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Scribe Training > Course 2: Pathophysiology Everything > Flashcards

Course 2: Pathophysiology Everything Flashcards

1
Q

Coronary Artery Disease (CAD): Etiology?

A

Narrowing of the coronary arteries limits blood supply to the heart muscle causing angina (chest pain specifically due to heart muscle ischemia)

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2
Q

Coronary Artery Disease (CAD): Catch Phrase?

A

Chest pain with physical exertion

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3
Q

Coronary Artery Disease (CAD): Chief Complaint?

A

Chest pain or chest pressure. Worse with exertion. Improved by rest or NTG

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4
Q

Coronary Artery Disease (CAD): Assoc. Meds? (2)

A

Aspirin (ASA) PO (blood thinner)

Nitroglycerin (NTG) SL (vasodilator)

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5
Q

Coronary Artery Disease (CAD): Diagnosed by?

A

Cardiac Catheterization (not done in the ED)

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6
Q

Coronary Artery Disease (CAD): Scribe Alert? (4)

A
  1. CAD is the single greatest risk factor for an MI.
  2. Stress tests or cardiac catheterization assess the severity of CAD.
  3. A patient has CAD if they have a PMHx of angina, MI, CABG, cardiac stents, or angioplasty.
  4. Every patient complaining of chest pain should always receive aspirin PO, unless it was given PTA or if it is contra-indicated due to bleeding or allergy.
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7
Q

Myocardial Infarction (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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8
Q

Myocardial Infarction (MI) STEMI/non-STEMI: Catch Phrase? (3)

A

Chest pressure with diaphoresis, N/V, and SOB

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9
Q

Myocardial Infarction (MI) STEMI/non-STEMI: Risk Factors? (6)

A

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

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10
Q

Myocardial Infarction (MI) STEMI/non-STEMI: Chief Complaint?

A

Chest pain or chest pressure

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11
Q

Myocardial Infarction (MI) STEMI/non-STEMI: Diagnosed by?

A 
EKG (STEMI)
Elevated Troponin (non-STEMI)
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12
Q

Myocardial Infarction (MI) STEMI/non-STEMI: Assoc. Meds? (4)

A

ASA (blood thinner), NTG (vasodilator), beta blocker (slows HR), Thrombolytic (heparin- powerful blood thinner)

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13
Q

Myocardial Infarction (MI) STEMI/non-STEMI: Scribe Alert? (2)

A
  1. Acute MI patients must receive aspirin as soon as possible.
  2. STEMI patients must get to Cath-lab within 90 min of arrival. Document ED arrival and depart time.
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14
Q

Congestive Heart Failure (CHF): Etiology?

A

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

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15
Q

Congestive Heart Failure (CHF): Catch Phrase?

A

SOB with pedal edema (LE swelling) and orthopnea (SOB while lying flat)

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16
Q

Congestive Heart Failure (CHF): Chief Complaint? (3)

A

SOB – worse while lying flat (orthopnea), paroxysmal nocturnal dyspnea (PND) (at night due to pressure of fluid), dyspnea on exertion (DOE)

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17
Q

Congestive Heart Failure (CHF): Physical Exam? (2)

A

Rales (crackles) in lungs, jugular vein distention (JVD) in neck

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18
Q

Congestive Heart Failure (CHF): Assoc. Meds?

A

Diuretics (Lasix, furosemide) – urinate extra fluid

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19
Q

Congestive Heart Failure (CHF): Diagnosed by? (2)

A 
CXR – heart looks like >50% of space
Elevated BNP (B type natriuretic peptide) – blood test
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20
Q

Congestive Heart Failure (CHF): Scribe Alert?

A

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

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21
Q

Atrial Fibrillation (A-Fib): Etiology?

A

Electrical abnormalities in the “wiring” of the heart caused the atria to quiver abnormally.

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22
Q

Atrial Fibrillation (A-Fib): Chief Complaint?

A

Palpitations (fast, pounding, irregular)

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23
Q

Atrial Fibrillation (A-Fib): Risk Factors? (2)

A

Paroxysmal A-Fib, Chronic A-Fib

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24
Q

Atrial Fibrillation (A-Fib): Physical Exam? (2)

A

Irregularly irregular rhythm, tachycardia

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25
Q

Atrial Fibrillation (A-Fib): Diagnosed by?

