Day 2 Review Flashcards
CAD
Coronary Artery Disease
What past Hx suggest that Pt had CAD?
MI, Angina, CABG, Stent, Angioplasty
Does a surgical Hx of Angioplasty mean Pt has CAD?
Yes
Dif btw CAD and MI
CAD: broad term for heart disease
MI: included in CAD; an active heart attack
If someone has PMHx of A-Fib or CHF, do they also have CAD?
No
cardiac risk factors
HTN, DM, HLD, CAD, smoking, FHx CAD < 55 y/o
How is CAD diagnosed ?
NOT done in ED
cardiac catheterization done by cardiologist
Name 2 ways a MI can be diagnosed
STEMI: EKG
Non-STEMI: Troponin
Associated Sx’s of MI other than CP
N/V, SOB, Diaphoresis (sweating)
Associated Sx’s of CHF
-SOB
• Orthopnea (worse with lying flat )
• PND (Paroxysmal Nocturnal Dyspnea)
• DOE (Dyspnea on exertion)
-Pedal edema
PND
Paroxysmal Nocturnal Dyspnea
DOE
Dyspnea on Exertion
What 2 studies would diagnose CHF
- CXR
- elevated BNP
What is AFib
Atrial Fibrillation
- electronic abnormality of the heart causing top part of heart (atria) to quiver
What might someone feel with AFib?
Palpitations (fast/ pounding/ irregular heart beat )
How is AFib diagnosed ?
EKG
What could be the CC of someone with a PE?
Pleuritic CP, SOB
What are risk factors for a PE?
Known DVT, PMHx of DVT or PE, FHx of DVT or PE, recent surgery, CA, AFib, immobility, pregnancy, BCP, smoking
What study would diagnose a PE?
CTA Chest/VQ Scan
D-dimer can only rule it out
Can a CT Chest without IV contrast diagnose a PE? Why or why not?
No
No IV contrast does not allow for intravenous visibility
What is a PTX?
Pneumothorax “collapsed lung”
Most common cause of PTX
Trauma
How is a PTX diagnosed?
CXR
What SHx will most COPD Pt’s also have?
Smoking
What is the dif btw an inhaler and a nebulizer for asthma?
Inhaler: portable, one time dose, rapid release of meds
Nebulizer: home machine, continuous treatment over period of time
What is asthma?
Constricting of airways due to inflammation and muscular contraction of bronchioles.
AKA Reactive Airway Disease
What PE finding closely associates with asthma?
Wheezing
What is PNA?
Pneumonia
Bacterial infection (infiltrates) and inflammation inside lung
What might a person with PNA c/o?
Productive cough and fever
How is PNA diagnosed?
CXR
Name all 7 areas of the abdomen
Epigastrium, RUQ, LUQ, RLQ, LLQ, Suprapubic, Periumbilical (Right/left flank)
Layman’s name for GERD
“Heartburn” or Acid Reflux
What might someone with GERD c/o?
Epigastric pain “burning”
For older Pt’s with GERD, what life-threatening disease may also need to be ruled out?
MI
What does bile do? Where is it stored?
- emulsifies the fats in food
- made in liver
- stored in gallbladder
What is the dif btw Cholelithiasis and Cholecystitis ?
Cholelithiasis is gallstones
Cholecystitis is acute inflammation/ infection of gallbladder
CC of Pt with gallstones
RUQ Abd Pain
PE finding closely associated with Cholecystitis
Murphy’s sign (hook finger under right rib and ask Pt to take deep breath)
How are gallstones diagnosed?
Abd US of RUQ
Associated Sx’s of appendicitis
Fever, N/V , decreased appetite (anorexia)
CC of appendicitis
RLQ pain gradual and constant, worse with movement
How is appendicitis diagnosed
CT A/P with PO contrast
What would Pt with pancreatitis c/o?
LUQ Abd Pain, N/V, fever
How is pancreatitis diagnosed
Elevated lipase (or amylase which is less specific)
4 possible CC’s for GI bleed Pt
Hematemesis, coffee ground emesis, hematochezia, Melena
How is a GI bleed diagnosed in ED?
Guaiac positive or heme + stool, gastroccult
What are we worried about for someone with a GI bleed?
