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Scribe > Course 2: Pathophysiology > Flashcards

Course 2: Pathophysiology Flashcards

1
Q

Pertinent Positives

A

Specific symptoms that raise the physician’s suspicion for a particular disease.

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2
Q

Pertinent Negatives

A

Specific symptoms that are not present which cause the physician to doubt certain diagnoses.

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3
Q

Timing

A

Constant
Intermittent
Waxing and Waning

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4
Q

CAD: etiology

A

Narrowing of the coronary arteries limits blood supply to the heart muscle causing angina.

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5
Q

Angina

A

Chest pain specifically due to heart-muscle ischemia.

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6
Q

CAD: catch phrase

A

Chest pain with physical exertion.

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7
Q

CAD: chief complaint

A

Chest pain or Chest pressure: worse with exertion, improved by rest or NTG.

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8
Q

CAD: assoc. med.

A

ASA 324mg PO

NTG 0.4mg SL

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9
Q

CAD: diagnosed by

A

Cardiac catheterization (not diagnosed in ED)

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10
Q

CAD: scribe alert

A
  1. CAD is the single greatest risk factor for MI.
  2. Stress tests or Cardiac Catheterization assess the severity of CAD.
  3. A pt has CAD if they have a PMHx pf Angina, MI, CABG, Cardiac stents, or Angioplasty.
  4. Every pt complaining of CP should always receive Aspirin 324 mg PO, unless it was given PTA or if it is contraindicated due to bleeding or allergy.
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11
Q

MI (stemi, non-stemi): etiology

A

Acute blockage of the coronary arteries results in ischemia and infarct of the heart muscle.

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12
Q

MI (stemi, non-stemi): catch phrase

A

Chest pressure with diaphoresis, N/V, and SOB

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13
Q

MI (stemi, non-stemi): risk factors

A

CAD, HTN, HLD, DM, Smoker, FHx of CA

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14
Q

MI (stemi, non-stemi): CC

A

Chest pain or chest pressure

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15
Q

MI (stemi, non-stemi): diagnosed by

A

EKC(stemi) or elevated Troponin (non-stemi)

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16
Q

MI (stemi, non-stemi): assoc. med

A

ASA
NTG
B-Blocker
Thrombolytic (Heparin)

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17
Q

MI (stemi, non-stemi): scribe alert

A
  1. Acute MI pts must receive ASA 324mg as soon as possible.

2. STEMI pts must get to Cath-lab within 90 minutes of arrival. Document ED arrival and depart times.

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18
Q

CHF: etiology

A

The heart becomes enlarged, inefficient, and congested with excess fluid.

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19
Q

CHF: catch phrase

A

SOB with pedal edema and orthopnea.

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20
Q

CHF: CC

A

SOB:
worse when lying flat (orhtopnea)
PND
dyspnea on excertion (DOE)

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21
Q

PND

A

Paroxysmal nocturnal dyspnea

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22
Q

Orthopnea

A

SOB when lying flat

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23
Q

CHF: physical exam

A

Rales in lungs, JVD, in neck, pitting pedal edema.

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24
Q

CHF: assoc. med

A

diuretics (Lasix, Furosemide) –> Urinate extra fluid.

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25
Q

CHF: Diagnosed by

A

CXR or elevated BNP

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26
Q

BNP

A

B-type Natriuretic Peptide

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27
Q

CHF: scribe alert

A

You can think of CHF as a fluid traffic jam in the heart; fluid gets backed up the neck (JVD) and down the legs (pedal edema).

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28
Q

A Fib: etiology

A

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

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29
Q

A Fib: CC

A

Palpitations (Fast, Pounding, Irregular)

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30
Q

A Fib: risk factors

A

Paroxysmal A Fib, Chronic A Fib

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31
Q

A Fib: physical exam

A

Irregularly irregular rhythm, Tachycardia

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32
Q

A Fib: diagnosed by

A

EKG

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33
Q

A Fib: assoc. med

A

Coumadin (Warfarin), Digoxin

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34
Q

Coumadin (Warfarin)

A

Blood thinner, prevents blood clots in atria

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35
Q

Digoxin

A

Slows down heart rate

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36
Q

A Fib: scribe alert

A

ED concern is RVR, Theese patients will often be “cardioverted” which means they are put back into a regular rhythm, known as NSR

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37
Q

RVR

A

Rapid Ventricular Response

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38
Q

Non-cardiac CP: Pericarditis

A

Inflammation of the sac surrounding the heart causing CP.

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39
Q

Non-cardiac CP: Pleurisy

A

Inflammation of the sac surrounding the lungs causing pleuritic CP.

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40
Q

Non-cardiac CP: Costochondritis

A

Irritation of the ribs causing CP worsened by pressing on the sternum.

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41
Q

Non-cardiac CP:

Chest Wall Pain

A

Irritation of the chest wall causing pain with palpation of the chest.

