1
Q
Example Pathophysiology (ED Flow)
A
2
Q
Differential Diagnosis
A
1. Differential Diagnosis: the different diseases the physician comes up with to explain the true source of the pc’s chief complaint
- associated symptoms, associated meds, PE findings, and diagnosis of diseases are all methods used to condirm the differential diagnosis
3
Q
Pertinent Positives
A
specific symptoms that raise the physician’s suspicion for a particular disease
4
Q
Pertinent Negatives
A
specific symptoms that are not present which cause teh physician to doubt certain diagnosis
5
Q
A
6
Q
Coronary Artery Disease
(Etiology)
A
CAD
7
Q
Myocardial Infarction
(Etiology)
A
- MI:
- STEMI—» ST elevation present (EKG)
- non-STEMI—» happened recently but non-ST elevated MI (troponin lvls)
8
Q
Congestive Heart Faliure
(Etiology)
A
- CHF
- heart becomes enlarged, inefficient, and congested with excess fluid
- PE:
A) rales (snap, crackle, pop sound in lungs upon breathing),
B) Jugular Vein Distention (JVD) in neck,
C) pitting pedal edema ( Observable swelling of body tissues due to fluid accumulation that may be demonstrated by applying pressure to the swollen area)
9
Q
Atrial Fibrillation
(Etiology)
A
- AFIB
- electrical abnormalities in the “wiring” of the heart causes the top of the heart (atria) to quiver abnormally
10
Q
what are 3 Shortness of Breath (SOB) Symptoms associated with CHF?
A
- worse with lying flat (Orthopnea)
- paroxysmal nocturnal dyspnea (PND)
- Dyspnea on Exertion (DOE)
11
Q
inflammation of the sac surrounding the heart causing CP (chest pain)
A
Pericarditis
12
Q
inflammation of the sac surrounding the lungs causing pleuritic CP
A
Pleurisy
13
Q
irritation of the ribs causing CP worsened by pressing on the sternum
A
Costochondritis
14
Q
irritation of the chest wall causing pain with palpation of the chest
A
Chest Wall Pain
15
Q
fluid collecting around the lungs causing SOB or CP
A
Pleural Effusion
16
Q
Cardiovascular Summary Slide
- Diagnosis
- What is it?
- Diagnosed by what tests?
A
17
Q
Pulmonary Embolism
(Etiology)
A
- PE
- a blood clot disloges from pulmonary artery and blocks blood flow to the lungs
18
Q
Pneumonia
(Etiology)
A
- PNA
- infiltrate (bacterial infection) and inflammation within the lung
19
Q
Pneumothorax
(Etiology)
A
- PTX
- collapsed lung due to trauma or a spontaneous small rupture of the lung
20
Q
Chronic Obstructive Pulmonary Disease
(Etiology)
A
- COPD
- long-term damage to lung’s alveoli (emphysema) along w/inflammation and mucus production (chronic bronchitis)
21
Q
Asthma (Reactive Airway Disease)
(Etiology)
A
- Asthma
- constricting of the airway due to inflammation and muscular contraction of the bronchioles (i.e. bronchospasm)
22
Q
Pulmonary Summary
- Diagnosis
- catch phrase?
- Diagnosed by…?
A
23
Q
Ischemic Cerebrovascular Accident
(Etiology)
A
- CVA
- blockage of the arteries supplying blood to the brain resulting in permanent brain damage
24
Q
Transient Ischemic Attack
(Etiology)
A
- TIA
- vascular changes temporarily deprive part of the brain from oxygen—»symptoms generally last less than 1 hr
25
Hemorrhagic Cerebrovascular Accident
1. **CVA** (brain bleed)
2. traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in brain
26
Meningitis: Bacterial vs. Viral
(Etiology)
inflammation and infection of the meninges; the sac surrounding the brain and spinal cord
27
Spinal Chord Injury
(Etiology)
injury to the spinal cord = weakness/numbness in the extremeties, past the site of injury
28
Seizure
(Etiology)
1. **SZ**
2. abnormal electrical activity in the brain = abnormal physical manifestations
3. common causes = epilepsy, ETOH withdrawl, febrile SZ in pediatric pts
29
Bell's Palsy
(Etiology)
inflammation or viral infection of facial nerve causes one-sided weakness of the entire face
30
Headache (Cephalgia)
(Etiology)
1. **HA**
2. anything from hypertensive headaches (high BP), recurrent diagnosed migraines, sinusitis, etc,
31
Altered Mental Status
(Etiology)
1. **AMS**
2. multiple causes: hypoglycemia, infection, intoxication, and neurological causes
32
syncope
(Etiology)
1. temporary loss of blood supply to the brain = loss of consciousness
2. common causes = vasovagal & low blood volume (dehydration/hypovolemia), and rarely due to cardia/neurologic causes
33
Vertigo (Dizziness)
(Etiology)
caused by 1 of 2 etiologies...
