Course 2: Pathophysiology Flashcards
What is CAD?
Coronary Artery Disease
What other past histories would suggest the patient has CAD?
- MI
- Angina
- CABG
- Stent
- Angioplasty
Does a PMHx of CVA mean the patient has CAD?
No
Does a surgical history of angioplasty mean the patient has CAD?
Yes
Explain the differences between CAD and an MI
CAD=broad term for heart disease
MI=included in CAD; is an active heart attack
If someone has a PMHx of A-Fib or CHF, do they have CAD?
No
What are the cardiac risk factors?
- HTN
- DM
- HLD
- CAD
- Smoking
- FHx of CAD <55y/o
How is CAD diagnosed?
By a cardiologist during a cardiac catheterization (not done in the ED)
Name 2 ways that an MI can be diagnosed?
STEMI—> EKG
Non-STEMI—> Troponin
What are some associated symptoms of an MI other than CP?
- N/V
- SOB
- Diaphoresis
What are some associated symptoms of CHF?
SOB—> orthopnea, PND, DOE
Pedal edema
What 2 studies would diagnose CHF?
CXR or elevated BNP
What is A-Fib?
EKG
What could be the CC of someone with a PE?
Pleuritic CP or SOB
What are risk factors for a PE?
- known DVT
- PMHx of DVTor PE
- FHx of DVT or PE
- recent surgery
- CA
- Afib
- immobility
- pregnancy
- birth control pill (BCP)
- Smoking
What study would diagnose a PE?
- CTA chest/VQ scan
- D-Dimer can only rule it out
What part of the heard does CAD affect: arteries, veins, nerves?
Arteries
Can a CT Chest without IV contrast diagnose a PE? Why or Why not?
NO
-contrast in the vessels (IV) helps clearly see a blockage
What is PTX?
Pneumothorax
What is the most common cause of a PTX?
Trauma
How is a PTX diagnosed?
CXR
What Social History will most COPD patients also have?
Smoking
What is the difference between an inhaler and a nebulizer for asthma?
Inhaler—> portable and gives a line time dose and provides a rapid release of medication
Nebulizer—> home machine that delivers continuous treatment over a period of time
What is asthma?
Constricting of the airway due to inflammation and muscular contraction of the bronchioles
-Also called reactive airway disease
What physical exam finding is closely associated with asthma?
Wheezing
What is PNA?
Pneumonia
-usually a bacterial infection (infiltrates) and inflammation inside the lung
What might a person with PNA complain of?
Productive talk and fever
How is PNA diagnosed?
CXR
Name all 7 areas of the abdomen
1) Epigastric
2) RUQ
3) LUQ
4) RLQ
5) LLQ
6) Suprapubic
7) Periumbilical (right/left flank)
What is the layman’s term for GERD?
Heartburn or Acid reflux
What might someone with GERD complain of?
Epigastric pain “burning”
For older patients with GER symptoms, what life-threatening disease may also need to be ruled out?
MI
What dies bile do? Where is bile stored?
- bile emulsifies fats in foods
- bile is stored in the gallbladder
- bile is made in the liver
What is the difference between colelithiases and cholecystitis?
Cholelithiases=gallstones
Cholecystitis= acute gallbladder inflammation/infection
What might be the chief complaint of a person with gallstones?
RUQ abdominal pain
What physical exam finding is closely associated with cholecystitis?
Murphy’s signs
How are gallstones diagnosed?
Abdominal ultrasound of RUQ
Name associated symptoms of appendicitis
- Fever
- N/V
- decreased appetite (anorexia)
- Note: RLQ pain- gradual, constant, worse with movements is the CC NOT an associated sx
How is appendicitis diagnosed?
CT A/P with PO contrast
What would someone with pancreatitis c/o?
LUQ or Epigastric abdominal pain
- N/V
- Fever
How is pancreatitis diagnosed?
Elevated lipase (or amylase which is less specific)
Name 4 possible CCs for a GI bleed
1) Hematemesis
2) Coffee ground emesis
3) Hematochezia melena
How is GI bleed diagnosed in the ED?
- Guaiac positive stool
- Heme positive stool
- gastroccult
What are we worried about for someone with a GI bleed?
- Too much blood loss
- Anemia
- Diverticulosis
What will be the CC of someone with diverticulitis?
