Integration Flashcards
Explain the pathophysiology & approach. Analyze patient history. Analyze age, gender, health status. Explain potential complications.
Aneurysm (intracranial, abdominal aortic)
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Arteriosclerosis
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Deep vein thrombosis
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Hypertension
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Peripheral vascular disease
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Thoracic aortic dissection
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Endocarditis
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Myocarditis
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Pericarditis
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Prolapsed mitral valve
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Valve Regurgitation
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Valve Stenosis
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Infarction (STEMI vs. NSTEMI)
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Infraction (transmural vs. subendocardial)
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Ischemia / angina
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Cardiomyopathies
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Left sided heart failure
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Pericardial tamponade
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Right sided heart failure
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Benign arrhythmias
e.g. infrequent PVCs, sinus arrhythmia, isolated atrial ectopic beats
Lethal arrhythmias
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Life threatening arrhythmias
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Atrial septal defect
A “hole” in the wall that separates the top two chambers of the heart. This defect allows oxygen-rich blood to leak into the oxygen-poor blood chambers in the heart.
Atrial septal defect signs and symptoms may include:
Shortness of breath, especially when exercising.
Fatigue.
Swelling of legs, feet or abdomen.
Heart palpitations or skipped beats.
Stroke.
Heart murmur, a whooshing sound that can be heard through a stethoscope.
Patent ductus arteriosus
The ductus arteriosus is a fetal blood vessel that closes soon after birth. In a PDA, the vessel does not close and remains “patent” (open), resulting in irregular transmission of blood between the aorta and the pulmonary artery.
Unoxygenated blood is recirculated.
Signs in infants:
Fast breathing, working hard to breathe, or shortness of breath. Premature infants may need increased oxygen or help breathing from a ventilator.
Poor feeding and poor weight gain.
Tiring easily.
Sweating with exertion, such as while feeding.
Transposition of the great vessels
Transposition of the great arteries is a serious but rare heart defect present at birth (congenital), in which the aorta and pulmonary artery are reversed (transposed).
Transposition of the great arteries is usually detected either prenatally or within the first hours to weeks of life.
Transposition of the great arteries symptoms include: Blue color of the skin (cyanosis) Shortness of breath. Lack of appetite. Poor weight gain.
Ventricular septal defect
Most common congenital heart defect. If small may require no intervention. Causes blood from LV to cross to RV. If severe will require surgery. May require antibiotics prophylactically during dental procedures to reduce risk of endocarditis.
Aortic disruption
Traumatic aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the aorta, the largest artery in the body, is torn or ruptured as a result of trauma to the body. The condition is frequently fatal due to the profuse bleeding that results from the rupture.
Myocardial contusion
A myocardial contusion is a bruise of the heart muscle, which can occur with serious bodily injury. This is most commonly caused: by a car accident. by falling from heights greater than 20 feet. by receiving chest compressions during cardiopulmonary resuscitation
Peripheral vascular disruption
Traumatic “disruption” of an artery / vein. Consider hemorrhage, compartment syndrome, ischemic limb; treatments direct pressure, CAT, fluid resus.
Febrile seizures
Associated with fever but no evidence of intracranial infection. Usually bt ages of 6 mos and 5 years. 30% will experience a recurrence. >50% occur in 9 mos to 20 mos. Family history of febrile seizures often a factor.
Usually associated with underlying viral infection.
Rapid rise in body temperature.
SEverity of seizure not related to severity of fever.
generally less than 5 minutes duration.
all children should be transported for GP assessment.
Generalized seizures
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Partial seizures (focal)
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Infection
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Intracranial hermorrhage
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Migraine
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Tension headache
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Ischemic stroke (thrombotic vs. embolic)
Thrombotic strokes: These are caused by a blood clot that develops in the blood vessels inside the brain.
Embolic strokes: These are caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to one of the blood vessels in the brain through the bloodstream.
Hemorrhagic stroke
Most common causes are cerebral aneurysms, AV malformations and hypertension.
Fatal in 50-80% of cases.
Often occur during stress or exercise or with cocaine / sympathomimetic drug use due to rapid increase in BP.
“Thunderclap headache” often at onset.
N/V, progressive decrease in LOC are common
- sometimes seizures @ onset
- rising ICP causes coma, increasing HTN, bradycardia, diminished resp effort
Transient ischemic attack
“mini stroke”. Episode of cerebral dysfunction that affect a specific portion of the brain. May last minutes to several hours. The patient returns to normal within 24 hours without permanent neurological deficit.