A

EKG

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26
Q

Atrial Fibrillation (A-Fib): Assoc. Meds?

A

Coumadin (Warfarin) – blood thinner, prevents blood clots in atria

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27
Q

Atrial Fibrillation (A-Fib): Scribe Alert?

A

ED concern is Rapid Ventricular Response (RVR), which can cause blood clots. These patients will often be “cardioverted” which means they are put back into a regular rhythm, known as normal sinus rhythm (NSR).

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28
Q

Pulmonary Embolism (PE): Etiology?

A

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

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29
Q

Pulmonary Embolism (PE): Catch Phrase?

A

Pleuritic chest pain with tachycardia and hypoxia

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30
Q

Pulmonary Embolism (PE): Risk Factors? (10)

A

Known DVT, PMHx of DVT or PE, FHx, recent surgery, cancer, A-Fib, immobility, pregnancy, BCP (birth control pills), smoking

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31
Q

Pulmonary Embolism (PE): Chief Complaint?

A

SOB or pleuritic CP (worse with deep breaths)

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32
Q

Pulmonary Embolism (PE): Diagnosed by?

A 
CTA Chest (CT Chest with IV contrast) or VQ scan
D-Dimer aids in detecting clots, but cannot diagnose a PE. (if neg, no PE. If pos, may be PE, in which need to do CTA or VQ to diagnose.)
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33
Q

Pneumonia (PNA): Etiology?

A

Infiltrate (bacterial infection) and inflammation in the lungs.

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34
Q

Pneumonia (PNA): Catch Phrase?

A

Productive cough with fever

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35
Q

Pneumonia (PNA): Risk factors? (4)

A

Elderly, bedridden, recent chest injury, recent surgery

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36
Q

Pneumonia (PNA): Chief Complaint?

A

SOB or productive cough

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37
Q

Pneumonia (PNA): Assoc. Sx? (3)

A

Cough with sputum, fever, chest pain

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38
Q

Pneumonia (PNA): Assoc. Meds? (2)

A

Rocephin, Zithromax (antibiotics)

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39
Q

Pneumonia (PNA): Physical Exam?

A

Rhonchi

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40
Q

Pneumonia (PNA): Diagnosed by?

A

CXR

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41
Q

Pneumonia (PNA): Scribe Alert?

A

Community Acquired Pneumonia (CAP) protocol applies to pt’s with PNA. CAP protocol requires documenting Abx, vital signs – check for low oxygen, SaO2, mental status- disoriented, and blood cultures.

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42
Q

Pneumothorax (PTX): Etiology?

A

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

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43
Q

Pneumothorax (PTX): Chief Complaint? (2)

A

SOB and one-sided CP; sudden onset, often trauma patients

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44
Q

Pneumothorax (PTX): Physical Exam?

A

Absent breath sounds unilaterally

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45
Q

Pneumothorax (PTX): Diagnosed by?

A

CXR

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46
Q

Pneumothorax (PTX): Scribe Alert?

A

Document the percentage of lung collapsed (i.e. 20% PTX)

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47
Q

Chronic Obstructive Pulmonary Disease (COPD): Etiology?

A

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

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48
Q

Chronic Obstructive Pulmonary Disease (COPD): Risk Factors?

A

Smoking

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49
Q

Chronic Obstructive Pulmonary Disease (COPD): Chief Complaint?

A

SOB

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50
Q

Chronic Obstructive Pulmonary Disease (COPD): Physical Exam? (3)

A

Decreased breath sounds, wheezes, rales

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51
Q

Chronic Obstructive Pulmonary Disease (COPD): Assoc. Meds?

A

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

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52
Q

Chronic Obstructive Pulmonary Disease (COPD): Diagnosed by?

A

CXR and Hx of smoking

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53
Q

Reactive Airway Disease (RAD): Etiology?

A

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

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54
Q

Reactive Airway Disease (RAD): Chief Complaint? (2)

A

SOB/Wheezing

Improved by nebulizer breathing treatments (bronchodilators)

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55
Q

Reactive Airway Disease (RAD): Physical Exam?