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42
Q

Non-cardiac CP: Pleural Effusion

A

Fluid collecting around the lungs causing SOB or CP

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43
Q

MI

A

Heart attack
Diagnosed by:
EKG (STEMI) or Elevated Troponin (Non- STEMI)

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44
Q

A Fib

A

Electrical problem
Diagnosed by:
EKG

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45
Q

CHF

A

Fluid traffic jam
Diagnosed by:
CXR or Elevated BNP

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46
Q

CAD

A

Major risk factor for MI
Diagnosed by:
Positive cardiac catheterization (not in ED)

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47
Q

Angina

A

Symptom of CAD
Diagnosed by:
Exertional CP with Hx of CAD

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48
Q

PE: etiology

A

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

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49
Q

PE: catch phrase

A

Pleuritic chest pain with tachycardia and hypoxia

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50
Q

PE: risk factor

A

Known DVT, PMHx of DVT or PE, FHx, Recent surgery, Cancer, A Fib, Immobility, Pregnancy, BCP, Smoking

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51
Q

PE: CC

A

SOB or Pleuritic chest pain (CO worse with deep breaths)

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52
Q

PE: diagnosed by

A

CTA Chest or VQ scan.

D-dimer

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53
Q

CTA Chest

A

CT Chest with IV contrast

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54
Q

D-dimer

A

aids in detecting clots, but cannot diagnose a PE.

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55
Q

PNA: etiology

A

Infiltrate (bacterial infection) and inflammation inside the lung

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56
Q

PNA: catch phrase

A

Productive cough with fever

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57
Q

PNA : risk factors

A

Elderly, bedridden, recent chest injury, recent surgery

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58
Q

PNA: CC

A

SOB or productive cough

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59
Q

PNA: assoc. med

A

Rocephin and Zithromax (Abx)

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60
Q

PNA: assoc. Sx

A

Cough with sputum, fever, CP

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61
Q

PNA: physical exam

A

Rhonchi

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62
Q

PNA: diagnosed by

A

CXR

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63
Q

PNA: scribe alert

A

Core measure: CAP protocol applies to pts with PNA. CAP protocol requires documenting Abx, vital signs, SaO2, mental status and blood cultures

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64
Q

CAP

A

Community Acquired Pneumonia

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65
Q

PTX

A

Pneumothorax

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66
Q

PTX: etiology

A

Collapsed lung due to trauma or a spontaneous small rupture of the lung

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67
Q

PTX: CC

A

SOB and one-sided chest pain:
Sudden onset
Often trauma pts

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68
Q

PTX: physical exam

A

Absent breath sounds unilaterally

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69
Q

PTX: diagnosed by

A

CXR

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70
Q

PTX: scribe alert

A

Document the percentage of lung collapsed (eg. 20% PTX). These pts will have a chest tube placed to reinflate the lung.

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71
Q

COPD: etiology

A

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

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72
Q

COPD: risk factors

A

Smoking

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73
Q

COPD: CC

A

SOB

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74
Q

COPD: physical exam

A

Decreases breath sounds, wheezes, rales

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75
Q

COPD: assoc. med

A

Home O2 (document how much O2 they use at baseline).

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76
Q

COPD: diagnosed by

A

CXR and hx of smoking

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77
Q

RAD

A

Reactive Airway Disease

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78
Q

RAD: etiology

A

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

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79
Q

RAD: CC

A

SOB/Wheezing:

Improved by nebulizer “breathing treatments” (bronchodilators)

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80
Q

RAD: physical exam

A

Wheezes (Inspiratory or Expiratory)

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81
Q

RAD: assoc. med

A

Inhalers, Nebulizers, Corticosteroids

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82
Q

RAD: diagnosed by

A

Clinically

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83
Q

RAD: scribe alert

A

The physician will ask the asthma pt:

  1. Do they have a home nebulizer (machine)?
  2. Have they been on steroids recently?
  3. Hx of hospitalization for asthma?
  4. Hx of intubation (breathing tube)?
  5. Asthma trigger?
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84
Q

PE

A

Pleuritic CP with tachycardia and hypoxia
Diagnosed by:
CTA Chest

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85
Q

PTX

A

Unilateral CP and SOB
Diagnosed by:
CXR

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86
Q

PNA

A

SOB and productive cough
Diagnosed by:
CXR

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87
Q

COPD

A

SOB with Hx of smoking
Diagnosed by:
CXR

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88
Q

Asthma

A

Wheezing with Hx of Asthma
Diagnosed by:
Clinically

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89
Q

Ischemic CVA: etiology

A

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

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90
Q

Ischemic CVA: CC

A

Unilateral focal neurological deficits: One-sided weakness/numbness or changes in speech/vision

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91
Q

Ischemic CVA: risk factors

A

HTN, HLD, DM, Hx TIA/CVA, smoking, FHx CVA, A Fib

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92
Q

Ischemic CVA: physical exam

A

Neurological deficits: hemiparesis, unilateral paresthesias, aphasia, visual field deficits

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93
Q

Ischemic CVA: diagnosed by

A

Clinically, potentially normal CT Head

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94
Q

Ischemic CVA: scribe alert

A

For any stroke pt ALWAYS document 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, a powerful blood thinner that can reverse a CVA.
Document tPA considered and not indicated due to:
1. Onset greater than 3 hours or Unkown/Unreliable time of onset.
2. Symptoms are rapidly improving.

