Course 2: Pathophysiology Flashcards
1
Q
Pertinent Positives
A
Specific symptoms that raise the physician’s suspicion for a particular disease.
2
Q
Pertinent Negatives
A
Specific symptoms that are not present which cause the physician to doubt certain diagnoses.
3
Q
Timing
A
Constant
Intermittent
Waxing and Waning
4
Q
CAD: etiology
A
Narrowing of the coronary arteries limits blood supply to the heart muscle causing angina.
5
Q
Angina
A
Chest pain specifically due to heart-muscle ischemia.
6
Q
CAD: catch phrase
A
Chest pain with physical exertion.
7
Q
CAD: chief complaint
A
Chest pain or Chest pressure: worse with exertion, improved by rest or NTG.
8
Q
CAD: assoc. med.
A
ASA 324mg PO
NTG 0.4mg SL
9
Q
CAD: diagnosed by
A
Cardiac catheterization (not diagnosed in ED)
10
Q
CAD: scribe alert
A
- CAD is the single greatest risk factor for MI.
- Stress tests or Cardiac Catheterization assess the severity of CAD.
- A pt has CAD if they have a PMHx pf Angina, MI, CABG, Cardiac stents, or Angioplasty.
- 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.
11
Q
MI (stemi, non-stemi): etiology
A
Acute blockage of the coronary arteries results in ischemia and infarct of the heart muscle.
12
Q
MI (stemi, non-stemi): catch phrase
A
Chest pressure with diaphoresis, N/V, and SOB
13
Q
MI (stemi, non-stemi): risk factors
A
CAD, HTN, HLD, DM, Smoker, FHx of CA
14
Q
MI (stemi, non-stemi): CC
A
Chest pain or chest pressure
15
Q
MI (stemi, non-stemi): diagnosed by
A
EKC(stemi) or elevated Troponin (non-stemi)
16
Q
MI (stemi, non-stemi): assoc. med
A
ASA
NTG
B-Blocker
Thrombolytic (Heparin)
17
Q
MI (stemi, non-stemi): scribe alert
A
- 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.
18
Q
CHF: etiology
A
The heart becomes enlarged, inefficient, and congested with excess fluid.
19
Q
CHF: catch phrase
A
SOB with pedal edema and orthopnea.
20
Q
CHF: CC
A
SOB:
worse when lying flat (orhtopnea)
PND
dyspnea on excertion (DOE)
21
Q
PND
A
Paroxysmal nocturnal dyspnea
22
Q
Orthopnea
A
SOB when lying flat
23
Q
CHF: physical exam
A
Rales in lungs, JVD, in neck, pitting pedal edema.
24
Q
CHF: assoc. med
A
diuretics (Lasix, Furosemide) –> Urinate extra fluid.
25
CHF: Diagnosed by
CXR or elevated BNP
26
BNP
B-type Natriuretic Peptide
27
CHF: scribe alert
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).
28
A Fib: etiology
Electrical abnormalities in the "wiring" of the heart causes the top of the heart (atria) to quiver abnormally.
29
A Fib: CC
Palpitations (Fast, Pounding, Irregular)
30
A Fib: risk factors
Paroxysmal A Fib, Chronic A Fib
31
A Fib: physical exam
Irregularly irregular rhythm, Tachycardia
32
A Fib: diagnosed by
EKG
33
A Fib: assoc. med
Coumadin (Warfarin), Digoxin
34
Coumadin (Warfarin)
Blood thinner, prevents blood clots in atria
35
Digoxin
Slows down heart rate
36
A Fib: scribe alert
ED concern is RVR, Theese patients will often be "cardioverted" which means they are put back into a regular rhythm, known as NSR
37
RVR
Rapid Ventricular Response
38
Non-cardiac CP: Pericarditis
Inflammation of the sac surrounding the heart causing CP.
39
Non-cardiac CP: Pleurisy
Inflammation of the sac surrounding the lungs causing pleuritic CP.
