Week 5 - Back/Flank Pain & Genital Urinary

Question 1

ETCO2 in Cardiac Arrest

What does a spike AND drop in ETCO2 mean?

Answer 1

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

Question 2

Back Pain

Show me the lower back muscles

Answer 2

Question 3

Back Pain

Show me the pocket assessments for back pain

Answer 3

Question 4

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

Answer 4

What ALS to study for test #2

Analgesia Medical Directive

Question 5

Low Back pain

What are the common cheif complaints?

What should you obtain?

Answer 5

Spinal origins

Non-spinal origins

OPQRST
SAMPLE
Physical Assessment - Hands On

Question 6

Low Back Pain

What are the spinal origins?

Answer 6

Musculoligamentous (common)

Discogenic

Fractures

Spondylolisthesis

Ankylosing Spondylitis

Osteomyelitis

Epidural Abscess/Hematoma

Cauda Equina Syndrome (nerve root)

Neoplasm

Question 7

Show me the different types of spinal curvature

Answer 7

Question 8

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

Answer 8

Gunshot

Stabbing

Fractures

Motor Vehicle Collision

Question 9

Incomplete Spinal Cord Syndromes

Brown-Sequard Syndrome

Central Cord Syndrome

Anterior Cord Syndrome

Answer 9

Question 10

Explain

Myelitis

Transverse Myelitis

Acute Flaccid Myelitis (AFM)

What are the causes of AFM?

Answer 10

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)

Question 11

Cauda Equina Syndrome

What is it? What are the complications?

Answer 11

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

Question 12

Sciatica - back pain

What happens when the sciatic area hurts?

Answer 12

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

Question 13

Lower-Back Pain

What about tight hamstrings?

Answer 13

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)

Question 14

Low-Back Pain

What are the Non-Spinal Origins?

Answer 14

Abdominal Aortic Aneurysm (pulsatile mass ?)

Renal Colic

Prostatitis

Ascending Urinary Tract Infection

Cystitis (Bladder Inflammation)

Pyelonephritis (Kidney Inflammation)

Neoplasm

Infection

Question 15

Abdominal Aortic Aneurysm

Show & tell me the basics?

Answer 15

May have radiating pain to the back

Described at a tearing sensation

Pulsatile mass possible

Low Blood Pressure

Leaking blood follows gravity / pooling

Question 16

Hematuria

Blood in the urine

Show me the causes

Answer 16

Question 17

Nocturia

The need to get up at night to urinate regularly

What’s this associated with?

Answer 17

significant morbidity and marker of poor health

Question 18

Show me the Bristol Stool Chart

Show me the Urine Properties

Answer 18

Question 19

Show me the female antomy

Answer 19

Show me the Male anatomy

Question 20

What’s a Pap Smear?

Show me the stages for cervical cancer

Answer 20

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

Question 21

Prostate Cancer

What’s the common age/gender?

Answer 21

Men over 70y/o

Question 22

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

Answer 22

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

Question 23

Urine Output

Normal -

Oliguria -

Anuria -

Answer 23

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

Question 24

Urinary Tract Infection

What will the patient present as?

Show me the upper and lower urinary tract presentations

Answer 24

With dementia

Confused

Altered

Question 25

What are potential urinary catheter complications?

Answer 25

Infection Catheter blockage/inability to flush Retention balloon is not deflating

Question 26

# Kidney Stones What's the ER presentation of the patient? | Is there a comfortable position for the patient? ## Footnote What are they presenting with that's concering?

Answer 26

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

Question 27

# Kidney Stones What/where is colicky pain?

Answer 27

Question 28

# Urinary Obstruction/Retention What are the differntials?

Answer 28

Renal Calculi - Kidney Stones Acute Kidney Injury Benign Prostatic Hypertrophy (BPH) – Rx: Options Urethral Obstructions Blocked Foley Catheter Urinary Tract Infections Nerve Damage

Question 29

# 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

Question 30

# Urinary Incontinance Show me the types of incontinance

Answer 30

Question 31

Show me the kidney's anatomy ## Footnote What are kidney injury differentials?

Answer 31

## Footnote Volume overload Hyperkalemia Uremia Metabolic Acidosis

Question 32

# Acute Kindey Failure What are the S+S?

Answer 32

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

Question 33

# Failing Kidneys What are the treatments?

Answer 33

Peritoneal Dialysis Hemodialysis

Question 34

# Pyelonephritis Inflammation of the kidney - usually bacterial infection | What are the complications? ## Footnote What are the S+S?

