Review Questions Flashcards
What does HIPAA stand for?
Health Insurance Portability
and Accountability Act,
What does PHI stand for ?
protected health information and it refers to ANY
type of information that can be directly or indirectly tied to a
particular patient or visit:
T/F : It’s okay to email yourself a patient’s chart for HPI practice as
long as you delete it within 48 hours.
F
Fill in the blanks for ED Flow:
Walk –in →_______→ Bed → Physician Assessment →Lab/Rad/Meds → Results → MDM → Diagnosis → Consults →_________
1) Triage
2) Disposition: 1. Discharge 2. Admit 3. Transfer 4. AMA 5. Death
What are the 4 types of histories?
Medical Hx, Surgical Hx, Family Hx, Social Hx
The HPI and ROS are what type of information (subjective or objective)?
Subjective
The Physical Exam is what type of information (subjective or objective)?
Objective
While evaluating a patient complaining of chest pain, your physician tells you
that the heart sounds are normal. Would you document it in the HPI, ROS, or
PE?
PE
- Would you be contradicting yourself if you wrote “The patient has abdominal pain” in the HPI, but
then later in the physical exam documented “The abdomen is nontender.” Why or why not?
No,
because the patient stating they have abdominal pain is a subjective complaint. A non-tender abdomen is an objective finding.
What does disposition (dispo) mean?
The patient’s destination after they leave the Emergency
Department.
What is the abbreviation for a heart attack?
MI- Myocardial Infarction
What is the abbreviation for high blood pressure?
HTN- Hypertension
What is the medical term for acid reflux?
GERD- Gastroesophageal Reflux Disease
What is the medical term for stroke?
CVA- Cerebrovascular Accident
What is the term for gallbladder removal?
Cholecystectomy
What does NKDA stand for?
No Known Drug Allergies
What is the medical term for redness?
Erythema
What is the medical term for bruising?
Ecchymosis
If the doctor says the exam was “benign”, what does that mean?
Normal- Nothing of
concern
What is CAD?
Coronary Artery Disease.
What other past surgical and medical histories would suggest that a 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 difference between CAD and an MI.
CAD is a broad term for heart disease. MI is
included in CAD. It’s an active heart attack.
If someone has a PMHx of A-Fib or CHF, do they also have CAD?
No
What are the “cardiac risk factors?”
HTN, DM, HLD, CAD, Smoking, FHx CAD < 55 y/o
How is CAD diagnosed?
By a cardiologist during a cardiac catheterization. Not done in the
ED.
Name two 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 for CHF?
SOB (Orthopnea, PND, DOE), pedal edema
What 2 studies would diagnose CHF?
CXR or elevated BNP
What is A-Fib?
Electrical abnormality of the heart causing the top of the heart to quiver
What might someone feel with A-Fib?
Palpitations, fast, pounding, irregular heartbeat
How is A-Fib diagnosed?
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 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
What part of the heart does CAD affect; Arteries, Veins, or 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 a PTX?
Pneumothorax, “collapsed lung”
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?
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. Also called Reactive Airway Disease
What physical exam finding is closely associated with asthma?
Wheezes/ing
What is PNA?
Pneumonia. Usually a bacterial infection (infiltrates) and inflammation inside the
lung
What might a person with PNA complain of?
Productive cough and fever
How is PNA diagnosed?
CXR
Name all 7 areas of the abdomen.
Epigastric, RUQ, LUQ, RLQ, LLQ, Suprapubic, Periumbilical
Right/ Left flank
What is the layman’s name for GERD?
“Heartburn” or Acid Reflux
What might someone with GERD complain of?
Epigastric pain “burning”
For older patients with GERD symptoms, what life-threatening disease may also need to be ruled
out?
MI
What does bile do? Where is it stored?
Bile emulsifies the fats in foods. It is stored in the
gallbladder and made in the liver
What is the difference between Cholelithiasis and Cholecystitis?
Cholelithiasis is gallstones.
Cholecystitis is 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 the RUQ
Name associated symptoms of appendicitis.
Fever, N/V, decreased appetite (anorexia) Note:
RLQ pain- gradual, constant, worse w/ movements is the CC (not associated sx)
How is appendicitis diagnosed?
CT A/P with PO contrast
What might a person with a SBO complain of?
Abd pain/bloating, vomiting, abdominal
distention, no BM’s, constipation
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 four possible CC’s for a GI bleed pt.
