Course 2: Pathophysiology Everything Flashcards
(270 cards)
1
Q
Coronary Artery Disease (CAD): Etiology?
A
Narrowing of the coronary arteries limits blood supply to the heart muscle causing angina (chest pain specifically due to heart muscle ischemia)
2
Q
Coronary Artery Disease (CAD): Catch Phrase?
A
Chest pain with physical exertion
3
Q
Coronary Artery Disease (CAD): Chief Complaint?
A
Chest pain or chest pressure. Worse with exertion. Improved by rest or NTG
4
Q
Coronary Artery Disease (CAD): Assoc. Meds? (2)
A
Aspirin (ASA) PO (blood thinner)
Nitroglycerin (NTG) SL (vasodilator)
5
Q
Coronary Artery Disease (CAD): Diagnosed by?
A
Cardiac Catheterization (not done in the ED)
6
Q
Coronary Artery Disease (CAD): Scribe Alert? (4)
A
- CAD is the single greatest risk factor for an MI.
- Stress tests or cardiac catheterization assess the severity of CAD.
- A patient has CAD if they have a PMHx of angina, MI, CABG, cardiac stents, or angioplasty.
- Every patient complaining of chest pain should always receive aspirin PO, unless it was given PTA or if it is contra-indicated due to bleeding or allergy.
7
Q
Myocardial Infarction (MI) STEMI/non-STEMI: Etiology?
A
Acute blockage of the coronary arteries results in ischemia and infarct of the heart muscle.
8
Q
Myocardial Infarction (MI) STEMI/non-STEMI: Catch Phrase? (3)
A
Chest pressure with diaphoresis, N/V, and SOB
9
Q
Myocardial Infarction (MI) STEMI/non-STEMI: Risk Factors? (6)
A
CAD, HTN, HLD, DM, Smoker, FHx of CAD
10
Q
Myocardial Infarction (MI) STEMI/non-STEMI: Chief Complaint?
A
Chest pain or chest pressure
11
Q
Myocardial Infarction (MI) STEMI/non-STEMI: Diagnosed by?
A
EKG (STEMI) Elevated Troponin (non-STEMI)
12
Q
Myocardial Infarction (MI) STEMI/non-STEMI: Assoc. Meds? (4)
A
ASA (blood thinner), NTG (vasodilator), beta blocker (slows HR), Thrombolytic (heparin- powerful blood thinner)
13
Q
Myocardial Infarction (MI) STEMI/non-STEMI: Scribe Alert? (2)
A
- Acute MI patients must receive aspirin as soon as possible.
- STEMI patients must get to Cath-lab within 90 min of arrival. Document ED arrival and depart time.
14
Q
Congestive Heart Failure (CHF): Etiology?
A
The heart becomes enlarged, inefficient, and congested with excess fluid.
15
Q
Congestive Heart Failure (CHF): Catch Phrase?
A
SOB with pedal edema (LE swelling) and orthopnea (SOB while lying flat)
16
Q
Congestive Heart Failure (CHF): Chief Complaint? (3)
A
SOB – worse while lying flat (orthopnea), paroxysmal nocturnal dyspnea (PND) (at night due to pressure of fluid), dyspnea on exertion (DOE)
17
Q
Congestive Heart Failure (CHF): Physical Exam? (2)
A
Rales (crackles) in lungs, jugular vein distention (JVD) in neck
18
Q
Congestive Heart Failure (CHF): Assoc. Meds?
A
Diuretics (Lasix, furosemide) – urinate extra fluid
19
Q
Congestive Heart Failure (CHF): Diagnosed by? (2)
A
CXR – heart looks like >50% of space Elevated BNP (B type natriuretic peptide) – blood test
20
Q
Congestive Heart Failure (CHF): Scribe Alert?
A
You can think of CHF as a fluid traffic jam in the heart; fluid gets backed up in the neck (JVD) and down the legs (pedal edema)
21
Q
Atrial Fibrillation (A-Fib): Etiology?
A
Electrical abnormalities in the “wiring” of the heart caused the atria to quiver abnormally.
22
Q
Atrial Fibrillation (A-Fib): Chief Complaint?
A
Palpitations (fast, pounding, irregular)
23
Q
Atrial Fibrillation (A-Fib): Risk Factors? (2)
A
Paroxysmal A-Fib, Chronic A-Fib
24
Q
Atrial Fibrillation (A-Fib): Physical Exam? (2)
A
Irregularly irregular rhythm, tachycardia
25
Atrial Fibrillation (A-Fib): Diagnosed by?
