Course 2 Flashcards
1
Q
Differential DX
A
The diseases being considered as the true source of your symptoms
2
Q
Pertinent positives
A
Specific symptoms that raise the physicians suspicion for a particular disease
3
Q
Pertinent negatives
A
Specific symptoms that are not present which cause the physician to doubt certain diagnoses
4
Q
Etiology
A
The physiological process causing the symptoms
5
Q
Risk factors
A
What puts the pts at risk
6
Q
CC
A
The typical major symptom
7
Q
What are the different types of timing?
A
Constant/ intermittent/ waxing and waning
8
Q
Pericarditis:
A
inflammation of the sac surrounding the heart causing CP
9
Q
Pleurisy:
A
inflammation of the sac surrounding the lungs causing pleuritic CP
10
Q
Costochondritis:
A
irritation of the ribs causing CP worsened by pressing on the sternum
11
Q
Chest Wall Pain:
A
irritation of the chest was causing pain with palpation of the chest
12
Q
Pleural Effusion:
A
Fluid collecting around the lungs causing SOB or CP
13
Q
What is the etiology of AFib?
A
Electrical abnormalities in the “wiring” of the heart causes the top of the heart to quiver abnormally
14
Q
What is the CC of AFib?
A
Palpitations that are irregularly irregular
15
Q
What are the risk factors of AFib?
A
Paroxysmal A Fib, Chronic A FIb
16
Q
What should the PE show with AFib?
A
Tachycardia and irregular irregular rhythm
17
Q
How is AFib diagnosed?
A
EKG
18
Q
What are the associated medications of Afib and what are they used for?
A
Coumadin (Warfarin) which is a blood thinner. Digoxin which slows down the heart rate.
19
Q
What is RVR?
A
rapid ventricular response
20
Q
What is NSR?
A
Normal sinus rhythm
21
Q
Cardioverted:
A
Put back into regular rhythm
22
Q
What is the scribe alert of A Fib?
A
RVR
23
Q
What is CHF?
A
The heart becomes enlarged, inefficient, and congested with excess fluid
24
Q
What is the catch phrase of CHF?
A
SOB with pedal edema and orthopnea
25
What is the CC of CHF?
SOB
26
Orthopnea
Worse when lying flat
27
PND and DOE are associated with CHF. What are PND and DOE?
PND- paroxysmal nocturnal dyspnea
| DOE- dyspnea on exertion
28
What is the predicted findings of a PE of someone with CHF?
Rales, JVD, pitting pedal edema
29
What are the assoc. med.?
Diuretics (Lasix, Furosemide)
30
How is CHF diagnosed?
CXR or elevated BNP
31
What is BNP?
B-type Natriuretic Peptide
32
A “heart traffic jam”
CHF
33
What’s an MI?
An Acute blockage of the coronary artery resulting in ischemia and infarct of the heart muscle
34
What is the catch phrase of MI?
Chest pressure with diaphoresis, N/V, and SOB
35
What are the risk factors of MI?
CAD, HTN, HLD, DM, Smoker, FHx of CAD <55 y/o
36
What are the CC of MI?
Chest pain/pressure
37
What are the two types of MI? How do we diagnose each?
STEMI- EKG
| Non-STEMI- troponin
38
ASA, NTG, Thombolytic (Activase), and Anti-COAG (Heparin) are all medications associated with what?
MI
39
Acute MI pt must receive _______ _______ mg ASAP
ASA 324
40
What is CAD? Etiology?
Coronary artery disease, which is the narrowing or coronary arteries which limits blood supply to the heart muscle causing angina
41
Angina
Chest pain specifically due to heart-muscle ischemia
42
What is the CC of CAD?
CP worsened with extortion and improved with rest or NTG
43
What are the associated medications of CAD?
ASA and NTG
44
What does ASA and NTG stand for?
ASA- Aspirin
| NTG- Nitroglycerin
45
How is CAD diagnosed?
Cardiac catheterization
46
_________ is the greatest risk factor for MI
CAD
47
PMHx of MI, CABG, cardiac stents, or angioplasty means that the pt has _________
CAD
48
What is angina? What is it diagnosed by?
Angina is a symptom of CAD and it is diagnosed by CP upon exertion with Hx of CAD
49
What is Asthma or Reactive Airway Disease?
Contracting of the airway due to inflammation and muscular contraction of the bronchioles known as “broncospasm”
50
What is the CC is asthma?
