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Ashley's - Paramedicine III > Week 5 - Back/Flank Pain & Genital Urinary > Flashcards

Week 5 - Back/Flank Pain & Genital Urinary Flashcards

1
Q

ETCO2 in Cardiac Arrest

What does a spike AND drop in ETCO2 mean?

A

Spike - 1st sign of a ROSC
Drop - 1st sign it (life) is lost

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2
Q

Back Pain

Show me the lower back muscles

A
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3
Q

Back Pain

Show me the pocket assessments for back pain

A
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4
Q

What BLS to study for Test #2

General Pediatric
General Geriatric
Child in need of protection
Sexual Assult
Vaginal Bleeding Standard
Non-Traumatic:
- Abdominal Pain
- Chest Pain
- Back Pain

A

What ALS to study for test #2

Analgesia Medical Directive

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5
Q

Low Back pain

What are the common cheif complaints?

What should you obtain?

A

Spinal origins

Non-spinal origins

OPQRST
SAMPLE
Physical Assessment - Hands On

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6
Q

Low Back Pain

What are the spinal origins?

A

Musculoligamentous (common)

Discogenic

Fractures

Spondylolisthesis

Ankylosing Spondylitis

Osteomyelitis

Epidural Abscess/Hematoma

Cauda Equina Syndrome (nerve root)

Neoplasm

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7
Q

Show me the different types of spinal curvature

A
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8
Q

What are the types of trauma that can cause incomplete spinal cord syndrome?

A

Gunshot

Stabbing

Fractures

Motor Vehicle Collision

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9
Q

Incomplete Spinal Cord Syndromes

Brown-Sequard Syndrome

Central Cord Syndrome

Anterior Cord Syndrome

A
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10
Q

Explain

Myelitis

Transverse Myelitis

Acute Flaccid Myelitis (AFM)

What are the causes of AFM?

A

Inflammation of the spinal cord

Inflammtion of myelin ACROSS a section of spinal cord

AFM - the sudden onset of weakness (due to inflammation of the spinal cord) in one or more limbs

autoimmune diseases
or
exposure to environmental toxins
or
viruses (enteroviruse/west nile virus)

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11
Q

Cauda Equina Syndrome

What is it? What are the complications?

A

A protruding disc applies pressure to the nerve

  • the patient may loose motor & sensory function
  • alters bladder and bowel control
  • causes leg syndromes
  • leads (may) to serious & permanent irreversible diability
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12
Q

Sciatica - back pain

What happens when the sciatic area hurts?

A

There’s compression of the L4 nerve that results in pain radiating from the lower back down to the knee

There’s compression of the S1 nerve that results in pain radiating down to the foot

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13
Q

Lower-Back Pain

What about tight hamstrings?

A

Tight hamstrings i.e. if you don’t stretch them then it could cause radiating pain in the buttocks and back of the leg (sciatic pain)

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14
Q

Low-Back Pain

What are the Non-Spinal Origins?

A

Abdominal Aortic Aneurysm (pulsatile mass ?)

Renal Colic

Prostatitis

Ascending Urinary Tract Infection

Cystitis (Bladder Inflammation)

Pyelonephritis (Kidney Inflammation)

Neoplasm

Infection

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15
Q

Abdominal Aortic Aneurysm

Show & tell me the basics?

A

May have radiating pain to the back

Described at a tearing sensation

Pulsatile mass possible

Low Blood Pressure

Leaking blood follows gravity / pooling

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16
Q

Hematuria

Blood in the urine

Show me the causes

A
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17
Q

Nocturia

The need to get up at night to urinate regularly

What’s this associated with?

A

significant morbidity and marker of poor health

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18
Q

Show me the Bristol Stool Chart

Show me the Urine Properties

A
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19
Q

Show me the female antomy

A

Show me the Male anatomy

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20
Q

What’s a Pap Smear?

Show me the stages for cervical cancer

A

When the physican takes a sample of cells that are scraped from the cervix and examined under a microscope

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21
Q

Prostate Cancer

What’s the common age/gender?

A

Men over 70y/o

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22
Q

What is Trans-urethral resection of the prosate (TURP)?

A

A surgery that treats urinary problems that are caused by an enlarged prostate

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23
Q

Urine Output

Normal -

Oliguria -

Anuria -

A

urinates at least every 6h (35-105c/hr for 70kg)

Decreased output - 40-120cc/hr for 80kg usually less than 500cc/day adu

No/minimal urine output - 14-135cc/hr usually less than 100ml/day in adults

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24
Q

Urinary Tract Infection

What will the patient present as?

