Course 2 Flashcards
pertinent positives
Specific symptoms that raise the physician’s suspicion for a particular disease.
Pertinent Negatives
Specific symptoms that are not present which cause the physician to doubt certain diagnoses.
How do physicians rule out certain diseases?
They will order a specific Objective study that can diagnose it or rule it out. Also the physical exam can rule out some diseases.
What DDx can be drawn from chest pain (the subjective complaint)?
PE, Musculor-skeletal chest pain, MI.
Risk Factors
What puts the patient at risk
Chief Complaint (CC)
Typical major sx. Want to know Timing (constant, intermittent, waxing and waning), quality (dull, sharp, pressure, cramping), what makes it better or worse.
Assoc Sx
pertinent positives; sx that raise the physician’s suspicion for the disease.
Pert. Neg
pertinent negatives; important sx that are not present.
Assoc MEd
medications related to the disease.
PE
Common physical exam findings associated with the disease.
Diagnosed by
how the disease is ruled out or diagnosed
CAD Etiology
Narrowing of the coronary arteries limits blood supply to the heart muscle causing angina.
Angina
Chest pain specifically due to heart-muscle ischemia. Sx of CAD
CAD CC
CP or chest pressure. worse with exertion, improved by rest and NTG.
CAD Assoc Med
Aspirin (ASA) 324mg PO
Nitroglycerin (NTG) 0.4mg SL
CAD diagnosed by
Cardiac catheterization ( not in the ED)
A patient has CAD if they…
Have a PMHx of Angina, MI, CABG, Cardiac stents, angioplasty.
Any patient complaining of CP should..
Receive ASA PO unless given PTA.
MI etiology
acute blockage of the coronary arteries results in ischemia and infarct of the heart muscle.
CAD catch phrase
chest pain with physical exertion.
MI Catch phrase
Chest pressure with diaphoresis, N/V, and SOB
MI Risk Factors
CAD, HTN, HLD, DM, smoker, FHx of CAD <55
MI CC
Chest pain or chest pressure
MI study
EKG (STEMI) or elevated Troponin (non-STEMI)
MI Assoc Med
ASA NTG B-blocker Thrombolytic (Heparin)
B-blocker
Reduces blood pressure by blocking epinephrine. Makes beat more slowly and less force.
CHF Etiology
The heart becomes enlarged, inefficient, and congested with excess fluid
CHF Catch phrase
SOB with pedal edema and orthopnea
CHF CC
SOB, orthopnea, PND, DOE
orthopnea
SOB worsen when lying down
PND
Paroxysmal Nocturnal Dyspnea - SOB at night
CHF PE
Rales, JVD in nec, Pitting pedal edema
CHF assoc Med
diuretics (Lasix, Furosemide) - unrinate extra fluid.
CHF study
CXR or elevated BNP
A FIb CC
Palpitations (Fast, Pounding, Irregular)
AFib risk factors
Paroxysmal A Fib, Chronic A Fib
AFib PE
Irregularly irregular rhythm, Tachycardia
AFib study
EKG
AFib Assoc Med
Coumadin (Warfarin): Blood thinner, prevents blood clots in atria. Digoxin: Slows down heart rate
pericarditis
Inflammation of the sac surrounding
the heart causing CP
Pleurisy
Inflammation of the sac surrounding
the lungs causing pleuritic CP
Costochondritis
Irritation of the ribs causing CP
worsened by pressing on the sternum
Chest Wall Pain
Irritation of the chest wall causing pain
with palpation of the chest
Pleural Effusion
Fluid collecting around the lungs causing
SOB or CP
AFib
electrical problem, irregular HR
MI
Heart attack
CHF
fluid traffic jam
CAD
Risk for MI
PE ET
A blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs
PE catch phrase
Pleuritic chest pain with tachycardia and hypoxia
PE risk factors
Known DVT, PMHx of DVT or PE, FHx, Recent surgery, Cancer, A-Fib, Immobility, Pregnancy, BCP, Smoking
PE CC
SOB or Pleuritic chest pain (CP worse with deep breaths)
PE study
CTA Chest (CT Chest w/ IV contrast) or VQ scan. D-dimer aids in detecting clots, but cannot diagnose a PE.