1. vertigo may be from a harmless problem of inner ear (**benign positional vertigo)**
2. due to camage in a specific center of the brain (i.e. possible CVA)
34
Neurological Summary
1. diagnosis
2. important things to document
35
Abdominal Quandrants & Associated Disorders
36
Appendicitis
(Etiology)
1. **APPY**
2, infection of appendix causes inflammation and blockage, sometimes leading to rupture
37
Small Bowel Obstruction
1. **SBO**
2. physical blockage of the small intestine
38
Gallstones
1. **Cholelithiasis / Cholecyctitis**
2. minerals from liver's bile condense to form gallstones –» irritate, inflame, or obstruct gallbladder
39
Gastrointestinal Bleed
1. **GI Bleed**
2. hemorrhage in upper/lower GI tract leads to anemia
40
Hematemesis
1. vommiting of blood (usually from the GI tract)
(A) brighter blood = upper GI tract
41
Coffee ground emesis
1. vommiting of blood (usually from the GI tract)
(A) darker blood = lower part of GI tract
42
Hematochezia
1. passage of blood through stool (usually from the GI tract)
(A) brighter blood = lower GI tract
43
Melena
1. passage of blood though stool (usually from the GI tract)
(A) darker blood = upper GI tract
44
Diverticulitis
acute inflammation and infection of abnormal pockets of the large intestine (i.e. diverticula)
45
Pancreatitis
inflammation of the pancreas
46
Gastroesophageal Reflux Disease
1. **GERD**
2. stomach acid regurgitating into the esophagus
47
C. Diff Colitis
opportunistic bacteria that causes persistent diarrhea (Stool therapy)
48
gastroenteritis
1. vomiting and diarrhea
2. "GI Bug" often viral or bacterial
49
Crohn's Disease
immune disorder causing diarrhea and abdominal pain
50
Irritable Bowel Syndrome
chronically sensitive bowels prone to diarrhea
51
Gastritis
1. irritated stomach w/vomiting
2. "somach ache"
52
GI Tract Summary
1. diagnosis
2. abdominal region
3. diagnosed with...?
53
Urinary Tract Infection
1. **UTI**
2. infection in the urinary tract (bladder or urethra)
54
(1) NEPHROLITHIASIS
vs.
(2) Renal Calculi
vs.
(3) URETEROLITHIASIS
1. **NEPHROLITHIASIS:** the process of forming a kidney stone
2. **Renal Calculi:** term for physicial kidney stone
3. **URETEROLITHIASIS:** process of stones traveling through ureter
55
Kidney Stone
Nephrolithiasis / Renal Calculi / Ureterolithiasis
56
Ectopic Pregnancy (Tubal Pregnancy)
fertilizzed egg develops outside the utereus (usually in fallopian tube) —» high risk for rupture/death
57
Testicular Torsion
Male
58
Ovarian Torsion
Female
59
Genitourinary Summary
60
Abdominal Aortic Aneurysm
1. **AAA**
2. widened and weakened arterial wall at risk of rupture
61
Aortic Dissection
separation of muscular wall from membrane of the artery, putting the pt at risk for aortic rupture and death
62
Deep Vein Thrombosis
1. **DVT**
2. slow filling blood in the straight veins of extremities can lead to clotting, which can eventually block the vein
63
Sepsis
* chemicals in the immune system that release into the blood to fight infection, cause inflammation throughout the body instead
* severe cases can lead to septic shock (medical emergency)
64
Upper Respiratory Infection
1. **URI**
2. most often viral infection causing congestion, cough, and inflammation of upper airway
65
Otitis Media
1. Middle Ear Infection
2. viral/bacterial infection of tympanic membrane (TM) causing ear pain and pressure
66
Strep Throat
1. STREPTOCOCCAL PHARYNGITIS
2. bacterial infection of the tonsils and pharync causing a sore throat and frequently swollen lymph nodes
67
Musculoskeletal Back Pain
68
Extreme Injury
69
Allergic Reaction
70
Allergic vs. Adverse Reactions
71
Cellulitis
infection of the skin cells
72
Abscess (Cellulitis w/Fluctuance)
skin infection with an underlying collection of pus
73
Rash
74
Diabetic Ketoacidosis
1. **DKA**
2. shortage of insulin resulting in hyperglycemia and production of ketones
75
Trauma (Physical Injury)
76
Trauma: Mechanism of Injury [**MOI**]
77
Psychological Disorders
78
what other past histories would suggest that a patient has CAD?
