM, hx TIA/CVA, Smoking, FHx CVA, AFIB

Chief Complaint: Unilateral FNDs: one-sided weakness/numbness or changes in speech/vision

Medications: tPA (thrombolytics) will be administered if pt meets criteria

Physical Exam: Unilaterial Focal Neurological deficits

Dx By: Clinically, following a CT head in order to rule out Hemorrhagic CVA.

28
Q

What is important to do as a scribe when encountering a possible CVA?

A

Document date/time they were “last known well” for a baseline as well as source of info (was it the pt? familial historian?)

This information is used to assess eligibility for tPA (tissue plasminogen activator)

Also, document tPA considered and if it was not indicated due to:
- Onset greater than 3 hours or Unk/Unrealiable time of onset
- Symptoms are rapidly improving

29
Q

Neurological Diseases

Hemorrhagic CVA

Etiology
Risk Factors
Chief Complaint
Associated Sx
Physical Exam
Dx By

A

Etiology - Traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in the brain

Risk Factors - HTN, anticoagulant use, recent head trauma

Chief Complaint - Severe, sudden onset (“thunder clap”) Headache

Associated Sx - Nausea, AMS, FNDs (unilateral weakness, numbness, tingling, changes in speech/vision)

Physical Exam - Unilateral FNDs

Dx By - CT Head is preferred method of dx. However, imaging is not completely reliable at detecting brain bleeds. Pt’s clinical presentation will play role in diagnostic process.

Rare cases, lumbar puncture (LP) may be performed for further diagnostic purposes.

30
Q

Why would tPA not be indicated in the case of a Hemorrhagic CVA?

A

tPA is a thrombolytic meaning it is an anticoagulant which could worsen a brain bleed and instigate death.

31
Q

Neurological Diseases

Transient Ischemic Attack (TIA)

Etiology
Risk Factors
Chief Complaint
Dx By

A

Etiology - Vascular changes temporarily deprive a part of the brain oxygen (symptoms usually last less than 1 hour)

Risk Factors - HTN, HLD, DM, hx TIA/CVA, Smoking, FHx CVA, AFIB

Chief Complaint - Transient FND (changes in speech, vision, strength, or sensation)

Dx By - Clincally

32
Q

Why would a scribe document that tPA was considered and then not indicated for a TIA?

A

SInce TIA symptoms typically last less than 1 hour, the symptoms typically resolve on their own therefore it is no longer indicated (there is no actively clotting mass in the brain)

33
Q

Neurological Diseases

Meningitis

Etiology
Risk Factors
Chief Complaint
Physical Exam
Dx By

A

Etiology: Inflammation and infection of the meninges which is the sac surrounding the brain and spinal cord.

Risk Factors: Recent International Travel, recent exposure to a sick contact

Chief Complaint: Headache, neck pain or stiffness, fever, AMS

Physical Exam: Meningismus (means 3-symptom syndrome of nuchal ridigity, photophobia, and headache), Nuchal Rigidity (stiff neck)

Dx By: Lumbar Puncture (LP)

34
Q

Scribes document the symptoms patients have and dont have; why is this especially important with meningitis?

A

Meningitis is notorously hard to diagnose. It is imperative to document EVERYTHING.

Any person with a headache or fever will be asked if they have headache, neck pain, or fever.

35
Q

Neurological Diseases

Altered Mental Status (AMS)

Etiology
Risk Factors
Chief Complaint
Dx By

A

Etiology - Globalized confusion, caused by things that affect the entire brain. Most common are hypoglycemia, infection, intoxication, and neurological

Risk Factors - known infections (commonly UTIs in elderly patients), DM, elderly, Dementia, EtOH (ethyl alcohol) use, Drug use.

Chief Complaint - Confusion, Decreased responsiveness, Unresponsive

Dx By - Case Dependent

36
Q

Why is AMS very different compared to a FND?

A

AMS is generalized and typically by things that affect the whole brain.

Remember, FND is very specfic deficits caused by damage in specfic parts of the brain that functions to control such actions.

37
Q

Neurological Diseases

Syncope (Passing out)

Etiology

Chief Complaint

A

Etiology - Temp loss of blood supply to the brain resulting in loss of conciousness. There are a variety of causes; most common are vasovagal and low blood volume (dehydration/hypovolemia). Occasionally syncope occurs due to cardiac/neurlogic causes.

Chief Complaint - LoC (Loss of conciousness), Fainting or Passing out

38
Q

What must a scribe document when dealing with a syncope case?

A

Document what happened:

Before the episode
During the episode
After the episode (how were there upon waking?)
How the pt is currently feeling

Were they near-syncopal? Did they almost pass out or have lightheadedness?

39
Q

Gastrointestinal Diseases

Appendicitis

Etiology
Chief Complaint
Associated Sx
Physical Exam
Dx By

A

Etiology - Infection of the appendix causes inflammation and blockage, possibly leading to rupture

Chief Complaint - Abdominal Pain (Location: RLQ)
MF: Worst w/ movement

Associated Sx - Nausea, emesis, fever, decreased appetite

Physical Exam - RLQ tenderness, McBurney’s point tenderness

Dx By - CT abdomen/Pelvis w/ PO contrast

40
Q

Gastrointestinal Diseases

Cholelithiasis

Etiology
Risk Factors
Chief Complaint
Physical Exam
Dx by

A

Etiology - Minterals from the liver’s bile condense to form gallstones which can irritate, inflame, or obstruct the gallbladder

RF - Females, age 40 or older. Being Native American/Hispanic/Mexican origin. Overweight/Obese. Sedentary. Pregnant. Eating a high-fat diet.