PNA ET
Infiltrate (bacterial infection) and inflammation inside the lung
PNA Risk Factors
Elderly, Bedridden, Recent chest injury, Recent surgery
PNA CC
SOB or Productive cough
PNA Assoc Sx
Cough with sputum, Fever, Chest pain
PNA Assoc Med
Rocephin and Zithromax (antibiotics)
PNA PE
Rhonchi
PNA study
CXR
Pneumothorax
PTX
PTX Et
Collapsed lung due to trauma or a spontaneous small rupture of the lung
PTX CC
SOB and one-sided chest pain
Sudden onset. Often trauma patients.
PTX PE
Absent breath sounds unilaterally
PTX study
CXR
COPD Et
Long-term damage to the lung’s alveoli (emphysema) along with inflammation and mucous production (chronic bronchitis)
COPD Risk factors
smoking
COPD CC
SOB
COPD PE
Decreased breath sounds, Wheezes, Rales
COPD Assoc Meds
Home O2 (Document how much O2 they use at baseline)
COPD study
CXR hx smoking
Reactive Airway Disease (RAD) Et
(asthma) Constricting of the airway due to inflammation and muscular contraction of the bronchioles, known as a “bronchospasm”
RAD CC
SOB/Wheezing
Improved by nebulizer “breathing treatments” (bronchodilators)
RAD PE
Wheezes (Inspiratory or Expiratory)
RAD Assoc med
Inhalers, Nebulizers, Corticosteroids
RAD study
clinically
I-CVA Et
Blockage of the arteries supplying blood to the brain resulting in permanent brain damage
I-CVA CC
Unilateral focal neurological deficits: One-sided weakness/numbness or changes in speech/vision
I-CVA Risk Factors
HTN, HLD, DM, hx TIA/CVA, Smoking, FHx CVA, AFIB
I-CVA PE
Neurological deficits: hemiparesis, unilateral paresthesias, aphasia, visual field deficits
I-CVA study
Clinically, Potentially normal CT Head
H-CVA ET
Traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in the brain
H-CVA CC
Headache Sudden Onset (Thunderclap, Worst of life)
H-CVA Assoc Sx
Changes in Speech, Vision, Sensation (numbness), or Motor strength (weakness), AMS, Seizure, Headache
H-CVA PE
Unilateral neurological deficits
H-CVA study
CT head or LP
TIA ET
Vascular changes temporarily deprive a part of the brain of oxygen (Symptoms usually last less than 1 hour)
TIA CC
Transient focal neurological deficit
Changes in Speech, Vision, Strength, or Sensation
TIA Study
clinically
Meningitis Et
Inflammation and infection of the meninges; the sac surrounding the brain and spinal cord
Bacterial vs. viral
Meningitis CC
Headache and neck pain.
Meningitis Assoc Sx
fever, neck pain, neck stiffness, AMS
Meningitis PE
Meningismus, Nuchal rigidity
Meningitus study
LP
Spinal cord injury Et
Injury to the spinal cord may create weakness or numbness in the extremities past the site of the injury
Spinal cord injury cc
Neck pain or Back pain, Bilateral extremity weakness
Spinal cord injury PE
Midline bony tenderness, deformities, or step-offs, Bilateral extremity weakness, Numbness, Decreased rectal tone
Spinal cord injury study
CT Cervical Spine (Neck)
CT Thoracic Spine (Upper back)
CT Lumbar Spine (Lower back)
Seizure (SZ) Et
Abnormal electrical activity in the brain leading to abnormal physical manifestations. Often caused by epilepsy, ETOH withdrawals, or febrile seizure in pediatric pts
SZ CC
Seizure activity, Syncope
SZ assoc Sx
Injuries (tongue bite), Confusion, Headache,
Incontinence (urinary or fecal)
SZ PE
Somnolent, Confused (Post-Ictal)
SZ Med
Dilantin, Tegretol, Keppra, Depakote, Neurontin
Bells Palsy Et
Inflammation or viral infection of the facial nerve causes one-sided weakness of the entire face
Bells Palsy CC
Facial Droop
Sudden Onset
Bells Palsy Assoc Sx
Jaw or ear pain, Increased tear flow of one eye
Bells Palsy Pert Neg
No extremity weakness, No changes in speech or vision.