(5)
1. MI,
2. Angina (CP due to heart-muscle ischemia)
3. CABG,
4. Stent,
5. Angioplasty (ballon)
79
1. Does a PMHx of CVA mean the patient has CAD?
2. Does a surgical history of angioplasty mean the patient has CAD?
1. NO
2. YES
80
Explain the difference between CAD and an MI
CAD is a broad term for heart disease. MI is included in CAD —» It’s an active heart attack.
81
If someone has a PMHx of A-Fib or CHF, do they also have CAD?
NO
82
What are the “cardiac risk factors?”
| (6)
1. HTN,
2. DM,
3. HLD,
4. CAD,
5. Smoking,
6. FHx CAD \< 55 y/o
83
How is CAD diagnosed?
By a cardiologist during a cardiac catheterization (Not done in the ED)
84
Name two ways that an MI can be diagnosed?
1. STEMI —» **EKG**
2. Non-STEMI —» **Troponin**
85
What are some associated symptoms of an MI other than CP?
1. N/V,
2. SOB,
3. Diaphoresis (sweating)
86
Diaphoresis
**sweating —»** especially to an unusual degree as a symptom of _disease_ or a side effect of a _drug_
87
What are some associated symptoms for CHF?
1. SOB (Orthopnea, PND, DOE)
2. pedal edema
88
What 2 studies would diagnose CHF?
1. CXR
2. Elevated BNP
89
What is A-Fib?
Electrical abnormality of the heart causing the top of the heart to quiver
90
What might someone feel with A-Fib?
Palpitations, fast, pounding, irregular heartbeat
91
How is A-Fib diagnosed?
EKG
92
What could be the CC of someone with a PE?
Pleuritic CP or SOB
93
What are 10 risk factors for a PE?
1. Known DVT,
2. PMHx of DVT or PE,
3. FHx of DVT or PE,
4. recent surgery,
5. CA,
6. Afib,
7. immobility,
8. pregnancy,
9. BCP,
10. smoking
94
What study would diagnose a PE?
1. CTA Chest/VQ Scan —» (D-Dimer can only rule it out)
95
What part of the heart does CAD affect; Arteries, Veins, or Nerves?
Arteries
96
Can a CT Chest without IV contrast diagnose a PE? Why or why not?
No. Contrast in the vessels(IV) helps clearly see a blockage.
97
What is the most common cause of a PTX?
trauma
98
How is a PTX diagnosed?
CXR
99
What social history will most COPD patients also have?
smoking
100
What is the difference between an inhaler and a nebulizer for asthma?
* An **inhaler** is portable and gives a one time dose and provides a rapid release of medication.
* A **nebulizer** is a home machine that delivers continuous treatment over a period of time.
101
What is asthma?
Constricting of the airway due to inflammation and muscular contraction of the bronchioles. Also called Reactive Airway Disease
102
What physical exam finding is closely associated with asthma?
Wheezes/ing
103
What are the CC for a person with PNA?
Productive cough and fever
104
How is PNA diagnosed?
CXR
105
Name all 7 areas of the abdomen.
1. Epigastric,
2. RUQ,
3. LUQ,
4. RLQ,
5. LLQ,
6. Suprapubic,
7. Periumbilical (Right/ Left flank)
106
What is the layman’s name for GERD?
“Heartburn” or Acid Reflux
107
What might someone with GERD complain of?
Epigastric pain “burning”
108
For older patients with GERD symptoms, what life-threatening disease may also need to be ruled
out?