Thought to be the most important indicator of impending stroke; about 5% of patients who have a TIA go on to have a complete stroke within 1 month if left untreated (Mosby’s)
Metabolic altered mental status
Electrolytes (esp glucose) Acid-base imbalance Acute hypoxia REnal failure Hepatic failure Endocrine disorder (thyroid) Infectious disease (meningitis, encephalitis) Trauma (concussion) CV disorder (TIA, hypotension) Drugs / ETOH Iatrogenic drug effects (B-blockers, anticonvulsants, etc.)
Structural altered mental status
Structural etiologies usually cause compression or dysfunction in the area of the ascending reticular activating system whereas most medical etiologies lead to general dysfunction of both cerebral hemispheres
Intracranial hemorrhage Cerebral edema CVA hydrocephalus Tumors Chronic dementia process
Alzheimers
Condition in which nerve cells in the cerebral cortex die and the brain substance shrinks. Single most common cause of dementia.
Does not cause death directly… death usually due to malnutrition and immobilization leading to intercurrent infections.
Unknown cause. No cure.
- Mosby’s
Amyotrophic lateral sclerosis
AKA Lou Gehrig’s disease
Motor neuron disease
May involve Deterioration of both upper and lower neuron tracts.
Begins in limbs, progresses to respiration and swallowing.
- Mosby’s
Bell’s palsy
Paralysis of the facial muscles, caused by inflammation of CN VII. Usually one-sided and temporary. Often develops suddenly.
Usually causes corner of the eyelid and corner of mouth to droop on one side.
Cerebral palsy
Non-progressive disorders of movement and posture. Results from damage to fetal brain during pregnancy, newborn or early childhood.
Multiple sclerosis
Progressive and incurable autoimmune disease of CNS in which scattered patches of myelin in the brain and spinal cord are destroyed. Usually begins early in adult life, becomes active for a brief time and then resumes years later.
Muscular dystrophy
Inherited muscle disorder that results in a slow but progressive degeneration of muscle fibers.
Parkinson’s disease
Caused by degeneration of nerves in the basal ganglia in the brain. Causes a lack of dopamine. Prevents the basal ganglia from modifying nerve pathways that control muscle contraction. Result is muscles that are over-tense. Causes tremor, joint rigidity and slow movement. Leading cause of neurological disability in people over 60 yo.
Poliomyelitis
Caused by poliovirus with varying degrees of severity. Paralytic and non-paralytic forms. HA, fever, sore throat and malaise common to both forms. Paralytic assoc with gen pain, weakness, muscle spasms and paralysis of limbs and other muscles. More than half experience full recovery but may develop postpolio deterioration.
Encephalitis
Encephalitis is an acute inflammation (swelling) of the brain usually resulting from either a viral infection or due to the body’s own immune system mistakenly attacking brain tissue.
Guillian Barre syndrome
Rare autoimmune disorder that affects the body’s peripheral nervous system. Initial symptoms start in weakness/tingling sensation in the legs that may spread to the arms and upper body. Can increase to total or near-total paralysis. Often require mechanical ventilation.
Occurs a few days or weeks after pt has had sx of a resp or GI viral infection. Can develop over course of hours/days/weeks.
Meningitis
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Structural tumor
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Vascular tumor
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Head injury
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Focal (epidural, subdural, subarachnoid hematoma) injury
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Diffuse axonal injury
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Spinal cord injury
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Downs syndrome
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Hydrocephalus
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Spina bifida
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Acute respiratory failure
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Adult respiratory disease syndrome
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Aspiration
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Chronic obstructive pulmonary disorder
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Hyperventilation syndrome
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Pleural effusion
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Pneumonia / bronchitis
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Pulmonary edema
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Pulmonary embolism
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Reactive airways disease /asthma
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Severe Acute Respiratory Syndrome (SARS)
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Antibiotic resistant strains
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Aspirated foreign body
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Burns
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Diaphragmatic injuries
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Flail chest
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Hemothorax
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Penetrating injury
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Pneumothorax (simple, tension)
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Pulmonary contusion
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Toxic inhalation
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Tracheobronchial disruption
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Acute respiratory failure
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Bronchiolitis
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Croup
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Cystic fibrosis
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Epiglottitis
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Sudden infant death syndrome
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reproductive system bleeding / discharge
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reproductive system infection
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Ovarian cyst
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Testicular torsion
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Colic / calculi
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Renal infection
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Renal obstruction
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Renal failure
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Traumatic renal injuries
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Esophageal varices
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Esophagitis
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Gastritis
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GERD
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Bowel obstruction
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Peptic ulcer disease
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Upper GI bleed
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Cholecystitis / biliary colic
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Cirrhosis
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Hepatitis
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Pancreatitis
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