Course 2: Pathophysiology Flashcards
Pertinent negatives
Specific symptoms that are not present which cause the physician to doubt certain diagnoses
What will the physician do if he or she has suspicion about a certain disease?
Order the specific objective study that can diagnose it or rule it out
Etiology
The physiological process causing the symptoms
Etiology of CAD
Narrowing of the coronary arteries limits blood supply to the heart muscle causing angina
Angina
Chest pain specifically due to heart-muscle ischemia
Symptoms of CAD
- Chest pain or chest pressure
* worse with exertion but improved by rest or nitroglycerin (NTG)
Associated meds of CAD
Aspirin (ASA) 324mg PO
Nitroglycerin (NTG) 0.4 mg SL
CAD diagnosed by
Cardiac catheterization (Not diagnosed in the ED) or stress test which can assess the severity of CAD
What is the single greatest risk for an MI?
CAD
What PMHx can a patient have to be diagnosed with CAD?
Angina, MI, CABG, Cardiac stents or angioplasty
What is the function of aspirin?
Blood thinner that reduces the clumping action of platelets, possibly preventing a heart attack
Etiology of MI
Acute blockage of the coronary arteries results in ischemia and infarct of the heart muscle
Symptoms of MI
Chest pressure or chest pain with diaphoresis, N/V and SOB
Diaphoresis
Sweating, especially to an unusual degree as a symptom of disease or a side effect of a drug
Risk factors of MI
CAD, HTN, HLD, DM, Smoker, FHx of CAD
MI is diagnosed by
EKG (STEMI) or elevated Troponin (non-STEMI)
Associated meds of MI
ASA, NTG, B-Blocker, Thromboytic (Heparin)
In what amount of time must STEMI patients must get to the Cath-lab upon arrival?
90 minutes (document ED arrival and depart times)
STEMI
STEMI: transmittal infarction of the myocardium (the entire thickness of the myocardium has undergone necrosis), resulting in ST elevation. Usually due to a complete block of a coronary artery (occlusive thrombus)
NSTEMI
Partial dynamic block to coronary arteries (non-occlusive thrombus)
Etiology of CHF
The heart becomes enlarged, inefficient, and congested with excess fluid
Symptoms of CHF
SOB •worse with lying flat (Orthopnea) •paroxysmal nocturnal dyspnea (PND) •pedal edema •Dyspnea on exertion (DOE)
PE of CHF
Rales (crackles) in lungs, Jugular Vein distension (JVD) in neck, putting pedal edema
Associated meds of CHF
Diuretics (Lasix, Furosemide) which leads to the pt urinating extra fluid
CHF is diagnosed by
CXR or elevated BNP
Etiology of AFIB
Electrical abnormalities in the “wiring” of the heart causes the top of the heart (atria) to quiver abnormally
Symptoms of AFIB
Palpitations (fast, pounding, irregular)
PE of AFIB
Irregularly irregular rhythm, tachycardia
AFIB is diagnosed by
EKG
Associated meds of AFIB
Coumadin (warfarin): blood thinner, prevents blood clots in atria. Digoxin: slows down and helps regulate heart rate
What is the ED concern for AFIB?
Rapid ventricular response (RVR) patients will often be cardioverted
Cardioversion
To be put back into a normal sinus rhythm (NSR) with electricity or drugs
Non-cardiac chest pain
(Add later)
Etiology of PE
A blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs
Symptoms of PE
Pleuritic chest pain with tachycardia and hypoxia and SOB. CP worse w/ deep breaths
Risk factors of PE
Known DVT, PMHx of DVT or PE, FHx, recent surgery, cancer, A-Fib, immobility, pregnancy, birth control pills (BCP), smoking
PE is diagnosed by
CTA Chest, VQ scan
•D-dimer AIDS in detecting clots but cannot diagnose PE
Etiology of PNA
Infiltrate (bacterial infection) and inflammation inside the lung
Symptoms of PNA
Productive cough, fever, SOB
•Assoc. Sx: cough with sputum, fever, chest pain
PNA is diagnosed by
CXR
What is the core measure for PNA?