A

Wheezes (inspiratory or expiratory)

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56
Q

Reactive Airway Disease (RAD): Diagnosed by?

A

Clinically

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57
Q

Reactive Airway Disease (RAD): Scribe Alert? (5)

A

The physician will ask the asthma patient…

  1. Do they have home nebulizer (machine)?
  2. Have they been on steroids recently?
  3. Hx of hospitalization for asthma?
  4. Hx of intubation (breathing tube)?
  5. Asthma triggers?
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58
Q

Reactive Airway Disease (RAD): Assoc. Meds? (3)

A

Inhalers, nebulizers, corticosteroids

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59
Q

Ischemic CVA: Etiology?

A

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

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60
Q

Ischemic CVA: Chief Complaint?

A

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

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61
Q

Ischemic CVA: Risk Factors? (7)

A

HTN, HLD, DM, Hx TIA/CVA, Smoking, FHx CVA, AFIB

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62
Q

Ischemic CVA: Physical Exam?

A

Neurological deficits: hemiparesis (weakness of left or right side), unilateral paresthesias (abnormal sensations), aphasia (difficulty with speech), visual field deficits

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63
Q

Ischemic CVA: Diagnosed by? (2)

A

Clinically, Potentially normal CT Head

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64
Q

Ischemic CVA: Scribe Alert? (2)

A

For any stroke patient, 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 (

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65
Q

Hemorrhagic CVA (Brain Bleed): Etiology?

A

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

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66
Q

Hemorrhagic CVA (Brain Bleed): Chief Complaint?

A

HA, sudden onset (thunderclap, worst of life)

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67
Q

Hemorrhagic CVA (Brain Bleed): Assoc. Sx? (3)

A

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

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68
Q

Hemorrhagic CVA (Brain Bleed): Physical Exam?

A

Unilateral neurological deficits

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69
Q

Hemorrhagic CVA (Brain Bleed): Diagnosed by?

A

CT Head or LP (check spinal fluid for blood)

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70
Q

Hemorrhagic CVA (Brain Bleed): Scribe Alert?

A

Document tPA not indicated due to hemorrhage (because tPA is a blood thinner).

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71
Q

Transient Ischemic Attack (TIA): Etiology?

A

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

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72
Q

Transient Ischemic Attack (TIA): Chief Complaint?

A

Transient focal neurological deficit (changes in speech, vision, strength, or sensation)

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73
Q

Transient Ischemic Attack (TIA): Diagnosed by?

A

Clinically

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74
Q

Transient Ischemic Attack (TIA): Scribe Alert?

A

Document tPA considered and not indicated due to the fact that symptoms are resolved.

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75
Q

Meningitis- Bacterial v Viral: Etiology?

A

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

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76
Q

Meningitis- Bacterial v Viral: Chief Complaint? (2)

A

HA and neck pain

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77
Q

Meningitis- Bacterial v Viral: Assoc. Sx? (4)

A

Fever, neck pain, neck stiffness, AMS

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78
Q

Meningitis- Bacterial v Viral: Physical Exam? (2)

A

Meningismus (headache, neck pain), nuchal rigidity (cannot flex neck forward due to rigidity of neck muscles)

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79
Q

Meningitis – Bacterial v Viral: Diagnosed by?

A

LP

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80
Q

Spinal Cord Injury: Etiology?

A

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

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81
Q

Spinal Cord Injury: Chief Complaint? (2)

A

Neck pain or back pain, bilateral extremity weakness

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82
Q

Spinal Cord Injury: Physical Exam? (5)

A

Midline bony tenderness, deformities or step-offs (bones should be aligned, but not), bilateral extremity weakness, numbness, decreased rectal tone

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83
Q

Spinal Cord Injury: Diagnosed by? (3)

A

CT Cervical Spine (Neck)
CT Thoracic Spine (Upper back)
CT Lumber Spine (lower back)

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84
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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85
Q

Seizure (Sz): Etiology?