Show me the upper and lower urinary tract presentations

A

With dementia

Confused

Altered

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25
Q

What are potential urinary catheter complications?

A

Infection

Catheter blockage/inability to flush

Retention balloon is not deflating

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26
Q

Kidney Stones

What’s the ER presentation of the patient?

Is there a comfortable position for the patient?

What are they presenting with that’s concering?

A

Fever Greater/Equal to 38 degrees celcius

A burning feeling/pain with peeing everytime

Repeated vomiting

Unable to Fully pee

No - let them ove around to figure it out

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27
Q

Kidney Stones

What/where is colicky pain?

A
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28
Q

Urinary Obstruction/Retention

What are the differntials?

A

Renal Calculi - Kidney Stones

Acute Kidney Injury

Benign Prostatic Hypertrophy (BPH) – Rx: Options

Urethral Obstructions

Blocked Foley Catheter

Urinary Tract Infections

Nerve Damage

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29
Q

Micturition Syncope/Nocturia

The vagus nerve stimulus causes slowing down of the HR and a drop in BP

Sometimes related to a very rare tumor called a paraprostatic pheochromocytoma within the urinary bladder

A
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30
Q

Urinary Incontinance

Show me the types of incontinance

A
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31
Q

Show me the kidney’s anatomy

What are kidney injury differentials?

A

Volume overload

Hyperkalemia

Uremia

Metabolic Acidosis

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32
Q

Acute Kindey Failure

What are the S+S?

A

Decreased urine output, although occasionally urine
output remains normal

Fluid retention, causing swelling in your legs, ankles or
feet

Shortness of breath

Fatigue

Confusion

Nausea

Weakness

Irregular heartbeat

Chest pain or pressure

Seizures or coma in severe cases

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33
Q

Failing Kidneys

What are the treatments?

A

Peritoneal Dialysis

Hemodialysis

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34
Q

Pyelonephritis

Inflammation of the kidney - usually bacterial infection

What are the complications?

What are the S+S?

A

pus around the kidney
Sepsis
Kindey failure

fever
flank tenderness
nausea
buring with urination
frequent urination

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35
Q

Rhabdomyolysis

What is it?

Kidneys are responsible for removing myoglobin from the blood so that urine can flush it out of the body

A

a life-threatening condition caused by muscle breakdown and muscle death. This dangerous muscle damage can result from overexertion, trauma, toxic substances or disease.

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36
Q

Rhabdomyolysis

Who does it affect?

What are the causes?

A

Endurance athletes - HIIT people

Firefighters - the overheating

Service members - intense training

Older people - people who fall and aren’t discovered for a longtime

High-intensity exercise - not enough time for the muscles to heal

Severe dehydration and overheating - faster muscle breakdown

Trauma - rapid disintigration of muscles in burns, electrocutions, and crushing injures

Medications - antipsychotic, antidepressant, and antiviral drugs. Also statin drugs for diabetics or liver diseased patients

Illegal Drugs and Alcohol - Heroine, LSD, Cocaine, and excessive alcohol

Long periods of inactivity - the falls, can’t get up (people)

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37
Q

Renal Infarct

Caused by vascular occlusion, usually affecting the renal cortex

A
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38
Q

Chronic Kidney Disease (CKD)

What are the potential differentials?

Show me the S+S

A

Diabetes
Undiagnosed diabetes
Hyperinsulinemia
Insulin Resistance
NSAIDS
Poorly treated diabetes
Poorly treated hypertension

39
Q

Renal Atery Stenosis

The narrowing of 1 or more (renal) arteries that carry blood to your kidneys.

What happens as a result?

A

leads to lack of normal amounts of oxygen-rich blood from reaching your kidneys

this can injury kidney tissue and increase BP throughout the whole body

40
Q

End-Stage Renal Disease (ESRD)

Consider dialysis and/or a kidney transplant

A
41
Q

PCOS - Polycystic Ovary Syndrome

What is it?

A

Disorder involving infrequent, irregular or prolonged
menstrual periods, and often excess male hormone (androgen) levels.
The ovaries develop numerous small collections of fluid — called follicles — and may fail to regularly release eggs

42
Q

Ovarian Cysts

What are they/What do they do?

What’s the pain like?

When does it become a problem?