40
Non-cardiac CP: Costochondritis
Irritation of the ribs causing CP worsened by pressing on the sternum.
41
Non-cardiac CP:
| Chest Wall Pain
Irritation of the chest wall causing pain with palpation of the chest.
42
Non-cardiac CP: Pleural Effusion
Fluid collecting around the lungs causing SOB or CP
43
MI
Heart attack
Diagnosed by:
EKG (STEMI) or Elevated Troponin (Non- STEMI)
44
A Fib
Electrical problem
Diagnosed by:
EKG
45
CHF
Fluid traffic jam
Diagnosed by:
CXR or Elevated BNP
46
CAD
Major risk factor for MI
Diagnosed by:
Positive cardiac catheterization (not in ED)
47
Angina
Symptom of CAD
Diagnosed by:
Exertional CP with Hx of CAD
48
PE: etiology
A blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs
49
PE: catch phrase
Pleuritic chest pain with tachycardia and hypoxia
50
PE: risk factor
Known DVT, PMHx of DVT or PE, FHx, Recent surgery, Cancer, A Fib, Immobility, Pregnancy, BCP, Smoking
51
PE: CC
SOB or Pleuritic chest pain (CO worse with deep breaths)
52
PE: diagnosed by
CTA Chest or VQ scan.
| D-dimer
53
CTA Chest
CT Chest with IV contrast
54
D-dimer
aids in detecting clots, but cannot diagnose a PE.
55
PNA: etiology
Infiltrate (bacterial infection) and inflammation inside the lung
56
PNA: catch phrase
Productive cough with fever
57
PNA : risk factors
Elderly, bedridden, recent chest injury, recent surgery
58
PNA: CC
SOB or productive cough
59
PNA: assoc. med
Rocephin and Zithromax (Abx)
60
PNA: assoc. Sx
Cough with sputum, fever, CP
61
PNA: physical exam
Rhonchi
62
PNA: diagnosed by
CXR
63
PNA: scribe alert
Core measure: CAP protocol applies to pts with PNA. CAP protocol requires documenting Abx, vital signs, SaO2, mental status and blood cultures
64
CAP
Community Acquired Pneumonia
65
PTX
Pneumothorax
66
PTX: etiology
Collapsed lung due to trauma or a spontaneous small rupture of the lung
67
PTX: CC
SOB and one-sided chest pain:
Sudden onset
Often trauma pts
68
PTX: physical exam
Absent breath sounds unilaterally
69
PTX: diagnosed by
CXR
70
PTX: scribe alert
Document the percentage of lung collapsed (eg. 20% PTX). These pts will have a chest tube placed to reinflate the lung.
71
COPD: etiology
Long-term damage to the lung's alveoli (emphysema) along with inflammation and mucous production (chronic bronchitis)
72
COPD: risk factors
Smoking
73
COPD: CC
SOB
74
COPD: physical exam
Decreases breath sounds, wheezes, rales
75
COPD: assoc. med
Home O2 (document how much O2 they use at baseline).
76
COPD: diagnosed by
CXR and hx of smoking
77
RAD
Reactive Airway Disease
78
RAD: etiology
Constricting of the airway due to inflammation and muscular contraction of the bronchioles, known as "bronchospasm".
79
RAD: CC
SOB/Wheezing:
| Improved by nebulizer "breathing treatments" (bronchodilators)
80
RAD: physical exam
Wheezes (Inspiratory or Expiratory)
81
RAD: assoc. med
Inhalers, Nebulizers, Corticosteroids
82
RAD: diagnosed by
Clinically
83
RAD: scribe alert
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?