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95
Q

Hemorrhagic CVA

A

Brain bleed

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96
Q

Hemorrhagic CVA: etiology

A

Traumatic or spontaneous rupture of blood vessels int he head leads to bleeding in the brain.

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97
Q

Hemorrhagic CVA: CC

A 
Headache: 
Sudden onset (Thunderclap)
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98
Q

Hemorrhagic CVA: assoc, Sx

A

Changes in speech, vision, sensation (numbness), or motor strength (weakness), AMS, Seizure, Headache

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99
Q

Hemorrhagic CVA: physical exam

A

Unilateral neurological deficits

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100
Q

Hemorrhagic CVA: diagnosed by

A

CT Head or LP

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101
Q

Hemorrhagic CVA: scribe alert

A

Document “tPA not indicated due to hemorrhage”

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102
Q

TIA: etiology

A

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

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103
Q

TIA: CC

A

Transient focal neurological deficit:

Changes in Speech, Vision, Strength, or Snesation

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104
Q

TIA: diagnosed by

A

Clinically

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105
Q

TIA: scribe alert

A

TIA’s are also known as “Mini Strokes” because Sx usually last

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106
Q

Meningitis: etiology

A

Inflammation and infection of the meninges; the sac surrounding the brain and spinal cord.

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107
Q

Meningitis: CC

A

Headache and neck pain

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108
Q

Headache

A

Cephalgia

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109
Q

Meningitis: assoc. Sx

A

Fever, neck pain, neck stiffness, AMS

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110
Q

Meningitis: physical exam

A

Meningismus, nuchal rigidity

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111
Q

Meningitis: diagnosed by

A

LP

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112
Q

Spinal Cord Injury: etiology

A

Injury to the spinal cord may create weakness or numbness in the extremities past the sire of the injury

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113
Q

Spinal Cord Injury: CC

A

Neck pain or Back pain, bilateral extremity weakness

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114
Q

Spinal Cord Injury: physical exam

A

Midline bony tenderness, deformities, or step-offs, bilateral extremity weakness, numbness, decreased rectal tone.

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115
Q

Spinal Cord Injury: diagnosed by

A

CT Cervical Spine (Neck)
CT Thoracic Spine (Upper back)
CT Lumbar Spine (Lower Back)

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116
Q

Spinal Cord Injury: scribe alert

A

remember that during the initial physical exam the spine is often immobilized with a C-collar and backboard; document accordingly.

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117
Q

Sz

A

Seizure

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118
Q

Sz: etiology

A

Abnormal electrical activity in the brain leading to abnormal physical manifestations. Often caused by epilepsy, ETOH withdrawals, or febrile seizure in pediatric pts

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119
Q

Sz: CC

A

Seizure activity, syncope

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120
Q

Sz: assoc. Sx

A

Injuries (tongue bite), confusion, headache, incontinence (urinary or fecal)

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121
Q

Sz: physical exam

A

somnolent, confused (Post-Ictal)

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122
Q

Sz: medications

A

Dilantin, Tegretol Keppra, Depakote, Neurontin

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123
Q

Sz: scribe alert

A

The physician will ask:

  1. Has the pt had a similar sz in the past?
  2. Does the pt have a hx of seizures?
  3. What was the date of their last seizure?
  4. What sz medication do they take?
  5. Have they missed in medication doses?
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124
Q

Bells palsy: etiology

A

Inflammation or viral infection of the facial nerve causes one-sided weakness of the entire face.

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125
Q

Bells palsy: CC

A

Facial droop:

Sudden onset

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126
Q

Bells palsy: assoc. Sx

A

Jaw or ear pain, increased tear flow of one eye

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127
Q

Bells palsy: Pert. Neg

A

No extremity weakness, no changes in speech or vision.

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128
Q

Bells palsy: physical exam

A

Unilateral weakness of the upper and lower face.

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129
Q

Bells palsy: Diagnosed by

A

Clinically

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130
Q

Bells palsy: scribe alert

A

Bell’s Palsy is the most common cause of facial droop in young pts who do not have CVA risk factors. Remember to document the absence of other FND.

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131
Q

HA: etiology

A

Various causes including hypertensive headaches (from high blood pressure), recurrent diagnosed migraines, Sinusitis, etc.

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132
Q

HA: CC

A

headache (gradual or onset)

Pressure, throbbing

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133
Q

HA: Pert. Neg

A

No fever, no neck stiffness, no numbness/weakness, no changes in speech or vision

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134
Q

HA: scribe alert

A

Always remember to document if the HA is similar or dissimilar to any prior HA. Never document “Worst headache of life” or “Thunderclap onset” unless specifically instructed by a physician.