A

Ovarian cysts are solid or fluid-filled pockets in or on your ovary.

Common in women who are pregnant or who haven’t gone through menopause

painless and harmless - go away on their own without treatment

When the cyst doesn’t go away or it gets bigger or it does get painful

42
Q

Endometriosis

What is it?

Where does it occur?

A

Painful disorder in which tissue similar to the tissue that
normally lines the inside of your uterus — the endometrium — grows outside your uterus.

Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis

ovaries, fallopian tubes, and the tissue linning you pelvis

42
Q

Pelvic Inflammatory Disease

What is it?

What are the common S+S?

A

an infection of a woman’s reproductive organs

It is a complication often caused by some STD’s like chlamydia and gonorrhea.
Other infections that are not sexually transmitted can cause this

Pain in your lower abdomen
Fever
An unusual discharge with a bad odor from your vagina
Pain and/or bleeding when you have sex
Burning sensation when you urinate
Bleeding between periods

43
Q

Prostatits

What is it?

A

Acute Bacterial Prostatitis
Chronic Prostatitis
Chronic Pelvic Pain Syndrome
Asymptomatic Inflammatory Prostatitis

44
Q

Testicular Issues

What are the top 6 DDX?

A

Testicular Torsion
Testicular Masses
Testicular Trauma
Orchitis
Epididymitis
Fournier’s Gangrene
- Risk Sepsis

45
Q

Orchiectomy - removal of 1 or both testicles

Why/When is it performed?

A

Prostate cancer (procedure prevents it from spreading)

Testicular cancer and breast cancer in men

A medical condition of the male reproductive
organs (such as testicular torsion)

Cancer prevention

Treatment of an undescended testicle after
puberty

Severe trauma (to the testicle)

Male-to-female gender reassignment surgery

46
Q

Phismosis - Paraphimosis

What is it?

What is phumosis?

A

Paraphimosis is a condition that only affects uncircumcised males. It develops when the foreskin can no longer be pulled forward over the tip of the penis.

This causes the foreskin to become swollen and stuck, which may slow or stop the flow of blood to the tip of the penis.

Paraphimosis shouldn’t be confused with phimosis.

a condition in which the foreskin can no longer be pulled back from the tip of the penis - usually occuring in younger children

47
Q

Priapism

What’s the max amount of time until it’s ER? What are the causes?

A

4h

Spinal Chord Injury

Erectile Dysfunction Rx

Antidepressants

Antipsychotics

Anticoagulants

Antihypertensives

Cocaine, Marijuana

Sickle Cell Disease

Leukemia

48
Q

Renal Trauma

What is it?

A

When the kidney is damaged from an outside source

49
Q

Shiv/Shank

Where is the target location?

A

Lower back/kidney area
Liver

50
Q

Ruptured Bladder

Tell me what you know

A

Blunt force trauma most
common

Mechanism usually MVC

Full Bladder increases injury
rates

80% associated with pelvic
fracture

Common in pediatrics due to
height of seatbelt/area
compressed

51
Q

Abuse

What should you consider/look out for?

A

Living Conditions

History that does not make sense

Person refusing to let the patient answer questions

Sexual Assault

Sex Trafficking

Children’s Aid Society Notification

Notification of Police to attend
scene (be discrete)

52
Q

Show me differentials for all 9 quadrants of the abdominal cavity

A
53
Q

Show me the organs than lie in the abdominal cavity

A
54
Q

Show me sites of pain on the body that relate to abdominal pain - suspected issue/disease

A
55
Q

Bowel Sounds

What’s the pitch and frequency of NORMAL BOWEL sounds?

What’s the pitch and frequency for ileus?

What’s the pitch and frequency of an obstruction?

A

Low-pitched gurgling
Every 5-10sec (veries per person)

None

None

High-pitched increased volume
Increased frequency (so more than every 5-10sec)

56
Q

Food Poisoning

What are the common signs and symptoms?

A

Bloody Diarrhea and/or diarrhea that lasts more than 3 days

High Fever

Frequent vomiting that prevents keeping liquids in
Signs of dehydration - little to no urination, dry mouth/throat, and feeling dizzy when standing up

57
Q

Lectins

What are they? What do they contribute to?

What food have the highest content of lectins?