Hematemesis, coffee ground emesis, hematochezia,
melena
How is a GI bleed diagnosed in the ED?
Guaiac positive or heme + stool, gastroccult
What are we worried about for someone with a GI bleed?
Too much blood loss, Anemia
What is the pre-existing condition you must have before you can get diverticulitis?
Diverticulosis
What will be the CC for someone with diverticulitis?
LLQ abdominal pain
What studies would diagnose diverticulitis?
CT A/P with PO contrast
How is an SBO diagnosed?
CT A/P w/ PO contrast or AAS (acute abd series) X-ray
What is a UTI?
Urinary tract infection
What is pyelo?
Pyelonephritis, Kidney infection (different and worse than a UTI), usually 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 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 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 (usually 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 to the
ovary. Could result in infarct of the ovary.
How is ovarian torsion diagnosed?
US Pelvis
Name the 2 types of CVA’s (strokes).
Hemorrhagic CVA. Ischemic CVA. (TIA is not a type of a
stroke)
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
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 changes (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, symptoms usually resolve in less than a
hour. CVA - Stroke, symptoms last longer, and potentially may not go away
What is a common cause for seizures in children?
Fevers
What is the name of the state after a seizure?
Post-ictal
What are 3 symptoms of meningitis?
Fever, neck pain/stiffness, headache
What study would diagnose meningitis?
LP- Lumbar puncture
What are 4 important things to document for syncopal episodes?
How they felt before, during,
after, and how they currently feel
Name 4 causes of altered mental status.
Hypoglycemia, infection, intoxication, neurological
How is AMS different from a focal neuro deficit?
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 a DVT?
Deep venous thrombosis
What are the risk factors that cause 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 (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 3 symptoms of cellulitis?
Redness, swelling, and 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 and drainage
What is the main concern with an allergic reaction?
Anaphylaxis or respiratory failure
What are the ONLY three symptoms of a true allergic reaction?
Rash, itching, swelling, SOB
due to airway swelling
How can Diabetic Ketoacidosis (DKA) be diagnosed?
Arterial Blood Gas showing low pH or
Positive Serum Ketones
What is the Emergency Physician’s main responsibility for psychiatric patients?
Medical
clearance
Name three important things to document for any trauma patient.
LOC, head injury, neck pain,
back pain, numbness, weakness
In your own words, describe the significance of an HPI.
The HPI is the story of the
symptoms and events that led to the patient’s ED visit. It includes the CC and the associated
sx
How is the HPI different from the ROS?
HPI focuses is a story about the chief complaint
and its associated symptoms. ROS is a checklist of symptoms. It includes the chief
complaint, associated symptoms, and all other complaints the pt may have.
Name five “elements” of the HPI.
Onset, timing, location, quality, severity, modifying
factors, associated symptoms, context
Name eight of the body systems included in the ROS.
Constitutional, eyes, ENT, CV,
Resp, GI, GU, MS, skin, neuro, psych, endocrine, heme/lymph, immunological
Can the symptoms listed in the ROS ever contradict the symptoms described in the HPI?
Why or why not?
No. Symptoms that are documented in the HPI also need to be documented
in the ROS.
What do you need to remember to document in the HPI and ROS for any patient that is
unconscious or incapable of providing information?
“HPI/ROS limited by…”
Identify the error in this sentence from an example HPI: “Patient states the CP has been
intermittent since Thursday.”
We do not document days of the week in the HPI. Instead, we
would count back the number of days and document this numerically.
Why is it important to remember to document if the patient has had similar symptoms in
the past?
Because it is less likely that their current symptoms are life threatening if they have
survived similar symptoms in the past.
Name one detail that is important to document if the patient has been evaluated in the
past for a similar complaint.
What symptoms prompted the prior evaluation? How long ago
did the prior evaluation occur? Who did they see? (Name and specialty) What treatment did
they receive? Did it help What diagnosis was given? Any prior test results?
What should you focus on when writing an HPI (choose one).
a) Capturing everything that is said by the patient
b) Documenting the answers to every question asked by the doctor
b) Documenting the answers to every question asked by the doctor
Which is the first item in the formula for writing an HPI?
a) Pertinent negatives
b) Timing, quality, and location
c) Chief complaint and onset
d) Associated symptoms
c) Chief complaint and onset
What does MOI stand for in a Trauma HPI?
