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Scribe America Course Material > Course 2: Pathophysiology > Flashcards

Course 2: Pathophysiology Flashcards

1
Q

Pertinent negatives

A

Specific symptoms that are not present which cause the physician to doubt certain diagnoses

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2
Q

What will the physician do if he or she has suspicion about a certain disease?

A

Order the specific objective study that can diagnose it or rule it out

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3
Q

Etiology

A

The physiological process causing the symptoms

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4
Q

Etiology of CAD

A

Narrowing of the coronary arteries limits blood supply to the heart muscle causing angina

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5
Q

Angina

A

Chest pain specifically due to heart-muscle ischemia

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6
Q

Symptoms of CAD

A
  • Chest pain or chest pressure

* worse with exertion but improved by rest or nitroglycerin (NTG)

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7
Q

Associated meds of CAD

A

Aspirin (ASA) 324mg PO

Nitroglycerin (NTG) 0.4 mg SL

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8
Q

CAD diagnosed by

A

Cardiac catheterization (Not diagnosed in the ED) or stress test which can assess the severity of CAD

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9
Q

What is the single greatest risk for an MI?

A

CAD

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10
Q

What PMHx can a patient have to be diagnosed with CAD?

A

Angina, MI, CABG, Cardiac stents or angioplasty

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11
Q

What is the function of aspirin?

A

Blood thinner that reduces the clumping action of platelets, possibly preventing a heart attack

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12
Q

Etiology of MI

A

Acute blockage of the coronary arteries results in ischemia and infarct of the heart muscle

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13
Q

Symptoms of MI

A

Chest pressure or chest pain with diaphoresis, N/V and SOB

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14
Q

Diaphoresis

A

Sweating, especially to an unusual degree as a symptom of disease or a side effect of a drug

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15
Q

Risk factors of MI

A

CAD, HTN, HLD, DM, Smoker, FHx of CAD

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16
Q

MI is diagnosed by

A

EKG (STEMI) or elevated Troponin (non-STEMI)

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17
Q

Associated meds of MI

A

ASA, NTG, B-Blocker, Thromboytic (Heparin)

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18
Q

In what amount of time must STEMI patients must get to the Cath-lab upon arrival?

A

90 minutes (document ED arrival and depart times)

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19
Q

STEMI

A

STEMI: transmittal infarction of the myocardium (the entire thickness of the myocardium has undergone necrosis), resulting in ST elevation. Usually due to a complete block of a coronary artery (occlusive thrombus)

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20
Q

NSTEMI

A

Partial dynamic block to coronary arteries (non-occlusive thrombus)

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21
Q

Etiology of CHF

A

The heart becomes enlarged, inefficient, and congested with excess fluid

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22
Q

Symptoms of CHF

A 
SOB
•worse with lying flat (Orthopnea)
•paroxysmal nocturnal dyspnea (PND)
•pedal edema
•Dyspnea on exertion (DOE)
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23
Q

PE of CHF

A

Rales (crackles) in lungs, Jugular Vein distension (JVD) in neck, putting pedal edema

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24
Q

Associated meds of CHF

A

Diuretics (Lasix, Furosemide) which leads to the pt urinating extra fluid

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25
Q

CHF is diagnosed by

A

CXR or elevated BNP

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26
Q

Etiology of AFIB

A

Electrical abnormalities in the “wiring” of the heart causes the top of the heart (atria) to quiver abnormally

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27
Q

Symptoms of AFIB

A

Palpitations (fast, pounding, irregular)

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28
Q

PE of AFIB

A

Irregularly irregular rhythm, tachycardia

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29
Q

AFIB is diagnosed by

A

EKG

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30
Q

Associated meds of AFIB

A

Coumadin (warfarin): blood thinner, prevents blood clots in atria. Digoxin: slows down and helps regulate heart rate

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31
Q

What is the ED concern for AFIB?