A

Sugar-binding proteins (can agglutinate becoming problematic for health)

The development of diseases such as celiac disease, autoimmune disease, rheumatoid arthritis, obesity, cardiovascular disease, and type 2 diabetes

Grain
Legumes
Nightshades
Vegtables - tomatoes, potatoes, goji berries

58
Q

FOOD MAP (what does it stand for/what does it mean)?

What are the symptoms/side affects?

A

Fermentable oligosaccharides
Disaccharides
Monosccharides
Polyols

(all are short-chain carbohdrates i.e. food you might eat)

Cramping
Diarrhea
Constipation
Stomach bloating
Gas and flatulence

59
Q

Lactose Intolerant / Lactose Malabsorption

What’s (patho) wrong with these people?

What are the symptoms? When do they occur?

A

They are unable to fully digest the sugar (lactose) in dairy products. It’s usually harmless but do come with uncomfartable symptoms.

30min - 2h from the ingestion of said dairy prodcut

Diarrhea

Nausea, and sometimes, vomiting

Stomach cramps

Bloating

Gas

60
Q

SIBO - Small intestinal bacterial overgrowth

What is it? What happens?

Symptoms?

When does it occur?

A

Also called BLIND LOOP SYNDROME - it’s when there is an abnormal increase in the overall bacterial population in the small intestine — particularly types of bacteria not commonly found in that part of the digestive tract

when something slows the passage of food and waste prodcuts in the digestive tract - a breeding ground for bacteria

61
Q

SIBO

What are the most common sings and symptoms?

A

Loss of appetite

Abdominal pain

Nausea

Bloating

An uncomfortable feeling of fullness after eating

Diarrhea

Unintentional weight loss

Malnutrition

62
Q

What are the top differentials for diarrhea?

A

Dehydration

Electrolyte Imbalance

Shock

Hypovolemia

Sepsis

63
Q

Gastroenteritis

What is it?

What are the common signs and symptoms?

A

inflammation of the stomach and intestines. A virus, bacterium, or parasite can cause gastroenteritis. When it’s caused by a type of bacteria, it’s called bacterial gastroenteritis

Fever
Vomiting
Decreased appetite
Diarrhea
Chills
Nausea

64
Q

C.Difficile (CDI)

What is it? What does it do?

A

It’s a germ that causes diarrhea and colitis

65
Q

What’s the TOP 9 DDX for the life threats of abdominal pain?

A

Cardiac Event – Epigastric region

Ruptured / Dissecting AAA

Ruptured Ectopic Pregnancy (age and body parts)

Mesenteric Ischemia (10% mortality)
Mesenteric Infarction (85% mortality)

Bowel Obstruction

Bowel Perforation

Pancreatitis

Cholangitis

Perforated Diverticulitis

66
Q

Upper Gastrointestinal Bleeding

Describe the following words?

Hematemsis

Hematochezia

Melena

Coffee Grounds Emesis

A

Hematemsis - vomiting blood

Hematochezia - fresh blood via the anus

Melena - black/tary stool

Coffee Grounds Emesis - vomit that looks like coffee grounds

67
Q

Upper GI Bleeding

What are the top differentials?

A

Peptic Ulcer Disease
Gastric lining erosion (NSAID use / Alcohol)
Esophageal Varices
Mallory-Weiss tears
Esophagitis
Duodenitis

68
Q

Show me Mallory-Weiss Tear / Boerhaave Syndrome

A
69
Q

What’s the most common cause of esophageal varices?

What are the symptoms?

A

Scarring of the liver

unusually pale skin

ongoing tiredness

shortness of breath

faintness or dizziness

black or tarry stools

dark or bright red blood in stool

bright red blood in vomit

70
Q

Lower GI Bleeding

What’s the most common cause?

What are other differentials?

A

Diverticulitis/diverticulosis

Angiodysplasia (abnormal dilated sm blood vessel in GI)

Cancer / Polyps

Rectal Disease

Inflammatory Bowel Disease

Mesenteric infarction

Aortoenteric Fistula (Graft after repair AAA)

71
Q

What is the #1 cause of peptic ulcer disease?

A

Helicobacter Pylori

72
Q

What are the top differentials for liver disease?

A

Viral Hepatitis

Drug Induced Hepatitis

Cirrhosis

Sepsis

Billiary Obstruction (stone, tumour, infection)

73
Q

Hepatitis

What are the types?

4

What are the types of viral hepatitis?