EKG
26
Atrial Fibrillation (A-Fib): Assoc. Meds?
Coumadin (Warfarin) – blood thinner, prevents blood clots in atria
27
Atrial Fibrillation (A-Fib): Scribe Alert?
ED concern is Rapid Ventricular Response (RVR), which can cause blood clots. These patients will often be “cardioverted” which means they are put back into a regular rhythm, known as normal sinus rhythm (NSR).
28
Pulmonary Embolism (PE): Etiology?
A blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs.
29
Pulmonary Embolism (PE): Catch Phrase?
Pleuritic chest pain with tachycardia and hypoxia
30
Pulmonary Embolism (PE): Risk Factors? (10)
Known DVT, PMHx of DVT or PE, FHx, recent surgery, cancer, A-Fib, immobility, pregnancy, BCP (birth control pills), smoking
31
Pulmonary Embolism (PE): Chief Complaint?
SOB or pleuritic CP (worse with deep breaths)
32
Pulmonary Embolism (PE): Diagnosed by?
```
CTA Chest (CT Chest with IV contrast) or VQ scan
D-Dimer aids in detecting clots, but cannot diagnose a PE. (if neg, no PE. If pos, may be PE, in which need to do CTA or VQ to diagnose.)
```
33
Pneumonia (PNA): Etiology?
Infiltrate (bacterial infection) and inflammation in the lungs.
34
Pneumonia (PNA): Catch Phrase?
Productive cough with fever
35
Pneumonia (PNA): Risk factors? (4)
Elderly, bedridden, recent chest injury, recent surgery
36
Pneumonia (PNA): Chief Complaint?
SOB or productive cough
37
Pneumonia (PNA): Assoc. Sx? (3)
Cough with sputum, fever, chest pain
38
Pneumonia (PNA): Assoc. Meds? (2)
Rocephin, Zithromax (antibiotics)
39
Pneumonia (PNA): Physical Exam?
Rhonchi
40
Pneumonia (PNA): Diagnosed by?
CXR
41
Pneumonia (PNA): Scribe Alert?
Community Acquired Pneumonia (CAP) protocol applies to pt’s with PNA. CAP protocol requires documenting Abx, vital signs – check for low oxygen, SaO2, mental status- disoriented, and blood cultures.
42
Pneumothorax (PTX): Etiology?
Collapsed lung due to trauma or a spontaneous small rupture of the lung.
43
Pneumothorax (PTX): Chief Complaint? (2)
SOB and one-sided CP; sudden onset, often trauma patients
44
Pneumothorax (PTX): Physical Exam?
Absent breath sounds unilaterally
45
Pneumothorax (PTX): Diagnosed by?
CXR
46
Pneumothorax (PTX): Scribe Alert?
Document the percentage of lung collapsed (i.e. 20% PTX)
47
Chronic Obstructive Pulmonary Disease (COPD): Etiology?
Long-term damage to the lung’s alveoli (emphysema) along with inflammation and mucous production (chronic bronchitis)
48
Chronic Obstructive Pulmonary Disease (COPD): Risk Factors?
Smoking
49
Chronic Obstructive Pulmonary Disease (COPD): Chief Complaint?
SOB
50
Chronic Obstructive Pulmonary Disease (COPD): Physical Exam? (3)
Decreased breath sounds, wheezes, rales
51
Chronic Obstructive Pulmonary Disease (COPD): Assoc. Meds?
Home O2 (document how much O2 they use at baseline)
52
Chronic Obstructive Pulmonary Disease (COPD): Diagnosed by?
CXR and Hx of smoking
53
Reactive Airway Disease (RAD): Etiology?
Constricting of the airways due to inflammation and muscular contraction of the bronchioles, known as a “bronchospasm”.
54
Reactive Airway Disease (RAD): Chief Complaint? (2)
SOB/Wheezing
| Improved by nebulizer breathing treatments (bronchodilators)
55
Reactive Airway Disease (RAD): Physical Exam?
Wheezes (inspiratory or expiratory)
56
Reactive Airway Disease (RAD): Diagnosed by?