84
PE
Pleuritic CP with tachycardia and hypoxia
Diagnosed by:
CTA Chest
85
PTX
Unilateral CP and SOB
Diagnosed by:
CXR
86
PNA
SOB and productive cough
Diagnosed by:
CXR
87
COPD
SOB with Hx of smoking
Diagnosed by:
CXR
88
Asthma
Wheezing with Hx of Asthma
Diagnosed by:
Clinically
89
Ischemic CVA: etiology
Blockage of the arteries supplying blood to the brain resulting in permanent brain damage
90
Ischemic CVA: CC
Unilateral focal neurological deficits: One-sided weakness/numbness or changes in speech/vision
91
Ischemic CVA: risk factors
HTN, HLD, DM, Hx TIA/CVA, smoking, FHx CVA, A Fib
92
Ischemic CVA: physical exam
Neurological deficits: hemiparesis, unilateral paresthesias, aphasia, visual field deficits
93
Ischemic CVA: diagnosed by
Clinically, potentially normal CT Head
94
Ischemic CVA: scribe alert
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.
95
Hemorrhagic CVA
Brain bleed
96
Hemorrhagic CVA: etiology
Traumatic or spontaneous rupture of blood vessels int he head leads to bleeding in the brain.
97
Hemorrhagic CVA: CC
```
Headache:
Sudden onset (Thunderclap)
```
98
Hemorrhagic CVA: assoc, Sx
Changes in speech, vision, sensation (numbness), or motor strength (weakness), AMS, Seizure, Headache
99
Hemorrhagic CVA: physical exam
Unilateral neurological deficits
100
Hemorrhagic CVA: diagnosed by
CT Head or LP
101
Hemorrhagic CVA: scribe alert
Document "tPA not indicated due to hemorrhage"
102
TIA: etiology
Vascular changes temporarily deprive a part of the brain of oxygen (Sx usually last less than 1 hour)
103
TIA: CC
Transient focal neurological deficit:
| Changes in Speech, Vision, Strength, or Snesation
104
TIA: diagnosed by
Clinically
105
TIA: scribe alert
TIA's are also known as "Mini Strokes" because Sx usually last
106
Meningitis: etiology
Inflammation and infection of the meninges; the sac surrounding the brain and spinal cord.
107
Meningitis: CC
Headache and neck pain
108
Headache
Cephalgia
109
Meningitis: assoc. Sx
Fever, neck pain, neck stiffness, AMS
110
Meningitis: physical exam
Meningismus, nuchal rigidity
111
Meningitis: diagnosed by
LP
112
Spinal Cord Injury: etiology
Injury to the spinal cord may create weakness or numbness in the extremities past the sire of the injury
113
Spinal Cord Injury: CC
Neck pain or Back pain, bilateral extremity weakness
114
Spinal Cord Injury: physical exam
Midline bony tenderness, deformities, or step-offs, bilateral extremity weakness, numbness, decreased rectal tone.
115
Spinal Cord Injury: diagnosed by
CT Cervical Spine (Neck)
CT Thoracic Spine (Upper back)
CT Lumbar Spine (Lower Back)
116
Spinal Cord Injury: scribe alert
remember that during the initial physical exam the spine is often immobilized with a C-collar and backboard; document accordingly.
117
Sz
Seizure
118
Sz: etiology
Abnormal electrical activity in the brain leading to abnormal physical manifestations. Often caused by epilepsy, ETOH withdrawals, or febrile seizure in pediatric pts
119
Sz: CC
Seizure activity, syncope
120
Sz: assoc. Sx
Injuries (tongue bite), confusion, headache, incontinence (urinary or fecal)
121
Sz: physical exam
somnolent, confused (Post-Ictal)
122
Sz: medications
Dilantin, Tegretol Keppra, Depakote, Neurontin
123
Sz: scribe alert
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?
124
Bells palsy: etiology
Inflammation or viral infection of the facial nerve causes one-sided weakness of the entire face.
125
Bells palsy: CC
Facial droop:
| Sudden onset
126
Bells palsy: assoc. Sx
Jaw or ear pain, increased tear flow of one eye
127
Bells palsy: Pert. Neg
No extremity weakness, no changes in speech or vision.
128
Bells palsy: physical exam
Unilateral weakness of the upper and lower face.
129
Bells palsy: Diagnosed by
Clinically
130
Bells palsy: scribe alert
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.
