Pathophysiology

Question 1

CVA

Answer 1

Etiology: Blockage of arteries that limit blood circulation to the brain and result in brain damage

CC: Unilateral/focal sx; weakness/numbness/visual& speech deficits

RF: HTN, HDL, DM, Smoking, FHx of CVA, PMHx of CVA or TIA, AFIB

PE: 1. Hemiparesis
2. Unilateral Paresthesia
3. Neurological deficits (Visual field & Aphasia)
Dx: Clinically; CT is clear
MED: tPA (Blood-thinner that reverses CVA Sx)
Document time of onset & Sx improve rapidly

Question 2

Hemorrhagic CVA/Brainbleed

Answer 2

E: spontaneous or traumatic rupture of blood vessels in the brain
CC: sudden, throbbing HA
Assox sx: HA, seizure, AMS, numbness, weakness, changes in vision & speech
PE: Unilateral Neurological Deficits
Dx: CT & LP

Question 3

TIA

Answer 3

E: temporary changes in vessels depriving brain of O2
CC: transient focal neurological deficits (strength, sensation, vision, speech)
Dx: clinically

**Sx last <1hr

Question 4

Meningitis

Answer 4

E: inflammation and infection of meninges
CC: Neck pain & HA
ASx: Neck stiffness, neck pain, fever, AMS
PE: Meningismus & Nuchal Rigidity
Dx: LP

Bacterial or Viral

Question 5

Spinal Cord Injury

Answer 5

E: Trauma causing bilateral numbness & weakness in extremities
CC: neck p, back p, extremity weakness & numbness
PE: mid-line bony tenderness, deformities (or step-offs), rectal tone, bilateral extremity numbness & weakness
Dx: C-spine CT, T-spine CT, L-spine CT

Question 6

Seizures (SZ)

Answer 6

E: abnormal electrical activity in the brain causing abnormal physical manifestations
CC: seizure activity, syncope
ASx: confusion, HA, injuries (tongue-bite), incontinence
PE: Somnolent, postictal (confused)
M: Keppra, Depakote, Neurontin, Dilantin, Tegretol

Question 7

Bell’s Palsy

Answer 7

E: inflammation or infection of facial nerve causing weakness in muscles of one side
CC: sudden onset droopy face
Pertinent negative: no extremity weakness; no changes in vision or speech
PE: Unilateral weakness of upper and lower facial muscles
Dx: Clinically

Question 8

HA/Cephalgia

Answer 8

E: HTN, Sinusitis, migraines
CC: pressure, throbbing HA w/ gradual onset
Pert.Neg: No fever, numbness, weakness, neck-pain or stiffness

Question 9

AMS

Answer 9

E: multiple causes: infection, neurological, hypoglycemia
CC: confusion, decreased responsiveness
RF: dementia, old age, MD, EtOH * drug use

*maybe caused by UTI, demntia, hypoglycemia

Question 10

Syncope

Answer 10

E: Temporary loss of blood circulation to the brain due to dehydration or hypovolemia
CC: passing out vs. about to pass-out

Question 11

Vertigo

Answer 11

E: room-spinning due to inner ear infection or neurological probs
CC: room spinning, disequilibrium, worsens w/ head motion
ASx: N/V & Tinnitus
PE: Nystagmus, Roberg, Dix-Hallpike test
Dx: Clinically

Question 12

Appendicitis

Answer 12

E: infection of the appendix causing inflammation and possible rupture
CC: RLQ pain that is constant, gradual, and that worsens upon movement
PE: RLQ tenderness, McBurney’s point tenderness
Dx: CT A/P w/ PO contrast
ASx: Fever, N/V, decreased appetite

Question 13

SBO

Answer 13

Small Bowel Obstruction
CC: abd pain, constipation, vomiting
RF: elderly, infants, narcotic drug usage, abd surgery
PE: abd tenderness, abd distension
Asx: abd distention, bloating, no BMs
Dx: CT A/P w/ PO contrast & Acute abd series (AAS)

