Course 2 Flashcards
1
Q
pertinent positives
A
Specific symptoms that raise the physician’s suspicion for a particular disease.
2
Q
Pertinent Negatives
A
Specific symptoms that are not present which cause the physician to doubt certain diagnoses.
3
Q
How do physicians rule out certain diseases?
A
They will order a specific Objective study that can diagnose it or rule it out. Also the physical exam can rule out some diseases.
4
Q
What DDx can be drawn from chest pain (the subjective complaint)?
A
PE, Musculor-skeletal chest pain, MI.
5
Q
Risk Factors
A
What puts the patient at risk
6
Q
Chief Complaint (CC)
A
Typical major sx. Want to know Timing (constant, intermittent, waxing and waning), quality (dull, sharp, pressure, cramping), what makes it better or worse.
7
Q
Assoc Sx
A
pertinent positives; sx that raise the physician’s suspicion for the disease.
8
Q
Pert. Neg
A
pertinent negatives; important sx that are not present.
9
Q
Assoc MEd
A
medications related to the disease.
10
Q
PE
A
Common physical exam findings associated with the disease.
11
Q
Diagnosed by
A
how the disease is ruled out or diagnosed
12
Q
CAD Etiology
A
Narrowing of the coronary arteries limits blood supply to the heart muscle causing angina.
13
Q
Angina
A
Chest pain specifically due to heart-muscle ischemia. Sx of CAD
14
Q
CAD CC
A
CP or chest pressure. worse with exertion, improved by rest and NTG.
15
Q
CAD Assoc Med
A
Aspirin (ASA) 324mg PO
Nitroglycerin (NTG) 0.4mg SL
16
Q
CAD diagnosed by
A
Cardiac catheterization ( not in the ED)
17
Q
A patient has CAD if they…
A
Have a PMHx of Angina, MI, CABG, Cardiac stents, angioplasty.
18
Q
Any patient complaining of CP should..
A
Receive ASA PO unless given PTA.
19
Q
MI etiology
A
acute blockage of the coronary arteries results in ischemia and infarct of the heart muscle.
20
Q
CAD catch phrase
A
chest pain with physical exertion.
21
Q
MI Catch phrase
A
Chest pressure with diaphoresis, N/V, and SOB
22
Q
MI Risk Factors
A
CAD, HTN, HLD, DM, smoker, FHx of CAD <55
23
Q
MI CC
A
Chest pain or chest pressure
24
Q
MI study
A
EKG (STEMI) or elevated Troponin (non-STEMI)
25
MI Assoc Med
ASA NTG B-blocker Thrombolytic (Heparin)
26
B-blocker
Reduces blood pressure by blocking epinephrine. Makes beat more slowly and less force.
27
CHF Etiology
The heart becomes enlarged, inefficient, and congested with excess fluid
28
CHF Catch phrase
SOB with pedal edema and orthopnea
29
CHF CC
SOB, orthopnea, PND, DOE
30
orthopnea
SOB worsen when lying down
31
PND
Paroxysmal Nocturnal Dyspnea - SOB at night
32
CHF PE
Rales, JVD in nec, Pitting pedal edema
33
CHF assoc Med
diuretics (Lasix, Furosemide) - unrinate extra fluid.
34
CHF study
CXR or elevated BNP
35
A FIb CC
Palpitations (Fast, Pounding, Irregular)
36
AFib risk factors
Paroxysmal A Fib, Chronic A Fib
37
AFib PE
Irregularly irregular rhythm, Tachycardia
38
AFib study
EKG
39
AFib Assoc Med
Coumadin (Warfarin): Blood thinner, prevents blood clots in atria. Digoxin: Slows down heart rate
40
pericarditis
Inflammation of the sac surrounding
| the heart causing CP
41
Pleurisy
Inflammation of the sac surrounding
| the lungs causing pleuritic CP
42
Costochondritis
Irritation of the ribs causing CP
| worsened by pressing on the sternum
43
Chest Wall Pain
Irritation of the chest wall causing pain
| with palpation of the chest
44
Pleural Effusion
Fluid collecting around the lungs causing
| SOB or CP
45
AFib
electrical problem, irregular HR
46
MI
Heart attack
47
CHF
fluid traffic jam
48
CAD
Risk for MI
49
PE ET
A blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs
50
PE catch phrase
Pleuritic chest pain with tachycardia and hypoxia
51
PE risk factors
Known DVT, PMHx of DVT or PE, FHx, Recent surgery, Cancer, A-Fib, Immobility, Pregnancy, BCP, Smoking
52
PE CC
SOB or Pleuritic chest pain (CP worse with deep breaths)
53
PE study
```
CTA Chest (CT Chest w/ IV contrast) or VQ scan.