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135
Q

AMS: etiology

A

Multiple causes: most common are hypoglycemia, infection, intoxication, and neurological.

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136
Q

AMS: risk factors

A

Diabetic, elderly, demented, EtOH use, drug use

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137
Q

AMS: CC

A

Confusion, decreased responsiveness, unresponsive

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138
Q

AMS: diagnosed by

A

Case dependent

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139
Q

AMS: scribe alert

A

AMS is very different than a focal neurological deficit.
AMS is generalized and is typically caused by things that affect the whole brain (drugs, low blood sugar).
Focal neuro deficits are localized weakness/numbness in one specific area, corresponding with damage at one specific site in the brain.
The most common cause of AMS for patients without a hx of dementia is from infection, most often caused by a UTI.

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140
Q

Syncope: etiology

A

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.

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141
Q

Syncope: CC

A

Passing-out vs. about to pass-out (near-syncope)

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142
Q

Syncope: scribe alert

A

Document what happened prior, during, and after the syncopal episode, as well as how the patient currently feels.

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143
Q

Vertigo: etiology

A

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).

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144
Q

Vertigo: CC

A

Room-spinning, feeling off balance (disequilibrium):

worsened with head movement

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145
Q

Vertigo: assoc. Sx

A

N/V, Tinnitus (ringing in ears)

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146
Q

Vertigo: physical exam

A

Horizontal Nystagmus, + Romberg, + Dix-Hallpike Test

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147
Q

Vertigo: assoc. med

A

Meclizine (Antivert)

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148
Q

Vertigo: diagnosed by

A

Clinically

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149
Q

Hemorrhagic CVA

A

Document:

tPA ineligibility

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150
Q

Ischemic CVA

A

Document:

tPA eligibility, last known normal

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151
Q

Meningitis

A

Document:

HA, fever, neck pain

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152
Q

Spinal Cord Injury

A

Document:

Bilateral extremity weakness

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153
Q

TIA

A

Document:

When did Sx resolve?

154
Q

Sz

A

Post-Ictal state, missed Sz meds?

155
Q

Bell’s Palsy

A

Absence of other FND

156
Q

HA/Migraine

A

Similar Sx in past? Gradual onset

157
Q

AMS

A

Infection? DM? Drugs? Baseline?

158
Q

Syncope

A

Before, during, after, current status

159
Q

Vertigo

A

N/V, Nystagmus

160
Q

Abdominal Quadrants

A 
RUQ, RLQ, LLQ, LUQ
R Flank, L Flank
Periumbilical (belly button) 
Suprapubic (on top of pubic hairs)
Epigastrium (lower chest)
161
Q

Epigastric

Associated Diseases

A

GERD, MI

162
Q

RUQ

Associated Diseases

A

Cholecystitis

163
Q

LUQ

Associated Diseases

A

Pancreatitis

164
Q

Periumbilical

Associated Diseases

A

SOB

165
Q

RLQ

Associated Diseases

A

Appendicitis

166
Q

LLQ

Associated Diseases

A

Diverticulitis

167
Q

Suprapubic

Associated Diseases

A

Ovarian Torsion
Ovarian Cyst
UTI

168
Q

Flanks

Associated Diseases

A

Pyelonephritis

Renal Calculi

169
Q

APPY

A

Appendicitis

170
Q

APPY: etiology

A

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

171
Q

APPY: CC

A

RLQ Pain:
Gradial Onset
Constant
Worsened with movement

172
Q

APPY: assoc. Sx

A

Decreased appetite (anorexia), fever, N/V

173
Q

APPY: physical exam

A

McBurney’s point tenderness, RLQ tenderness

174
Q

APPY: diagnosed by

A

CT A/P with PO constrast

175
Q

SBO

A

Small Bowel Obstruction

176
Q

SBO: etiology

A

Physical blockage of the small intestine

177
Q

SBO: risk factor

A

Elderly, infants, abdominal surgery, narcotic pain medication.

178
Q

SBO: CC

A

Abdominal pain, vomiting, constipation

179
Q

SBO: assoc. Sx

A

Abd distension, bloating, no BMs

180
Q

SBO: physical exam

A

Abd tenderness, guarding, rebound, abnormal bowel sounds, abd distension, tympany

181
Q

SBO: diagnosed by

A

CT A/P with PO Contrast AAS

182
Q

AAS

A

Acute Abdominal Series

183
Q

Gallstones

A

Cholelithiasis, Cholecystitis

184
Q

Gallstones: etiology

A

Minerals from the liver’s bile condense to form gallstones which can irritate, inflame, or obstruct the gallbladder.

185
Q

Gallstones: catch phrase

A

RUQ abd pain after eating fatty foods

186
Q

Gallstones: CC

A

RUQ Pain:
sharp
worsened with eating, deep breaths and palpation

187
Q

Gallstones: physical exam

A

RUQ tenderness, Murphy’s sign

188
Q

Gallstones: diagnosed by

A

Abd US, RUQ

189
Q

GI bleed: etiology

A

Hemorrhage in the upper or lower GI tract can lead to anemia.