A

Rapid ventricular response (RVR) patients will often be cardioverted

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32
Q

Cardioversion

A

To be put back into a normal sinus rhythm (NSR) with electricity or drugs

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33
Q

Non-cardiac chest pain

A

(Add later)

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34
Q

Etiology of PE

A

A blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs

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35
Q

Symptoms of PE

A

Pleuritic chest pain with tachycardia and hypoxia and SOB. CP worse w/ deep breaths

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36
Q

Risk factors of PE

A

Known DVT, PMHx of DVT or PE, FHx, recent surgery, cancer, A-Fib, immobility, pregnancy, birth control pills (BCP), smoking

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37
Q

PE is diagnosed by

A

CTA Chest, VQ scan

•D-dimer AIDS in detecting clots but cannot diagnose PE

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38
Q

Etiology of PNA

A

Infiltrate (bacterial infection) and inflammation inside the lung

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39
Q

Symptoms of PNA

A

Productive cough, fever, SOB

•Assoc. Sx: cough with sputum, fever, chest pain

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40
Q

PNA is diagnosed by

A

CXR

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41
Q

What is the core measure for PNA?

A

Community acquired pneumonia (CAP) protocol requires documenting antibiotics (Abx), vital signs, SaO2, mental status, and blood cultures

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42
Q

Etiology of Pneumothorax (PTX)

A

Collapsed lung due to trauma or a spontaneous small rupture of the lung

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43
Q

Symptoms of PTX

A

SOB and one-sided chest pain
•sudden onset
•often trauma patients

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44
Q

PE of PTX

A

Absent breath sounds unilaterally

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45
Q

PTX is diagnosed by

A

CXR

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46
Q

What should you document a patient with PTX?

A

The percentage of lung collapsed. Pt will have a chest tube placed to reinflate the lung

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47
Q

Etiology of COPD

A

Long-term damage to the lung’s alveoli (emphysema) along with inflammation and mucous production (chronic bronchitis)

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48
Q

COPD is commonly diagnosed in…

A

Smokers

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49
Q

Symptoms of COPD

A

SOB

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50
Q

PE of COPD

A

Decreased breath sounds, wheezes, rales

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51
Q

Associated meds of COPD

A

Home oxygen (document how much o2 they use at baseline)

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52
Q

COPD is diagnosed by

A

CXR and Hx of smoking

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53
Q

Etiology of asthma aka Reactive airway disease (RAD)

A

Constructing of the airway due to inflammation and muscular contraction of the bronchioles, known as a “bronchospasm”

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54
Q

Symptoms of asthma

A

SOB/Wheezing

•improved by nebulizer “breathing treatments” (bronchodilators)

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55
Q

PE of asthma

A

Wheezes (inspiratory or expiratory)

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56
Q

Associated meds of asthma

A

Inhalers (portable and gives a one time dose and provides a rapid release of medication), nebulizers (home machine that delivers continuous treatment over a period of time), corticosteroids (drug)

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57
Q

Asthma is diagnosed by

A

Clinically (know the 5 questions physicians will ask the pt)

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58
Q

Etiology of Ischemic CVA

A

Blockage of the arteries supplying blood to the brain resulting in permanent brain damage

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59
Q

Symptoms of ischemic CVA

A

Unilateral focal neurological deficits: one-sided weakness/numbness or changes in speech/vision

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60
Q

Risk factors of Ischemic CVA

A

HTN, HLD, DM, Hx TIA/CVA, smoking, FHx CVA, A-Fib

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61
Q

PE of Ischemic CVA

A

Neurological deficits: hemiparesis, unilateral paresthesias, aphasia, visual field deficits

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62
Q

Ischemic CVA is diagnosed

A

Clinically, potentially normal CT head scan

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63
Q

What should you document for ischemic CVA?

A

The date and time they were “last known well” (at baseline) as well as the source of this information. This is used to assess eligibility for tPA (powerful blood thinner to reverse CVA)

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64
Q

Etiology of Hemorrhagic CVA

A

Traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in the brain

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65
Q

Symptoms of hemorrhagic CVA

A

Headache
•sudden onset (thunderclap, worst of life)
Assoc. Sx: changes in speech, vision, sensation (numbness), or motor strength (weakness), AMS, seizure, headache

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66
Q

PE of hemorrhagic CVA

A

Unilateral neurological deficits

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67
Q

Hemorrhagic CVA is diagnosed by

A

CT head or LP (lumbar puncture)

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68
Q

What should you document for hemorrhagic CVA?