SOB/wheezing
51
PE of asthma?
Wheezing
52
What are the assoc. meds. Of inhalers, nebulizers, and corticosteroids treating?
asthma
53
How is asthma diagnosed?
Clinically
54
What is the COPD?
Long term damage to the lungs alveoli (emphysema) along with inflammation and mucus production (chronic bronchitis)
55
What is the largest risk factor for COPD?
Smoking
56
What is the CC of COPD?
SOB
57
What is the PE of COPD? (3)
Decreased breath sounds, wheezes, and rales
58
What are the assoc. meds of COPD?
Home O2 (make sure to document how much o2 they use at baseline)
59
How is COPD diagnosed?
CXR and history of smoking
60
What is PTX?
A collapsed lung due to trauma or a spontaneous small rupture of the lung.
61
CC of PTX?
SOB and one-sided CP
62
What is a PTX diagnosed by?
CXR
63
What is the scribe alert of PTX?
To document the amount of the lung (%) collapsed, also note that a chest tube will be placed
64
What is PNA? Etiology?
Pneumonia is which a infiltrate causes inflammation inside the lungs
65
Infiltrate
Bacterial infection
66
What is the catch phrase of someone who has PNA?
Productive cough and fever
67
Who are at risk for PNA?
People with compromised immune systems; old people, bedridden, kids, or peeps with recent chest injuries
68
What is the CC of PNA?
SOB and productive cough
69
What are the associated med. for PNA?
Rocephin and Zithromax (antibiotics)
70
PNA PE?
Rhonchi
71
How do you diagnose PNA?
CXR
72
CAP
Community acquired pneumonia
73
What is the etiology of a PE?
A blood clot that is lodged in the pulmonary artery and blocks blood supply to the lungs
74
What is the catch phrase of PE?
Pleuritic chest pain with tachycardia and hypoxia
75
What are risk factors of a PE?
DVT, recent surgery, cancer, A Fib, Immobility, Pregnancy, and BCP, and smoking
76
CC of PE?
SOB and pleuritic CP
77
PE diagnosis?
```
CTA chest (with contrast)
VQ Scan
```
78
What is a D-Dimer and what is its sig in PE?
D-Dimer is a way to tell if there is a blood clot somewhere in your body. Good- you know for sure yes/no if there a blood clot
Bad- bc doesn’t tell you where
79
What is the etiology vertigo? What are the two kinds?
Spinning due to inner ear problem (benign positional vertigo) or it is stemming from your brain being dumb (possible CVA)
80
2 assoc. Sx. Of vertigo?
tinnitus, N/V
81
CC of vertigo?
Dizziness, disequilibrium, worsened with head movement
82
PE vertigo?
Horizontal nystagmus and Romberg’s.
83
Horizontal nystagmus:
Eyes move back and forth
84
Romberg test?
Have pt stand and watch how they compensate physically for mental dizziness
85
Syncope? Etiology?
Passing out and fainting. Temp loss of blood supply to brain resulting in LOC. Common reasons are vasovagal and hypovolemia.
86
Vasovagal
Dehydration
87
Hypovolemia
Loss/low blood supply
88
What is the scribe alert of syncope?
Make sure to document what happened prior, during, and after and how the pt currently feels
89
What is the difference between AMS and FND?
AMS is the brain-wide
| FND are localized weakness that are directly related to one point in the brain
90
What is the buogie name for headache?
Cephaligia
91
What are the pertinent negatives to a HA?
Fever and neck pain - meningitis
| No numbness or change in vision/speech- CVA
92
Bells Palsy etiology.
Inflammation of the facial nerve causing ONE sided weakness of the entire face
93
What is the CC of Bells Palsy?
Sudden onset facial droop
94
Assoc Sx of Bell’s Palsy? (2)
Jaw or ear pain
| Increased tear flow to one eye
95
Pert. - to Bell’s Palsy?
Unilateral extremity weakness
Changes in focal abilities
Aphasia
(Stroke! CVA!)
96
Dx. Of Bell’s Palsy?
Clinical
97
Postictal
The postictal state is the altered state of consciousness after an epileptic seizure
98
What are the main 2 seizure medications?
Keppra
| Depakote
99
What is the etiology of a spinal cord injury?