190
Q

GI bleed: CC

A

Hematemesis (Upper), coffee ground emesis (Lower), Hematochezia (Lower), Melena (Upper)

191
Q

GI bleed: assoc. Sx

A

Generalized weakness, lightheadedness, SOB, abd pain, rectal pain

192
Q

GI bleed: physical exam

A

Pale conjunctiva, pallor, Tachycardia Rectal Exam: melena, grossly bloody stool

193
Q

GI bleed: diagnosed by

A

Heme positive stool (Guaiac positive) during a rectal exam

194
Q

GI bleed: scribe alert

A

ED concern is the need for a possible blood transfusion due to significant blood loss.

195
Q

Diverticulitis: etiology

A

Acute inflammation and infection of abnormal pockets of the large intestine, known as diverticuli

196
Q

Diverticulitis: risk factors

A

Diverticulosis, advanced age

197
Q

Diverticulitis: CC

A

LLQ pain

198
Q

Diverticulitis: assoc. Sx

A

Nausea, fever, diarrhea

199
Q

Diverticulitis: diagnosed by

A

CT A/P with PO Contrast

200
Q

Pancreatitis: etiology

A

Inflammation of the pancreas

201
Q

Pancreatitis: risk factors

A

EtOH abuse, Cholecystitis, specific medications

202
Q

Pancreatitis: CC

A

LUQ, epigastric pain

203
Q

Pancreatitis: assoc. Sx

A

N/V

204
Q

Pancreatitis: physical exam

A

epigastric tenderness

205
Q

Pancreatitis: diagnosed by

A

Elevated Lipase lab test (or sometimes elevated Amylase)

206
Q

GERD

A

Gastroesophageal reflux

207
Q

GERD: etiology

A

Stomach acid regurgitating into the esophagus

208
Q

GERD: CC

A

Epigastric Pain:
Burning
Improved with antacids

209
Q

GERD: physical exam

A

Epigastric tenderness

210
Q

GERD: assoc. med

A

GI cocktail (numbs and soothes the esophagus and stomach)

211
Q

GERD: scribe alert

A

Due to the proximity of the stomach to the heart, patients with cardiac risk factors and epigastric pain will always get a cardiac workup.

212
Q

C. Diff Colitis

A

Opportunistic bacteria that causes persistent diarrhea

213
Q

Gastroenteritis

A

Vomiting and diarrhea; “GI bug” often viral or bacterial

214
Q

Crohn’s Disease

A

Immune disorder causing diarrhea and abdominal pain

215
Q

Irritable Bowel Syndrome

A

Chronically sensitive bowels prone to diarrhea

216
Q

Gastritis

A

Irritated stomach with vomiting; “Stomach ache”

217
Q

Appendicitis

A

RLQ
Diagnosed by:
CT A/P with PO

218
Q

SBO

A

Periumbillical
Diagnosed by:
CT A/P with PO, AAS

219
Q

Cholecystitis

A

RUQ
Diagnosed by:
US RUQ

220
Q

GI bleed

A

Any quadrant
Diagnosed by:
Guaiac (heme) Positive

221
Q

Diverticulitis

A

LLQ
Diagnosed by:
CT A/P with PO

222
Q

Pancreatitis

A

Epigastic, LUQ
Diagnosed by:
Elevated Lipase

223
Q

GERD

A

Epigastric
Diagnosed by:
Endoscopy (not in ED)

224
Q

UTI: etiology

A

Infection in the urinary tract (bladder or urethra)

225
Q

UTI: CC

A

Dysuria (painful urination)

226
Q

UTI: risk factors

A

Female

227
Q

UTI: assoc. Sx

A

Frequency, urgency, malodorous urine, AMS(elderly)

228
Q

UTI: physical exam

A

Suprapubic tenderness

229
Q

UTI: diagnosed by

A

Urine dip (done in ED) or urinalysis (specimen sent to lab to test for Nitrite, WBC and Bacteria in urine)

230
Q

Pyelonephritis: etiology

A

Infection of the tissue in the kidneys, usually spread from a UTI.

231
Q

Pyelonephritis: risk factors

A

female, frequent UTI’s

232
Q

Pyelonephritis: CC

A

Flank pain with dysuria

233
Q

Pyelonephritis: assoc. Sx

A

Fever,N/V

234
Q

Pyelonephritis: physical exam

A

Costo-vertebral Angle (CVA) tenderness

235
Q

Pyelonephritis: diagnosed by

A

CT Abd/Pel without contrast or confirmed UTI with CVA tenderness on exam

236
Q

Kidney stones

A

Nephrolithiasis, Renal Calculi, Urolithiasis

237
Q

Kidney stones: etiology

A

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.

238
Q

Kidney stones: CC

A

Flank pain:
sudden onset
radiating to groin

239
Q

Kidney stones: assoc. Sx

A

Hematuria, N/V, unable to void

240
Q

Kidney stones: exam

A

CVA tenderness

241
Q

Kidney stones: diagnosed by

A

CT Abd/Pelvis

RBC in UA may be a clue.