131
HA: etiology
Various causes including hypertensive headaches (from high blood pressure), recurrent diagnosed migraines, Sinusitis, etc.
132
HA: CC
headache (gradual or onset)
| Pressure, throbbing
133
HA: Pert. Neg
No fever, no neck stiffness, no numbness/weakness, no changes in speech or vision
134
HA: scribe alert
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.
135
AMS: etiology
Multiple causes: most common are hypoglycemia, infection, intoxication, and neurological.
136
AMS: risk factors
Diabetic, elderly, demented, EtOH use, drug use
137
AMS: CC
Confusion, decreased responsiveness, unresponsive
138
AMS: diagnosed by
Case dependent
139
AMS: scribe alert
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.
140
Syncope: etiology
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.
141
Syncope: CC
Passing-out vs. about to pass-out (near-syncope)
142
Syncope: scribe alert
Document what happened prior, during, and after the syncopal episode, as well as how the patient currently feels.
143
Vertigo: etiology
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).
144
Vertigo: CC
Room-spinning, feeling off balance (disequilibrium):
| worsened with head movement
145
Vertigo: assoc. Sx
N/V, Tinnitus (ringing in ears)
146
Vertigo: physical exam
Horizontal Nystagmus, + Romberg, + Dix-Hallpike Test
147
Vertigo: assoc. med
Meclizine (Antivert)
148
Vertigo: diagnosed by
Clinically
149
Hemorrhagic CVA
Document:
| tPA ineligibility
150
Ischemic CVA
Document:
| tPA eligibility, last known normal
151
Meningitis
Document:
| HA, fever, neck pain
152
Spinal Cord Injury
Document:
| Bilateral extremity weakness
153
TIA
Document:
| When did Sx resolve?
154
Sz
Post-Ictal state, missed Sz meds?
155
Bell's Palsy
Absence of other FND
156
HA/Migraine
Similar Sx in past? Gradual onset
157
AMS
Infection? DM? Drugs? Baseline?
158
Syncope
Before, during, after, current status
159
Vertigo
N/V, Nystagmus
160
Abdominal Quadrants
```
RUQ, RLQ, LLQ, LUQ
R Flank, L Flank
Periumbilical (belly button)
Suprapubic (on top of pubic hairs)
Epigastrium (lower chest)
```
161
Epigastric
| Associated Diseases
GERD, MI
162
RUQ
| Associated Diseases
Cholecystitis
163
LUQ
| Associated Diseases
Pancreatitis
164
Periumbilical
| Associated Diseases
SOB
165
RLQ
| Associated Diseases
Appendicitis
166
LLQ
| Associated Diseases
Diverticulitis
167
Suprapubic
| Associated Diseases
Ovarian Torsion
Ovarian Cyst
UTI
168
Flanks
| Associated Diseases
Pyelonephritis
| Renal Calculi
169
APPY
Appendicitis
170
APPY: etiology
Infection of the appendix causes inflammation and blockage, possibly leading to rupture
171
APPY: CC
RLQ Pain:
Gradial Onset
Constant
Worsened with movement
172
APPY: assoc. Sx
Decreased appetite (anorexia), fever, N/V
173
APPY: physical exam
McBurney's point tenderness, RLQ tenderness
174
APPY: diagnosed by
CT A/P with PO constrast
175
SBO
Small Bowel Obstruction
176
SBO: etiology
Physical blockage of the small intestine
177
SBO: risk factor
Elderly, infants, abdominal surgery, narcotic pain medication.
178
SBO: CC
Abdominal pain, vomiting, constipation
179
SBO: assoc. Sx
Abd distension, bloating, no BMs
180
SBO: physical exam
Abd tenderness, guarding, rebound, abnormal bowel sounds, abd distension, tympany
181
SBO: diagnosed by
CT A/P with PO Contrast AAS
182
AAS
Acute Abdominal Series
183
Gallstones
Cholelithiasis, Cholecystitis
184
Gallstones: etiology
Minerals from the liver's bile condense to form gallstones which can irritate, inflame, or obstruct the gallbladder.
