pathophysiology2 Flashcards
what is CAD?
coronary artery disease; narrowing of coronary arteries causing reduced blood flow to the heart muscle
what past histories would suggest that a patient has CAD?
HTN, DM, HLD, smoking, FMHx of CAD/MI <55 y/o
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 difference between CAD and an MI
CAD the reduced blood flow to the heart muscle because of narrowing arteries, while and MI is a blockage in the heart caused from a blood clot. An MI is more likely to occur if a person has CAD
If someone has a PMHx of Afib or CHF, do they also have CAD?
no. AFib is an electrical irregularity causing the atria to contract or quiver spontaneously. CHF is enlargement of the heart causing congestion with excess fluid
what are the “cardiac risk factors?”
the triple threat: hypertension (HTN), diabetes (DM, high blood glucose), and hyperlipidemia (HLD, high cholesterol); additionally smoking, FHx of CAD <55y/o
how is CAD diagnosed
cardiac catheterization by a cardiologist; not diagnosed in the ED
name two ways that an MI can be diagnosed
STEMI - EKG; NON-STEMI - troponin T levels
what is angina
exertional chest pain or pressure that is specifically caused by CAD bc the heart muscle is deprived of blood
t/f: STEMI pt must get to Cath-lab within 90 minutes of arrival
true
what are some associated sx of an MI other than CP?
diaphoresis (sweating), n/v, shortness of breath
what is the main CC for CHF?
shortness of breath
what are some associated sx for CHF?
bilateral lower extremity swelling, fatigue, cough
what 2 studies could diagnose CHF?
chest x-ray and elevated BNP (B-type Natriuretic peptide)
what is AFib?
atrial fibrillation; sporadic quivering of atria due to irregular electrical impulses, not a full contraction
what are some assoc. sx of Afib?
global weakness, fatigue, lightheadedness
what might someone feel with AFib?
palpitations, feeling their heart beat in their chest, fluttering, fast beating, pounding
how is AFib diagnosed?
EKG
what could be the CC of someone with a PE?
chest pain
what are risk factors for a PE?
known DVT, PMHx of DVT or PE, recent surgery, cancer, AFib, immobility, pregnancy, BCP, smoking
what are some assoc. sx of PE?
shortness of breath, tachycardic, hypoxic
what study would diagnose a PE?
D-dimer to rule it out, or CTA chest (CT chest w/ IV contrast)
what part of the heart does CAD affect?
coronary arteries
what are the risk factors for PNA?
elderly, bedridden, immunocompromised, recent chest injury, recent surgery
what is pneumonia (PNA)? how is it diagnosed?
bacterial infection and inflammation inside the lung, diagnosed by CXR
what is the chief complaint of PNA?
productive cough
can a CT chest without IV contrast diagnose a PE? why or why not?
no because the contrast in the vessels (IV) helps clearly see a blockage
what is COPD?
chronic obstructive pulmonary disease, long term damage to the alveoli (emphysema) along w inflammation and mucus production (chronic bronchitis)
what social history will most COPD patients also have?
smoking
what is the difference between an inhaler and a nebulizer for asthma?
an inhaler is portable and gives a one time dose and provides a rapid release of medication. a nebulizer is a 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, known as a “bronchospasm”
what physical exam finding is closely associated with asthma?
wheezing
what might a person with PNA complain of?
often shortness of breath and/or chest pain, fever. productive cough often main CC but usually not the main reason for people coming into ED
how is PNA diagnosed?
chest x-ray (CXR)
name all 7 areas of the abdomen
epigastric, RUQ, LUQ RLQ, LLQ, suprapubic, periumbilical (right/left flank)
what is the layman’s term for GERD?
heart burn or acid reflux
what might someone with GERD complain of?
epigastric pain “burning”
for older px with GERD sx, what life-threatening disease may also need to be ruled out?
MI
what does bile do? where is it stored?
bile is stored in the gallbladder and is used to digest and emulsify fat in foods
what is the difference between Cholelithiasis and cholecystitis?
cholecystitis is acute inflammation/infection of the gallbladder while cholelithiasis is gallstones
what might be the chief complaint of person with gallstones?
sharp abdominal pain in the RUQ, worse with eating fatty foods
what physical exam finding is closely associated with cholecystitis?
murphy’s signs
how are gallstones (cholelithiasis) diagnosed?
abdominal ultrasound of the RUQ
name associated sx of appendicitis
N/V, fever, decreased appetite
what is the chief complaint of appendicitis
gradual pain in the RLQ that is constant and gets worse with movement
how is appendicitis diagnosed?