Community acquired pneumonia (CAP) protocol requires documenting antibiotics (Abx), vital signs, SaO2, mental status, and blood cultures
Etiology of Pneumothorax (PTX)
Collapsed lung due to trauma or a spontaneous small rupture of the lung
Symptoms of PTX
SOB and one-sided chest pain
•sudden onset
•often trauma patients
PE of PTX
Absent breath sounds unilaterally
PTX is diagnosed by
CXR
What should you document a patient with PTX?
The percentage of lung collapsed. Pt will have a chest tube placed to reinflate the lung
Etiology of COPD
Long-term damage to the lung’s alveoli (emphysema) along with inflammation and mucous production (chronic bronchitis)
COPD is commonly diagnosed in…
Smokers
Symptoms of COPD
SOB
PE of COPD
Decreased breath sounds, wheezes, rales
Associated meds of COPD
Home oxygen (document how much o2 they use at baseline)
COPD is diagnosed by
CXR and Hx of smoking
Etiology of asthma aka Reactive airway disease (RAD)
Constructing of the airway due to inflammation and muscular contraction of the bronchioles, known as a “bronchospasm”
Symptoms of asthma
SOB/Wheezing
•improved by nebulizer “breathing treatments” (bronchodilators)
PE of asthma
Wheezes (inspiratory or expiratory)
Associated meds of asthma
Inhalers (portable and gives a one time dose and provides a rapid release of medication), nebulizers (home machine that delivers continuous treatment over a period of time), corticosteroids (drug)
Asthma is diagnosed by
Clinically (know the 5 questions physicians will ask the pt)
Etiology of Ischemic CVA
Blockage of the arteries supplying blood to the brain resulting in permanent brain damage
Symptoms of ischemic CVA
Unilateral focal neurological deficits: one-sided weakness/numbness or changes in speech/vision
Risk factors of Ischemic CVA
HTN, HLD, DM, Hx TIA/CVA, smoking, FHx CVA, A-Fib
PE of Ischemic CVA
Neurological deficits: hemiparesis, unilateral paresthesias, aphasia, visual field deficits
Ischemic CVA is diagnosed
Clinically, potentially normal CT head scan
What should you document for ischemic CVA?
The date and time they were “last known well” (at baseline) as well as the source of this information. This is used to assess eligibility for tPA (powerful blood thinner to reverse CVA)
Etiology of Hemorrhagic CVA
Traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in the brain
Symptoms of hemorrhagic CVA
Headache
•sudden onset (thunderclap, worst of life)
Assoc. Sx: changes in speech, vision, sensation (numbness), or motor strength (weakness), AMS, seizure, headache
PE of hemorrhagic CVA
Unilateral neurological deficits
Hemorrhagic CVA is diagnosed by
CT head or LP (lumbar puncture)
What should you document for hemorrhagic CVA?
“tPA not indicated due to hemorrhage”
Etiology of TIA
Vascular changes temporarily deprive a part of the brain of oxygen (Sx usually last less than 1 hour)
Sx of TIA
Transient focal neurological deficit•changes in speech, vision, strength, or sensation
TIA is diagnosed
Clinically
Difference between a stroke and TIA
TIA does not cause permanent brain damage
What should you document for TIA patients?
“tPA considered and not indicated due to the fact that symptoms are resolved”
Etiology of meningitis
Inflammation and infection of the meninges; the sac surrounding the brain and spinal cord
Sx of meningitis
Headache and neck pain/stiffness
Assoc. Sx: fever
PE of meningitis
Meningismus, Nuchal rigidity
Meningitis is diagnosed by
Lumbar puncture (LP)
Etiology of spinal cord injury
Injury to the spinal cord may create weakness or numbness in the extremities past the site of the injury
Sx of spinal cord injuries
Neck pain, back pain, bilateral extremity weakness
PE of spinal cord injuries
Midline bony tenderness, deformities, or step-offs, bilateral extremity weakness, numbness, decrease recycled tone
Spinal cord injury diagnosed by
- CT cervical spine (neck)
- CT thoracic spine (upper back)
- CT lumbar spine (lower back)
What should you document for a spinal cord injury?