185
Gallstones: catch phrase
RUQ abd pain after eating fatty foods
186
Gallstones: CC
RUQ Pain:
sharp
worsened with eating, deep breaths and palpation
187
Gallstones: physical exam
RUQ tenderness, Murphy's sign
188
Gallstones: diagnosed by
Abd US, RUQ
189
GI bleed: etiology
Hemorrhage in the upper or lower GI tract can lead to anemia.
190
GI bleed: CC
Hematemesis (Upper), coffee ground emesis (Lower), Hematochezia (Lower), Melena (Upper)
191
GI bleed: assoc. Sx
Generalized weakness, lightheadedness, SOB, abd pain, rectal pain
192
GI bleed: physical exam
Pale conjunctiva, pallor, Tachycardia Rectal Exam: melena, grossly bloody stool
193
GI bleed: diagnosed by
Heme positive stool (Guaiac positive) during a rectal exam
194
GI bleed: scribe alert
ED concern is the need for a possible blood transfusion due to significant blood loss.
195
Diverticulitis: etiology
Acute inflammation and infection of abnormal pockets of the large intestine, known as diverticuli
196
Diverticulitis: risk factors
Diverticulosis, advanced age
197
Diverticulitis: CC
LLQ pain
198
Diverticulitis: assoc. Sx
Nausea, fever, diarrhea
199
Diverticulitis: diagnosed by
CT A/P with PO Contrast
200
Pancreatitis: etiology
Inflammation of the pancreas
201
Pancreatitis: risk factors
EtOH abuse, Cholecystitis, specific medications
202
Pancreatitis: CC
LUQ, epigastric pain
203
Pancreatitis: assoc. Sx
N/V
204
Pancreatitis: physical exam
epigastric tenderness
205
Pancreatitis: diagnosed by
Elevated Lipase lab test (or sometimes elevated Amylase)
206
GERD
Gastroesophageal reflux
207
GERD: etiology
Stomach acid regurgitating into the esophagus
208
GERD: CC
Epigastric Pain:
Burning
Improved with antacids
209
GERD: physical exam
Epigastric tenderness
210
GERD: assoc. med
GI cocktail (numbs and soothes the esophagus and stomach)
211
GERD: scribe alert
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
C. Diff Colitis
Opportunistic bacteria that causes persistent diarrhea
213
Gastroenteritis
Vomiting and diarrhea; "GI bug" often viral or bacterial
214
Crohn's Disease
Immune disorder causing diarrhea and abdominal pain
215
Irritable Bowel Syndrome
Chronically sensitive bowels prone to diarrhea
216
Gastritis
Irritated stomach with vomiting; "Stomach ache"
217
Appendicitis
RLQ
Diagnosed by:
CT A/P with PO
218
SBO
Periumbillical
Diagnosed by:
CT A/P with PO, AAS
219
Cholecystitis
RUQ
Diagnosed by:
US RUQ
220
GI bleed
Any quadrant
Diagnosed by:
Guaiac (heme) Positive
221
Diverticulitis
LLQ
Diagnosed by:
CT A/P with PO
222
Pancreatitis
Epigastic, LUQ
Diagnosed by:
Elevated Lipase
223
GERD
Epigastric
Diagnosed by:
Endoscopy (not in ED)
224
UTI: etiology
Infection in the urinary tract (bladder or urethra)
225
UTI: CC
Dysuria (painful urination)
226
UTI: risk factors
Female
227
UTI: assoc. Sx
Frequency, urgency, malodorous urine, AMS(elderly)
228
UTI: physical exam
Suprapubic tenderness
229
UTI: diagnosed by
Urine dip (done in ED) or urinalysis (specimen sent to lab to test for Nitrite, WBC and Bacteria in urine)
230
Pyelonephritis: etiology
Infection of the tissue in the kidneys, usually spread from a UTI.