D-dimer aids in detecting clots, but cannot diagnose a PE.
```
54
PNA ET
Infiltrate (bacterial infection) and inflammation inside the lung
55
PNA Risk Factors
Elderly, Bedridden, Recent chest injury, Recent surgery
56
PNA CC
SOB or Productive cough
57
PNA Assoc Sx
Cough with sputum, Fever, Chest pain
58
PNA Assoc Med
Rocephin and Zithromax (antibiotics)
59
PNA PE
Rhonchi
60
PNA study
CXR
61
Pneumothorax
PTX
62
PTX Et
Collapsed lung due to trauma or a spontaneous small rupture of the lung
63
PTX CC
SOB and one-sided chest pain
| Sudden onset. Often trauma patients.
64
PTX PE
Absent breath sounds unilaterally
65
PTX study
CXR
66
COPD Et
Long-term damage to the lung’s alveoli (emphysema) along with inflammation and mucous production (chronic bronchitis)
67
COPD Risk factors
smoking
68
COPD CC
SOB
69
COPD PE
Decreased breath sounds, Wheezes, Rales
70
COPD Assoc Meds
Home O2 (Document how much O2 they use at baseline)
71
COPD study
CXR hx smoking
72
Reactive Airway Disease (RAD) Et
(asthma) Constricting of the airway due to inflammation and muscular contraction of the bronchioles, known as a “bronchospasm”
73
RAD CC
SOB/Wheezing
| Improved by nebulizer “breathing treatments” (bronchodilators)
74
RAD PE
Wheezes (Inspiratory or Expiratory)
75
RAD Assoc med
Inhalers, Nebulizers, Corticosteroids
76
RAD study
clinically
77
I-CVA Et
Blockage of the arteries supplying blood to the brain resulting in permanent brain damage
78
I-CVA CC
Unilateral focal neurological deficits: One-sided weakness/numbness or changes in speech/vision
79
I-CVA Risk Factors
HTN, HLD, DM, hx TIA/CVA, Smoking, FHx CVA, AFIB
80
I-CVA PE
Neurological deficits: hemiparesis, unilateral paresthesias, aphasia, visual field deficits
81
I-CVA study
Clinically, Potentially normal CT Head
82
H-CVA ET
Traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in the brain
83
H-CVA CC
```
Headache
Sudden Onset (Thunderclap, Worst of life)
```
84
H-CVA Assoc Sx
Changes in Speech, Vision, Sensation (numbness), or Motor strength (weakness), AMS, Seizure, Headache
85
H-CVA PE
Unilateral neurological deficits
86
H-CVA study
CT head or LP
87
TIA ET
Vascular changes temporarily deprive a part of the brain of oxygen (Symptoms usually last less than 1 hour)
88
TIA CC
Transient focal neurological deficit
| Changes in Speech, Vision, Strength, or Sensation
89
TIA Study
clinically
90
Meningitis Et
Inflammation and infection of the meninges; the sac surrounding the brain and spinal cord
Bacterial vs. viral
91
Meningitis CC
Headache and neck pain.