242
Q

Ectopic Pregnancy

A

Tubal pregnancy

243
Q

Ectopic Pregnancy: etiology

A

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

244
Q

Ectopic pregnancy: risk factors

A

Pregnant female (HCG positive), STD (PID)

245
Q

Ectopic pregnancy: CC

A

Lower abdominal pain or vaginal bleeding while pregnant

246
Q

Ectopic pregnancy: diagnosed by

A

US Pelvis–> Determine location of fetus

247
Q

Ectopic pregnancy: scribe alert

A

Any female with a positive pregnancy test who is complaining of lower abd pain or vaginal bleeding will always receive an US Pelvis to rule out a possible ectopic pregnancy.

248
Q

Ovarian torsion: etiology

A

Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in infarct of the ovary.

249
Q

Ovarian torsion: CC

A

Lower abd pain (RLQ, LLQ)

250
Q

Ovarian torsion: physical exam

A

Adnexal tenderness (right or left). Tenderness in the RLQ or LLQ

251
Q

Ovarian torsion: diagnosed by

A

US Pelvis–> Assesses blood flow to ovaries.

252
Q

Ovarian torsion: scribe alert

A

Ovarian and testicular torsion are very time sensitive due to the risk of losing an ovary or testicle. Be sure to document accurate times for the pt arrival, US results, and any physician (surgical) consultations.

253
Q

Testicular torsion: etiology

A

Twisting of the spermatic cord resulting in loss of blood flow and nerve function to the testicle

254
Q

Testicular torsion: CC

A

testicular pain

255
Q

Testicular torsion: physical exam

A

Testicular tenderness and swelling (right or left)

256
Q

Testicular torsion: diagnosed by

A

US Scrotum

257
Q

UIT: diagnosed by

A

Urinalysis (WBC, Nitrite, or Bacteria)

258
Q

Pyelo: diagnosed by

A

CT Abd/Pelvis (A/P) UTI with CVA tenderness on exam

259
Q

Kidney stone: diagnosed by

A

CT A/P (RBC in UA may be a clue)

260
Q

Ectopic pregnancy: diagnosed by

A

US Pelvis

261
Q

Ovarian torsion: diagnosed by

A

US Pelvis

262
Q

Testicular torsion: diagnosed by

A

US Scrotum

263
Q

Upper Respiratory Infection

A

URI

264
Q

URI: etiology

A

Most often viral infection causes congestion, cough, and inflammation of the upper airway.

265
Q

URI: CC

A

Cough/congestion

266
Q

URI: assoc. Sx

A

Fever, sore throat, headache, myalgias

267
Q

URI: physical exam

A

Rhinorrhea, boggy turbinates, pharyngeal erythema

268
Q

URI: diagnosed by

A

Clinicallly

269
Q

URI: scribe alert

A

Pay special attention to any complaints of CP or SOB for URI pts; always be careful to describe the CP or SOB accurately so as not to accidentally create the impression of symptoms consistent with an MI or PE.

270
Q

Otitis Media

A

Middle ear infection

271
Q

Otitis media: etiology

A

Viral or bacterial infection of the TM causing ear pain and pressure.

272
Q

Otitis media: CC

A

Ear pain, ear pulling

273
Q

Otitis media: assoc. Sx

A

Fever, sore throat, dry cough, congestion

274
Q

Otitis media: physical exam

A

Erythema, effusion, dullness, or bulging of the TM.

275
Q

Otitis media: diagnosed by

A

Clinically

276
Q

Strep Throat

A

Streptococcal Pharyngitis

277
Q

Strep throat: etiology

A

Bacterial infection of the tonsils and pharynx causing a sore throat and frequently swollen lymph nodes.

278
Q

Strep throat: CC

A

Sore throat

279
Q

Strep throat: physical exam

A 
Pharyngeal erythema
tonsillar hypertrophy (enlargement)
tonsillar exudates (pus)
280
Q

Strep throat: diagnosed by

A

Rapid strep

281
Q

Strep throat: scribe alert

A

More sore throats are viral, however Strep throat is bacterial so Abx will help.
The biggest concern about a sore throat is the possibility of a PTA. Signs of PTA include uvular shift or tonsillar asymmetry

282
Q

PTA

A

Peri-Tonsillar Abscess

283
Q

Conjunctivitis: etiology

A

Infection of the outer lining of the eye, known as the conjunctiva

284
Q

Conjunctivitis: CC

A

Eye redness, irritation or pain

285
Q

Conjunctivitis: assoc. Sx

A

Eyelid matting, eye discharge, fever

286
Q

Conjunctivitis: physical exam

A

Conjunctival injection (redness), edema, and exudates

287
Q

Injection

A

Redness

288
Q

Conjunctivitis: diagnosed by

A

Clinically

289
Q

Epistaxis: etiology

A

Rupture of a blood vessels inside the nose causes blood to flow out the nose and into the throat.