Mechanism of Injury
True or False: In the ROS, you should document “All other systems negative except as marked”
for every patient.
F
Based on your knowledge from Day 2, why should you always pay special attention to the
complaints of Chest Pain and SOB?
Direct concern for MI
Name three past surgical histories that indicate that the patient has a history of CAD.
Angioplasty, CABG, stents
What is the difference between a cardiac stress test and a cardiac catheterization?
Cardiac
catheterization - insertion of a catheter with injection of dye into the coronary artery, used to
diagnose CAD. Stress test - measures the heart’s ability to respond to physical stress to determine if
there is adequate blood flow to your heart during increasing levels of activity. There are two different
types of stress tests. Exercise (treadmill) stress test. Nuclear stress test is for patients with a
medical problem (e.g. arthritis) that prevents you from exercising. They use a medication to stresses
the heart (mimicking exercise)
What are the risk factors for an MI?
CAD, HTN, DM, hyperlipidemia, smoking, FHx of CAD < 55
y/o
What are the 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 are the risk factors for a CVA?
HTN, HLD, DM, hx TIA/CVA, Smoking, FHx CVA, AFIB
Do any patient complaints belong in the physical exam?
No
If a patient says their abdomen feels very painful, can you automatically document
“abdominal tenderness” in the physical exam? Why or why not?
No. Subjective vs Objective
Which of these two physical exam findings could a physician appreciate without
auscultating the patient’s lungs:
A. No respiratory distress
B. No rales
A. No respiratory distress
What does PERRL stand for?
Pupils are equal round and reactive to light
- What does AT/NC mean?
Atraumatic/Normocephalic
What does NAD stand for?
No acute distress/disease
- If a patient has pale conjunctiva, what does that indicate?
Anemia
What is scleral icterus, and what does it indicate?
Yellowing of the eyes, indicates
liver failure
In which body system would you document “TM erythema and bulging”?
Ears
What is the medical term for a nostril?
Naris (both nostrils is nares)
To describe a “runny nose” would the doctor use the word “epistaxis” or
“rhinorrhea”?
Rhinorrhea
What would dry mucous membranes indicate?
Dehydration
Why is midline bony tenderness “worse” than paraspinal tenderness?
Bony
tenderness (aka vertebral point tenderness) points towards a spinal fracture and
therefore concern for spinal cord injury. Paraspinal tenderness points toward a muscle
sprain or strain
Name an instrument a physician may use to closely investigate the eyes?
Slit lamp, wood lamp, Opthalmoscope (aka fundoscopic exam)
- If you saw “RRR” written in the cardiac exam, what do you think it might mean?
(Hint: It is a normal cardiac finding)
Regular Rate and Rhythm
Name the rhythm that the physician would hear if the patient was in Afib.
Irregularly
irregular rhythm
If the physician checks the pulse on the right wrist and says “The pulses are fine”,
what would you document in the physical exam:
a) Wrist pulse 5/5, right
b) Radial pulse OK
c) Right wrist pulse is fine
d) Right radial pulse is 2+
d) Right radial pulse is 2+
Name two “Peritoneal signs” in the abdominal exam?
Name two “Peritoneal signs” in the abdominal exam? Guarding,
What abdominal exam sign is indicative of Cholecystitis?
Murphy’s Sign
- If the doctor takes 1 finger and presses in a specific spot in the RLQ, what
is the name of the finding they are investigating?
McBurney’s point
tenderness
Which of these findings is NOT a peritoneal sign:
Guarding, Rebound, Tenderness, Rigidity
Tenderness,
What would a “Guaiac positive” stool sample diagnose?
GI Bleed
- What phrase do you have to document in the GU exam for every female
pelvic exam performed by a male physician?
Female Chaperone present
What is bony tenderness a sign of?
Bone deformity, fracture, or injury
What is CVA tenderness?
Flank tenderness (costovertebral angle tenderness). Tenderness over the kidney(s)
What is fluctuance a sign of?
Abscess
What is the difference between a laceration and abrasion?
Laceration –
incision in the skin that typically need sutures. Abrasion- scrape of the skin
What procedure is associated with a laceration, but not an abrasion?
Laceration Repair, Sutures
What does A&Ox3 mean?
Alert and oriented to person, place, time
What section of the neurological exam would you document “Normal
Finger-Nose-Finger test” and “Normal Heel-to-Shin”?