LLQ abdominal pain
What studies would diagnose diverticulitis?
CT A/P with P.O. contrast
What might a person with SBO complain of?
- Abd pain/bloating
- vomiting
- abdominal dissension
- no BMs
- Constipation
How is an SBO diagnosed?
CT A/P with P.O. contrast
OR
AAS (Acute Abdominal Series) X-Rays
What is a UTI?
Urinary tract infection
What is pyelo?
Pyelonephritis aka kidney infection
-different and worse than a UTI but normally spread from an UTI
What will be the CC of someone with a UTI?
Painful urination (dysuria) frequency, burning, hesitancy, malodorous urine
Where would a patient have pain if they had pyelo?
Flank pain, fever, dysuria
How is a UTI diagnosed?
Urine dip or urinalysis (UA) showing white blood cells, bacteria and nitrites
What might a person with kidney stones c/o?
Flank pain, sudden onset radiating to groin
How are kidney stones diagnosed?
CT A/P or RBC in UA
What is an ectopic pregnancy?
Tubal pregnancy when a fertilized egg develops outside the uterus (normally in the Fallopian tube)
-High risk for rupture and death
How is an ectopic pregnancy diagnosed?
US of the pelvis
What is ovarian torsion?
twisting of the ovarian artery which reduces the blood flow tot he ovary
-could result in Infarct to the ovary
How is ovarian torsion diagnosed?
US pelvis
Name the 2 types of CVAs
1) Hemorrhagic
2) Ischemic
What sx might a person with a brain bleed c/o?
HA—> sudden onset (thunderclap; worst headache of life)
- Changes in speech, vision and motor (weakness) sensation (numbness)
- AMS
What study would diagnose a brain bleed?
CT Head or Lumbar Puncture
What sx might a person with an ischemic CVA c/o?
-Focal Neurological Deficit: changes in speech, changes in vision, one sided motor (weakness), one-sided sensation changes (numbness)
How is an ischemic CVA diagnosed?
Clinically, potentially normal CT head
What is a TIA?
Transient Ischemic Attack
- mini stroke
- temporary loss of blood supply to the brain
How does a TIA differ from a CVA?
TIA= mini stroke, sx usually resolve in less than an hour
CVA= stroke, sx last longer, and potentially may not go away
What is a common cause of seizures in children?
Fever
What is the name of the state after a seizure?
Postictal
What are 3 symptoms of meningitis?
1) Fever
2) Neck Pain/Stiffness
3) Headache
What study would dx meningitis?
Lumbar Puncture
What are 4 important things to document for syncopal episodes?
How they felt before,m during, after and how they currently feel
Name 4 important causes of altered mental status
1) Hypoglycemia
2) Infection
3) Intoxication
4) Neurological
How is AMS different from a focal neuro deficit?
AMS=generalized, typically caused by something that can affect whole brain(blood, low BS)
FND= localized (weakness/numbness/speech/vision) to one specific area and corresponds with damage to specific spot in the brain
What is a DVT?
Deep Vein Thrombosis
What are the risk factors for a DVT?
- Known DVT
- PMHx of DVT or PE
- FHx of DVT or PE
- recent surgery
- CA
- Afib
- immobility
- pregnancy
- BCP
- smoking
What are common signs of a DVT?
Extremity pain, swelling (a traumatic)
What is an AAA?
Abdominal Aortic Aneurysm
What is an aortic dissection?
The separation of the muscular wall from the membrane of the artery, putting the patient at risk for aortic rupture and death
What are 3 symptoms of cellulitis?
1) Redness
2) Swelling
3) Pain
To an area of the skin
How is an abscess different from cellulitis?
Abscess is cellulitis with fluctuance (pus pocket)
What procedure will be performed for every abscess?
Incision& Drainage
What is the main concern with an allergic reaction?
- Anaphylaxis
- Respiratory Failure
What are the ONLY 3 symptoms of a true allergic reaction?
1) Rash
2) Itching
3) Swelling
4) SOB due to airway swelling
How can DKA be diagnosed?
Arterial blood glass showing low pH or Positive Serum Ketones
What is the ED Doc’s main responsibility for psychiatric patients?
Medical Clearance
Name 3 Important things to document for any trauma patient
- LOC
- Head Injury
- Neck Pain
- Back Pain
- Numbness
- Weakness