A

“tPA not indicated due to hemorrhage”

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69
Q

Etiology of TIA

A

Vascular changes temporarily deprive a part of the brain of oxygen (Sx usually last less than 1 hour)

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70
Q

Sx of TIA

A

Transient focal neurological deficit•changes in speech, vision, strength, or sensation

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71
Q

TIA is diagnosed

A

Clinically

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72
Q

Difference between a stroke and TIA

A

TIA does not cause permanent brain damage

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73
Q

What should you document for TIA patients?

A

“tPA considered and not indicated due to the fact that symptoms are resolved”

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74
Q

Etiology of meningitis

A

Inflammation and infection of the meninges; the sac surrounding the brain and spinal cord

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75
Q

Sx of meningitis

A

Headache and neck pain/stiffness

Assoc. Sx: fever

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76
Q

PE of meningitis

A

Meningismus, Nuchal rigidity

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77
Q

Meningitis is diagnosed by

A

Lumbar puncture (LP)

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78
Q

Etiology of spinal cord injury

A

Injury to the spinal cord may create weakness or numbness in the extremities past the site of the injury

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79
Q

Sx of spinal cord injuries

A

Neck pain, back pain, bilateral extremity weakness

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80
Q

PE of spinal cord injuries

A

Midline bony tenderness, deformities, or step-offs, bilateral extremity weakness, numbness, decrease recycled tone

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81
Q

Spinal cord injury diagnosed by

A
  • CT cervical spine (neck)
  • CT thoracic spine (upper back)
  • CT lumbar spine (lower back)
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82
Q

What should you document for a spinal cord injury?

A

Spine is immobilized with a C-collar and backboard

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83
Q

Etiology of Seizure (SZ)

A

Abnormal electrical activity in the brain leading to abnormal physical manifestations. Often caused by epilepsy, ETOH withdrawals, or febrile seizure in pediatric pts

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84
Q

Sx of SZ

A

Seizure activity, syncope

Assoc. Sx: injuries (tongue bite), confusion, headache, incontinence (urinary or fecal)

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85
Q

PE of SZ

A

Somnolent, confused (post-Ictal)

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86
Q

Medications for SZ

A

Dilantin, Tegretol, Keppra, Depakote, Neurontin

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87
Q

Scribe alert for SZ

A

Know the 5 questions the physician asks

88
Q

Etiology of Bells palsy

A

Inflammation or viral infection of the facial nerve causes one-sided weakness of the entire face

89
Q

Sx of Bells palsy

A 
Facial droop (sudden onset)
Assoc. Sx: jaw or ear pain, increased tear flow of one eye
90
Q

Pertinent negatives of bells palsy

A

No extremity weakness, no changes in speech or vision

91
Q

PE of bells palsy

A

Unilateral weakness of the upper and lower face

92
Q

Bells palsy is diagnosed by

A

Clinically

93
Q

Etiology of Headache (HA), cephalgia

A

Various causes including hypertensive headaches (from high blood pressure), recurrent diagnosed migraines, sinusitis, etc

94
Q

Sx of headaches

A

Headache (gradual onset)

•pressure, throbbing

95
Q

Pertinent negatives of headache

A

No fever, no neck stiffness, no numbness/weakness, no changes in speech or vision

96
Q

Etiology of Altered mental status (AMS)

A

Multiple causes: most common are hypoglycemia, infection, intoxication, and neurological

97
Q

Risk factors of AMS

A

Diabetic, elderly, demented, ETOH use, drug use

98
Q

Sx of AMS

A

Confusion, decreased responsiveness, unresponsive

99
Q

AMS is diagnosed by

A

Case dependent

100
Q

AMS vs FND

A

AMS is generalized and is typically caused by things that affect the whole brain (drugs, low blood sugar) while FND are localized weakness/numbness in one specific area, corresponding with damage at one specific site in the brain

101
Q

Etiology of Syncope (fainting, passing out)

A

Temporary loss of blood supply to the brain resulting in loss of consciousness. Many various causes: most common are vasovagal and low blood volume (dehydration/hypovolemia)

102
Q

Sx of syncope

A

Passing-out vs about to pass-out (near syncope

103
Q

What are the 4 things you should document for a syncope?