231
Pyelonephritis: risk factors
female, frequent UTI's
232
Pyelonephritis: CC
Flank pain with dysuria
233
Pyelonephritis: assoc. Sx
Fever,N/V
234
Pyelonephritis: physical exam
Costo-vertebral Angle (CVA) tenderness
235
Pyelonephritis: diagnosed by
CT Abd/Pel without contrast or confirmed UTI with CVA tenderness on exam
236
Kidney stones
Nephrolithiasis, Renal Calculi, Urolithiasis
237
Kidney stones: etiology
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
Kidney stones: CC
Flank pain:
sudden onset
radiating to groin
239
Kidney stones: assoc. Sx
Hematuria, N/V, unable to void
240
Kidney stones: exam
CVA tenderness
241
Kidney stones: diagnosed by
CT Abd/Pelvis
| RBC in UA may be a clue.
242
Ectopic Pregnancy
Tubal pregnancy
243
Ectopic Pregnancy: etiology
Fertilized egg develops outside the uterus, usually in the Fallopian tube. High risk for rupture and death.
244
Ectopic pregnancy: risk factors
Pregnant female (HCG positive), STD (PID)
245
Ectopic pregnancy: CC
Lower abdominal pain or vaginal bleeding while pregnant
246
Ectopic pregnancy: diagnosed by
US Pelvis--> Determine location of fetus
247
Ectopic pregnancy: scribe alert
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
Ovarian torsion: etiology
Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in infarct of the ovary.
249
Ovarian torsion: CC
Lower abd pain (RLQ, LLQ)
250
Ovarian torsion: physical exam
Adnexal tenderness (right or left). Tenderness in the RLQ or LLQ
251
Ovarian torsion: diagnosed by
US Pelvis--> Assesses blood flow to ovaries.
252
Ovarian torsion: scribe alert
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
Testicular torsion: etiology
Twisting of the spermatic cord resulting in loss of blood flow and nerve function to the testicle
254
Testicular torsion: CC
testicular pain
255
Testicular torsion: physical exam
Testicular tenderness and swelling (right or left)
256
Testicular torsion: diagnosed by
US Scrotum
257
UIT: diagnosed by
Urinalysis (WBC, Nitrite, or Bacteria)
258
Pyelo: diagnosed by
CT Abd/Pelvis (A/P) UTI with CVA tenderness on exam
259
Kidney stone: diagnosed by
CT A/P (RBC in UA may be a clue)
260
Ectopic pregnancy: diagnosed by
US Pelvis
261
Ovarian torsion: diagnosed by
US Pelvis
262
Testicular torsion: diagnosed by
US Scrotum
263
Upper Respiratory Infection
URI
264
URI: etiology
Most often viral infection causes congestion, cough, and inflammation of the upper airway.
265
URI: CC
Cough/congestion
266
URI: assoc. Sx
Fever, sore throat, headache, myalgias
267
URI: physical exam
Rhinorrhea, boggy turbinates, pharyngeal erythema
268
URI: diagnosed by
Clinicallly
269
URI: scribe alert
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
Otitis Media
Middle ear infection
271
Otitis media: etiology
Viral or bacterial infection of the TM causing ear pain and pressure.
272
Otitis media: CC
Ear pain, ear pulling
273
Otitis media: assoc. Sx
Fever, sore throat, dry cough, congestion
274
Otitis media: physical exam
Erythema, effusion, dullness, or bulging of the TM.
275
Otitis media: diagnosed by
Clinically
276
Strep Throat
Streptococcal Pharyngitis
277
Strep throat: etiology
Bacterial infection of the tonsils and pharynx causing a sore throat and frequently swollen lymph nodes.
278
Strep throat: CC
Sore throat
279
Strep throat: physical exam
```
Pharyngeal erythema
tonsillar hypertrophy (enlargement)
tonsillar exudates (pus)
```
280
Strep throat: diagnosed by
Rapid strep
281
Strep throat: scribe alert
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
PTA
Peri-Tonsillar Abscess
283
Conjunctivitis: etiology
Infection of the outer lining of the eye, known as the conjunctiva
284
Conjunctivitis: CC
Eye redness, irritation or pain
285
Conjunctivitis: assoc. Sx
Eyelid matting, eye discharge, fever
286
Conjunctivitis: physical exam
Conjunctival injection (redness), edema, and exudates
287
Injection
Redness
288
Conjunctivitis: diagnosed by
Clinically
289
Epistaxis: etiology
Rupture of a blood vessels inside the nose causes blood to flow out the nose and into the throat.