Spine is immobilized with a C-collar and backboard
Etiology of Seizure (SZ)
Abnormal electrical activity in the brain leading to abnormal physical manifestations. Often caused by epilepsy, ETOH withdrawals, or febrile seizure in pediatric pts
Sx of SZ
Seizure activity, syncope
Assoc. Sx: injuries (tongue bite), confusion, headache, incontinence (urinary or fecal)
PE of SZ
Somnolent, confused (post-Ictal)
Medications for SZ
Dilantin, Tegretol, Keppra, Depakote, Neurontin
Scribe alert for SZ
Know the 5 questions the physician asks
Etiology of Bells palsy
Inflammation or viral infection of the facial nerve causes one-sided weakness of the entire face
Sx of Bells palsy
Facial droop (sudden onset) Assoc. Sx: jaw or ear pain, increased tear flow of one eye
Pertinent negatives of bells palsy
No extremity weakness, no changes in speech or vision
PE of bells palsy
Unilateral weakness of the upper and lower face
Bells palsy is diagnosed by
Clinically
Etiology of Headache (HA), cephalgia
Various causes including hypertensive headaches (from high blood pressure), recurrent diagnosed migraines, sinusitis, etc
Sx of headaches
Headache (gradual onset)
•pressure, throbbing
Pertinent negatives of headache
No fever, no neck stiffness, no numbness/weakness, no changes in speech or vision
Etiology of Altered mental status (AMS)
Multiple causes: most common are hypoglycemia, infection, intoxication, and neurological
Risk factors of AMS
Diabetic, elderly, demented, ETOH use, drug use
Sx of AMS
Confusion, decreased responsiveness, unresponsive
AMS is diagnosed by
Case dependent
AMS vs FND
AMS is generalized and is typically caused by things that affect the whole brain (drugs, low blood sugar) while FND are localized weakness/numbness in one specific area, corresponding with damage at one specific site in the brain
Etiology of Syncope (fainting, passing out)
Temporary loss of blood supply to the brain resulting in loss of consciousness. Many various causes: most common are vasovagal and low blood volume (dehydration/hypovolemia)
Sx of syncope
Passing-out vs about to pass-out (near syncope
What are the 4 things you should document for a syncope?
What happened prior, during, and after the syncopal episode, as well as how the pt currently feels
Etiology of Vertigo (dizziness)
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)
Sx of vertigo
Room-spinning, feeling off balance (disequilibrium)
•worsened with head movement
Assoc. Sx: N/V, tinnitus (ringing in ears)
PE of vertigo
Horizontal nystagmus, + Romberg, + Dix-Hallpike test
Assoc. meds of vertigo
Meclizine (Antivert)
Vertigo is diagnosed by
Clinically
Pertinent positives
Specific symptoms that raise the physician’s suspicion for a particular disease
Etiology of appendicitis (APPY)
Infection of the appendix causes inflammation and blockage, possibly leading to rupture
Sx of APPY
RLQ pain •gradual onset •constant •worsened with movement Assoc. Sx: decreased appetite, fever, N/V
PE of APPY
McBurney’s point tenderness, RLQ tenderness
APPY is diagnosed by
CT A/P with PO contrast
Etiology of Small bowel obstruction (SBO)
Physical blockage of the small intestine
Risk factors for SBO
Elderly, infants, abdominal surgery, narcotic pain medication
Sx of SBO
Abdominal pain, vomiting, constipation
Assoc. Sx: Abd distension, bloating, no BMs
PE of SBO
Abdominal tenderness, guarding, rebound, abdominal bowel sounds, abdominal distension, tympany
SBO is diagnosed by
CT A/P with PO Contrast, Acute Abdominal Series (AAS) x-Ray
Etiology of gallstones (cholelithiasis, cholecystitis)
Minerals from the liver’s bile condense to form gallstones which can irritate, inflame, or obstruct the gallbladder
Sx of gallstones
RUQ abdominal pain after eating fatty foods
•sharp
•worsened with eating, deep breaths and Palpation
PE of gallstones