Clinically
57
Reactive Airway Disease (RAD): Scribe Alert? (5)
The physician will ask the asthma patient…
1. Do they have home nebulizer (machine)?
2. Have they been on steroids recently?
3. Hx of hospitalization for asthma?
4. Hx of intubation (breathing tube)?
5. Asthma triggers?
58
Reactive Airway Disease (RAD): Assoc. Meds? (3)
Inhalers, nebulizers, corticosteroids
59
Ischemic CVA: Etiology?
Blockage of the arteries supplying blood to the brain resulting in permanent brain damage.
60
Ischemic CVA: Chief Complaint?
Unilateral focal neurological deficits: one sided weakness/numbness or changes in speech/vision
61
Ischemic CVA: Risk Factors? (7)
HTN, HLD, DM, Hx TIA/CVA, Smoking, FHx CVA, AFIB
62
Ischemic CVA: Physical Exam?
Neurological deficits: hemiparesis (weakness of left or right side), unilateral paresthesias (abnormal sensations), aphasia (difficulty with speech), visual field deficits
63
Ischemic CVA: Diagnosed by? (2)
Clinically, Potentially normal CT Head
64
Ischemic CVA: Scribe Alert? (2)
For any stroke patient, ALWAYS document 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 (
65
Hemorrhagic CVA (Brain Bleed): Etiology?
Traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in the brain.
66
Hemorrhagic CVA (Brain Bleed): Chief Complaint?
HA, sudden onset (thunderclap, worst of life)
67
Hemorrhagic CVA (Brain Bleed): Assoc. Sx? (3)
Changes in speech, vision, sensation (numbness), or motor strength (weakness), AMS, Sz
68
Hemorrhagic CVA (Brain Bleed): Physical Exam?
Unilateral neurological deficits
69
Hemorrhagic CVA (Brain Bleed): Diagnosed by?
CT Head or LP (check spinal fluid for blood)
70
Hemorrhagic CVA (Brain Bleed): Scribe Alert?
Document tPA not indicated due to hemorrhage (because tPA is a blood thinner).
71
Transient Ischemic Attack (TIA): Etiology?
Vascular changes temporarily deprive a part of the brain of oxygen (symptoms usually last less than 1 hour)
72
Transient Ischemic Attack (TIA): Chief Complaint?
Transient focal neurological deficit (changes in speech, vision, strength, or sensation)
73
Transient Ischemic Attack (TIA): Diagnosed by?
Clinically
74
Transient Ischemic Attack (TIA): Scribe Alert?
Document tPA considered and not indicated due to the fact that symptoms are resolved.
75
Meningitis- Bacterial v Viral: Etiology?
Inflammation and infection of the meninges; the sac surrounding the brain and spinal cord
76
Meningitis- Bacterial v Viral: Chief Complaint? (2)
HA and neck pain
77
Meningitis- Bacterial v Viral: Assoc. Sx? (4)
Fever, neck pain, neck stiffness, AMS
78
Meningitis- Bacterial v Viral: Physical Exam? (2)
Meningismus (headache, neck pain), nuchal rigidity (cannot flex neck forward due to rigidity of neck muscles)
79
Meningitis – Bacterial v Viral: Diagnosed by?
LP
80
Spinal Cord Injury: Etiology?
Injury to the spinal cord may create weakness or numbness in the extremities past the site of injury
81
Spinal Cord Injury: Chief Complaint? (2)
Neck pain or back pain, bilateral extremity weakness
82
Spinal Cord Injury: Physical Exam? (5)
Midline bony tenderness, deformities or step-offs (bones should be aligned, but not), bilateral extremity weakness, numbness, decreased rectal tone
83
Spinal Cord Injury: Diagnosed by? (3)
CT Cervical Spine (Neck)
CT Thoracic Spine (Upper back)
CT Lumber Spine (lower back)
84
Spinal Cord Injury: Scribe Alert?
Remember that during the initial physical exam the spine is often immobilized with a C-collar and backboard; document accordingly.
85
Seizure (Sz): Etiology?
Abnormal electrical activity in the brain leading to abnormal physical manifestations. Often caused by epilepsy, EtOH withdrawals, or febrile sz in pediatric pts.
86
Seizure (Sz): Chief Complaint? (2)
Sz activity, syncope
87
Seizure (Sz): Assoc. Sx? (4)
Injuries (tongue-bite), confusion, HA, incontinence (urinary or fecal)
88
Seizure (Sz): Physical Exam? (2)
Somnolent (sleepy), confused (postictal – after sz)
89
Seizure (Sz): Scribe Alert? (5)
The physician will ask…
1. Has the patient had a similar Sz in the past?
2. Does the patient have a Hx of Sz?
3. What was the date of their last sz?
4. What sz medication do they take?
5. Have they missed med doses?
90
Bells Palsy: Etiology?