Injury to the spinal cord can cause weakness or numbness in the extremities past the site of injury
100
“Neck spine”
Cervical spine
101
“Upper back spine”
Thoracic spine
102
“Lower back spine”
Lumbar spine
103
Meninges
The sac surrounding the brain and spinal cord
104
How do you Dx meningitis?
LP
105
LP
Lumbar puncture
106
How many LP will you take?
4, because the first 2 are almost always contaminated
107
“Brain Bleed”
Hemorrhagic Cerebrovascular Accident
108
What is the etiology of a brain bleed?
Traumatic or spontaneous rupture of the blood vessels in your head which leads to bleeding in the brain
109
What is the CC of someone with a hemorrhagic CVA?
Thunderclap headache!
110
PE of CVA?
Unilateral neurological deficits
111
How do we Dx CVA?
Lumbar puncture
| CT head
112
In a hemorrhagic CVA will they give troponin?
No, document as such
113
TIA etiology?
Vascular changes temporarily deprive the brain of O2 (symptoms last an hourish)
114
CC of TIA
Transient focal neurological deficit
115
How do you diagnose TIA?
Clinically
116
Is TPA given in TIA?
No
117
What is an ischemic cerebrovascular accident?
Blockage of arteries supplying blood to the brain resulting in permanent brain damage
118
What are the risk factors of CVA? (8)
HTN, HLD, DM, Hx TIA/CVA, Smoking, FHX CVA, and A Fib
119
WTF is tPA?
TPA is a drug used to lyse blood clots AKA thrombolytic
120
There are 2 reasons you can’t use a thrombolytic in CVA instances what are they?
1. Onset greater than 3 hours/ don’t how long
| 2. Symptoms are rapidly improving
121
GERD = what quadrant?
Epigastic
122
MI = what Abd quadrant?
Epigastric
123
Cholecystitis/cholethiasis = what quadrant?
RUQ
124
Pancreatitis = what quadrant?
LUQ
125
SBO = what quadrant?
Periumbilical
126
Appendicitis
RLQ
127
Diverticulitis
LLQ
128
Ovarian torsion, Ovarian cist, UTI = what quadrant?
Suprapubic
129
Pyelonephritis = what quadrant?
Flanks
130
Renal Calculi = what quadrant?
Flanks
131
APPY
appendicitis
132
CC of APPY
RLQ pain, gradual onset, constant, worse with movement
133
Assoc. sx of APPY (3)
Fever, anorexia, and N/V
134
PE of APPY
McBurney’s Point Tenderness and RLQ tenderness
135
DX of APPY
CT A/P with PO contrast
136
SBO etiology
Physical blockage of the small intestine
137
Risk factor SBO (4)
Elderly, infants, ab surgery, and narcotic pain med
138
CC SBO (3)
Abd pain, vomiting, constipation
139
PE SBO (6)
```
Abdominal tenderness
Guarding
Rebound
Abnormal bowel sounds
Abdominal distention
Tympany
```
140
Tympany
Swelling of abdomen with gas and air
141
SBO Dx
CT A/P with PO contrast
| AAS (Acura abdominal series)
142
AAS
Acute abdominal series
143
“Gallstones”
Cholelithiasis and Cholecystitis
144
Etiology Cholelithiasis
Minerals from the liver’s bile condense to form gallstones which can irritate, inflame, or obstruct the gallbladder
145
CC Cholelithiasis
RUQ pain, sharp, worsened with eating, deep breaths, and palpation
146
PE Cholelithiasis
RUQ tenderness, Murphy’s signs
147
Cholelithiasis Dx
Abdominal US, RUQ
148
GI Bleed Etiology
Hemorrhage in the upper or lower GI tract can lead to anemia
149
CC of GI Bleed (4)
Hematemesis
Coffee ground emesis
Hematochezia
Melena
150
Hematochezia
Bright lower bleed
151
Hematemesis
Bright blood, upper Bleed
152
Coffee ground emesis
Dark, lower Bleed
153
What are the assoc sx of a GI bleed (5)
```
Weakness
Lightheadedness
SOB
Abdominal pain
Rectal pain
```
154
PE of GI (3), rectal exam (1)
PE: Pale conjunctiva, pallor, and tachycardia
Rectal Exam: Melena, grossly bloody stool
155
GI Bleed Dx
Guaiac positive- heme positive stool
156
Diverticulitis etiology
Acute inflammation and infection of abnormal pockets of the large intestine, known as diverticula
157
Risk factor diverticulitis
Diverticulosis, advanced age
158
CC diverticulitis
LLQ pain
159
Assoc sx diverticulitis (3)
Nausea, fever, diarrhea
160
What is the Dx for diverticulitis
CT A/P with PO contrast
161
Pancreatitis etiology
Inflammation of the pancreas
162
Risk factors for pancreatitis (3)
1. EtOH abuse
2. Cholecystitis
3. Specific medications
163
CC of pancreatitis
LUQ, epigastric pain
164
Assoc sx pancreatitis
N/V
165
PE pancreatitis
LUQ tenderness, epigastric tenderness
166
Pancreatitis Dx by
Elevated lipase lab test (or sometimes elevated amylase)
167
GERD etiology
Stomach acid regurgitating into the esophagus
168
GERD CC
Epigastric pain that is burning and improved with antacids
169
PE of GERD
Epigastric tenderness
170
Assoc meds GERD
GI cocktail (numbs and soothes esophagus and stomach)
171
Scribe alert! Of GERD?