A

What happened prior, during, and after the syncopal episode, as well as how the pt currently feels

104
Q

Etiology of Vertigo (dizziness)

A

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)

105
Q

Sx of vertigo

A

Room-spinning, feeling off balance (disequilibrium)
•worsened with head movement
Assoc. Sx: N/V, tinnitus (ringing in ears)

106
Q

PE of vertigo

A

Horizontal nystagmus, + Romberg, + Dix-Hallpike test

107
Q

Assoc. meds of vertigo

A

Meclizine (Antivert)

108
Q

Vertigo is diagnosed by

A

Clinically

109
Q

Pertinent positives

A

Specific symptoms that raise the physician’s suspicion for a particular disease

110
Q

Etiology of appendicitis (APPY)

A

Infection of the appendix causes inflammation and blockage, possibly leading to rupture

111
Q

Sx of APPY

A 
RLQ pain
•gradual onset
•constant
•worsened with movement
Assoc. Sx: decreased appetite, fever, N/V
112
Q

PE of APPY

A

McBurney’s point tenderness, RLQ tenderness

113
Q

APPY is diagnosed by

A

CT A/P with PO contrast

114
Q

Etiology of Small bowel obstruction (SBO)

A

Physical blockage of the small intestine

115
Q

Risk factors for SBO

A

Elderly, infants, abdominal surgery, narcotic pain medication

116
Q

Sx of SBO

A

Abdominal pain, vomiting, constipation

Assoc. Sx: Abd distension, bloating, no BMs

117
Q

PE of SBO

A

Abdominal tenderness, guarding, rebound, abdominal bowel sounds, abdominal distension, tympany

118
Q

SBO is diagnosed by

A

CT A/P with PO Contrast, Acute Abdominal Series (AAS) x-Ray

119
Q

Etiology of gallstones (cholelithiasis, cholecystitis)

A

Minerals from the liver’s bile condense to form gallstones which can irritate, inflame, or obstruct the gallbladder

120
Q

Sx of gallstones

A

RUQ abdominal pain after eating fatty foods
•sharp
•worsened with eating, deep breaths and Palpation

121
Q

PE of gallstones

A

RUQ tenderness, Murphy’s sign

122
Q

Gallstones is diagnosed by

A

Abdominal US of RUQ

123
Q

Etiology of Gastrointestinal bleed (GI bleed)

A

Hemorrhage in the upper or lower gastrointestinal tract can lead to anemia

124
Q

Sx of GI bleed

A

Generalized weakness, lightheadedness, SOB, abdominal pain, rectal pain

125
Q

PE of GI bleed

A

Rectal exam: Melena, grossly bloody stool

126
Q

GI bleed is diagnosed by

A

heme positive stool during a rectal exam, gastroccult

127
Q

Etiology of diverticulitis

A

Acute inflammation and infection of abnormal pockets of the large intestine, known as diverticuli

128
Q

Risk factor of diverticulitis

A

Diverticulosis (must have to get -litis)

129
Q

Sx of diverticulitis

A

LLQ pain

Assoc. Sx: nausea, fever, diarrhea

130
Q

Diverticulitis is diagnosed by

A

CT A/P with PO contrast

131
Q

Etiology of pancreatitis

A

Inflammation of the pancreas

132
Q

Risk factors of pancreatitis

A

ETOH abuse, cholecystitis, specific medications

133
Q

Sx of pancreatitis

A

LUQ, epigastric pain

Assoc. Sx: N/V

134
Q

PE of pancreatitis

A

Epigastric tenderness

135
Q

Pancreatitis is diagnosed by

A

Elevated lipase lab test

136
Q

Etiology of Gastroesophageal reflux disease (GERD) aka heart burn and acid reflux

A

Stomach acid regurgitating into the esophagus

137
Q

Sx of GERD

A

Epigastric pain
•burning
•improved with antacids

138
Q

PE of GERD

A

Epigastric tenderness

139
Q

Etiology of UTI

A

Infection in the urinary tract (bladder or urethra)