290
Q

Epistaxis: CC

A

Nose bleed

291
Q

Epistaxis: risk factors

A

Blood thinners (Coumadin/Warfarin, ASA, Plavix) or HTN

292
Q

Epistaxis: physical exam

A

Anterior, posterior, or Septal source (of the bleeding)

293
Q

Epistaxis: diagnosed by

A

Clinically

294
Q

Epistaxis: scribe alert

A

Procedure Epistaxis management: Nose bleeds that do not stop spontaneously are often cauterized (burned) or stopped with pressure by Nasal Tamponade, on blood thinners will have coagulation labs (PT/INR) drawn to make sure their blood is not too thin.

295
Q

Musculoskeletal back pain: etiology

A

Deterioration or strain of the back creates pain that is worse with movement.

296
Q

Musculoskeletal back pain: CC

A

Back pain:

Most commonly low back (lumbar) pain

297
Q

Musculoskeletal back pain: assoc. Sx

A

Shooting posterior lower extremity pain.

298
Q

Musculoskeletal back pain: pert. negs.

A

No LE weakness, no incontinence

299
Q

Musculoskeletal back pain: physical exam

A

Paraspinal tenderness, positive straight leg raise (+ SLR diagnoses Sciatica; back pain that radiates down the legs)

300
Q

Musculoskeletal back pain: scribe alert

A

Remember to document if there is any recent trauma related to the back pain; trauma increases the physician’s concern about possible spinal injury

301
Q

Extremity injury: etiology

A

trauma creates pain/swelling in an extremity

302
Q

Extremity injury: CC

A

Extremity pain

303
Q

Extremity injury: assoc. Sx

A

Swelling, bruising, deformity, use limitation.

304
Q

Extremity injury: pert. negs.

A

No motor weakness, no numbness or tingling

305
Q

Extremity injury: physical exam

A

Distal CSMT intact (Circulation, Sensory, Motor, Tendon) No tendon or ligament laxity ROM limited secondary to pain.

306
Q

Extremity injury: scribe alert

A

Remember the majority of extremity injuries will receive some type of splint; always remember to document a Splint Application Procedure Note!

307
Q

AAA: etiology

A

Widened and weakened arterial wall at risk of rupture

308
Q

AAA: CC

A

Midline pulsatile abd mass, abd bruit, unequal femoral pulses, hypotension

309
Q

AAA: diagnosed by

A

CT A/P with IV contrast dye

310
Q

Aortic dissection: etiology

A

Separation of the muscular wall from the membrane of the artery, putting the pt at risk of aortic rupture and death.

311
Q

Aortic dissection: CC

A

Chest pain radiating to the back:

ripping or tearing

312
Q

Aortic dissection: physical exam

A

Unequal brachial or radial pulses, hypotension

313
Q

Aortic dissection: diagnosed by

A

CT Chest with IV contrast dye

314
Q

DVT: etiology

A

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.

315
Q

DVT: risk factors

A

PMHx of DVT or PE, FHx, Recent Surgery, CA, Immobility, Pregnancy, BCP, smoking, LE Trauma, LE Casts

316
Q

DVT: CC

A

Extremmmity pain and swelling (atraumatic):

Usually located in a lower extremity

317
Q

DVT: physical exam

A

Calf tenderness, cords, Homan’s sign

318
Q

DVT: diagnosed by

A

US/Doppler of the extremity

319
Q

Cellulitis: etiology

A

Infection of the skin cells

320
Q

Cellulitis: CC

A

Red, swollen, ppainful, and sometimes warn area of skin

321
Q

Cellulitis: physical exam

A

erythema, edema, increased warmth (calor), induration

322
Q

Cellulitis: assoc. meds

A

Abx

323
Q

Cellulitis: diagnosed by

A

Clinically

324
Q

Abscess

A

Cellulitis with fluctuance

325
Q

Abscess: etiology

A

Skin infection with an underlying collection of pus

326
Q

Abscess: CC

A

red, swollen, and painful lump

327
Q

Abscess: physical exam

A

Fluctuance (pus-pocket), induration, purulent drainage

328
Q

Abscess: diagnosed by

A

Clinically

329
Q

Abscess: scribe alert

A

Abscesses must have the pus-pocket drained. Remember to always document Incision and Drainage (I&D) Procedure notes for abscesses.

330
Q

Rash: etiology

A

Changes in the skin’s appearance due to systemic or localized reaction. May be caused from medication, virus, bacteria, fungus, insect, etc.

331
Q

Rash: CC

A

Rash:

Red, pruritic or painful

332
Q

Rash: physical exam

A 
Urticaria
Macules
Papules
Vesicles
Blanching
Petechaie 
Purpura
333
Q

Urticaria

A

Hives or wheals (rash)

334
Q

Macules

A

flat (rash)

335
Q

Papules

A

raised bumps (rash)

336
Q

Vescicles

A

small blisters (rash)

337
Q

Blanching

A

not dangerous rash

338
Q

Petechaie

A

dangerous rash

339
Q

Purpura

A

dangerous rash

340
Q

Rash: diagnosed by

A

Clinically

341
Q

Allergic reaction: etiology

A

Immune response causing an inflammatory reaction consisting of swelling, pruritis, and rash.