MI
109
What does bile do? Where is it stored?
1. Bile emulsifies the fats in foods.
2. It is stored in the gallbladder and made in the liver
110
What is the difference between Cholelithiasis and Cholecystitis?
1. **Cholelithiasis** is gallstones.
2. **Cholecystitis** is acute gallbladder inflammation/infection.
111
What might be the chief complaint of a person with gallstones?
RUQ abdominal pain
112
What physical exam finding is closely associated with Cholecystitis?
Murphy’s Signs
113
How are gallstones diagnosed?
Abdominal Ultrasound of the RUQ
114
Name associated symptoms of appendicitis.
1. Fever
2. N/V
3. decreased appetite (anorexia)
4. Note: RLQ pain —» gradual, constant, worse w/ movements is the CC (not associated sx)
115
How is appendicitis diagnosed?
CT A/P with PO contrast
116
What would someone with pancreatitis c/o?
1. LUQ or epigastric abdominal pain
2. N/V
3. fever
117
How is pancreatitis diagnosed?
Elevated Lipase (or Amylase which is less specific)
118
Name four possible CC’s for a GI bleed pt.
1. hematemesis
2. coffee ground emesis
3. hematochezia
4. melena
119
How is a GI bleed diagnosed in the ED?
1. Guaiac positive or heme + stool
2. gastroccult
120
What are we worried about for someone with a GI bleed?
**Anemia—»**too much blood loss
121
What is the pre-existing condition you must have before you can get diverticulitis?
**Diverticulosis** —» the condition of having diverticula, small outpouchings from the large intestine
122
What will be the CC for someone with diverticulitis?
LLQ abdominal pain
123
What studies would diagnose diverticulitis?
CT A/P with PO contrast
124
What might a person with a SBO complain of?
1. Abd pain/bloating
2. vomiting
3. abdominal distention (occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its expansion)
4. no BM's —» constipation
125
How is an SBO diagnosed?
1. CT A/P w/ PO contrast
2. AAS (acute abd series) X-ray
126
What is pyelo?
1. **Pyelonephritis —»** Kidney infection (different and worse than a UTI)
(A) usually spread from an UTI
127
What will be the CC of someone with a UTI?
painful urination (dysuria)—» frequency, burning, hesitancy, and malodorous urine
128
Where would a patient feel pain if they had pyelo?
1. flank pain
2. fever
3. Dysuria (painful/difficult urination)
129
How is a UTI diagnosed?
Urine dip or **urinalysis (UA**) showing white blood cells, bacteria and nitrites
130
What might a person with kidney stones c/o?
1. Flank pain
2. sudden onset
3. radiating to groin
131
How are kidney stones diagnosed?
1. CT A/P
2. RBC in UA
132
How is an ectopic pregnancy diagnosed?
US of the pelvis
133
How is ovarian torsion diagnosed?
US Pelvis
134
What sx might a person with a brain bleed c/o?
1. HA- sudden (“thunderclap”) onset + worst HA of their life,
2. changes in speech, vision, motor (weakness), sensation (numbness),
3. AMS
135
What study would diagnose a brain bleed?
**CT Head** or **Lumbar Puncture**
136
What sx might a person with an ischemic CVA c/o?
_Focal Neurological Deficit_ **(FND)**: changes in speech, changes in vision, one-sided motor changes (weakness), one-sided sensation changes (numbness)
137
How is an ischemic CVA diagnosed?
Clinically —» potentially normal CT head
138
How does a TIA differ from a CVA?
**TIA** - mini stroke, symptoms usually resolve in less than a hour.
**CVA** - Stroke, symptoms last longer, and potentially may not go away
139
What is a common cause for seizures in children?
fevers
140
What is the name of the state after a seizure?
Post-ictal
141
What are 3 symptoms of meningitis?
1. fever
2. neck pain/stiffness
3. headache
142
What study would diagnose meningitis?
LP - lumbar puncture
143
What are 4 important things to document for syncopal episodes?
1. how they felt before
2. how they felt during
3. how they felt after
4. and how they currently feel
144
Name 4 causes of altered mental status.
1. hypoglycemia
2. infection
3. intoxication
4. neurological
145
How is AMS different from a focal neuro deficit?