Due to the proximity of the stomach to the heart, pt with cardiac risk factors, and epigastric pain will always get a cardiac workup
172
Gastroenteritis
Vomiting and diarrhea; GI bug often viral or bacterial
173
Gastritis
Irritated stomach with vomiting “stomach ache”
174
Urinary tract infection (UTI) risk factors?
Female
175
UTI CC
Dysuria
176
Assoc sx UTI
Frequency, urgency, malodorous urine, AMS (elderly)
177
PE UTI
Suprapubic tenderness
178
UTI dx
Urine dip or urinalysis
179
UTI can move to the kidney and start ________________
Pyelonephritis
180
Kidney stone (nephrolithiasis, renal Calculi, ureterolithiasis) etiology
A kidney stone dislodges from the kidney the begins traveling down the ureter. The stone scrapes and irritates the ureter, causing sever flank pain and bloody urine
181
CC kidney stone
Flank pain that is sudden onset and radiating to groin
182
Kidney Stone exams what?
CVA tenderness
183
Kidney stone dx by
CT abd/pelvis and RBC in UA may be a clue
184
Ectopic pregnancy etiology
Fert egg outside the uterus
185
Risk factor ectopic pregnancy
Pregnant female (HCG positive), STD
186
Dx ectopic pregnancy
US pelvis
187
Testicular torsion etiology
Twisting of the spermatic cord resulting in loss of blood flow and nerve function to the testicle
188
CC testicular torsion
Testicular pain
189
PE testicular torsion
Testicular tenderness and swelling (left or right)
190
testicular torsion dx by
US scrotum
191
Ovarian torsion etiology
Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in infarct of the ovary
192
Ovarian torsion CC
lower abdominal pain (RLQ and LLQ)
193
PE ovarian torsion
```
Adnexal tenderness (right or left)
Tenderness in the RLQ or LLQ
```
194
Ovarian torsion dx by
US pelvis assesses blood flow to ovaries
195
UTI dx by
Urinalysis (WBC, Nitrite, or Bacteria)
196
Pyelo dx by
CT abdomen/pelvis (A/P)
| UTI with CVA tenderness on exam
197
Kidney stone
CT A/P (RBC in UA may be clue)
198
Ectopic pregnancy dx by
US pelvis
199
Ovarian torsion Dx by
US pelvis
200
testicular torsion dx by
US pelvis
201
Sepsis etiology
Happens when the chemicals in the immune system that release into the bloodstream to fight an infection cause inflammation throughout the entire body instead
202
Severe cases of sepsis can lead to _______ _________
Septic shock
203
Aortic dissection etiology
Caused by separation of the muscular wall from the membrane of the artery
204
What are the risk of aortic dissection
Aortic rupture and death
205
Often the CC aortic dissection
chest/abdominal pain radiating to the back or ripping/tear pain
206
PE aortic dissection
Unequal brachial or radial pulses and hypotension
207
Diagnosis for aortic dissection
CT chest A/P with IV contrast dye
208
DVT etiology
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 the vein.