92
Meningitis Assoc Sx
fever, neck pain, neck stiffness, AMS
93
Meningitis PE
Meningismus, Nuchal rigidity
94
Meningitus study
LP
95
Spinal cord injury Et
Injury to the spinal cord may create weakness or numbness in the extremities past the site of the injury
96
Spinal cord injury cc
Neck pain or Back pain, Bilateral extremity weakness
97
Spinal cord injury PE
Midline bony tenderness, deformities, or step-offs, Bilateral extremity weakness, Numbness, Decreased rectal tone
98
Spinal cord injury study
CT Cervical Spine (Neck)
CT Thoracic Spine (Upper back)
CT Lumbar Spine (Lower back)
99
Seizure (SZ) Et
Abnormal electrical activity in the brain leading to abnormal physical manifestations. Often caused by epilepsy, ETOH withdrawals, or febrile seizure in pediatric pts
100
SZ CC
Seizure activity, Syncope
101
SZ assoc Sx
Injuries (tongue bite), Confusion, Headache,
| Incontinence (urinary or fecal)
102
SZ PE
Somnolent, Confused (Post-Ictal)
103
SZ Med
Dilantin, Tegretol, Keppra, Depakote, Neurontin
104
Bells Palsy Et
Inflammation or viral infection of the facial nerve causes one-sided weakness of the entire face
105
Bells Palsy CC
Facial Droop
| Sudden Onset
106
Bells Palsy Assoc Sx
Jaw or ear pain, Increased tear flow of one eye
107
Bells Palsy Pert Neg
No extremity weakness, No changes in speech or vision.
108
Bell Palsy PE
Unilateral weakness of the upper and lower face
109
Bell Palsy Study
clinical
110
HA Et
Various causes including hypertensive headaches (from high blood pressure), recurrent diagnosed migraines, Sinusitis, etc.
111
HA CC
Headache (gradual onset)
| Pressure, Throbbing
112
HA Pert Neg
No fever; No neck stiffness; No numbness/weakness; No changes in speech or vision
113
AMS Et
Multiple causes: most common are hypoglycemia, infection, intoxication, and neurological
114
AMS Risk Factors
Diabetic, Elderly, Demented, EtOH use, Drug use
115
AMS CC
Confusion, Decreased responsiveness, Unresponsive
116
AMS study
case dependent
117
syncope et
Temporary loss of blood supply to the brain resulting in loss of consciousness. There are a variety of causes; most common are vasovagal and low blood volume (dehydration/hypovolemia). Occasionally syncope occurs due to cardiac/neurologic causes.
118
Syncope CC
Passing-out vs. About to pass-out (near-syncope)
119
Vertigo et
Caused by two etiologies: the vertigo may be from a harmless problem of the inner ear (benign positional vertigo), or it may be caused due to damage in a specific center of the brain (possible CVA).
120
Vertigo CC
Room-spinning, Feeling off balance (disequilibrium)
| Worsened with head movement
121
Vertigo Assoc Sx
N/V, Tinnitus (ringing in ears)
122
vertigo PE
Horizontal Nystagmus, + Romberg,
| + Dix-Hallpike Test
123
Vertigo Med
Meclizine (Antivert)
124
Vertigo study
Clinically
125
Appendicitis (APPY) et
Infection of the appendix causes inflammation and blockage, possibly leading to rupture
126
APPY CC
RLQ Pain
Gradual Onset • Constant
Worsened with Movement
127
APPY assoc Sx
Decreased appetite (anorexia), Fever, N/V
128
APPY PE
McBurney's point tenderness, RLQ tenderness
129
APPY study
CT A/P with PO contrast
130
Small bowel obstruction (SBO) Et
Physical blockage of the small intestine
131
SBO Risk Factor
Elderly, infants, Abdominal surgery, Narcotic pain medication
132
SBO CC
Abdominal pain, Vomiting, Constipation
133
SBO assoc Sx
Abd Distension, Bloating, No BMs
134
SBO PE
Abdominal tenderness, Guarding, Rebound, Abnormal bowel sounds, Abdominal distension, Tympany
135
SBO study
CT A/P with PO Contrast
| Acute Abdominal Series (AAS)
136
Gall stones synonyms
Cholelithiasis, cholecystitis
137
Gall stones et
Minerals from the liver’s bile condense to form gallstones which can irritate, inflame, or obstruct the gallbladder
138
Gall stones Catch phrase
RUQ abdominal pain after eating fatty foods
139
Gall stones CC