140
Q

Risk factors of UTI

A

Female

141
Q

Sx of UTI

A

Dysuria (painful urination)

Assoc. Sx: frequency, urgency, malodorous urine, AMS (elderly)

142
Q

PE of UTI

A

Suprapubic tenderness

143
Q

UTI is diagnosis by

A

Urine dip (done in ED) or urinalysis (specimen sent to lab to test for Nitrate, WBC and Bacteria in urine)

144
Q

Etiology of pyelonephritis

A

Infection of the tissue in the kidneys, usually spread from a UTI

145
Q

Risk factors of pyelonephritis

A

Female, frequent UTIs

146
Q

Sx of Pyelo

A

Flank pain with dysuria

Assoc. Sx: fever, N/V

147
Q

PE of Pyelo

A

Costco-vertebral angle tenderness

148
Q

Pyelo is diagnosed by

A

CT Abd/Pel without contrast or confirmed UTI with Costo-vertebral angle tenderness on exam

149
Q

Etiology of kidney stone (renal calculi)

A

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

150
Q

Sx of kidney stone

A

Flank pain
•sudden onset
•radiating to groin

151
Q

Kidney stone is diagnosed by

A

CT A/P Abd/Pelvis or RBC in UA

152
Q

Etiology of Ectopic pregnancy (tubal pregnancy)

A

Fertilized egg develops outside the uterus, usually in the Fallopian tube. High risk for rupture and death

153
Q

Risk factors of ectopic pregnancy

A

pregnant female (HCG positive), std

154
Q

Sx of ectopic pregnancy

A

Lower abdominal pain or vaginal bleeding while pregnant

155
Q

Ectopic pregnancy is diagnosed by

A

US pelvis to determine location of fetus

156
Q

Etiology of Ovarian torsion

A

Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in infarct of the ovary

157
Q

Sx of ovarian torsion

A

Lower abdominal pain

158
Q

Ovarian torsion is diagnosed by

A

US pelvis to assess blood flow to ovaries

159
Q

Etiology of Testicular torsion

A

Twisting of the spermatic cord resulting in loss of blood flow and nerve function to the testicle

160
Q

Sx of testicular torsion

A

Testicular pain

161
Q

Diagnosed by

A

US scrotum

162
Q

Etiology of URI

A

Most often viral infection causes congestion, cough, and inflammation of the upper airway

163
Q

Sx of URI

A

Cough/congestion

Assoc. Sx: fever, sore throat, headache, Myalgias

164
Q

URI is diagnosed by

A

Clinically

165
Q

Etiology of Otitis media (middle ear infection)

A

Viral or bacterial infection of the tympanic membrane (TM) causing ear pain and pressure

166
Q

Sx of otitis media

A

Ear pain, ear pulling

Assoc. Sx: fever, sore throat, dry cough, congestion

167
Q

Otitis media is diagnosed

A

Clinically

168
Q

Etiology of Streptococcal pharyngitis (strep throat)

A

Bacterial infection of the tonsils and pharynx causing a sore throat and frequently swollen lymph nodes

169
Q

Sx of Strep throat

A

Sore throat

Assoc. Sx: tonsillar hypertrophy, tonsillar exudates (pus)

170
Q

Strep throat is diagnosed by

A

Rapid strep

171
Q

Etiology of Conjunctivitis (pink eye)

A

Infection of the outer lining of the eye, known as the conjunctiva

172
Q

Sx of pink eye

A

Eye redness, irritation or pain

Assoc. Sx: eyelid matting, eye discharge, fever

173
Q

Pink eye is diagnosed by

A

Clinically

174
Q

Etiology of Epistaxis (nosebleed)

A

Rupture of a blood vessel inside the nose causes blood to flow out the nose and into the throat

175
Q

Risk factors of epistaxis

A

Blood thinners or HTN

176
Q

Name of the procedure associated with an epistaxis

A

Procedure epistaxis management (nose bleeds that do not stop are cauterized or stopped with a nasal tamponade)