CT of abdomen/pelvis with PO contrast
what might a person with a SBO (small bowel obstruction) complain of?
abdominal pain or bloating, vomiting, abdominal distention, no BM’s, constipation
what is a UTI?
urinary tract infection
what is pyelo?
pyelonephritis, kidney infection; different from a UTI but often caused by the spreading of a UTI from the bladder to the kidneys
what will be the CC of someone with a UTI?
painful urination (dysuria), fever, frequent urination, urgency, malodorous urine, AMS (elderly)
where would a patient feel pain if they had pyelo?
flank pain, fever and 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 (renal calculi) complain of?
flank pain, blood in urine, sudden onset, radiating to groin
how are kidney stones diagnosed?
CT of A/P or RBC in UA
what is an ectopic pregnancy? what is the CC?
when the fertilized egg develops outside the uterus, usually in the fallopian tube. main cc is lower abdominal pain or vaginal bleeding while pregnant
how is an ectopic pregnancy diagnosed?
ultrasound pelvis
what is the CC of a spinal cord injury
neck or back pain, bilateral extremity weakness
how is a spinal cord injury (SCI) diagnosed?
CT C-spine, T-spine and/or L-spine
name the 2 types of CVA’s (strokes)
ischemic, which is a CVA caused by a blockage in the blood vessels that supply the brain, and hemorrhagic, which is a bleed in the blood vessels that supply the brain (ruptured blood vessels)
what sx might a person with a brain bleed c/o?
hemorrhagic CVA, a sudden “thunderclap” headache, worst HA of their life, AMS, FND in speech, vision, motor, or sensation
what study would diagnose a brain bleed?
head CT or lumbar puncture
what sx might a person with an ischemic CVA c/o?
unilateral FND (focal neurological deficit), changes in speech, vision, motor, sensation. all one-sided
how is an ischemic CVA diagnosed?
clinically, following a head CT to rule out a hemorrhagic CVA
at what point would a clinician administer tPA to medicate what kind of CVA
tPA can be used to treat an ischemic CVA if the pt qualifies. Pt will NOT receive tPA if the onset >3 hr or unknown, or if sx are rapidly improving
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 is a mini-stroke that lasts about an hour and resolves on its own. CVA sx last longs and potentially do not go away
what is the name of the state after a seizure?
postictal
what is pneumothorax (PTX)? how is it diagnosed?
collapsed lung; CXR
what is the cc of a ptx?
shortness of breath, one-sided chest pain
what are 3 sx of meningitis?
headache, neck pain or stiffness, fever
what study would diagnose meningitis?
lumbar puncture; hard to diagnose bc not always performing LPs on every patient with these symptoms
what is syncope?
passing out/loss of consciousness/fainting
what are 4 important things to document for syncopal episodes?
how they felt before episode, after episode, during, and currently feel
how is AMS different from an FND?
AMS is generalized and typically caused by something that can affect the whole brain (drugs, low BS). FND are localized (weakness/numbness/speech/vision) to one specific area and corresponds with damage to specific spot in the brain
what is DVT?
deep vein thrombosis
what are the risk factors for DVT?
known DVT, PMHx of DVT or PE, FHx of DVT or PE, recent surgery, pregnancy, BCP, smoking
what are common signs of DVT?
extremity pain, swelling (atraumatic)
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 pt at risk for aortic rupture and death
what are the important things to document for any trauma patient
loss of consciousness (LOC), head injury, neck pain, back pain, numbness, weakness, abdominal pain, chest pain, mechanism of injury (in HPI), if they are taking blood thinners (in HPI), GCS (in PE)
what is the Glascow Coma Scale?
objective measure of responsiveness in the PE, ranging from 3-15. normal GCS is 15
what is sepsis? what is the CC?
an infection that spreads into the bloodstream; CC is fever and ams
describe the stages of the sepsis protocol
stage 1: trending vital signs
stage 2: monitoring labs
stage 3: preliminary management
stage 4: finalized management
describe cellulitis
infection of the skin cells. CC is red, swollen, painful and sometimes warm area of the skin. diagnosed clinically
describe an abscess
infection of the skin with an underlying collection of pus, presents as a red, swollen, painful lump with induration and fluctuance (pus-pocket)