RUQ Pain
Sharp
Worsened with Eating, Deep breaths,
and Palpation
140
Gall stones PE
RUQ tenderness, Murphy’s sign
141
Gall stones study
Abdominal US, RUQ
142
GI bleed et
Hemorrhage in the upper or lower gastrointestinal tract can lead to anemia
143
GI CC
Hematemesis (Upper), Coffee ground emesis (Lower), Hematochezia (Lower), Melena (Upper)
144
GI Bleed Assoc Sx
Generalized weakness, lightheadedness, SOB, abdominal pain, rectal pain
145
GI Bleed PE
Pale conjunctiva, Pallor, Tachycardia
| Rectal Exam: Melena, Grossly bloody stool
146
GI Bleed study
Heme positive stool (Guaiac positive) during a rectal exam
147
Diverticulitis Et
Acute inflammation and infection of abnormal pockets of the large intestine, known as diverticuli
148
Diverticulitis Risk factors
Diverticulosis, advanced age
149
Diverticulitis CC
LLQ pain
150
Diverticulitis Assoc Sx
Nausea, fever, diahrea
151
Diverticulitis study
CT A/P with PO contrast
152
pancreatitis Et
Inflammation of the pancreas
153
Pancreatitis Risk factors
EtOH abuse, Cholecystitis, specific medications
154
Pancreatitis CC
LUQ, Epigastric pain
155
Pancreatitis Assoc Sx
N/V
156
Pancreatitis PE
Epigastric tenderness
157
Pancreatitis Study
Elevated Lipase lab test (or sometimes elevated Amylase)
158
GERD et
Stomach acid regurgitating into the esophagus
159
GERD CC
Epigastric Pain
| Burning • Improved with Antacids
160
GERD PE
Epigastric tenderness
161
GERD Assoc Med
GI Cocktail (numbs and soothes the esophagus and stomach)
162
C. Diff Colitis
opportunistic bacteria that causes persistent diarrhea
163
Gastroenteritis
V/D. viral or bacteril
164
Crohn's disease
immune disorder causing diarrhea and abd pain
165
IBS
Chronically sensitive bowels prone to diarrhea
166
Gastritis
Irritated stomach with vomiting; stomach ache
167
UTI Et
Infection in the urinary tract, bladder or urethra
168
UTI CC
Dysuria
169
UTI Assoc Sx
frequency, urgency, malodorous urine, AMS (elderly)
170
UTI study
Urine drip or urinalysis
171
Pyelo Et
Infection of the tissue in the kidney, usually spread from a UTI
172
Pyelo Risk factors
Female, frequent UTI
173
Pyelo CC
Flank pain with dysuria
174
Pyelo Assoc Sx
Fever, N/V
175
Pyelo PE
Costo-vertebral Angle (CVA) tenderness
176
Pyelo Study
CT abd/Pel without contrast or Confirmed tenderness
177
Kidney stone names
Renal calculi, Nephrolithiasis, urolithiasis
178
Kidney stones Et
A kidney stone dislodges from the kidney and begins traveling down the ureter. The stone scrapes and irritates the ureter, causing severe flank pain and bloody urine.
179
Kidney stone CC
Flank pain, sudden, radiating to groin
180
Kidney stone ASsoc Sx
Hematuria, N/V, Unable to void
181
Kidney stone PE
CVA tenderness
182
Kidney stone study
CT Abd/Pelvis . RBC in UA can be clue.
183
ectopic pregnancy et
fertilized egg develops outside the uterus, usually in the fallopian tube. High risk for rupture and death
184
Ectopic pregn Risk factors
pregnant female (HCG positive), STD (PID)
185
Ectopic pregn CC
Lower Abd pain or vaginal bleeding while pregnant.
186
Ectopic Pregn Study
US Pelvis
187
Ovarian Torsion et
Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in infarct of ovare
188
Ovarian torsian CC
Lower abd pain (RLQ or LLQ)
189
Ovarian Torsion PE
Adnexal tenderness (Right or left). Tenderness in RLQ or LLQ
190
Ovarian Torsion study
US pelvis .
191
Testicular torsion et
Twisting of the spermatic cord resulting in loss of blood flow and nerve function to the testicle
192
Testicular torsion CC
Testicular pain
193
Testicular torsion PE
Testicular tenderness and swelling (right or left)
194
Testicular torsion study
US scrotum
195
URI et
Most often viral infection causes congestion, cough, and inflammation of the upper airway
196
URI CC
cough/congestion
197
URI Assoc Sx
Fever, sor throat, HA, Myalgias
198
URI PE
Rhinorrhea, boggy turbinates, pharyngeal Erythema.