290
Epistaxis: CC
Nose bleed
291
Epistaxis: risk factors
Blood thinners (Coumadin/Warfarin, ASA, Plavix) or HTN
292
Epistaxis: physical exam
Anterior, posterior, or Septal source (of the bleeding)
293
Epistaxis: diagnosed by
Clinically
294
Epistaxis: scribe alert
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
Musculoskeletal back pain: etiology
Deterioration or strain of the back creates pain that is worse with movement.
296
Musculoskeletal back pain: CC
Back pain:
| Most commonly low back (lumbar) pain
297
Musculoskeletal back pain: assoc. Sx
Shooting posterior lower extremity pain.
298
Musculoskeletal back pain: pert. negs.
No LE weakness, no incontinence
299
Musculoskeletal back pain: physical exam
Paraspinal tenderness, positive straight leg raise (+ SLR diagnoses Sciatica; back pain that radiates down the legs)
300
Musculoskeletal back pain: scribe alert
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
Extremity injury: etiology
trauma creates pain/swelling in an extremity
302
Extremity injury: CC
Extremity pain
303
Extremity injury: assoc. Sx
Swelling, bruising, deformity, use limitation.
304
Extremity injury: pert. negs.
No motor weakness, no numbness or tingling
305
Extremity injury: physical exam
Distal CSMT intact (Circulation, Sensory, Motor, Tendon) No tendon or ligament laxity ROM limited secondary to pain.
306
Extremity injury: scribe alert
Remember the majority of extremity injuries will receive some type of splint; always remember to document a Splint Application Procedure Note!
307
AAA: etiology
Widened and weakened arterial wall at risk of rupture
308
AAA: CC
Midline pulsatile abd mass, abd bruit, unequal femoral pulses, hypotension
309
AAA: diagnosed by
CT A/P with IV contrast dye
310
Aortic dissection: etiology
Separation of the muscular wall from the membrane of the artery, putting the pt at risk of aortic rupture and death.
311
Aortic dissection: CC
Chest pain radiating to the back:
| ripping or tearing
312
Aortic dissection: physical exam
Unequal brachial or radial pulses, hypotension
313
Aortic dissection: diagnosed by
CT Chest with IV contrast dye
314
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 (block) the vein.
315
DVT: risk factors
PMHx of DVT or PE, FHx, Recent Surgery, CA, Immobility, Pregnancy, BCP, smoking, LE Trauma, LE Casts
316
DVT: CC
Extremmmity pain and swelling (atraumatic):
| Usually located in a lower extremity
317
DVT: physical exam
Calf tenderness, cords, Homan's sign
318
DVT: diagnosed by
US/Doppler of the extremity
319
Cellulitis: etiology
Infection of the skin cells
320
Cellulitis: CC
Red, swollen, ppainful, and sometimes warn area of skin
321
Cellulitis: physical exam
erythema, edema, increased warmth (calor), induration
322
Cellulitis: assoc. meds
Abx
323
Cellulitis: diagnosed by
Clinically
324
Abscess
Cellulitis with fluctuance
325
Abscess: etiology
Skin infection with an underlying collection of pus
326
Abscess: CC
red, swollen, and painful lump
327
Abscess: physical exam
Fluctuance (pus-pocket), induration, purulent drainage
328
Abscess: diagnosed by
Clinically
329
Abscess: scribe alert
Abscesses must have the pus-pocket drained. Remember to always document Incision and Drainage (I&D) Procedure notes for abscesses.
330
Rash: etiology
Changes in the skin's appearance due to systemic or localized reaction. May be caused from medication, virus, bacteria, fungus, insect, etc.