Inflammation or viral infection of the facial nerve causes one-sided weakness of the entire face.
91
Bells Palsy: Chief Complaint?
Facial droop, sudden onset
92
Bells Palsy: Assoc. Sx? (2)
Jaw or ear pain, increased tear flow of one eye
93
Bells Palsy: Pert. Neg? (2)
No extremity weakness, no changes in speech or vision
94
Bells Palsy: Physical Exam?
Unilateral weakness of the upper and lower face
95
Bells Palsy: Diagnosed by?
Clinically
96
Bells Palsy: Scribe Alert?
Most common cause of facial droop in young patients who do not have CVA risk factors. Remember to document the absence of other FND.
97
Headache (HA) – Cephalgia: Etiology?
Various causes including hypertensive HA (from high BP), recurrent diagnosed migraines, sinusitis, etc.
98
Headache (HA) – Cephalgia: Chief Complaint?
HA (gradual onset), pressure, throbbing
99
Headache (HA) – Cephalgia: Pert Neg? (4)
No fever, no neck stiffness, no numbness/weakness, no changes in speech or vision
100
Headache (HA) – Cephalgia: Scribe Alert?
Always remember to document if the HA is similar or dissimilar to any prior HA. Never document “worst headache of life” or “thunderclap” onset unless specifically instructed by physician.
101
Altered Mental Status (AMS): Etiology?
Multiple causes: most common are hypoglycemia, infection, intoxication, and neurological.
102
Altered Mental Status (AMS): Risk Factors? (5)
Diabetic, Elderly, Demented, EtOH use, drug use
103
Altered Mental Status (AMS): Chief Complaint? (3)
Confusion, decreased responsiveness, unresponsive
104
Altered Mental Status (AMS): Diagnosed by?
Case dependent
105
Altered Mental Status (AMS): Scribe Alert?
AMS is very different than a focal neurological deficit. It is generalized and typically caused by things that affect the whole brain (drugs, low sugar). Focal neuro deficits are localized weakness/numbness in one specific area, corresponding with damage at one specific site in the brain.
106
Syncope (Fainting): Etiology?
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). Occassionally, syncope occurs due to cardiac/neurologic causes.
107
Syncope (Fainting): Chief Complaint?
Passing out v about to pass out (near syncope)
108
Syncope (Fainting): Scribe Alert?
Document what happened prior, during, and after syncopal episode, as well as how the patient currently feels.
109
Vertigo (Room Spinning): Etiology?
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 the brain (possible CVA).
110
Vertigo (Room Spinning): Chief Complaint?
Room-spinning, feeling off balance (disequilibrium) – worsened with head movement
111
Vertigo (Room Spinning): Assoc. Sx?
N/V, tinnitus (ringing in ears)
112
Vertigo (Room Spinning): Physical Exam?
Horizontal nystagmus, positive Romberg, positive dix-hallpike test
113
Vertigo (Room Spinning): Assoc. Med?
Meclizine (Antivert- gets rid of dizziness symptoms)
114
Vertigo (Room Spinning): Diagnosed by?
Clinically
115
Appendicitis (APPY): Etiology?
Infection of the appendix causes inflammation and blockage, possibly leading to rupture.
116
Appendicitis (APPY): Chief Complaint?
RLQ pain, gradual onset, constant, worsened with movement
117
Appendicitis (APPY): Assoc. Sx? (3)
Decreased appetite (anorexia), fever, N/V
118
Appendicitis (APPY): Physical Exam?
McBurney’s point tenderness, RLQ tenderness, peritoneal signs: guarding, rebound, rigidity
119
Appendicitis (APPY): Diagnosed by?
CT A/P with PO contrast (oral solution lightens image of organs)
120
Small Bowel Obstruction (SBO): Etiology?
Physical blockage of the small intestine
121
Small Bowel Obstruction (SBO): Risk Factors? (4)
Elderly, infants, abdominal surgery, narcotic pain meds
122
Small Bowel Obstruction (SBO): Chief Complaint? (3)
Abdominal pain, vomiting, constipation
123
Small Bowel Obstruction (SBO): Assoc. Sx?