A

Viral Hepatitis

Toxic Hepatitis

Alcoholic Hepatitis

Non-alcoholic Fatty Liver Disease

A = Fecal oral transmission, jaundice, diarrhea, recent travel

B = IV drug use, contaminated food / sharing, sexual transmission

C = IV drug use, blood transfusion, increased incidence with HIV patients

D, E,G

74
Q

Ascities

What is it?

What’s difficult about having ascites?

A

accumulation of excess fluid in the abdomen, which is a key complication of liver cirrhosis (“liver ascites”) and is also caused by certain late-stage cancers (“malignant ascites”).

Eating, moving, breathing, and sleeping

75
Q

Hepatic Encephalopathy

What is it?

Is it short or long term?

What happens?

A

an impairment of brain functions that occurs due to liver diseases.

Can be either

the liver fails to properly clear the toxins from the blood, which keeps accumulating, and the toxins in the bloodstream increase, ultimately reaching the brain.

This buildup of toxins damages the brain’s functioning, and if untreated, the person can slip into a coma as the brain becomes unresponsive.

76
Q

What’s the #1 cause of liver failure worldwide AND in north america?

A

Hepatitis A & E

Acetaminophen Hepatotoxicity

77
Q

What’s the Toxic single dose of acetaminophen in adults AND children?

What’s in a bottle?

A

Adults Toxic Single Dose = 7.5-10 grams

Children Toxic Single Dose = 150mg/kg

325 mg / 100 tablets in a bottle = 32,500 mg / 32.5 grams

78
Q

Acute Cholecysitis - gallbladder

What are the top differentials?

A

Stones

Biliary colic - not inflammed but comes with pain and vomiting

Cholecystitis - comes with pain, vomiting, inflammation, and fever.

79
Q

Hemorrhoids

Show me the internal grades

A
80
Q

Perforated Bowel

Show me the common causes by section of the bowel

A
81
Q

Toxic Megacolon

When does it occur/what is it?

What happens/the complications?

A

occurs when inflammatory bowel diseases cause the colon to expand, dilate, and distend.

the colon is unable to remove gas or feces from the body. If gas and feces build up in the colon, your large intestine may eventually rupture. Rupture of your colon is life-threatening.

82
Q

Hernias

What are the 2 main types and how’s the blood supply?

A

Incarcerated - has blood supply, obstructs the intestinal flow, and CAN’T be reduced

Strangulated - blood supply is compromised and intestinal flow is obstructed

83
Q

Bowel obstructions

What are the top causes for small bowel obstruction?

Large bowel obstruction

A

Precious surgery - adhesions

Incarcerated Hernias

Cancer

84
Q

Intissusception

What are the sigs and symptoms?

part of the intestine slides into an adjacent part of the intestine

A

sudden loud crying caused by abdominal pain

Stool mixed with blood and mucus - jelly stool

Vomiting

A lump in the abdomen

Weakness or lack of energy

Diarrhea

85
Q

Show me inflammatory bowel diseases vs a healthy bowel

A
86
Q

Volvulus

What is it?

What can happen?

A

when a portion of the digestive system loops around and folds over itself.

may cut off blood supply causing extreme pain, discomfort, bloody stool, cramps, bloating, and obstruction of the bowel making it difficult to have a bowel movement, or necrosis of the bowel

87
Q

Ascending Cholengitis

What is it?

What’s the charcot’s triad (for DDX)?

A

An infection thoughout the biliary tree

Jaundice

Fever

RUQ pain

88
Q

Pancreatitis - epigastric pain

What are the top 5 DDX?

A

Alcohol

Gallstones

Tumors

Abdominal Trauma

Infections

89
Q

Peritonitis

What is it?

What’s the cause? - life threatening?

A

redness and swelling (inflammation) of the lining of your belly or abdomen. This lining is called the peritoneum

Infection (bacteria or fungal) from a hole in the bowel or a burst appendix

If it gets into the blood it will cause sepsis

90
Q

Spontaneous Bacterial Peritonitis

What is it? what’s the mortality rate?

What the triad differntial?

A

An acute infection of the ascitic fluid in a pt with liver disease

50%

Fever

Abdominal Pain

Increasing Ascities

91
Q

What is Ileus?

What are the causes and complications?

A

Diagnosis is made by x-ray. it is a temporary lack of the normal muscle contractions of the intestines.

Abdominal surgery and drugs

Bloating, vomiting, constipation, cramps, and loss of appetite occur.

92
Q

Show and explain to me the 3 signs of appendicitis

A

Ashley's - Paramedicine III (16 decks)

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