Chief Complaint - Abd pain RUQ, Quality Sharp Pain
MF: Worse with eating fatty foods, deep breaths and palpation

Physical Exam - RUQ tenderness, Murphy’s Sign (sign of acute cholecystitis)

Dx by - Abdominal Ultrasound (RUQ)

41
Q

Where are the three abdominal quadrants located? Epigastric, Suprapubic, Perumbilicial.

A

Epigastric is north and under the pectorals, Periumbilical is center mass of the belly button. Suprapubic is at the groin region.

42
Q

Genitourinary Diseases

Urinary Tract Infection (UTI)

Etiology
Chief Complaint
Associated Sx
Physical Exam
Dx By

A

Etiology - Infection of the urinary tract (bladder or uretha)

Risk Factors - Female

Chief Complaint - Painful urination (dysuria)

Associated Sx - Urinary frequency, urgency, malodorous urine, AMS (elderly)

Physical Exam - Suprapubic tenderness

Dx By - Urine drip or Urinalysis

43
Q

What can happen if a UTI is left untreated?

A

It can migrate to the kidneys via the ureters causing Pyelonephritis.

In these patients, their urinary symptoms may be similiar but also include flank pain, with fever, malaise and N/V. A PE finding of costovertebral angle (CVA) tenderness and a positive urine can dx this condition but may be further evaluated with a CT A/P.

44
Q

Genitourinary Diseases

Kidney Stones

Etiology
Chief Complaint
Associated Sx
PE
Dx By

A

Etiology - A kidney stone dislodged from the kidney and begins traveling down the ureter. The stone scrapes and irritates the ureter, causing severe flank pain and bloody urine.

Chief Complaint - Flank Pain

Associated Sx - Blood in the urine (hematuria), N/V, unable to void

PE - CVA tenderness

Dx by - CT A/P; Red blood cells in the UA may be a clue

45
Q

Explain what the Costovertebral angle (CVA) is?

What are other names for Kidney Stones?

A

It is the angle created by the 12th rib (last rib) and the spine. Within this gap, is where the kidneys sit.

Nephrolithiasis, Renal Calculi, Urolithiasis

46
Q

Genitourinary Diseases

Ectopic Pregnancy

Etiology
Risk Factors
Cheif Complaint
Dx By

A

Etiology - Fertilized egg develops outside the uterus, usually in the fallopian tube. High risk for rupture and death.

Risk Factors - Pregnant Female (HCG positiive), STD (PID)

Chief Complaint - Lower abdominal pain or vaginal bleeding while pregnant

Dx - Ultrasound Pelvis (Determine location of fetus. Intrauterine

47
Q

What will any female with a positive pregnancy test recieve IF they complain of lower abdominal pain or vaginal bleeding?

A

They will recieve a pelvis ultrasound to rule out a possible extopic pregnancy.

48
Q

Acute Trauma Dx

Describe the following disease along with their chief complaint and how they are dx’d.

Hemorrhagic CVA

A

Rupture of the blood vessels in the head leading to bleeding in the brain

Sever headache, change in menta status

CT Head

49
Q

Acute Trauma Dx

Describe the following disease along with their chief complaint and how they are dx’d.

Spinal Cord Injury

A

Bruise, partial tear, or complete tear of the spinal cord

Neck or back pain, bilateral extremity weakness

CT C-spine, t-spine, and/or l-spine

50
Q

Acute Trauma Dx

Describe the following disease along with their chief complaint and how they are dx’d.

Pneumothorax

A

Collasped lung

Shortness of breath, one-sided chest pain

CXR

51
Q

Acute Trauma Dx

Describe the following disease along with their chief complaint and how they are dx’d.

Internal Organ Injury (Spleen, Liver)

A

Rupture leading to hemorrhage/bleeding

Abdominal pain, abdominal distention

CT Abdomen

52
Q

Acute Trauma Dx

Describe the following disease along with their chief complaint and how they are dx’d.

Fracture

A

Trauma creates pain/swelling

Pain, swelling, bruising, use limitation

X-ray

53
Q

What should you document for a trauma case?

Three things that are pertinent

_ _ _ _ _ _ of injury

Something that increases risk of internal bleeding following a trauma.

What is the objective measure of responsiveness in the PE, ranging from 3-15. Normal GCS is 15.

Hint GCS

A

The mechanism of injury describes the trauma so healthcare providers can determine how likely it is that a serious injury has occured.

Annotating that a patient takes blood thinners could increase the risk of internal bleeding following a trauma.

The Glasgow Coma Scale

54
Q

Miscellaneous Diseases

Back Pain

Etiology
RF
CC
PE

A

Etiology - deterioration or strain of the back creates pain that is worse with movement

RF - Chronic back pain, age, physically demanding job

CC - Back pain (mostly lumbar)

PE - paraspinal tenderness, positive straight leg raise (+ SLR diagnoses sciatica; back pain radiates down the legs)

55
Q

Miscellaneous Diseases

What is the difference between abdominal aortic aneurysm (AAA) and aortic dissection?

A

An AAA is the widened/weakened arterial wall at risk of rupture while the dissection indicates separation of the muscular wall from the membrane of the artery, putting the pt at risk of aoritc rupture and death.

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