331
Rash: CC
Rash:
| Red, pruritic or painful
332
Rash: physical exam
```
Urticaria
Macules
Papules
Vesicles
Blanching
Petechaie
Purpura
```
333
Urticaria
Hives or wheals (rash)
334
Macules
flat (rash)
335
Papules
raised bumps (rash)
336
Vescicles
small blisters (rash)
337
Blanching
not dangerous rash
338
Petechaie
dangerous rash
339
Purpura
dangerous rash
340
Rash: diagnosed by
Clinically
341
Allergic reaction: etiology
Immune response causing an inflammatory reaction consisting of swelling, pruritis, and rash.
342
Allergic reaction: risk factors
Known drug or food allergy
343
Allergic reaction: CC
Rash, swelling, itching, or SOB
344
Allergic reaction: physical exam
Edema, facial angiodema, urticaria
345
Allergic reaction: diagnosed by
Clinically
346
Allergic reaction: scribe alert
ED concern is Anaphylaxis or Respiratory failure
347
True allergic reactions
Rash
Itching
Swelling
SOB due to airway swelling
348
DKA: etiology
Shortage of insulin resulting in hyperglycemia and production of ketones
349
DKA: risk factors
DM
350
DKA: CC
Persistent vomiting with a Hx of DM
351
DKA: assoc. Sx
SOB, polydipsia (increased thirst), polyuria (increased urination
352
DKA: physical exam
Ketotic odor "fruity", dry mucous membranes (dehydration), tachypnea
353
DKA: diagnosed by
Arterial blood gas (ABG or VBG) showing low pH (acidosis) or Positive Serum ketones
354
Psychological disorder:; etiology
Various types of psychological disease produce abnormal thoughts, bahaviors, or actions
355
Psychological disorder: PMHx
Bipolar Disorder, Schizophrenia, PTSD, Depression, Anxiety, Alcoholism, Drug Abuse, Suicide Attempt
356
Psychological disorder: CC
```
SI
HI
Hallucinations
Substance abuse
Self injury
OD
```
357
SI
Suicidal Ideation
358
HI
Homicidal Ideation
359
Psychological disorder: physical exam
Flat affect, SI, HI, Tangential or Pressured speech
360
Psychological disorder: scribe alert
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
Trauma
Physical Injury
362
Trauma: etiology
Depending on the MOI physical trauma may break bones, sever nerves, rupture blood vessels, or damage internal organs.
363
MOI
Mechanism of Injury
364
Trauma: CC
MVA, fall, GSW
365
Trauma: physical exam
GCS
366
GCS
Glasgow Coma Scale
367
Trauma: assoc. med
blood thinners (Coumadin, ASA, or Plavix)
368
Trauma: diagnosed by
Trauma Protocol depending on MOI: CT or XR
369
Trauma: scribe alert
```
Neurological Injury (Brain, Spine):
LOC
confusion
numbness
weakness
HA
Neck/Back Pain
Internal organ injury (lungs, Spleen, Liver):
SOB
CP
Abd Pain
```
370
Trauma (MOI): etiology
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
Trauma (MOI): rapid forward deceleration (MVC)
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
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 pt or > 20 ft
373
Trauma (MOI): penetrating trauma
1. Stab wounds: location, blade length, angle of penetration
| 2. Firearms: Type of weapon, caliber, distance, bullet deformity
374
DDx
A short list of diseases the doctor considers when diagnosing a pt.
375
Pertinent Positives
Specific Sx that raise the physician's concern for that particular disease
376
Pertinent Negatives
Specific Sx that are not present which cause the physician to doubt certain diagnoses
377
Risk Factors
"red Flags: that would put a pt at risk for that particular Dz.
378
Etiology
The study of the causes of Dz.
379
Pleura
Membrane lining the thoracic cavity (parietal pleura) and covering the lungs (visceral pleura)
380
Artery
A blood vessel that carries oxygenated blood from the heart throughout the body
381
CTA
Computed Tomography Angiography