Cerebellar/ Coordination
What does DTR stand for?
Deep tendon reflex
Point to the general area of your body that Cranial Nerves (CN) control.
Face
- In the neurological exam, what does “Normal gait” mean?
Walking normally
In the psychiatric exam, what do SI and HI stand for?
Suicidal and Homicidal
ideations
Is the Glascow Coma Scale (GCS) associated with Trauma pts or Medical
patients?
Trauma
Would you document “RUE strength 3/5” under the “Neurological” or
“Extremities” section of the exam?
“Neurological”
What would you guess “TTP” means? (e.g. “TTP in the RUQ”)
Tender to
palpation
A mother states her child has been extremely tired and drowsy recently; based
on that, can you document “Lethargic” in the child’s physical exam?
No!
Spell the medical term for “Hives” (allergic reaction rash)
Urticaria
What is the medical term for “Swollen lymph nodes?”
Lymphadenopathy
If you document “There is right pronator drift” in the neurological exam, can you
also document “No focal neurological deficits”?
No, contradiction
If you documented “NAD” in the constitutional section, would you be
contradicting yourself if you wrote “There is mild respiratory distress” in the
pulmonary exam?
Yes
- What lab order contains the “H&H” (hemoglobin and hematocrit)?
CBC- Complete Blood Count
What is the difference between a BMP and a CMP?
BMP- Basic metabolic panel. Contains
electrolytes, kidney function, and glucose levels. CMP- comprehensive metabolic panel. BMP in
addition to LFTs (liver function tests)
What part of the CBC does a “Differential” further characterize, RBC or WBC?
WBC?
What does Creatinine test?
Renal function
Is a high potassium level called “hyperkalemia” or “hypernatremia”?
“hyperkalemia”
What body organ do “LFT’s” investigate?
Liver
Would “Aspartate Transaminase” be documented as “AST” or “ALT”?
AST
Which cardiac enzyme is more specific to heart damage, Troponin or CK-MB?
Troponin
What does a negative D-Dimer mean?
No evidence of a Pulmonary Embolism
What does a positive D-Dimer mean?
Possible PE, must order a CTA Chest or VQ Scan
What does an elevated BNP diagnose?
Congestive Heart Failure
Does the blood sample for an ABG come from a vein or an artery?
Artery
Name two parts of the “Cardiac Order Set.”
CBC, BMP, (CK, CKMB, MYO, TROP), EKG, CXR
What procedure must first be performed before CSF can be obtained?
Lumbar Puncture
What do “Coag” lab tests examine?
Blood coagulation (how fast the blood clots) / Coumadin levels
Name one of the three “Coag” lab tests.
PT, PTT, INR
What does Lipase diagnose?
Pancreatitis
What do both “CRP” and “ESR” test for?
Inflammation. CRP- C-Reactive Protein. ESR- Erythrocyte
Sedimentation Rate
Will culture’s ever result during a patient’s ED visit?
No
What is the difference between a Urine Dip and a Urine Micro.
Urine Dip- done bedside and detects leuks,
nitrite, glucose, blood. Urine Micro- in lab and detects WBC, RBC, bacteria
Name one of three labs that are particularly important to track for efficiency.
Troponin, Creatinine, D-Dimer
What type of body structures are XR’s best suited to examine?
Bones
Do emergency physicians interpret XR’s or CT’s?
XR’s
What is the difference between a CTA and a CT?
CTA - CT angiogram looks at the arteries
(uses IV contrast). CT - no IV contrast but may or may not use PO contrast
What does an US of the RUQ rule out or diagnose?
Cholelithiasis, cholecystitis, Gallbladder wall
thickening, bile sludge, bile duct obstruction
Name one type of Orthopedic Procedure that may be performed by the EP.
Splinting, joint
reduction, arthrocentesis
What does I&D stand for?
Incision and Drainage
Name two procedures that qualify the patient for critical care.
Cardioversion, central line
placement, endotracheal intubation, chest tube placement
What does LAD stand for as an EKG abbreviation?
Left Axis Deviation
Name two diagnoses that would qualify a patient for critical care time.
AFIB with RVR, CVA, MI,
SEPSIS, DKA, CPR, Severe hypotension/hypertension, Severe anemia, PTX, PE, Overdose
When might an ER doctor obtain a Physician Consult?
Regarding admission, advice over
treatment plan, inform primary physician of results, etc.