A

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

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86
Q

Seizure (Sz): Chief Complaint? (2)

A

Sz activity, syncope

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87
Q

Seizure (Sz): Assoc. Sx? (4)

A

Injuries (tongue-bite), confusion, HA, incontinence (urinary or fecal)

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88
Q

Seizure (Sz): Physical Exam? (2)

A

Somnolent (sleepy), confused (postictal – after sz)

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89
Q

Seizure (Sz): Scribe Alert? (5)

A

The physician will ask…

  1. Has the patient had a similar Sz in the past?
  2. Does the patient have a Hx of Sz?
  3. What was the date of their last sz?
  4. What sz medication do they take?
  5. Have they missed med doses?
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90
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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91
Q

Bells Palsy: Chief Complaint?

A

Facial droop, sudden onset

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92
Q

Bells Palsy: Assoc. Sx? (2)

A

Jaw or ear pain, increased tear flow of one eye

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93
Q

Bells Palsy: Pert. Neg? (2)

A

No extremity weakness, no changes in speech or vision

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94
Q

Bells Palsy: Physical Exam?

A

Unilateral weakness of the upper and lower face

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95
Q

Bells Palsy: Diagnosed by?

A

Clinically

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96
Q

Bells Palsy: Scribe Alert?

A

Most common cause of facial droop in young patients who do not have CVA risk factors. Remember to document the absence of other FND.

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97
Q

Headache (HA) – Cephalgia: Etiology?

A

Various causes including hypertensive HA (from high BP), recurrent diagnosed migraines, sinusitis, etc.

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98
Q

Headache (HA) – Cephalgia: Chief Complaint?

A

HA (gradual onset), pressure, throbbing

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99
Q

Headache (HA) – Cephalgia: Pert Neg? (4)

A

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

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100
Q

Headache (HA) – Cephalgia: 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 physician.

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101
Q

Altered Mental Status (AMS): Etiology?

A

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

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102
Q

Altered Mental Status (AMS): Risk Factors? (5)

A

Diabetic, Elderly, Demented, EtOH use, drug use

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103
Q

Altered Mental Status (AMS): Chief Complaint? (3)

A

Confusion, decreased responsiveness, unresponsive

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104
Q

Altered Mental Status (AMS): Diagnosed by?

A

Case dependent

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105
Q

Altered Mental Status (AMS): Scribe Alert?

A

AMS is very different than a focal neurological deficit. It is generalized and typically caused by things that affect the whole brain (drugs, low sugar). Focal neuro deficits are localized weakness/numbness in one specific area, corresponding with damage at one specific site in the brain.

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106
Q

Syncope (Fainting): 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). Occassionally, syncope occurs due to cardiac/neurologic causes.

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107
Q

Syncope (Fainting): Chief Complaint?

A

Passing out v about to pass out (near syncope)

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108
Q

Syncope (Fainting): Scribe Alert?

A

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

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109
Q

Vertigo (Room Spinning): 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 the brain (possible CVA).

110
Q

Vertigo (Room Spinning): Chief Complaint?

A

Room-spinning, feeling off balance (disequilibrium) – worsened with head movement

111
Q

Vertigo (Room Spinning): Assoc. Sx?

A

N/V, tinnitus (ringing in ears)

112
Q

Vertigo (Room Spinning): Physical Exam?

A

Horizontal nystagmus, positive Romberg, positive dix-hallpike test

113
Q

Vertigo (Room Spinning): Assoc. Med?

A

Meclizine (Antivert- gets rid of dizziness symptoms)

114
Q

Vertigo (Room Spinning): Diagnosed by?

A

Clinically

115
Q

Appendicitis (APPY): Etiology?

A

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

116
Q

Appendicitis (APPY): Chief Complaint?

A

RLQ pain, gradual onset, constant, worsened with movement

117
Q

Appendicitis (APPY): Assoc. Sx? (3)

A

Decreased appetite (anorexia), fever, N/V

118
Q

Appendicitis (APPY): Physical Exam?

A

McBurney’s point tenderness, RLQ tenderness, peritoneal signs: guarding, rebound, rigidity

119
Q

Appendicitis (APPY): Diagnosed by?

A

CT A/P with PO contrast (oral solution lightens image of organs)

120
Q

Small Bowel Obstruction (SBO): Etiology?