Bell Palsy PE
Unilateral weakness of the upper and lower face
Bell Palsy Study
clinical
HA Et
Various causes including hypertensive headaches (from high blood pressure), recurrent diagnosed migraines, Sinusitis, etc.
HA CC
Headache (gradual onset)
Pressure, Throbbing
HA Pert Neg
No fever; No neck stiffness; No numbness/weakness; No changes in speech or vision
AMS Et
Multiple causes: most common are hypoglycemia, infection, intoxication, and neurological
AMS Risk Factors
Diabetic, Elderly, Demented, EtOH use, Drug use
AMS CC
Confusion, Decreased responsiveness, Unresponsive
AMS study
case dependent
syncope et
Temporary loss of blood supply to the brain resulting in loss of consciousness. There are a variety of causes; most common are vasovagal and low blood volume (dehydration/hypovolemia). Occasionally syncope occurs due to cardiac/neurologic causes.
Syncope CC
Passing-out vs. About to pass-out (near-syncope)
Vertigo et
Caused by two etiologies: the vertigo may be from a harmless problem of the inner ear (benign positional vertigo), or it may be caused due to damage in a specific center of the brain (possible CVA).
Vertigo CC
Room-spinning, Feeling off balance (disequilibrium)
Worsened with head movement
Vertigo Assoc Sx
N/V, Tinnitus (ringing in ears)
vertigo PE
Horizontal Nystagmus, + Romberg,
+ Dix-Hallpike Test
Vertigo Med
Meclizine (Antivert)
Vertigo study
Clinically
Appendicitis (APPY) et
Infection of the appendix causes inflammation and blockage, possibly leading to rupture
APPY CC
RLQ Pain
Gradual Onset • Constant
Worsened with Movement
APPY assoc Sx
Decreased appetite (anorexia), Fever, N/V
APPY PE
McBurney’s point tenderness, RLQ tenderness
APPY study
CT A/P with PO contrast
Small bowel obstruction (SBO) Et
Physical blockage of the small intestine
SBO Risk Factor
Elderly, infants, Abdominal surgery, Narcotic pain medication
SBO CC
Abdominal pain, Vomiting, Constipation
SBO assoc Sx
Abd Distension, Bloating, No BMs
SBO PE
Abdominal tenderness, Guarding, Rebound, Abnormal bowel sounds, Abdominal distension, Tympany
SBO study
CT A/P with PO Contrast
Acute Abdominal Series (AAS)
Gall stones synonyms
Cholelithiasis, cholecystitis
Gall stones et
Minerals from the liver’s bile condense to form gallstones which can irritate, inflame, or obstruct the gallbladder
Gall stones Catch phrase
RUQ abdominal pain after eating fatty foods
Gall stones CC
RUQ Pain
Sharp
Worsened with Eating, Deep breaths,
and Palpation
Gall stones PE
RUQ tenderness, Murphy’s sign
Gall stones study
Abdominal US, RUQ
GI bleed et
Hemorrhage in the upper or lower gastrointestinal tract can lead to anemia
GI CC
Hematemesis (Upper), Coffee ground emesis (Lower), Hematochezia (Lower), Melena (Upper)
GI Bleed Assoc Sx
Generalized weakness, lightheadedness, SOB, abdominal pain, rectal pain
GI Bleed PE
Pale conjunctiva, Pallor, Tachycardia
Rectal Exam: Melena, Grossly bloody stool
GI Bleed study
Heme positive stool (Guaiac positive) during a rectal exam
Diverticulitis Et