Distention, bloating, no BMs
124
Small Bowel Obstruction (SBO): Physical Exam? (6)
Abdominal tenderness, guarding, rebound, abnormal bowel sounds, abdominal distension, tympany
125
Small Bowel Obstruction (SBO): Diagnosed by? (2)
CT A/P with PO Contrast
| Acute Abdominal Series (AAS) – abdominal xray
126
Gallstones (Cholelithiasis, Cholecystitis): Etiology?
Minerals from the liver’s bile condense to form gallstones, which can irritate, inflame, or obstruct the gallbladder
127
Gallstones (Cholelithiasis, Cholecystitis): Catch Phrase?
RUQ abdominal pain after eating fatty foods
128
Gallstones (Cholelithiasis, Cholecystitis): Chief Complaint?
RUQ pain – sharp, worsened with eating, deep breaths, and palpitation
129
Gallstones (Cholelithiasis, Cholecystitis): PE?
RUQ tenderness, Murphy’s sign
130
Gallstones (Cholelithiasis, Cholecystitis): Diagnosed by?
Abdominal US, RUQ
131
Gastointestinal Bleed (GI Bleed): Etiology?
Hemorrhage in the upper or lower GI tract can lead to anemia
132
Gastointestinal Bleed (GI Bleed): CC? (4)
Hematemesis (upper tract), coffee ground emesis, hemtochezia (lower tract) – bloody stool, melena (upper tract)
133
Gastointestinal Bleed (GI Bleed): Assoc. Sx? (5)
Generalized weakness, lightheadedness, SOB, abd pain, rectal pain
134
Gastointestinal Bleed (GI Bleed): PE? (4)
Pale conjunctiva, pallor, tachycardia
| Rectal exam: grossly bloody stool
135
Gastointestinal Bleed (GI Bleed): Diagnosed by?
Heme positive stool (guaiac positive) during rectal exam
136
Diverticulitis: Etiology?
Acute inflammation and infection of abnormal pockets of the large intestine, known as diverticuli
137
Diverticulitis: Risk Factors? (2)
Diverticulosis, advanced age
138
Diverticulitis: CC?
LLQ pain
139
Diverticulitis: Assoc. Sx? (3)
Nausea, fever, diarrhea
140
Diverticulitis: Diagnosed by?
CT A/P with PO contrast
141
Pancreatitis: Etiology?
Inflammation of the pancreas
142
Pancreatitis: Risk factors? (3)
EtOH abuse, cholecystitis, specific medications
143
Pancreatitis: CC? (2)
LUQ, epigastric pain
144
Pancreatitis: Assoc. Sx?
N/V
145
Pancreatitis: PE?
Epigastric tenderness
146
Pancreatitis: Diagnosed by?
Elevated Lipase lab test (or sometimes elevated Amylase)
147
Gastroesophageal Reflux Disease (GERD): Etiology?
Stomach acid regurgitating into the esophagus
148
Gastroesophageal Reflux Disease (GERD): CC?
Epigastric pain, burning, improved with antacids
149
Gastroesophageal Reflux Disease (GERD): PE?
Epigastric tenderness
150
Gastroesophageal Reflux Disease (GERD): Assoc. Med?
GI Cocktail (numbs and soothes the esophagus and stomach)
151
Gastroesophageal Reflux Disease (GERD): Scribe Alert?
Due to the proximity of the stomach to the heart, patients with cardiac risk factors and epigastric pain always get a cardiac workup.
152
Urinary Tract Infection (UTI): Etiology?
Infection in the urinary tract (bladder or urethra)
153
Urinary Tract Infection (UTI): Risk Factors?
Female
154
Urinary Tract Infection (UTI): CC?
Dysuria
155
Urinary Tract Infection (UTI): Assoc. Sx?
Frequency, urgency, malodorous urine, AMS (elderly)
156
Urinary Tract Infection (UTI): PE?
Suprapubic tenderness
157
Urinary Tract Infection (UTI): Diagnosed by?
Urine dip or Urinalysis (tests for nitrite, WBC, and bacterine)
158
Pyelonephritis: Etiology?
Infection of the tissue in the kidneys, usually spread from a UTI
159
Pyelonephritis: CC?
Flank pain with dysuria
160
Pyelonephritis: Assoc. Sx?
Fever, N/V
161
Pyelonephritis: PE?
Costo-vertebral angle tenderness
162
Pyelonephritis: Diagnosed by?