A

Physical blockage of the small intestine

121
Q

Small Bowel Obstruction (SBO): Risk Factors? (4)

A

Elderly, infants, abdominal surgery, narcotic pain meds

122
Q

Small Bowel Obstruction (SBO): Chief Complaint? (3)

A

Abdominal pain, vomiting, constipation

123
Q

Small Bowel Obstruction (SBO): Assoc. Sx?

A

Distention, bloating, no BMs

124
Q

Small Bowel Obstruction (SBO): Physical Exam? (6)

A

Abdominal tenderness, guarding, rebound, abnormal bowel sounds, abdominal distension, tympany

125
Q

Small Bowel Obstruction (SBO): Diagnosed by? (2)

A

CT A/P with PO Contrast

Acute Abdominal Series (AAS) – abdominal xray

126
Q

Gallstones (Cholelithiasis, Cholecystitis): Etiology?

A

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

127
Q

Gallstones (Cholelithiasis, Cholecystitis): Catch Phrase?

A

RUQ abdominal pain after eating fatty foods

128
Q

Gallstones (Cholelithiasis, Cholecystitis): Chief Complaint?

A

RUQ pain – sharp, worsened with eating, deep breaths, and palpitation

129
Q

Gallstones (Cholelithiasis, Cholecystitis): PE?

A

RUQ tenderness, Murphy’s sign

130
Q

Gallstones (Cholelithiasis, Cholecystitis): Diagnosed by?

A

Abdominal US, RUQ

131
Q

Gastointestinal Bleed (GI Bleed): Etiology?

A

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

132
Q

Gastointestinal Bleed (GI Bleed): CC? (4)

A

Hematemesis (upper tract), coffee ground emesis, hemtochezia (lower tract) – bloody stool, melena (upper tract)

133
Q

Gastointestinal Bleed (GI Bleed): Assoc. Sx? (5)

A

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

134
Q

Gastointestinal Bleed (GI Bleed): PE? (4)

A

Pale conjunctiva, pallor, tachycardia

Rectal exam: grossly bloody stool

135
Q

Gastointestinal Bleed (GI Bleed): Diagnosed by?

A

Heme positive stool (guaiac positive) during rectal exam

136
Q

Diverticulitis: Etiology?

A

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

137
Q

Diverticulitis: Risk Factors? (2)

A

Diverticulosis, advanced age

138
Q

Diverticulitis: CC?

139
Q

Diverticulitis: Assoc. Sx? (3)

A

Nausea, fever, diarrhea

140
Q

Diverticulitis: Diagnosed by?

A

CT A/P with PO contrast

141
Q

Pancreatitis: Etiology?

A

Inflammation of the pancreas

142
Q

Pancreatitis: Risk factors? (3)

A

EtOH abuse, cholecystitis, specific medications

143
Q

Pancreatitis: CC? (2)

A

LUQ, epigastric pain

144
Q

Pancreatitis: Assoc. Sx?

145
Q

Pancreatitis: PE?

A

Epigastric tenderness

146
Q

Pancreatitis: Diagnosed by?

A

Elevated Lipase lab test (or sometimes elevated Amylase)

147
Q

Gastroesophageal Reflux Disease (GERD): Etiology?

A

Stomach acid regurgitating into the esophagus

148
Q

Gastroesophageal Reflux Disease (GERD): CC?

A

Epigastric pain, burning, improved with antacids

149
Q

Gastroesophageal Reflux Disease (GERD): PE?

A

Epigastric tenderness

150
Q

Gastroesophageal Reflux Disease (GERD): Assoc. Med?

A

GI Cocktail (numbs and soothes the esophagus and stomach)

151
Q

Gastroesophageal Reflux Disease (GERD): Scribe Alert?

A

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

152
Q

Urinary Tract Infection (UTI): Etiology?

A

Infection in the urinary tract (bladder or urethra)

153
Q

Urinary Tract Infection (UTI): Risk Factors?

154
Q

Urinary Tract Infection (UTI): CC?

155
Q

Urinary Tract Infection (UTI): Assoc. Sx?

A

Frequency, urgency, malodorous urine, AMS (elderly)

156
Q

Urinary Tract Infection (UTI): PE?