342
Q

Allergic reaction: risk factors

A

Known drug or food allergy

343
Q

Allergic reaction: CC

A

Rash, swelling, itching, or SOB

344
Q

Allergic reaction: physical exam

A

Edema, facial angiodema, urticaria

345
Q

Allergic reaction: diagnosed by

A

Clinically

346
Q

Allergic reaction: scribe alert

A

ED concern is Anaphylaxis or Respiratory failure

347
Q

True allergic reactions

A

Rash
Itching
Swelling
SOB due to airway swelling

348
Q

DKA: etiology

A

Shortage of insulin resulting in hyperglycemia and production of ketones

349
Q

DKA: risk factors

A

DM

350
Q

DKA: CC

A

Persistent vomiting with a Hx of DM

351
Q

DKA: assoc. Sx

A

SOB, polydipsia (increased thirst), polyuria (increased urination

352
Q

DKA: physical exam

A

Ketotic odor “fruity”, dry mucous membranes (dehydration), tachypnea

353
Q

DKA: diagnosed by

A

Arterial blood gas (ABG or VBG) showing low pH (acidosis) or Positive Serum ketones

354
Q

Psychological disorder:; etiology

A

Various types of psychological disease produce abnormal thoughts, bahaviors, or actions

355
Q

Psychological disorder: PMHx

A

Bipolar Disorder, Schizophrenia, PTSD, Depression, Anxiety, Alcoholism, Drug Abuse, Suicide Attempt

356
Q

Psychological disorder: CC

A 
SI
HI
Hallucinations 
Substance abuse
Self injury
OD
357
Q

SI

A

Suicidal Ideation

358
Q

HI

A

Homicidal Ideation

359
Q

Psychological disorder: physical exam

A

Flat affect, SI, HI, Tangential or Pressured speech

360
Q

Psychological disorder: scribe alert

A

Pay very careful attention to differentiating between medical (physical) and psychiatric complaints. As an emergency physician the main concern is medical clearance; determining that the pt is not medically ill. After medical clearance; determining that the pt is not medically ill. After medical clearance, the pt is cleared to be evaluated from a psychiatric standpoint.

361
Q

Trauma

A

Physical Injury

362
Q

Trauma: etiology

A

Depending on the MOI physical trauma may break bones, sever nerves, rupture blood vessels, or damage internal organs.

363
Q

MOI

A

Mechanism of Injury

364
Q

Trauma: CC

A

MVA, fall, GSW

365
Q

Trauma: physical exam

A

GCS

366
Q

GCS

A

Glasgow Coma Scale

367
Q

Trauma: assoc. med

A

blood thinners (Coumadin, ASA, or Plavix)

368
Q

Trauma: diagnosed by

A

Trauma Protocol depending on MOI: CT or XR

369
Q

Trauma: scribe alert

A 
Neurological Injury (Brain, Spine):
LOC
confusion
numbness
weakness
HA
Neck/Back Pain
Internal organ injury (lungs, Spleen, Liver):
SOB
CP
Abd Pain
370
Q

Trauma (MOI): etiology

A

Refers to the way damage to skin, muscles, organs, and bones happen.
Healthcare providers use MOI to determine how likely it is that serious injury has occurred.

371
Q

Trauma (MOI): rapid forward deceleration (MVC)

A
  1. Head-On collision (windshield starring, airbag deployment
  2. T-Bone Collision
  3. Rear-Impact Collision
  4. Rollover Collision
  5. Victim Ejected From Vehicle (Spinal cord injury, head injury)
  6. MVA/ ATV Crash (helmets)
  7. Auto vs. Pedestriam
372
Q

Trauma (MOI): rapid vertical deceleration “Falls”

A

Dependent upon distance body part impacted landing surface and type of landing surface
Severe: greater than 3x the height of pt or > 20 ft

373
Q

Trauma (MOI): penetrating trauma

A
  1. Stab wounds: location, blade length, angle of penetration

2. Firearms: Type of weapon, caliber, distance, bullet deformity

374
Q

DDx

A

A short list of diseases the doctor considers when diagnosing a pt.

375
Q

Pertinent Positives

A

Specific Sx that raise the physician’s concern for that particular disease

376
Q

Pertinent Negatives

A

Specific Sx that are not present which cause the physician to doubt certain diagnoses

377
Q

Risk Factors

A

“red Flags: that would put a pt at risk for that particular Dz.

378
Q

Etiology

A

The study of the causes of Dz.

379
Q

Pleura

A

Membrane lining the thoracic cavity (parietal pleura) and covering the lungs (visceral pleura)

380
Q

Artery

A

A blood vessel that carries oxygenated blood from the heart throughout the body

381
Q

CTA

A

Computed Tomography Angiography

Scribe (9 decks)

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