CT Abd/Pelvis without contrast or confirmed UTI with CVA tenderness on exam
163
Kidney Stone (Nephrolithiasis): Etiology?
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.
164
Kidney Stone (Nephrolithiasis): CC?
Flank pain, sudden onset, radiating to groin
165
Kidney Stone (Nephrolithiasis): Assoc. Sx? (3)
Hematuria, N/V, unable to void
166
Kidney Stone (Nephrolithiasis): PE?
CVA tenderness
167
Kidney Stone (Nephrolithiasis): Diagnosed by? (2)
CT Abd/Pelvis
| RBC in UA may be clue
168
Ectopic Pregnancy: Etiology?
Fertilized egg develops outside the uterus, usually in the fallopian tube. High risk for rupture and death
169
Ectopic Pregnancy: Risk Factors? (2)
Pregnant female (HCG positive), STD (PID)
170
Ectopic Pregnancy: CC?
Lower abdominal pain or vaginal bleeding while pregnant
171
Ectopic Pregnancy: Diagnosed by?
US Pelvis -> determine location of fetus
172
Ectopic Pregnancy: Scribe Alert?
Any female with a positive pregnancy test who is complaining of lower abdominal pain or vaginal bleeding will always receive a US Pelvis to rule out a possible ectopic pregnancy.
173
Ovarian Torsion: Etiology?
Twisting of an ovarian artery reducing blood flow to an ovary, possibly resulting in infarct of the ovary
174
Ovarian Torsion: CC?
Lower abdominal pain (RLQ or LLQ)
175
Ovarian Torsion: PE? (2)
Adnexal tenderness (right or left). Tenderness in the RLQ or LLQ
176
Ovarian Torsion: Diagnosed by?
US Pelvis -> assesses blood flow to ovaries
177
Ovarian Torsion: Scribe Alert?
Ovarian and testicular torsion are very time sensitive due to the risk of losing an ovary or testicle. Be sure to document accurate times for the pt arrival, US results, and any physician (surgical) consultations
178
Testicular Torsion: Etiology?
Twisting of the spermatic cord resulting in loss of blood flow and nerve function to the testicle
179
Testicular Torsion: CC?
Testicular pain
180
Testicular Torsion: PE? (2)
Testicular tenderness and swelling (right or left)
181
Testicular Torsion: Diagnosed by?
US Scrotum
182
Upper Respiratory Infection (URI): Etiology?
Most often viral infection causes congestion, cough, and inflammation of the upper airway
183
Upper Respiratory Infection (URI): CC? (2)
Cough, congestion
184
Upper Respiratory Infection (URI): Assoc. Sx? (4)
Fever, sore throat, headache, myalgia
185
Upper Respiratory Infection (URI): PE? (3)
Rhinorrhea, boggy turbinates, pharyngeal erythema
186
Upper Respiratory Infection (URI): Diagnosed by?
Clinically
187
Upper Respiratory Infection (URI): Scribe Alert?
Pay special attention to any complaints of CP or SOB for URI patients; always be careful to describe the CP or SOB accurately so as not to accidentally create the impression of symptoms consistent with an MI or PE.
188
Streptococcal Pharyngitis (Strep Throat): Etiology?
Bacterial infection of the tonsils and pharynx causing a sore throat and frequently swollen lymph nodes.
189
Streptococcal Pharyngitis (Strep Throat): CC?
Sore throat
190
Streptococcal Pharyngitis (Strep Throat): PE? (3)
```
Pharyngeal erythema
Tonsillar hypertrophy (enlargement)
Tonsillar exudates (pus)
```
191
Streptococcal Pharyngitis (Strep Throat): Diagnosed by?
Rapid Strep
192
Streptococcal Pharyngitis (Strep Throat): Scribe Alert? (2)
Most sore throats are viral, however strep is bacterial so Abx will help.
The biggest concern about a sore throat is the possibility of a peri-tonsillar abscess (PTA). Signs of PTA include uvular shift or tonsillar asymmetry.
193
Otitis Media (Middle Ear Infection): Etiology?
Viral or bacterial infection of the tympanic membrane (TM) causing ear pain and pressure.
194
Otitis Media (Middle Ear Infection): CC? (2)
Ear pain, ear pulling
195
Otitis Media (Middle Ear Infection): Assoc. Sx? (4)
Fever, sore throat, dry cough, congestion
196
Otitis Media (Middle Ear Infection): PE? (4)
Erythema, effusion, dullness, or bulging of the TM
197
Otitis Media (Middle Ear Infection): Diagnosed by?