A

Suprapubic tenderness

157
Q

Urinary Tract Infection (UTI): Diagnosed by?

A

Urine dip or Urinalysis (tests for nitrite, WBC, and bacterine)

158
Q

Pyelonephritis: Etiology?

A

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

159
Q

Pyelonephritis: CC?

A

Flank pain with dysuria

160
Q

Pyelonephritis: Assoc. Sx?

A

Fever, N/V

161
Q

Pyelonephritis: PE?

A

Costo-vertebral angle tenderness

162
Q

Pyelonephritis: Diagnosed by?

A

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

163
Q

Kidney Stone (Nephrolithiasis): 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.

164
Q

Kidney Stone (Nephrolithiasis): CC?

A

Flank pain, sudden onset, radiating to groin

165
Q

Kidney Stone (Nephrolithiasis): Assoc. Sx? (3)

A

Hematuria, N/V, unable to void

166
Q

Kidney Stone (Nephrolithiasis): PE?

A

CVA tenderness

167
Q

Kidney Stone (Nephrolithiasis): Diagnosed by? (2)

A

CT Abd/Pelvis

RBC in UA may be clue

168
Q

Ectopic Pregnancy: Etiology?

A

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

169
Q

Ectopic Pregnancy: Risk Factors? (2)

A

Pregnant female (HCG positive), STD (PID)

170
Q

Ectopic Pregnancy: CC?

A

Lower abdominal pain or vaginal bleeding while pregnant

171
Q

Ectopic Pregnancy: Diagnosed by?

A

US Pelvis -> determine location of fetus

172
Q

Ectopic Pregnancy: Scribe Alert?

A

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

173
Q

Ovarian Torsion: Etiology?

A

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

174
Q

Ovarian Torsion: CC?

A

Lower abdominal pain (RLQ or LLQ)

175
Q

Ovarian Torsion: PE? (2)

A

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

176
Q

Ovarian Torsion: Diagnosed by?

A

US Pelvis -> assesses blood flow to ovaries

177
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

178
Q

Testicular Torsion: Etiology?

A

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

179
Q

Testicular Torsion: CC?

A

Testicular pain

180
Q

Testicular Torsion: PE? (2)

A

Testicular tenderness and swelling (right or left)

181
Q

Testicular Torsion: Diagnosed by?

A

US Scrotum

182
Q

Upper Respiratory Infection (URI): Etiology?

A

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

183
Q

Upper Respiratory Infection (URI): CC? (2)

A

Cough, congestion

184
Q

Upper Respiratory Infection (URI): Assoc. Sx? (4)

A

Fever, sore throat, headache, myalgia

185
Q

Upper Respiratory Infection (URI): PE? (3)

A

Rhinorrhea, boggy turbinates, pharyngeal erythema

186
Q

Upper Respiratory Infection (URI): Diagnosed by?

A

Clinically

187
Q

Upper Respiratory Infection (URI): Scribe Alert?

A

Pay special attention to any complaints of CP or SOB for URI patients; 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.

188
Q

Streptococcal Pharyngitis (Strep Throat): Etiology?

A

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

189
Q

Streptococcal Pharyngitis (Strep Throat): CC?

A

Sore throat

190
Q

Streptococcal Pharyngitis (Strep Throat): PE? (3)

A 
Pharyngeal erythema
Tonsillar hypertrophy (enlargement)
Tonsillar exudates (pus)
191
Q

Streptococcal Pharyngitis (Strep Throat): Diagnosed by?

A

Rapid Strep

192
Q

Streptococcal Pharyngitis (Strep Throat): Scribe Alert? (2)

A

Most sore throats are viral, however strep is bacterial so Abx will help.
The biggest concern about a sore throat is the possibility of a peri-tonsillar abscess (PTA). Signs of PTA include uvular shift or tonsillar asymmetry.

193
Q

Otitis Media (Middle Ear Infection): Etiology?

A

Viral or bacterial infection of the tympanic membrane (TM) causing ear pain and pressure.

194
Q

Otitis Media (Middle Ear Infection): CC? (2)

A

Ear pain, ear pulling

195
Q

Otitis Media (Middle Ear Infection): Assoc. Sx? (4)

A

Fever, sore throat, dry cough, congestion

196
Q

Otitis Media (Middle Ear Infection): PE? (4)

A

Erythema, effusion, dullness, or bulging of the TM

197
Q

Otitis Media (Middle Ear Infection): Diagnosed by?