Acute inflammation and infection of abnormal pockets of the large intestine, known as diverticuli
Diverticulitis Risk factors
Diverticulosis, advanced age
Diverticulitis CC
LLQ pain
Diverticulitis Assoc Sx
Nausea, fever, diahrea
Diverticulitis study
CT A/P with PO contrast
pancreatitis Et
Inflammation of the pancreas
Pancreatitis Risk factors
EtOH abuse, Cholecystitis, specific medications
Pancreatitis CC
LUQ, Epigastric pain
Pancreatitis Assoc Sx
N/V
Pancreatitis PE
Epigastric tenderness
Pancreatitis Study
Elevated Lipase lab test (or sometimes elevated Amylase)
GERD et
Stomach acid regurgitating into the esophagus
GERD CC
Epigastric Pain
Burning • Improved with Antacids
GERD PE
Epigastric tenderness
GERD Assoc Med
GI Cocktail (numbs and soothes the esophagus and stomach)
C. Diff Colitis
opportunistic bacteria that causes persistent diarrhea
Gastroenteritis
V/D. viral or bacteril
Crohn’s disease
immune disorder causing diarrhea and abd pain
IBS
Chronically sensitive bowels prone to diarrhea
Gastritis
Irritated stomach with vomiting; stomach ache
UTI Et
Infection in the urinary tract, bladder or urethra
UTI CC
Dysuria
UTI Assoc Sx
frequency, urgency, malodorous urine, AMS (elderly)
UTI study
Urine drip or urinalysis
Pyelo Et
Infection of the tissue in the kidney, usually spread from a UTI
Pyelo Risk factors
Female, frequent UTI
Pyelo CC
Flank pain with dysuria
Pyelo Assoc Sx
Fever, N/V
Pyelo PE
Costo-vertebral Angle (CVA) tenderness
Pyelo Study
CT abd/Pel without contrast or Confirmed tenderness
Kidney stone names
Renal calculi, Nephrolithiasis, urolithiasis
Kidney stones Et
A kidney stone dislodges from the kidney and begins traveling down the ureter. The stone scrapes and irritates the ureter, causing severe flank pain and bloody urine.
Kidney stone CC
Flank pain, sudden, radiating to groin
Kidney stone ASsoc Sx
Hematuria, N/V, Unable to void
Kidney stone PE
CVA tenderness
Kidney stone study
CT Abd/Pelvis . RBC in UA can be clue.
ectopic pregnancy et
fertilized egg develops outside the uterus, usually in the fallopian tube. High risk for rupture and death
Ectopic pregn Risk factors
pregnant female (HCG positive), STD (PID)
Ectopic pregn CC
Lower Abd pain or vaginal bleeding while pregnant.
Ectopic Pregn Study
US Pelvis
Ovarian Torsion et
Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in infarct of ovare
Ovarian torsian CC
Lower abd pain (RLQ or LLQ)
Ovarian Torsion PE
Adnexal tenderness (Right or left). Tenderness in RLQ or LLQ
Ovarian Torsion study
US pelvis .
Testicular torsion et
Twisting of the spermatic cord resulting in loss of blood flow and nerve function to the testicle
Testicular torsion CC
Testicular pain
Testicular torsion PE
Testicular tenderness and swelling (right or left)
Testicular torsion study
US scrotum
URI et
Most often viral infection causes congestion, cough, and inflammation of the upper airway
URI CC
cough/congestion
URI Assoc Sx
Fever, sor throat, HA, Myalgias
URI PE
Rhinorrhea, boggy turbinates, pharyngeal Erythema.