Answer 34

| pus around the kidney Sepsis Kindey failure ## Footnote fever flank tenderness nausea buring with urination frequent urination

Question 35

# Rhabdomyolysis What is it? ## Footnote Kidneys are responsible for removing myoglobin from the blood so that urine can flush it out of the body

Answer 35

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

Question 36

# Rhabdomyolysis Who does it affect? ## Footnote What are the causes?

Answer 36

Endurance athletes - HIIT people Firefighters - the overheating Service members - intense training Older people - people who fall and aren't discovered for a longtime ## Footnote 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)

Question 37

# Renal Infarct Caused by vascular occlusion, usually affecting the renal cortex

Question 38

# Chronic Kidney Disease (CKD) What are the potential differentials? ## Footnote Show me the S+S

Answer 38

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

Question 39

# Renal Atery Stenosis The narrowing of 1 or more (renal) arteries that carry blood to your kidneys. | What happens as a result?

Answer 39

## Footnote 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

Question 40

# End-Stage Renal Disease (ESRD) Consider dialysis and/or a kidney transplant

Question 41

# PCOS - Polycystic Ovary Syndrome What is it?

Answer 41

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

Question 42

# Ovarian Cysts What are they/What do they do? | What's the pain like? ## Footnote When does it become a problem?

Answer 42

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 ## Footnote When the cyst doesn't go away or it gets bigger or it does get painful

Question 42

# Endometriosis What is it? ## Footnote Where does it occur?

Answer 42

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 ## Footnote ovaries, fallopian tubes, and the tissue linning you pelvis

Question 42

# Pelvic Inflammatory Disease What is it? ## Footnote What are the common S+S?

Answer 42

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 ## Footnote 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

Question 43

# Prostatits What is it?

Answer 43

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

Question 44

# Testicular Issues What are the top 6 DDX?

Answer 44

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

Question 45

# Orchiectomy - removal of 1 or both testicles Why/When is it performed?

Answer 45

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

Question 46

# Phismosis - Paraphimosis What is it? ## Footnote What is phumosis?

Answer 46

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

Question 47

# Priapism What's the max amount of time until it's ER? What are the causes?

Answer 47

4h Spinal Chord Injury Erectile Dysfunction Rx Antidepressants Antipsychotics Anticoagulants Antihypertensives Cocaine, Marijuana Sickle Cell Disease Leukemia

Question 48

# Renal Trauma What is it?

Answer 48

When the kidney is damaged from an outside source

Question 49

# Shiv/Shank Where is the target location?

Answer 49

Lower back/kidney area Liver

Question 50

# Ruptured Bladder Tell me what you know

Answer 50

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

Question 51

# Abuse What should you consider/look out for?

Answer 51

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)

Question 52

Show me differentials for all 9 quadrants of the abdominal cavity

Answer 52

Question 53

Show me the organs than lie in the abdominal cavity

Answer 53

Question 54

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

Answer 54

Question 55

# Bowel Sounds What's the pitch and frequency of NORMAL BOWEL sounds? | What's the pitch and frequency for ileus? ## Footnote What's the pitch and frequency of an obstruction?

Answer 55

Low-pitched gurgling Every 5-10sec (veries per person) None | None ## Footnote High-pitched increased volume Increased frequency (so more than every 5-10sec)

Question 56

# Food Poisoning What are the common signs and symptoms?

Answer 56

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

Question 57

# Lectins What are they? What do they contribute to? | What food have the highest content of lectins?

Answer 57

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

Question 58

FOOD MAP (what does it stand for/what does it mean)? ## Footnote What are the symptoms/side affects?

Answer 58

Fermentable oligosaccharides Disaccharides Monosccharides Polyols (all are short-chain carbohdrates i.e. food you might eat) ## Footnote Cramping Diarrhea Constipation Stomach bloating Gas and flatulence

Question 59

# Lactose Intolerant / Lactose Malabsorption What's (patho) wrong with these people? ## Footnote What are the symptoms? When do they occur?

Answer 59

They are unable to fully digest the sugar (lactose) in dairy products. It's usually harmless but do come with uncomfartable symptoms. ## Footnote 30min - 2h from the ingestion of said dairy prodcut Diarrhea Nausea, and sometimes, vomiting Stomach cramps Bloating Gas

Question 60

# SIBO - Small intestinal bacterial overgrowth What is it? What happens? | Symptoms? ## Footnote When does it occur?

Answer 60

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

Question 61

# SIBO What are the most common sings and symptoms?

Answer 61

Loss of appetite Abdominal pain Nausea Bloating An uncomfortable feeling of fullness after eating Diarrhea Unintentional weight loss Malnutrition

Question 62

What are the top differentials for diarrhea?

Answer 62

Dehydration Electrolyte Imbalance Shock Hypovolemia Sepsis

Question 63

# Gastroenteritis What is it? ## Footnote What are the common signs and symptoms?

Answer 63

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** ## Footnote Fever Vomiting Decreased appetite Diarrhea Chills Nausea

Question 64

# C.Difficile (CDI) What is it? What does it do?

Answer 64

It's a germ that causes diarrhea and colitis

Question 65

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

Answer 65

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

Question 66

# Upper Gastrointestinal Bleeding Describe the following words? ## Footnote Hematemsis Hematochezia Melena Coffee Grounds Emesis

Answer 66

Hematemsis - vomiting blood Hematochezia - fresh blood via the anus Melena - black/tary stool Coffee Grounds Emesis - vomit that looks like coffee grounds

Question 67

# Upper GI Bleeding What are the top differentials?

Answer 67

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

Question 68

Show me Mallory-Weiss Tear / Boerhaave Syndrome

Answer 68

Question 69

What's the most common cause of esophageal varices? ## Footnote What are the symptoms?