Question 14

Cholelithiasis/Cholecystitis

Answer 14

E: condensation of bile from liver to form stones that can irritate, inflame, and obstruct gallbladder
CC: sharp pain that worsens upon eating, taking a deep breath, and palpitation
Dx: US
PE: RUQ tenderness
worsened by eating fatty food

Question 15

GI Bleeding

Answer 15

E: Bleeding in upper or lower GI tract
CC: Hematemesis, Hematochezia, Melena, Coffee ground emesis
ASx: SOB, lightheadedness, weakness, abd pain, rectal pain
PE: melena, conjunctiva, pallor, tachycardia, grossly bloody stool
Dx: positive heme in stool

Question 16

Diverticulitis

Answer 16

E: inflammation and infection of diverticuli
RF: old age, diverticuli
CC: LLQ pain
ASX: N, diarrhea, fever
Dx: CT A/P w/ PO contrast

Question 17

Pancreatitis

Answer 17

E: inflammation of the pancreas
CC: LUQ & epigastric pain
RF: EtOH abuse & cholecystitis
ASx: N/V
PE: LUQ and epigastric tenderness
Dx: heightened lipase & amylase levels (lipase primarily)

Question 18

GERD

Answer 18

E: Regurgitation of stomach acid into esophagus
CC: epigastric pain and burning
PE: epigastric tenderness
Med: GI cocktail

***May cause anxiety about cardiac illnesses due to proximity of heart & stomach; cardiac workup is done

Question 19

C-diff colitis

Answer 19

Bacteria that causes persistent diarrhea

Question 20

Gastroenteritis

Answer 20

GI Bug; causes vomiting and diarrhea; bacterial or viral

Question 21

Crohn’s disease

Answer 21

Immune disease causing diarrhea & abd pain

Question 22

IBS

Answer 22

Sensitive bowel prone to diarrhea

Question 23

Gastritis

Answer 23

aka stomach ache

irritated stomach causing vomiting

Question 24

UTI

Answer 24

E: infection of urinary tract (bladder or urethra)
RF: F
CC: dysuria
ASx: urgency, frequency, malodorous urine, AMS
PE: suprapubic tenderness
Dx: Urine Dip/Urinalysis (WBC, bacteria & nitrile in urine measured)

Question 25

Pyelonephritis

Answer 25

E: infection of kidney tissue (usually spread from UTI) CC: Flank pain & dysuria RF: F & frequent UTI ASx: N/V & fever Dx: CT abd/pel w/no contrast or confirmed UTI by CVA tenderness PE: CVA tenderness (Costovertebral angle tenderness)

Question 26

Renal Calculi Nephrolithiasis Urolithiasis

Answer 26

ET: dislodged from kidney, causes irritation and bleeding of the urethra CC: Sharp flank pain radiating to groin ASx: N/V, hematuria, unable to void PE: CVA tenderness Dx: Pel/abd CT without contrast & RBC from UA

Question 27

Ectopic Pregnancy

Answer 27

E: potential for rupture; fatal / urgent CC: lower abd pain, vaginal bleeding Dx: US of fetus

Question 28

Ovarian Torsion

Answer 28

E: twisting of ovarian artery and reduction of blood supply to ovary, resulting in potential ovarian infarct CC: LLQ & RLQ abd pain PE: adnexal tenderness LLQ & RLQ Dx: US pelv---(assesses blood flow to the ovaries) ***document times for pt arrival, US results, surgical consultations****

Question 29

Testicular Torsion

Answer 29

E: twisting of spermatic artery and reduced blood flow, causing loss of one of the testicles CC: testicular pain PE: testicular tenderness & swelling Dx: US scrotum

Question 30

Musculoskeletal Back Pain

Answer 30

E: pain in the lower back, paraspinal & in extremities Pert.Neg: no LE weakness, no incontinence PE: paraspinal tenderness & Straight leg raise (SLR) with sciatica ***May be due to trauma***