177
Q

Etiology of Musculoskeletal back pain

A

Deterioration or strain of the back creates pain that is worse with movement

178
Q

PE of musculoskeletal back pain

A

Paraspinal tenderness or positive straight leg raise

179
Q

Etiology of Extremity injury

A

Trauma creates pain/swelling in a extremity

180
Q

Etiology of Abdominal aortic aneurysm (AAA)

A

Widened and weakened arterial wall at risk of rupture

181
Q

AAA is diagnosed by

A

CT A/P with IV contrast dye

182
Q

Etiology of Aortic dissection

A

Separation of the muscular wall from the membrane of the artery, putting the pt at risk of aortic rupture and death

183
Q

Sx of aortic dissection

A

Chest pain radiating to the back

•ripping or tearing

184
Q

Aortic dissection is diagnosed by

A

CT chest with IV contrast dye

185
Q

Etiology of DVT

A

Blood slows down 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 the vein.

186
Q

Risk factors of DVT

A

PMHx of DVT or PE, FHx, recent surgery, cancer, immobility, pregnancy, BCP, smoking, LE trauma, LE casts

187
Q

DVT is diagnosed by

A

US/Doppler of the extremity

188
Q

Etiology of cellulitis

A

Infection of the skin cells

189
Q

Assoc. meds for cellulitis

A

Antibiotics (Abx)

190
Q

Etiology of Abscess (cellulitis with fluctuance)

A

Skin infection with an underlying collection of pus

191
Q

Procedure for abcess

A

Incision and drainage (I and D) procedure

192
Q

Etiology of rash

A

Changes in skin’s appearance due to systemic or localized reaction. May be caused from medication, virus, bacteria, fungus, insect, etc)

193
Q

Etiology of Allergic reaction

A

Immune response causing an inflammatory reaction consisting of swelling, itching, and rash

194
Q

Etiology of Diabetic ketoacidosis (DKA)

A

Shortage of insulin resulting in hyperglycemia and production of ketones

195
Q

Risk factors of DKA

A

DM

196
Q

Sx of KDA

A

Persistent vomiting with Hx of DM

Assoc. Sx: SOB, polydipsia (increased thirst), polyuria (increase urination)

197
Q

PE of DKA

A

Ketotic odor “fruity”, dry mucous membranes (dehydration, tachypnea

198
Q

DKA is diagnosed by

A

Arterial blood gas showing low pH (acidosis) or positive serum ketones

199
Q

Etiology of trauma (physical injury)

A

Depending on the mechanism of injury (MOI), physical trauma may break bones, sever nerves, rupture blood vessels, or damage internal organs

200
Q

PE of trauma

A

Glasgow coma scale (GCS)

201
Q

Trauma diagnosed by

A

CT or X-Ray

202
Q

Name all 9 areas of the abdomen

A

RUQ, RLQ, LUQ, LLQ, epigastric, periumbilical, suprapubic, Right flank, left flank

203
Q

What might we have to rule out for GERD?

A

MI

204
Q

What does bile do?

A

Bile emulsified the fats in foods

205
Q

Where is bile stored?

A

Gallbladder but made in the liver

206
Q

Difference between cholelithiasis and cholecystitis

A

Cholelithiasis: gallstones
Cholecystitis: acute inflammation of the gallbladder

207
Q

Chief complaint for a GI blood pt

A

Hematemesis (blood in vomit), coffee ground emesis, Melena, hematochezia (bloody stool)

208
Q

What are we worried about for someone with a GI bleed?

A

Too much blood loss. Anemia

209
Q

Name of the state after a seizure

A

Post-ictal

210
Q

4 causes of altered mental status (AMS)

A

Hypoglycemia, infection, intoxication, neurological

211
Q

Common signs of DVT

A

Extremity pain, swelling

212
Q

Sx of cellulitis

A

Redness, swelling, and pain to an area of the skin

213
Q

Main concern with an allergic reaction

A

Anaphylaxis or respiratory failure

214
Q

ED Physician’s main responsibility for psychiatric patients

A

Medical clearance

215
Q

Important things to document for any trauma patient

A

LOC, head injury, neck pain, back pain, numbness, weakness

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