Answer 69

Scarring of the liver ## Footnote 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

Question 70

# Lower GI Bleeding What's the most common cause? ## Footnote What are other differentials?

Answer 70

Diverticulitis/diverticulosis ## Footnote Angiodysplasia (abnormal dilated sm blood vessel in GI) Cancer / Polyps Rectal Disease Inflammatory Bowel Disease Mesenteric infarction Aortoenteric Fistula (Graft after repair AAA)

Question 71

What is the #1 cause of peptic ulcer disease?

Answer 71

Helicobacter Pylori

Question 72

What are the top differentials for liver disease?

Answer 72

Viral Hepatitis Drug Induced Hepatitis Cirrhosis Sepsis Billiary Obstruction (stone, tumour, infection)

Question 73

# Hepatitis What are the types? | 4 ## Footnote What are the types of viral hepatitis?

Answer 73

Viral Hepatitis Toxic Hepatitis Alcoholic Hepatitis Non-alcoholic Fatty Liver Disease ## Footnote 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

Question 74

# Ascities What is it? ## Footnote What's difficult about having ascites?

Answer 74

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”). ## Footnote Eating, moving, breathing, and sleeping

Question 75

# Hepatic Encephalopathy What is it? | Is it short or long term? ## Footnote What happens?

Answer 75

an impairment of brain functions that occurs due to liver diseases. | Can be either ## Footnote 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.

Question 76

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

Answer 76

Hepatitis A & E Acetaminophen Hepatotoxicity

Question 77

What's the Toxic single dose of acetaminophen in adults AND children? ## Footnote What's in a bottle?

Answer 77

Adults Toxic Single Dose = 7.5-10 grams Children Toxic Single Dose = 150mg/kg ## Footnote 325 mg / 100 tablets in a bottle = 32,500 mg / 32.5 grams

Question 78

# Acute Cholecysitis - gallbladder What are the top differentials?

Answer 78

Stones Biliary colic - not inflammed but comes with pain and vomiting Cholecystitis - comes with pain, vomiting, inflammation, and fever.

Question 79

# Hemorrhoids Show me the internal grades

Answer 79

Question 80

# Perforated Bowel Show me the common causes by section of the bowel

Answer 80

Question 81

# Toxic Megacolon When does it occur/what is it? ## Footnote What happens/the complications?

Answer 81

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

Question 82

# Hernias What are the 2 main types and how's the blood supply?

Answer 82

Incarcerated - has blood supply, obstructs the intestinal flow, and CAN'T be reduced Strangulated - blood supply is compromised and intestinal flow is obstructed

Question 83

# Bowel obstructions What are the top causes for small bowel obstruction? ## Footnote Large bowel obstruction

Answer 83

Precious surgery - adhesions Incarcerated Hernias ## Footnote Cancer

Question 84

# Intissusception What are the sigs and symptoms? | part of the intestine slides into an adjacent part of the intestine

Answer 84

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

Question 85

Show me inflammatory bowel diseases vs a healthy bowel

Answer 85

Question 86

# Volvulus What is it? ## Footnote What can happen?

Answer 86

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

Question 87

# Ascending Cholengitis What is it? ## Footnote What's the charcot's triad (for DDX)?

Answer 87

An infection thoughout the biliary tree ## Footnote Jaundice Fever RUQ pain

Question 88

# Pancreatitis - epigastric pain What are the top 5 DDX?

Answer 88

Alcohol Gallstones Tumors Abdominal Trauma Infections

Question 89

# Peritonitis What is it? ## Footnote What's the cause? - life threatening?

Answer 89

redness and swelling (inflammation) of the lining of your belly or abdomen. This lining is called the peritoneum ## Footnote Infection (bacteria or fungal) from a hole in the bowel or a burst appendix If it gets into the blood it will cause sepsis

Question 90

# Spontaneous Bacterial Peritonitis What is it? what's the mortality rate? ## Footnote What the triad differntial?

Answer 90

An acute infection of the ascitic fluid in a pt with liver disease 50% ## Footnote Fever Abdominal Pain Increasing Ascities

Question 91

What is Ileus? ## Footnote What are the causes and complications?

Answer 91

Diagnosis is made by x-ray. it is a temporary lack of the normal muscle contractions of the intestines. ## Footnote Abdominal surgery and drugs Bloating, vomiting, constipation, cramps, and loss of appetite occur.

Question 92

Show and explain to me the 3 signs of appendicitis

Answer 92