199
URI Study
clinically
200
Otitis Media is
Middle ear infection
201
Otitis Media Et
Viral or bacterial infection of the tympanic membrane (TM) causing ear pain and pressure
202
Otitis Media CC
Ear pain, ear pulling
203
Otitis Assoc Sx
Fever, sore throat, dry cough, congestion
204
Otitis Media PE
Erythema, Effusion, Dullness, or Bulging of the Tympanic Membrane (TM)
205
Otitis study
Clinically
206
Strep throat is
streptococcal pharyngitis
207
Strep Et
bacterial infection of the tonsils and pharynx causing a sore throat and frequently swollen lymph nodes
208
Strep CC
sore throat
209
Strep PE
Pharyngeal Erythema Tonsillar hypertrophy(enlargement) tonsillar exudates (pus)
210
Strep Study
Rapid strep
211
Conjunctivitis is
Pink eye
212
Pink eye Et
infection of the outer lining of the eye, know as the conjunctiva
213
Pink eye CC
eye redness, irritation, or pain
214
Pink eye Assoc Sx
Eyelid matting, eye discharge, fever
215
Pink eye PE
Conjunctival injection (redness), edema, and exudates
216
Pink eye study
Clinically
217
Epistaxis
Rupture of a blood vessel inside the nose causes blood to flow out the nose and into the throat.
218
Epistaxis CC
nose bleed
219
Epistaxis Risk factors
Blood thinners (coumadin/warfarin, ASA, Plavix) or HTN
220
Epistaxis PE
Anterior, posterior, or septal source of bleeding
221
Epistaxis Study
Clinically
222
Musculoskeletal back pain et
deterioation or strain of the back creates pain that is worse with movement
223
Back pain CC
Back pain, commonly lumbar
224
Back pain Assoc Sx
Shooting posterior lower extremity pain.
225
Pert negs of back pain
no LE weakness, no incontinence .
226
Back pain PE
Paraspinal tenderness, Positive Straight Leg Raise (+ SLR diagnoses Sciatica; back pain that radiates down the legs)
227
extremity injury et
trauma creates pain/swelling in an extremity
228
Extremity injury CC
Extremity pain
229
Extremity injury Assoc Sx
Swelling, bruising, deformity, use limitation
230
Extremity injury Pert Neg
no motor weakness. no numbness or tingling
231
Extremity injury PE
Distal CSMT intact (Circulation, Sensory, Motor, Tendon)
No tendon or ligament laxity
ROM limited secondary to pain
232
AAA et
Widened and weakened arterial wall at risk of rupture
233
AAA CC
Midline Abdominal Pain
234
AA PE
Midline pulsatile abdominal mass, Abdominal bruit, Unequal femoral pulses, Hypotension
235
AAA study
CT A/P with IV contrast dye
236
Aortic Dissection et
Separation of the muscular wall from the membrane of the artery, putting the pt at risk of aortic rupture and death
237
Aortic Dissection CC
Chest pain radiating to the back
| Ripping or Tearing
238
Aortic Dissection PE
Unequal brachial or radial pulses, Hypotension
239
Aortic Dissection Study
CT Chest with IV contrast dye
240
DVT et
Blood slows down while flowing through long straight veins in the extremities; slow-flowing blood is more likely to clot. Once formed the clot can continue to grow and eventually occlude (block) the vein.
241
DVT risk factors
PMHx of DVT or PE, FHx, Recent Surgery, Cancer, Immobility, Pregnancy, BCP, Smoking, LE Trauma, LE Casts
242
DVT CC
Extremity Pain and Swelling (Atraumatic)
| Usually located in a lower extremity
243
DVT PE
Calf tenderness, Cords, Homan’s sign
244
DVT study
US/Doppler of the extremity
245
Cellulitis Et
Infection of the skin cells
246
Cellulitis CC
Red, swollen, painful, and sometimes warm area of skin
247
Cellulitis PE
Erythema, Edema, Increased warmth (calor), Induration
248
Cellulitis Assoc Med
Abx
249
Cellulitis Study
Clinically
250
Abscess is
cellulitis is flunctuance
251
Abscess Et
Skin Infection with an underlying collection of pus
252
Abscess CC
Red, Swollen, and Painful lump
253
Abscess PE
Fluctuance (pus-pocket), Induration, Purulent drainage (pus-like)
254
Abscess Study
Clinically
255
Rash Et
Changes in the skin’s appearance due to systemic or localized reaction. May be caused from medication, virus, bacteria, fungus, insect, etc.