A

Clinically

198
Q

Conjunctivitis (Pink Eye): Etiology?

A

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

199
Q

Conjunctivitis (Pink Eye): CC?

A

Eye redness, irritation, or pain

200
Q

Conjunctivitis (Pink Eye): Assoc. Sx?

A

Eyelid matting

201
Q

Conjunctivitis (Pink Eye): PE? (3)

A

Conjunctival injection (redness), edema, and exudates

202
Q

Conjunctivitis (Pink Eye): Diagnosed by?

A

Clinically

203
Q

Epistaxis (Nosebleed): Etiology?

A

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

204
Q

Epistaxis (Nosebleed): CC?

A

Nose bleed

205
Q

Epistaxis (Nosebleed): Risk Factors?

A

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

206
Q

Epistaxis (Nosebleed): PE?

A

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

207
Q

Epistaxis (Nosebleed): Diagnosed by?

A

Clinically

208
Q

Epistaxis (Nosebleed): Scribe Alert?

A

Procedure epistaxis management: nose bleeds that do not stop spontaneously are often cauterized (burned) or stopped with pressure by a nasal tamponade, commonly called a “rhino-rocket”

209
Q

Musculoskeletal Back Pain: Etiology?

A

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

210
Q

Musculoskeletal Back Pain: CC?

A

Back pain, most commonly low back (lumbar) pain

211
Q

Musculoskeletal Back Pain: Assoc. Sx?

A

Shooting posterior lower extremity pain

212
Q

Musculoskeletal Back Pain: Pert. Negs.? (2)

A

No LE weakness, no incontinence

213
Q

Musculoskeletal Back Pain: PE? (2)

A

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

214
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.

215
Q

Extremity Injury: Etiology?

A

Trauma creates pain/swelling in an extremity.

216
Q

Extremity Injury: CC?

A

Extremity pain

217
Q

Extremity Injury: Assoc. Sx? (3)

A

Swelling, bruising, deformity; use limitation

218
Q

Extremity Injury: Pert Negs? (2)

A

No motor weakness, no numbness or tingling

219
Q

Extremity Injury: PE? (3)

A

Distal CSMT intact (circulation, sensory, motor, tendon) – do they have good sensation/movement/blood flow
No tendon or ligament laxity
ROM limited secondary to pain

220
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.

221
Q

Aortic Dissection: Etiology?

A

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

222
Q

Aortic Dissection: CC?

A

Chest pain radiating to the back, ripping or tearing

223
Q

Aortic Dissection: PE? (2)

A

Unequal brachial or radial pulses, hypotension

224
Q

Aortic Dissection: Diagnosed by?

A

CT Chest with IV contrast dye

225
Q

Abdominal Aortic Aneurysm (AAA): Etiology?

A

Widened and weakened arterial wall at risk of rupture.

226
Q

Abdominal Aortic Aneurysm (AAA): CC?

A

Midline abdominal pain

227
Q

Abdominal Aortic Aneurysm (AAA): PE? (4)

A

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

228
Q

Abdominal Aortic Aneurysm (AAA): Diagnosed by?

A

CT A/P with IV contrast dye

229
Q

Deep Vein Thrombosis (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.

230
Q

Deep Vein Thrombosis (DVT): Risk Factors? (11)

A

PMHx of DVT or PE, FHx, Recent surgery, cancer, immobility, pregnancy, BCP, Smoking, LE, Trauma, LE Casts

231
Q

Deep Vein Thrombosis (DVT): CC?

A

Extremity pain and swelling (atraumatic), usually located in a lower extremity

232
Q

Deep Vein Thrombosis (DVT): PE? (3)

A

Calf tenderness, cords, homan’s sign

233
Q

Deep Vein Thrombosis (DVT): Diagnosed by?

A

US/Doppler of the extremity

234
Q

Abscess (Cellulitis with Fluctuance): Etiology?

A

Skin infection with an underlying collection of pus

235
Q

Abscess (Cellulitis with Fluctuance): CC?