Clinically
198
Conjunctivitis (Pink Eye): Etiology?
Infection of the outer lining of the eye, known as the conjunctiva
199
Conjunctivitis (Pink Eye): CC?
Eye redness, irritation, or pain
200
Conjunctivitis (Pink Eye): Assoc. Sx?
Eyelid matting
201
Conjunctivitis (Pink Eye): PE? (3)
Conjunctival injection (redness), edema, and exudates
202
Conjunctivitis (Pink Eye): Diagnosed by?
Clinically
203
Epistaxis (Nosebleed): Etiology?
Rupture of a blood vessel inside the nose causes blood to flow out the nose and into the throat.
204
Epistaxis (Nosebleed): CC?
Nose bleed
205
Epistaxis (Nosebleed): Risk Factors?
Blood thinners (Coumadin/Warfarin, ASA, Plavix) or HTN
206
Epistaxis (Nosebleed): PE?
Anterior, posterior, or septal source (of the bleeding)
207
Epistaxis (Nosebleed): Diagnosed by?
Clinically
208
Epistaxis (Nosebleed): Scribe Alert?
Procedure epistaxis management: nose bleeds that do not stop spontaneously are often cauterized (burned) or stopped with pressure by a nasal tamponade, commonly called a “rhino-rocket”
209
Musculoskeletal Back Pain: Etiology?
Deterioration or strain of the back creates pain that is worse with movement
210
Musculoskeletal Back Pain: CC?
Back pain, most commonly low back (lumbar) pain
211
Musculoskeletal Back Pain: Assoc. Sx?
Shooting posterior lower extremity pain
212
Musculoskeletal Back Pain: Pert. Negs.? (2)
No LE weakness, no incontinence
213
Musculoskeletal Back Pain: PE? (2)
Paraspinal tenderness, positive straight leg raise (pos SLR diagnoses Sciatica; back pain that radiates down the legs)
214
Musculoskeletal Back Pain: Scribe Alert?
Remember to document if there is any recent trauma related to the back pain; trauma increases the physician’s concern about possible spinal injury.
215
Extremity Injury: Etiology?
Trauma creates pain/swelling in an extremity.
216
Extremity Injury: CC?
Extremity pain
217
Extremity Injury: Assoc. Sx? (3)
Swelling, bruising, deformity; use limitation
218
Extremity Injury: Pert Negs? (2)
No motor weakness, no numbness or tingling
219
Extremity Injury: PE? (3)
Distal CSMT intact (circulation, sensory, motor, tendon) – do they have good sensation/movement/blood flow
No tendon or ligament laxity
ROM limited secondary to pain
220
Extremity Injury: Scribe Alert?
Remember the majority of extremity injuries will receive some type of splint; always remember to document a splint application procedure note.
221
Aortic Dissection: Etiology?
Separation of the muscular wall from the membrane of the artery, putting the patient at risk of aortic rupture and death.
222
Aortic Dissection: CC?
Chest pain radiating to the back, ripping or tearing
223
Aortic Dissection: PE? (2)
Unequal brachial or radial pulses, hypotension
224
Aortic Dissection: Diagnosed by?
CT Chest with IV contrast dye
225
Abdominal Aortic Aneurysm (AAA): Etiology?
Widened and weakened arterial wall at risk of rupture.
226
Abdominal Aortic Aneurysm (AAA): CC?
Midline abdominal pain
227
Abdominal Aortic Aneurysm (AAA): PE? (4)
Midline pulsatile abdominal mass, abdominal bruit, unequal femoral pulses, hypotension
228
Abdominal Aortic Aneurysm (AAA): Diagnosed by?
CT A/P with IV contrast dye
229
Deep Vein Thrombosis (DVT): Etiology?
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.
230
Deep Vein Thrombosis (DVT): Risk Factors? (11)
PMHx of DVT or PE, FHx, Recent surgery, cancer, immobility, pregnancy, BCP, Smoking, LE, Trauma, LE Casts
231
Deep Vein Thrombosis (DVT): CC?
Extremity pain and swelling (atraumatic), usually located in a lower extremity
232
Deep Vein Thrombosis (DVT): PE? (3)
Calf tenderness, cords, homan’s sign
233
Deep Vein Thrombosis (DVT): Diagnosed by?
US/Doppler of the extremity
234
Abscess (Cellulitis with Fluctuance): Etiology?