RUQ tenderness, Murphy’s sign
Gallstones is diagnosed by
Abdominal US of RUQ
Etiology of Gastrointestinal bleed (GI bleed)
Hemorrhage in the upper or lower gastrointestinal tract can lead to anemia
Sx of GI bleed
Generalized weakness, lightheadedness, SOB, abdominal pain, rectal pain
PE of GI bleed
Rectal exam: Melena, grossly bloody stool
GI bleed is diagnosed by
heme positive stool during a rectal exam, gastroccult
Etiology of diverticulitis
Acute inflammation and infection of abnormal pockets of the large intestine, known as diverticuli
Risk factor of diverticulitis
Diverticulosis (must have to get -litis)
Sx of diverticulitis
LLQ pain
Assoc. Sx: nausea, fever, diarrhea
Diverticulitis is diagnosed by
CT A/P with PO contrast
Etiology of pancreatitis
Inflammation of the pancreas
Risk factors of pancreatitis
ETOH abuse, cholecystitis, specific medications
Sx of pancreatitis
LUQ, epigastric pain
Assoc. Sx: N/V
PE of pancreatitis
Epigastric tenderness
Pancreatitis is diagnosed by
Elevated lipase lab test
Etiology of Gastroesophageal reflux disease (GERD) aka heart burn and acid reflux
Stomach acid regurgitating into the esophagus
Sx of GERD
Epigastric pain
•burning
•improved with antacids
PE of GERD
Epigastric tenderness
Etiology of UTI
Infection in the urinary tract (bladder or urethra)
Risk factors of UTI
Female
Sx of UTI
Dysuria (painful urination)
Assoc. Sx: frequency, urgency, malodorous urine, AMS (elderly)
PE of UTI
Suprapubic tenderness
UTI is diagnosis by
Urine dip (done in ED) or urinalysis (specimen sent to lab to test for Nitrate, WBC and Bacteria in urine)
Etiology of pyelonephritis
Infection of the tissue in the kidneys, usually spread from a UTI
Risk factors of pyelonephritis
Female, frequent UTIs
Sx of Pyelo
Flank pain with dysuria
Assoc. Sx: fever, N/V
PE of Pyelo
Costco-vertebral angle tenderness
Pyelo is diagnosed by
CT Abd/Pel without contrast or confirmed UTI with Costo-vertebral angle tenderness on exam
Etiology of kidney stone (renal calculi)
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
Sx of kidney stone
Flank pain
•sudden onset
•radiating to groin
Kidney stone is diagnosed by
CT A/P Abd/Pelvis or RBC in UA
Etiology of Ectopic pregnancy (tubal pregnancy)
Fertilized egg develops outside the uterus, usually in the Fallopian tube. High risk for rupture and death
Risk factors of ectopic pregnancy
pregnant female (HCG positive), std
Sx of ectopic pregnancy
Lower abdominal pain or vaginal bleeding while pregnant
Ectopic pregnancy is diagnosed by
US pelvis to determine location of fetus
Etiology of Ovarian torsion
Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in infarct of the ovary
Sx of ovarian torsion
Lower abdominal pain
Ovarian torsion is diagnosed by
US pelvis to assess blood flow to ovaries
Etiology of Testicular torsion
Twisting of the spermatic cord resulting in loss of blood flow and nerve function to the testicle
Sx of testicular torsion
Testicular pain
Diagnosed by
US scrotum
Etiology of URI
Most often viral infection causes congestion, cough, and inflammation of the upper airway
Sx of URI
Cough/congestion
Assoc. Sx: fever, sore throat, headache, Myalgias
URI is diagnosed by
Clinically
Etiology of Otitis media (middle ear infection)
Viral or bacterial infection of the tympanic membrane (TM) causing ear pain and pressure
Sx of otitis media
Ear pain, ear pulling
Assoc. Sx: fever, sore throat, dry cough, congestion
Otitis media is diagnosed
Clinically
Etiology of Streptococcal pharyngitis (strep throat)
Bacterial infection of the tonsils and pharynx causing a sore throat and frequently swollen lymph nodes
Sx of Strep throat
Sore throat
Assoc. Sx: tonsillar hypertrophy, tonsillar exudates (pus)
Strep throat is diagnosed by
Rapid strep
Etiology of Conjunctivitis (pink eye)