* **AMS** is generalized and typically caused by something that can affect the whole brain (drugs, low BS).
* **FND** are localized (weakness/numbness/speech/vision) to one specific area and corresponds with damage to specific spot in the brain
146
What are the risk factors for a DVT?
1. Known DVT,
2. PMHx of DVT or PE,
3. FHx of DVT or PE,
4. recent surgery,
5. CA,
6. Afib,
7. immobility + pregnancy,
8. BCP,
9. smoking
147
What are common signs of a DVT?
1. extremity pain
2. swelling —» atraumatic (minimal tissue injury)
148
What is an aortic dissection?
The separation of the muscular wall from the membrane of the artery, putting the pt at risk for aortic rupture and death.
149
What are 3 symptoms of cellulitis?
1. Redness,
2. swelling
3. pain to an area of the skin
150
How is an abscess different from cellulitis?
Abscess is cellulitis with **fluctuance** (pus pocket)
151
What procedure will be performed for every abscess?
Incision and drainage
## Footnote
**I&D**
152
What is the main concern with an allergic reaction?
**Anaphylaxis** or **respiratory failure**
153
What are the ONLY three symptoms of a true allergic reaction?
1. Rash,
2. itching,
3. swelling —» SOB due to airway swelling
154
How can Diabetic Ketoacidosis (DKA) be diagnosed?
1. Arterial Blood Gas showing low pH
2. Positive Serum Ketones
155
What is the Emergency Physician’s main responsibility for psychiatric patients?
medical clearance
156
Name three important things to document for any trauma patient.
1. LOC,
2. head injury,
3. neck pain,
4. back pain,
5. numbness,
6. weakness
157
Dysuria
painful or difficult urination.
158
159
160
161
162
163
Aortic Dissection
164
CHF
165
Testicular Torsion
166
DVT traveled to the lungs causing a PE
167
168
169
Sepsis
170
171
Fever
172
1. Nitroglycerin
2. Acetylsalicylic acid
173
Edema
medical term for swelling
174
Facial Angioedema
swelling of the face often secondary to an allergic rxn
175
Nystagmus
* Involuntary “shaking” eye movements, rather than normal continuous smooth motion
* sx of vertigo
176
Incontinence
lack of voluntary control over urination or defecation
177
Pale conjunctiva
Pale inner aspect of the eyelid most often due to anemia
178
Pallor
paleness
179
what is used to diagnosis a GI bleed?
Heme positive stool (Guaiac positive) during rectal exam
180
what are the pertinent negatives for musculoskeletal back pain?
1. No LE weakness
2. no incontinence
181
Dysuria
painful urination
182
Adnexal Tenderness
tenrerness of the ovaries during the pelvic exam indicative of ovarian cyst or torsion
183
effusion
escape of fluid into a cavity
184
Paroxysmal Afib
occasional, sporadic, transient Afib
185
PE Catch Phrase
Pleuritic CP w/tachycardia and hypoxia
186
Tonsillar **hypertrophy &** tonsillar **exudates**
**hypertrophy:** enlargement
**Exudates:** pus
187
CSMT
Circulation, sensory, motor, tendon
188
pruritic
itchiness/ defined as an unpleasant sensation of the skin that provokes the urge to scratch
189
CVA Tenderness
Costo‐vertebral Angle tenderness; tenderness over the kidney’s
190
Dyspnea
Difficult and labored breathing, shortness of breath
191
Guarding
1. Tensing of abdominal wall muscles as to guard the internal organs indicative of true abdominal disease
2. Listed in PE of pt w/SBO
192
Rebound
1. Pain when releasing hand from abdominal palpation
2. Listed in PE of SBO
193
Tympany
1. A bell‐like noise when tapping the abdomen
2. List in PE for pt w/SBO
194
Angina
CP due to heart-muscle ischemia (narrowing of coronary artery)
195
PTA
prior to arrival
196
CHF catch phrase
SOB w/pedal edema and orthopnea
197
CHF assoc. sx
1. Rales (crackles) in lungs
2. Jugular vein distention (JVD) in neck
3. pitting pedal edema
198
PE findings for critical injury
199
_Ischemic CVA_
Risk Factors & PE?
200
_CHF_
Catch Phrase, CC, & PE Findings
Scribe america
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Decks in class (8)
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