Question 31

Extremity Injuries

Answer 31

E: Pain/swelling caused by trauma CC: pain ASx: swelling, bruising, deformity, limited ROM PE: intact distal CSMT (circulation, sensation, motor function, tendon); no tendon or ligament laxity; limited ROM secondary to pain Pert. Neg: no motor weakness or numbness

Question 32

AAA

Answer 32

E: widened and weakened arterial wall at risk of rupture CC: mid-line abd pain PE: unequal femoral pulses, mid-line pulsatile abdominal mass, hypotension, abd bruit Dx: CT A/P w/ contrast

Question 33

Aortic Dissection

Answer 33

E: separation of chest muscle wall from the aorta's membrane, putting it at risk of rupture CC: chest pain radiating to the back (ripping and tearing) PE: hypotension Dx: CT A/P w/ contrast

Question 34

DVT

Answer 34

E: formation and growth of blood clot in LE due to slow moving blood circulating in the veins of the LE CC: pain and swelling of LE PE: calf tenderness RF: PMHx or FHx of DVT or PE, Pregnancy, Immobility, BCP, Smoking, trauma, casts, recent surgeries Dx: US LE

Question 35

Cellulitis

Answer 35

``` E: infection of the skin CC: Pain, swollen, red, calor (warm), tense (induration) PE: erethema, edema, calor, induration, Tx: Abx Dx: clinically ```

Question 36

Abscess

Answer 36

E: infection of skin with purulent pockets underneath skin CC: painful, swollen, red Procedure: I&D PE: Fluctuance (pocket-like), induration (tense), purulent discharge/drainage Dx: clinically

Question 37

Rash

Answer 37

E: skin appearance changes due to localized or generalized reactions to meds, bacteria, virus, fungus, insect bite, etc. CC: Rash that is erethematous, pruritic, painful Dx: clinically

Question 38

Allergic Rxn

Answer 38

E: Body's immunological response to an unknown substance with inflammation causing a rash, swelling, SOB or itching CC: rash, swell, SOB, pruritous PE: facial angioedema, edema, urticaria (hives, wheals) ***ED concern is respiratory failure & anaphylaxis***

Question 39

Adverse Reaction

Answer 39

N/V Diarrhea Abd pain dizziness

Question 40

DKA

Answer 40

E: Hyperglycemia & production of ketones due to lack of shortage of insulin CC: Persistent vomiting RF: DM ASx: polyuria, polydipsia, SOB PE: tachypnea, ketotic odor (fruity), dry mucous membrane Dx: by acidosis (low pH) through ABG or VBG or by positive serum ketones

Question 41

Psychological Disorder

Answer 41

E: produce abnormal thought, behavior, action PMHx: depression, bipolar, schizophrenia, Anxiety, PTSD, Alcoholism, Drug abuse, Suicide Attempt CC: suicide ideation (SI), Homicide Ideation (HI), overdose, self-injury, Hallucinations (visual or auditory), Substance Abuse PE: flat affect, HI, SI, Tangential or pressured speech Medically cleared for psychological evaluation

Question 42

Physical Trauma

Answer 42

E: Trauma causing bone fractures, nerve severance, blood vessel rupturing, and internal organ damage depending on MOI CC: MVA or GSW AMeds: Blood thinners (ASA, Coumadin, Plavix) Dx: by CT or XRay depending on MOI and trauma protocol Neurological injury * HA, Cervical/lumbar pain, confusion, LOC, weakness, numbness Internal Organ injury *SOB, CP, Abd pain

Question 43

MOI

Answer 43

E: the way damage to the skin, muscle, bone, & organ happened. ``` MVA: Head-on Collision T-bone collision Rear-impact Collision rollover collision victim ejected from vehicle Motorcylce, ATV crash Pedestrian vs. Vehicle ``` Stabbed? Location, length of blade, angle of penetration GSW? Type of gun, caliber, distance from the victim, bullet deformity How it occurred, when it occurred and what surface did it land on?