Infection of the outer lining of the eye, known as the conjunctiva
Sx of pink eye
Eye redness, irritation or pain
Assoc. Sx: eyelid matting, eye discharge, fever
Pink eye is diagnosed by
Clinically
Etiology of Epistaxis (nosebleed)
Rupture of a blood vessel inside the nose causes blood to flow out the nose and into the throat
Risk factors of epistaxis
Blood thinners or HTN
Name of the procedure associated with an epistaxis
Procedure epistaxis management (nose bleeds that do not stop are cauterized or stopped with a nasal tamponade)
Etiology of Musculoskeletal back pain
Deterioration or strain of the back creates pain that is worse with movement
PE of musculoskeletal back pain
Paraspinal tenderness or positive straight leg raise
Etiology of Extremity injury
Trauma creates pain/swelling in a extremity
Etiology of Abdominal aortic aneurysm (AAA)
Widened and weakened arterial wall at risk of rupture
AAA is diagnosed by
CT A/P with IV contrast dye
Etiology of Aortic dissection
Separation of the muscular wall from the membrane of the artery, putting the pt at risk of aortic rupture and death
Sx of aortic dissection
Chest pain radiating to the back
•ripping or tearing
Aortic dissection is diagnosed by
CT chest with IV contrast dye
Etiology of DVT
Blood slows down 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.
Risk factors of DVT
PMHx of DVT or PE, FHx, recent surgery, cancer, immobility, pregnancy, BCP, smoking, LE trauma, LE casts
DVT is diagnosed by
US/Doppler of the extremity
Etiology of cellulitis
Infection of the skin cells
Assoc. meds for cellulitis
Antibiotics (Abx)
Etiology of Abscess (cellulitis with fluctuance)
Skin infection with an underlying collection of pus
Procedure for abcess
Incision and drainage (I and D) procedure
Etiology of rash
Changes in skin’s appearance due to systemic or localized reaction. May be caused from medication, virus, bacteria, fungus, insect, etc)
Etiology of Allergic reaction
Immune response causing an inflammatory reaction consisting of swelling, itching, and rash
Etiology of Diabetic ketoacidosis (DKA)
Shortage of insulin resulting in hyperglycemia and production of ketones
Risk factors of DKA
DM
Sx of KDA
Persistent vomiting with Hx of DM
Assoc. Sx: SOB, polydipsia (increased thirst), polyuria (increase urination)
PE of DKA
Ketotic odor “fruity”, dry mucous membranes (dehydration, tachypnea
DKA is diagnosed by
Arterial blood gas showing low pH (acidosis) or positive serum ketones
Etiology of trauma (physical injury)
Depending on the mechanism of injury (MOI), physical trauma may break bones, sever nerves, rupture blood vessels, or damage internal organs
PE of trauma
Glasgow coma scale (GCS)
Trauma diagnosed by
CT or X-Ray
Name all 9 areas of the abdomen
RUQ, RLQ, LUQ, LLQ, epigastric, periumbilical, suprapubic, Right flank, left flank
What might we have to rule out for GERD?
MI
What does bile do?
Bile emulsified the fats in foods
Where is bile stored?
Gallbladder but made in the liver
Difference between cholelithiasis and cholecystitis
Cholelithiasis: gallstones
Cholecystitis: acute inflammation of the gallbladder
Chief complaint for a GI blood pt
Hematemesis (blood in vomit), coffee ground emesis, Melena, hematochezia (bloody stool)
What are we worried about for someone with a GI bleed?
Too much blood loss. Anemia
Name of the state after a seizure
Post-ictal
4 causes of altered mental status (AMS)
Hypoglycemia, infection, intoxication, neurological
Common signs of DVT
Extremity pain, swelling
Sx of cellulitis
Redness, swelling, and pain to an area of the skin
Main concern with an allergic reaction
Anaphylaxis or respiratory failure
ED Physician’s main responsibility for psychiatric patients
Medical clearance
Important things to document for any trauma patient
LOC, head injury, neck pain, back pain, numbness, weakness