URI Study
clinically
Otitis Media is
Middle ear infection
Otitis Media Et
Viral or bacterial infection of the tympanic membrane (TM) causing ear pain and pressure
Otitis Media CC
Ear pain, ear pulling
Otitis Assoc Sx
Fever, sore throat, dry cough, congestion
Otitis Media PE
Erythema, Effusion, Dullness, or Bulging of the Tympanic Membrane (TM)
Otitis study
Clinically
Strep throat is
streptococcal pharyngitis
Strep Et
bacterial infection of the tonsils and pharynx causing a sore throat and frequently swollen lymph nodes
Strep CC
sore throat
Strep PE
Pharyngeal Erythema Tonsillar hypertrophy(enlargement) tonsillar exudates (pus)
Strep Study
Rapid strep
Conjunctivitis is
Pink eye
Pink eye Et
infection of the outer lining of the eye, know as the conjunctiva
Pink eye CC
eye redness, irritation, or pain
Pink eye Assoc Sx
Eyelid matting, eye discharge, fever
Pink eye PE
Conjunctival injection (redness), edema, and exudates
Pink eye study
Clinically
Epistaxis
Rupture of a blood vessel inside the nose causes blood to flow out the nose and into the throat.
Epistaxis CC
nose bleed
Epistaxis Risk factors
Blood thinners (coumadin/warfarin, ASA, Plavix) or HTN
Epistaxis PE
Anterior, posterior, or septal source of bleeding
Epistaxis Study
Clinically
Musculoskeletal back pain et
deterioation or strain of the back creates pain that is worse with movement
Back pain CC
Back pain, commonly lumbar
Back pain Assoc Sx
Shooting posterior lower extremity pain.
Pert negs of back pain
no LE weakness, no incontinence .
Back pain PE
Paraspinal tenderness, Positive Straight Leg Raise (+ SLR diagnoses Sciatica; back pain that radiates down the legs)
extremity injury et
trauma creates pain/swelling in an extremity
Extremity injury CC
Extremity pain
Extremity injury Assoc Sx
Swelling, bruising, deformity, use limitation
Extremity injury Pert Neg
no motor weakness. no numbness or tingling
Extremity injury PE
Distal CSMT intact (Circulation, Sensory, Motor, Tendon)
No tendon or ligament laxity
ROM limited secondary to pain
AAA et
Widened and weakened arterial wall at risk of rupture
AAA CC
Midline Abdominal Pain
AA PE
Midline pulsatile abdominal mass, Abdominal bruit, Unequal femoral pulses, Hypotension
AAA study
CT A/P with IV contrast dye
Aortic Dissection et
Separation of the muscular wall from the membrane of the artery, putting the pt at risk of aortic rupture and death
Aortic Dissection CC
Chest pain radiating to the back
Ripping or Tearing
Aortic Dissection PE
Unequal brachial or radial pulses, Hypotension
Aortic Dissection Study
CT Chest with IV contrast dye
DVT et
Blood slows down while flowing through long straight veins in the extremities; slow-flowing blood is more likely to clot. Once formed the clot can continue to grow and eventually occlude (block) the vein.
DVT risk factors
PMHx of DVT or PE, FHx, Recent Surgery, Cancer, Immobility, Pregnancy, BCP, Smoking, LE Trauma, LE Casts
DVT CC
Extremity Pain and Swelling (Atraumatic)
Usually located in a lower extremity
DVT PE
Calf tenderness, Cords, Homan’s sign
DVT study
US/Doppler of the extremity
Cellulitis Et
Infection of the skin cells
Cellulitis CC
Red, swollen, painful, and sometimes warm area of skin
Cellulitis PE
Erythema, Edema, Increased warmth (calor), Induration
Cellulitis Assoc Med
Abx
Cellulitis Study
Clinically
Abscess is
cellulitis is flunctuance
Abscess Et
Skin Infection with an underlying collection of pus
Abscess CC
Red, Swollen, and Painful lump
Abscess PE
Fluctuance (pus-pocket), Induration, Purulent drainage (pus-like)
Abscess Study
Clinically
Rash Et
Changes in the skin’s appearance due to systemic or localized reaction. May be caused from medication, virus, bacteria, fungus, insect, etc.