Too much blood loss, anemia
What pre-existing condition must you have before you can get diverticulitis?
Diverticulosis
CC of Pt with diverticulitis
LLQ Abd Pain
What studies would Dx diverticulitis
CT A/P with PO contrast
SBO
Small bowel obstruction
What might a person with a SBO c/o?
Abd Pain, bloating, V, abd distention, no BM’s, constipation
How is an SBO diagnosed
CT A/P with PO contrast or AAS (acute abd series) XR
What is Pyelo
Pyelonephritis, kidney infection (dif and worse than UTI) usually spread from UTI
CC of someone with UTI
Dysuria (painful urination), frequency/ burning/ hesitancy/ malodorous urine
Where would a Pt feel pain if the had pyelo
Flank pain
How is a UTI diagnosed
Urine drip or urinalysis (UA) (more accurate) showing WBC
CC of Pt with kidney stones
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, fertilized egg develops outside uterus (usually in Fallopian tube)
High risk for rupture and death
How is ectopic pregnancy diagnosed
US of pelvis
What is an ovarian torsion
Twisting of ovarian artery, reduces blood flow to ovary, could result in infarct of ovary
How is ovarian torsion diagnosed
US pelvis
Name the 2 types of CVA
Hemorrhagic CVA
Ischemic CVA
What Sx might a person with a brain bleed c/o
HA (sudden “thunderclap” onset), Worst HA of their life, changes in speech, vision, motor (weakness), sensation (numbness), AMS (altered mental status)
What study would diagnose a brain bleed
CT head or lumbar puncture
What Sx might person with Ischemic CVA c/o
Focal Neurological Deficit: changes in speech, changes in vision, one-sided motor changes (weakness), one-sided sensation changes (numbness)
How is an Ischemic CVA diagnosed
Clinically, potentially normal CT head
TIA
Transient ischemic attack (mini stroke, temporary loss of blood to brain)
TIA vs CVA
TIA: mini stroke, Sx’s usually resolved in < 1 hr
CVA: stroke, Sx’s last longer and potentially may not go away
Common cause for seizures in children
Fever
What is the name for the state after a seizure
Postictal
3 Sx’s of meningitis
Fever, neck pain/stiffness, headache
What study would Dx meningitis
LP (lumbar puncture)
4 important things to document for syncopal episodes
How they felt before, during, after and how they currently feel
4 causes of AMS
Hypoglycemia, infection, intoxication, neurological
AMS vs Focal Neurological Deficit
AMS: generalized and usually caused by something that affects the whole brain (drugs, hypoglycemia)
Focal Neurological deficit (FND): usually localized (weakness/ numbness/ speech/ vision) to one specific area and corresponds with damage to specific spot in brain
FND
Focal Neurological Deficit
DVT
Deep venous thrombosis
Risk factors for DVT
Known DVT, PMHx of DVT or PE, FHx of DVT or PE, recent surgery, CA, AFib, immobility, pregnancy, BCP, smoking
Common signs of DVT
Extremity pain, atraumatic swelling
AAA
Abdominal aortic aneurysm
What is an aortic dissection
Separation of muscular wall from the membrane of the artery
Pt at risk for aortic rupture and death
3 Sx of cellulitis
Redness, swelling, pain to an area of the skin
How is an abscess dif from cellulitis
Abscess is cellulitis with fluctuance (pus pocket)
What procedure will be performed for every abscess
Incision and drainage
What is the main concern with an allergic rxt
Anaphylaxis or respiratory failure
What are the ONLY 3 Sx or a true allergic rxt
S.I.R. - swelling, itching, rash
- airway swelling -> SOB
How can DKA be diagnosed
Arterial blood gas showing low pH (XS acid) or positive serum ketones
DKA
Diabetic Ketoacidosis
What is an emergency physician’s main responsibility for psychiatric Pt’s
Medical clearance
3 important things to document for any trauma Pt
LOC (loss of consciousness), head injury, neck or back pain, numbness, weakness
Sx’s of Peylo
Flank pain, fever, dysuria
Meds used as vasodilator/bronchodilator
NTG, NEBULIZER/inhaler
EOMI
Extraocular movements intact
What is the opposite of nuchal rigidity
Supple
Cyanotic skin correlates to ________
Hypoxia