256
Rash CC
Rash
| Red, Itchy (pruritic) or Painful
257
Rash PE
Urticaria (Hives or wheals), Macules (flat), Papules (raised bumps), Vesicles (small blisters), Blanching (not dangerous), Petechaie (dangerous rash), Purpura (dangerous rash)
258
Rash Study
Cllinically
259
Allergic reaction et
Immune response causing an inflammatory reaction consisting of swelling, itching (pruritis), and rash
260
Allergy Risk factors
Know drug or food allergy
261
Allergy CC
Rash, Swelling, Itching, or SOB
262
Allergy PE
Edema, Facial Angioedema, Urticaria (Hives, Wheals)
263
Allergy study
clinically
264
Adverse reaction
N/V, Abd Pain, Diarrhea, Dizzinis
265
DKA Et
Shortage of insulin resulting in hyperglycemia and production of ketones
266
DKA Risk
Diabetes Mellitus (DM)
267
DKA CC
Persistan vomiting with a hx of DM
268
DKA Assoc Sx
SOB, polydipsia (increased thirst), polyuria (increased urination)
269
DKA PE
Ketotic odor “fruity”, Dry Mucous Membranes (Dehydration), Tachypnea
270
DKA study
Arterial Blood Gas (ABG or VBG) showing low pH (acidosis) or Positive Serum ketones
271
Psychological disorder Et
Various types of psychological disease produce abnormal thoughts, behaviors, or actions
272
Psych PMHx
Bipolar Disorder, Schizophrenia, PTSD, Depression, Anxiety, Alcoholism, Drug Abuse, Suicide Attempt
273
Psych CC
Suicidal Ideation (SI), Homicidal Ideation (HI), Hallucinations (Auditory or Visual), Substance abuse, Self injury, Overdose
274
Psych PE
Flat affect, SI, HI, Tangential or Pressured speech
275
Trauma is
physical injury
276
Trauma et
Depending on the Mechanism of Injury (MOI) physical trauma may break bones, sever nerves, rupture blood vessels, or damage internal organs
277
Trauma CC
Motor Vehicle Accident (MVA), Fall, Gun Shot Wound (GSW)
278
Trauma PE
Glasgow Coma Scale (GCS)
279
Trauma Assoc MEd
Blood thinners? (Coumadin, ASA, or Plavix)
280
Trauma Study
Trauma Protocol depending on MOI:
| CT or XR
281
Trauma MOI et
Refers to the way damage to skin, muscles, organs, and bones happen.
Healthcare providers use MOI to determine how likely it is that a serious injury has occurred
282
Trauma MOI Rapid Forward Deceleration, “Motor Vehicle Collision”
Head-On Collision (Windshield starring, airbag deployment)
T-Bone Collision
Rear-Impact Collision
Rollover Collision
Victim Ejected From Vehicle (Spinal cord injury, head injury)
Motorcycle/ ATV Crash (Helmets)
Auto vs. Pedestrian
283
Trauma MOI Rapid Vertical Deceleration, “Falls”
Dependent upon distance body part impacted landing surface and type of landing surface
Severe: Greater than 3x the height of patient or > 20 feet
284
MOI penetrating trauma
Stab wounds: Location, blade length, angle of penetration
| Firearms: Type of weapon, caliber, distance, bullet deformity
285
DDx
A short list of diseases the doctor considers when diagnosing a patient
286
Risk factors
“Red flags” that would put a patient at risk for that particular disease
287
Etiology
The study of the causes of diseases
288
Pleura
Membrane lining the thoracic cavity (parietal pleura) and covering the lungs (visceral pleura)
289
Artery
A blood vessel that carries oxygenated blood from the heart throughout the body
290
Vein
A tube that carries blood to the heart from the cells, tissues, and organs of the body
291
GERD study
endoscopy