Rash CC
Rash
Red, Itchy (pruritic) or Painful
Rash PE
Urticaria (Hives or wheals), Macules (flat), Papules (raised bumps), Vesicles (small blisters), Blanching (not dangerous), Petechaie (dangerous rash), Purpura (dangerous rash)
Rash Study
Cllinically
Allergic reaction et
Immune response causing an inflammatory reaction consisting of swelling, itching (pruritis), and rash
Allergy Risk factors
Know drug or food allergy
Allergy CC
Rash, Swelling, Itching, or SOB
Allergy PE
Edema, Facial Angioedema, Urticaria (Hives, Wheals)
Allergy study
clinically
Adverse reaction
N/V, Abd Pain, Diarrhea, Dizzinis
DKA Et
Shortage of insulin resulting in hyperglycemia and production of ketones
DKA Risk
Diabetes Mellitus (DM)
DKA CC
Persistan vomiting with a hx of DM
DKA Assoc Sx
SOB, polydipsia (increased thirst), polyuria (increased urination)
DKA PE
Ketotic odor “fruity”, Dry Mucous Membranes (Dehydration), Tachypnea
DKA study
Arterial Blood Gas (ABG or VBG) showing low pH (acidosis) or Positive Serum ketones
Psychological disorder Et
Various types of psychological disease produce abnormal thoughts, behaviors, or actions
Psych PMHx
Bipolar Disorder, Schizophrenia, PTSD, Depression, Anxiety, Alcoholism, Drug Abuse, Suicide Attempt
Psych CC
Suicidal Ideation (SI), Homicidal Ideation (HI), Hallucinations (Auditory or Visual), Substance abuse, Self injury, Overdose
Psych PE
Flat affect, SI, HI, Tangential or Pressured speech
Trauma is
physical injury
Trauma et
Depending on the Mechanism of Injury (MOI) physical trauma may break bones, sever nerves, rupture blood vessels, or damage internal organs
Trauma CC
Motor Vehicle Accident (MVA), Fall, Gun Shot Wound (GSW)
Trauma PE
Glasgow Coma Scale (GCS)
Trauma Assoc MEd
Blood thinners? (Coumadin, ASA, or Plavix)
Trauma Study
Trauma Protocol depending on MOI:
CT or XR
Trauma MOI et
Refers to the way damage to skin, muscles, organs, and bones happen.
Healthcare providers use MOI to determine how likely it is that a serious injury has occurred
Trauma MOI Rapid Forward Deceleration, “Motor Vehicle Collision”
Head-On Collision (Windshield starring, airbag deployment)
T-Bone Collision
Rear-Impact Collision
Rollover Collision
Victim Ejected From Vehicle (Spinal cord injury, head injury)
Motorcycle/ ATV Crash (Helmets)
Auto vs. Pedestrian
Trauma MOI Rapid Vertical Deceleration, “Falls”
Dependent upon distance body part impacted landing surface and type of landing surface
Severe: Greater than 3x the height of patient or > 20 feet
MOI penetrating trauma
Stab wounds: Location, blade length, angle of penetration
Firearms: Type of weapon, caliber, distance, bullet deformity
DDx
A short list of diseases the doctor considers when diagnosing a patient
Risk factors
“Red flags” that would put a patient at risk for that particular disease
Etiology
The study of the causes of diseases
Pleura
Membrane lining the thoracic cavity (parietal pleura) and covering the lungs (visceral pleura)
Artery
A blood vessel that carries oxygenated blood from the heart throughout the body
Vein
A tube that carries blood to the heart from the cells, tissues, and organs of the body
GERD study
endoscopy