209
Risk factors for DVT
PMHx of DVT or PE, FHx, Recent surgery, cancer
210
CC of DVT
Extremity pain and swelling (atraumatic) that is usually unilateral and located in a lower extremity
211
PE of DVT
Calf tenderness, palpable cords, and Homan’s sign
212
Dx of DVT
US/Doppler of the extremity
213
Abdominal Aortic Aneurysm (AAA) etiology
Widened and weakened arterial wall at risk of rupture
214
AAA
Abdominal Aortic Aneurysm
215
AAA CC
Midline abdominal pain
216
PE AAA (4)
Midline pulsatile Abdominal mass
Abdominal bruit
Unequal femoral pulses
Hypotension
217
Streptococcal Pharyngitis (Strep throat) etiology
a bacterial infection of the tonsils and pharynx causing sore throat and often swollen lymph nodes
218
What is the CC of strep throat
Sore throat
219
PE of strep throat (3)
Pharyngeal erythema
Tonsillar hypertrophy
Tonsillar exudates
220
Tonsillar hypertrophy
Enlargement
221
Tonsillar exudates
Pus
222
Dx of strep
Rapid strep test
223
PTA
Peritonsillar abscess
224
What are the signs of PTA
Uvular shift
| Tonsillar asymmetry
225
Ottis media etiology
Infection of the TM causing ear pain and pressure
226
CC of Ottis media
is usually ear pain and pulling
227
Assoc sx of Ottis media (4)
Fever
Congestion
Sore throat
Dry throat
228
PE Ottis media
Erythema
Effusion
Dullness
Bulging of the TM
229
Erythema
Skin redness
230
Effusion
Giving some liquid/smell/etc
231
Dx Ottis media
Clinically
232
URI
Upper respiratory infection
233
URI etiology
Infection of the upper airway
234
CC URI
Cough and congestion
235
Assoc sx URI (4)
Fever
Sore throat
Caphalgia
Erythema
236
URI dx
Clinical
237
Which pertinent positives could indicate something more in a URI pt?
CP, SOB = MI or PE
238
Extremity injury etiology
Caused by trauma that creates pain and swelling in an extremity
239
CC extremity injury
Extremity pain
240
Assoc sx of extremity pain (4)
Swelling
Bruising
Deformity
Limited ROM
241
Pertinent negatives of a extremity injury
No motor weakness, numbness, or tingling
242
PE of extremity injury should show (6)
```
CSMT intact
No tendon or ligament laxity
ROM limited secondary to pain
Tenderness
Edema
Ecchymosis
```
243
What is the scribe note of a extremity injury?
Record splint application procedure
244
CSMT
Circulation, sensory, motor, and tendon
245
What are the pertinent negatives of general musculoskeletal back pain?
LE weakness
| Incontinence
246
In a general musculoskeletal back pain a +SLR diagnoses: _________?
Siatica
247
What is the fancy name for hives?
Urticaria
248
What is the fancy name for itchy
Pruritic
249
An abscess can also be known as cellulitis with _______
Fluctuance
250
Etiology of Abscess
A skin infection with an underlying collection of pus
251
CC of an abscess
A red, swollen, and painful lump
252
Fluctuance
Pus pocket
253
What is the treatment of the abscess?
I&D
254
Cellulitis etiology
Infection of the skin cells
255
Cellulitis CC
Red, swollen, painful, and sometimes warm area of skin
256
Cellulitis PE
Show erythema, edema, increased warmth (calor), and induration
257
Calor
Increased warmth
258
Assoc med of cellulitis
Abx
259
Dx of cellulitis
Clinically
260
DKA
Diabetic Keto-Acidosis
261
DKA etiology
Caused by shortage of insulin resulting in hyperglycemia and production of ketones
262
Risk factors for DKA
Diabetic peeps (spec type I)
263
DKA CC
Persistent vomiting and hx of DM
264
Assoc sx DKA (3)
Polydipsia
Polyuria
SOB
265
Polydipsia
Increased thirst
266
Polyuria
Increased urination
267
PE DKA (3)
Ketotic odor
Dehydration (dry mucous membranes)
Tachypnea
268
DKA dx
ABG
VBG
Which shows acidosis and positive serum ketones
269
ABG
Arterial blood gas
270
VBG
Venous blood gas
271
Acidosis
Low pH in the blood
272
MOI
Mechanism of injury
273
What are the 3 kinds of MOI
Rapid forward deceleration
Rapid vertical deceleration
Penetrating trauma
274
“Rapid forward deceleration”
MVC
| Need to note the details of collision
275
“Rapid vertical deceleration”
Fall
| * only a bad fall if 3x the height of the person/ 20 ft
276
PE of a trauma should include (1)
GCS
277
GCS
Glasgow coma scale
278
What is the main job of the ED in a psych pt?
Medically clear them to psych