A

Red, swollen, and painful lump

236
Q

Abscess (Cellulitis with Fluctuance): PE? (3)

A

Fluctuance (pus-pocket), induration, purulent drainage

237
Q

Abscess (Cellulitis with Fluctuance): Diagnosed by?

A

Clinically

238
Q

Abscess (Cellulitis with Fluctuance): Scribe Alert?

A

Abscesses must have the pus-pocket drained. Remember to always document incision and drainage (I&D) procedure notes for abscesses.

239
Q

Cellulitis: Etiology?

A

Infection of the skin cells

240
Q

Cellulitis: CC?

A

Red, swollen, painful, and sometimes warm area of the skin

241
Q

Cellulitis: PE? (4)

A

Erythema, edema, increased warmth (calor), induration

242
Q

Cellulitis: Assoc. Meds?

243
Q

Cellulitis: Diagnosed by?

A

Clinically

244
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.

245
Q

Rash: CC?

A

Rash- red, itchy (pruritic) or painful

246
Q

Rash: PE? (7)

A

Urticaria (hives or wheals), macules (flat), papules (raised bumps), vesicles (small blisters), blanching (not dangerous), petechaie (dangerous rash), purpura (dangerous rash)

247
Q

Rash: Diagnosed by?

A

Clinically

248
Q

Allergic Reaction: Etiology?

A

Immune response causing an inflammatory reaction consisting of swelling, itching (pruritis), and rash

249
Q

Allergic Reaction: Risk Factors?

A

Known drug or food allergy

250
Q

Allergic Reaction: CC?

A

Rash, swelling, itching, or SOB

251
Q

Allergic Reaction: PE? (3)

A

Edema, facial angioedema, urticaria (hives, wheals)

252
Q

Allergic Reaction: Diagnosed by?

A

Clinically

253
Q

Allergic Reaction: Scribe Alert?

A

ED concern is anaphylaxis or respiratory failure.

254
Q

Diabetic Ketoacidosis (DKA): Etiology?

A

Shortage of insulin resulting in hyperglycemia and production of ketones.

255
Q

Diabetic Ketoacidosis (DKA): Risk Factors?

256
Q

Diabetic Ketoacidosis (DKA): CC?

A

Persistent vomiting with a Hx of DM

257
Q

Diabetic Ketoacidosis (DKA): Assoc. Sx? (3)

A

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

258
Q

Diabetic Ketoacidosis (DKA): PE? (3)

A

Ketotic order (fruity), dry mucous membranes (dehydration), tachypnea

259
Q

Diabetic Ketoacidosis (DKA): Diagnosed by?

A

Arterial blood gas (ABG or VBG) showing low pH (acidosis) or positive serum ketones

260
Q

Psychological Disorder: Etiology?

A

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

261
Q

Psychological Disorder: PMHx? (8)

A

Bipolar disorder, schizophrenia, PTSD, depression, anxiety, alcoholism, drug abuse, suicide attempt

262
Q

Psychological Disorder: Possible CC? (6)

A

Suicidal ideation (SI), homicidal ideation (HI), hallucinations (auditory or visual), substance abuse, self injury, overdose

263
Q

Psychological Disorder: PE? (4)

A

Flat affect, SI, HI, tangential or pressured speech

264
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 patient is not medically ill. After medical clearance, the patient is cleared to be evaluated from a psychiatric standpoint.

265
Q

Trauma: Etiology?

A

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

266
Q

Trauma: CC? (3)

A

Motor vehicle accident (MVA), fall, gun shot wound (GSW)

267
Q

Trauma: PE?

A

Glasgow Coma Scale (GCS)

268
Q

Trauma: Assoc. Med?

A

Blood thinners? (Coumadin, ASA, or Plavix)

269
Q

Trauma: Diagnosed by?

A

Trauma protocol depending on MOI: CT or XR

270
Q

Trauma: Scribe Alert?

A 
Neurological Injury (Brain, Spine): LOC, confusion, numbness, weakness, HA, neck/back pain
Internal Organ Injury (Lungs, Spleen, Liver): SOB, Chest Pain, Abd Pain

Scribe Training (23 decks)

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