Skin infection with an underlying collection of pus
235
Abscess (Cellulitis with Fluctuance): CC?
Red, swollen, and painful lump
236
Abscess (Cellulitis with Fluctuance): PE? (3)
Fluctuance (pus-pocket), induration, purulent drainage
237
Abscess (Cellulitis with Fluctuance): Diagnosed by?
Clinically
238
Abscess (Cellulitis with Fluctuance): Scribe Alert?
Abscesses must have the pus-pocket drained. Remember to always document incision and drainage (I&D) procedure notes for abscesses.
239
Cellulitis: Etiology?
Infection of the skin cells
240
Cellulitis: CC?
Red, swollen, painful, and sometimes warm area of the skin
241
Cellulitis: PE? (4)
Erythema, edema, increased warmth (calor), induration
242
Cellulitis: Assoc. Meds?
Abx
243
Cellulitis: Diagnosed by?
Clinically
244
Rash: Etiology?
Changes in the skin’s appearance due to systemic or localized reaction. May be caused from medication, virus, bacteria, fungus, insect, etc.
245
Rash: CC?
Rash- red, itchy (pruritic) or painful
246
Rash: PE? (7)
Urticaria (hives or wheals), macules (flat), papules (raised bumps), vesicles (small blisters), blanching (not dangerous), petechaie (dangerous rash), purpura (dangerous rash)
247
Rash: Diagnosed by?
Clinically
248
Allergic Reaction: Etiology?
Immune response causing an inflammatory reaction consisting of swelling, itching (pruritis), and rash
249
Allergic Reaction: Risk Factors?
Known drug or food allergy
250
Allergic Reaction: CC?
Rash, swelling, itching, or SOB
251
Allergic Reaction: PE? (3)
Edema, facial angioedema, urticaria (hives, wheals)
252
Allergic Reaction: Diagnosed by?
Clinically
253
Allergic Reaction: Scribe Alert?
ED concern is anaphylaxis or respiratory failure.
254
Diabetic Ketoacidosis (DKA): Etiology?
Shortage of insulin resulting in hyperglycemia and production of ketones.
255
Diabetic Ketoacidosis (DKA): Risk Factors?
DM
256
Diabetic Ketoacidosis (DKA): CC?
Persistent vomiting with a Hx of DM
257
Diabetic Ketoacidosis (DKA): Assoc. Sx? (3)
SOB, polydipsia (increased thirst), polyuria (increased urination)
258
Diabetic Ketoacidosis (DKA): PE? (3)
Ketotic order (fruity), dry mucous membranes (dehydration), tachypnea
259
Diabetic Ketoacidosis (DKA): Diagnosed by?
Arterial blood gas (ABG or VBG) showing low pH (acidosis) or positive serum ketones
260
Psychological Disorder: Etiology?
Various types of psychological disease produce abnormal thoughts, behaviors, or actions
261
Psychological Disorder: PMHx? (8)
Bipolar disorder, schizophrenia, PTSD, depression, anxiety, alcoholism, drug abuse, suicide attempt
262
Psychological Disorder: Possible CC? (6)
Suicidal ideation (SI), homicidal ideation (HI), hallucinations (auditory or visual), substance abuse, self injury, overdose
263
Psychological Disorder: PE? (4)
Flat affect, SI, HI, tangential or pressured speech
264
Psychological Disorder: Scribe Alert?
Pay very careful attention to differentiating between medical (physical) and psychiatric complaints. As an emergency physician, the main concern is medical clearance; determining that the patient is not medically ill. After medical clearance, the patient is cleared to be evaluated from a psychiatric standpoint.
265
Trauma: Etiology?
Depending on the mechanism of injury (MOI), physical trauma may break bones, sever nerves, rupture blood vessels, or damage internal organs.
266
Trauma: CC? (3)
Motor vehicle accident (MVA), fall, gun shot wound (GSW)
267
Trauma: PE?
Glasgow Coma Scale (GCS)
268
Trauma: Assoc. Med?
Blood thinners? (Coumadin, ASA, or Plavix)
269
Trauma: Diagnosed by?
Trauma protocol depending on MOI: CT or XR
270
Trauma: Scribe Alert?
```
Neurological Injury (Brain, Spine): LOC, confusion, numbness, weakness, HA, neck/back pain
Internal Organ Injury (Lungs, Spleen, Liver): SOB, Chest Pain, Abd Pain
```
