Class 2 - Diseases Flashcards
What is the physicain work up (asking the patient questions) designed to do?
It will point towards OR away from a particular differential diagnosis.
What are associated symptoms?
What are pertinent negatives?
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)
What is the foundation of Pathology? (4)
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)
What is the TRIIIIIIIPLE THREAT?!
Hyperglycaemia
Hypertension
Hyperlipidemia
Describe some of the effects of chronically high blood glucose?
- 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
Describe some of the effects of chronically high blood pressure?
- Retinopathy
- CVA
- Cardiac disease
- Renal failure
Describe some of the effects of chronically high cholesterol?
- CVA
- Cardiac Disease
- Pancreaitis due to free fatty acids in the blood can damage pancreatic cells, leading to inflammation.
Cardiovascular Diseases
Coronary Artery Disease (CAD)
Etiology:
Risk Factors:
Chief Complaint/MF:
Associated Sx:
Medications:
Dx By:
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)
What type of PMHx determines that a patient has CAD?
Angina, MI, CABG, Cardiac Stents, or angioplasty.
Cardiovascular Diseases
Myocardial Infarction (MI)
Etiology:
Risk Factors:
Chief Complaint/MF:
Associated Sx:
Medications:
Dx By:
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
What is important to document when dealing with MI or suspected MI cases?
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.
Cardiovascular Diseases
Congestive Heart Failure (CHF)
Etiology:
Risk Factors:
Associated Sx:
Medications:
Physical Exam:
Dx By:
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.
What should you do if a patient has CHF history?
Document current dosage of Lasix.
Search echocardiograms and document the cardiac output (EF or ejection fraction) and cardiac valve function)
Cardiovascular Diseases
Atrial Fibrillation (A Fib)
Etiology:
Risk Factors:
Chief Complaint:
Associated Sx
Medications
Physical Exam
Dx By
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
What is emergency department concern with Afib?
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.
Respiratory Diseases
Pulmonary Embolism (PE)
Etiology
Risk Factors
Chief Complaint
Associated Sx
Dx By (screening tool as well)
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)
What does a PE share with a DVT?
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.
Respiratory Diseases
Pneumonia (PNA)
Etiology
Cheif Complaint
Associated Sx
Medications
Physical Exam
Dx By
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)
What does it mean when community acquired pnemonia is suspected?
When multiple patients come from the same place with the same disease or malady. A hospital will generate best practice/methods to streamline treatment.
Respiratory Diseases
Chronic Obstructive Pulmonary Disease (COPD)
Etiology
Risk Factors
Chief Complaint
Associated Sx
Treatment/Meds
Physical Exam
Dx By
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.
What must a scribe document in the case of dealing with a COPD pt?
Pt’s baseline O2 requirement
Respiratory Diseases
Asthma
Etiology
Risk Factors
Chief Complaint
Associated Sx
Treatment
Physical Exam
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)
What should be documented in an asthma case in which the patient becomes hypoxic and requires supplmented oxygen or additional interventions?
The pt’s oxygen saturation
What are the two types of strokes that cause permanent brain damage and what is it known as?
Cerebrovascular Accident (CVA)
The two CVAs that cause irreversible damage:
- Ischemic CVA
- Hemorrhagic CVA
What is a “mini-stroke” that DOES NOT cause permanent brain damage referred as?
Transient Ischemic Attack (TIA)
What happens when the brain suffers an injury and what term is used to describe the effects?
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.
Neurological Diseases
Ischemic Cerebrovascular Accident (CVA)
Etiology
Risk Factors
Chief Complaint
Medications
Physical Exam
Dx By
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.
What is important to do as a scribe when encountering a possible CVA?
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
Neurological Diseases
Hemorrhagic CVA
Etiology
Risk Factors
Chief Complaint
Associated Sx
Physical Exam
Dx By
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.
Why would tPA not be indicated in the case of a Hemorrhagic CVA?
tPA is a thrombolytic meaning it is an anticoagulant which could worsen a brain bleed and instigate death.
Neurological Diseases
Transient Ischemic Attack (TIA)
Etiology
Risk Factors
Chief Complaint
Dx By
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
Why would a scribe document that tPA was considered and then not indicated for a TIA?
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)
Neurological Diseases
Meningitis
Etiology
Risk Factors
Chief Complaint
Physical Exam
Dx By
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)
Scribes document the symptoms patients have and dont have; why is this especially important with meningitis?
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.
Neurological Diseases
Altered Mental Status (AMS)
Etiology
Risk Factors
Chief Complaint
Dx By
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
Why is AMS very different compared to a FND?
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.
Neurological Diseases
Syncope (Passing out)
Etiology
Chief Complaint
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
What must a scribe document when dealing with a syncope case?
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?
Gastrointestinal Diseases
Appendicitis
Etiology
Chief Complaint
Associated Sx
Physical Exam
Dx By
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
Gastrointestinal Diseases
Cholelithiasis
Etiology
Risk Factors
Chief Complaint
Physical Exam
Dx by
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)
Where are the three abdominal quadrants located? Epigastric, Suprapubic, Perumbilicial.
Epigastric is north and under the pectorals, Periumbilical is center mass of the belly button. Suprapubic is at the groin region.
Genitourinary Diseases
Urinary Tract Infection (UTI)
Etiology
Chief Complaint
Associated Sx
Physical Exam
Dx By
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
What can happen if a UTI is left untreated?
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.
Genitourinary Diseases
Kidney Stones
Etiology
Chief Complaint
Associated Sx
PE
Dx By
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
Explain what the Costovertebral angle (CVA) is?
What are other names for Kidney Stones?
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
Genitourinary Diseases
Ectopic Pregnancy
Etiology
Risk Factors
Cheif Complaint
Dx By
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
What will any female with a positive pregnancy test recieve IF they complain of lower abdominal pain or vaginal bleeding?
They will recieve a pelvis ultrasound to rule out a possible extopic pregnancy.
Acute Trauma Dx
Describe the following disease along with their chief complaint and how they are dx’d.
Hemorrhagic CVA
Rupture of the blood vessels in the head leading to bleeding in the brain
Sever headache, change in menta status
CT Head
Acute Trauma Dx
Describe the following disease along with their chief complaint and how they are dx’d.
Spinal Cord Injury
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
Acute Trauma Dx
Describe the following disease along with their chief complaint and how they are dx’d.
Pneumothorax
Collasped lung
Shortness of breath, one-sided chest pain
CXR
Acute Trauma Dx
Describe the following disease along with their chief complaint and how they are dx’d.
Internal Organ Injury (Spleen, Liver)
Rupture leading to hemorrhage/bleeding
Abdominal pain, abdominal distention
CT Abdomen
Acute Trauma Dx
Describe the following disease along with their chief complaint and how they are dx’d.
Fracture
Trauma creates pain/swelling
Pain, swelling, bruising, use limitation
X-ray
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
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
Miscellaneous Diseases
Back Pain
Etiology
RF
CC
PE
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)
Miscellaneous Diseases
What is the difference between abdominal aortic aneurysm (AAA) and aortic dissection?
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.
