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What is CAD?
Coronary Artery Disease.
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2What other past histories would suggest that a patient has CAD?
MI, Angina, CABG, Stent, Angioplasty
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Does a PMHx of CVA mean the patient has CAD?
No
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Does a surgical history of angioplasty mean the patient has CAD?
Yes
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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.
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If someone has a PMHx of A-Fib or CHF, do they also have CAD?
No
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What are the “cardiac risk factors?”
HTN, DM, HLD, CAD, Smoking, FHx CAD < 55 y/o
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How is CAD diagnosed?
By a cardiologist during a cardiac catheterization. Not done in the ED.
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Name two ways that an MI can be diagnosed?
STEMI- EKG, Non-STEMI- Troponin
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What are some associated symptoms of an MI other than CP?
N/V, SOB, Diaphoresis
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What are some associated symptoms for CHF?
SOB (Orthopnea, PND, DOE), pedal edema
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What 2 studies would diagnose CHF?
CXR or elevated BNP
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What is A-Fib?
Electrical abnormality of the heart causing the top of the heart to quiver
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What might someone feel with A-Fib?
Palpitations, fast, pounding, irregular heartbeat
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How is A-Fib diagnosed?
EKG
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What could be the CC of someone with a PE?
Pleuritic CP or SOB
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What are risk factors for a PE?
Known DVT, PMHx of DVT or PE, FHx of DVT or PE, recent surgery, CA, Afib, immobility, pregnancy, BCP, smoking
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What study would diagnose a PE?
CTA Chest/VQ Scan. D-Dimer can only rule it out
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What part of the heart does CAD affect; Arteries, Veins, or Nerves?
Arteries
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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.
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What is a PTX?
Pneumothorax, “collapsed lung”
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What is the most common cause of a PTX?
Trauma
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How is a PTX diagnosed?
CXR
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What social history will most COPD patients also have?
Smoking
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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.
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What is asthma?
Constricting of the airway due to inflammation and muscular contraction of the bronchioles. Also called Reactive Airway Disease
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What physical exam finding is closely associated with asthma?
Wheezes/ing
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What is PNA?
Pneumonia. Usually a bacterial infection (infiltrates) and inflammation inside the lung
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What might a person with PNA complain of?
Productive cough and fever
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How is PNA diagnosed?
CXR
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Name all 7 areas of the abdomen.
Epigastric, RUQ, LUQ, RLQ, LLQ, Suprapubic, Periumbilical (Right/ Left flank)
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What is the layman’s name for GERD?
“Heartburn” or Acid Reflux
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What might someone with GERD complain of?
Epigastric pain “burning”
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For older patients with GERD symptoms, what life-threatening disease may also need to be ruled out?
MI
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What does bile do? Where is it stored?
Bile emulsifies the fats in foods. It is stored in the gallbladder and made in the liver
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What is the difference between Cholelithiasis and Cholecystitis?
- Cholelithiasis is gallstones.
- Cholecystitis is acute gallbladder inflammation/infection.
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What might be the chief complaint of a person with gallstones?
RUQ abdominal pain
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What physical exam finding is closely associated with Cholecystitis?
Murphy’s Signs
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How are gallstones diagnosed?
Abdominal Ultrasound of the RUQ
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Name associated symptoms of appendicitis.
Fever, N/V, decreased appetite (anorexia) Note: RLQ pain- gradual, constant, worse w/ movements is the CC (not associated sx)
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How is appendicitis diagnosed?
CT A/P with PO contrast
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What would someone with pancreatitis c/o?
LUQ or epigastric abdominal pain, N/V, fever
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How is pancreatitis diagnosed?
Elevated Lipase (or Amylase which is less specific)
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Name four possible CC’s for a GI bleed pt.
Hematemesis, coffee ground emesis, hematochezia, melena
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How is a GI bleed diagnosed in the ED?
Guaiac positive or heme + stool, gastroccult
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What are we worried about for someone with a GI bleed?
Too much blood loss, Anemia
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What is the pre-existing condition you must have before you can get diverticulitis?
Diverticulosis
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What will be the CC for someone with diverticulitis?
LLQ abdominal pain
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What studies would diagnose diverticulitis?
CT A/P with PO contrast
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What might a person with a SBO complain of?
Abd pain/bloating, vomiting, abdominal distention, no BM’s, constipation
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How is an SBO diagnosed?
CT A/P w/ PO contrast or AAS (acute abd series) X-ray
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What is a UTI?
Urinary tract infection
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What is pyelo?
Pyelonephritis, Kidney infection (different and worse than a UTI), usually spread from an UTI
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What will be the CC of someone with a UTI?
- Painful urination (dysuria), frequency, burning,
- hesitancy, malodorous urine
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Where would a patient feel pain if they had pyelo?
Flank pain, fever and dysuria
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How is a UTI diagnosed?
Urine dip or urinalysis (UA) showing white blood cells, bacteria and nitrites
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What might a person with kidney stones c/o?
Flank pain, sudden onset, radiating to groin
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How are kidney stones diagnosed?
CT A/P or RBC in UA
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What is an ectopic pregnancy?
Tubal pregnancy, when a fertilized egg develops outside the uterus (usually in the fallopian tube). High risk for rupture and death.
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How is an ectopic pregnancy diagnosed?
US of the pelvis
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What is ovarian torsion?
Twisting of the ovarian artery, which reduces the blood flow to the ovary. Could result in infarct of the ovary.
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How is ovarian torsion diagnosed?
US Pelvis
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Name the 2 types of CVA’s (strokes).
- Hemorrhagic CVA.
- Ischemic CVA. (TIA is not a type of a stroke)
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What sx might a person with a brain bleed c/o?
HA- sudden (“thunderclap”) onset, worst HA of their life, changes in speech, vision, motor (weakness), sensation (numbness), AMS
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What study would diagnose a brain bleed?
CT Head or Lumbar Puncture
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What sx might a person with an ischemic CVA c/o?
Focal Neurological Deficit: changes in speech, changes in vision, one-sided motor changes (weakness), one-sided sensation changes (numbness)
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How is an ischemic CVA diagnosed?
Clinically, potentially normal CT head
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What is a TIA?
Transient Ischemic Attack. Mini-stroke. Temporary loss of blood supply to the brain
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How does a TIA differ from a CVA?
- TIA - mini stroke, symptoms usually resolve in less than an hour.
- CVA - Stroke, symptoms last longer, and potentially may not go away
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What is a common cause for seizures in children?
Fevers
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What is the name of the state after a seizure?
Post-ictal
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What are 3 symptoms of meningitis?
Fever, neck pain/stiffness, headache
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What study would diagnose meningitis?
LP- Lumbar puncture
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What are 4 important things to document for syncopal episodes?
How they felt before, during, after, and how they currently feel
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Name 4 causes of altered mental status.
Hypoglycemia, infection, intoxication, neurological
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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
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What is a DVT?
Deep venous thrombosis
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What are the risk factors for a DVT?
Known DVT, PMHx of DVT or PE, FHx of DVT or PE, recent surgery, CA, Afib, immobility, pregnancy, BCP, smoking
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What are common signs of a DVT?
Extremity pain, swelling (atraumatic)
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What is an AAA?
Abdominal aortic aneurysm
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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
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What are 3 symptoms of cellulitis?
Redness, swelling, and pain to an area of the skin
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How is an abscess different from cellulitis?
Abscess is cellulitis with fluctuance (pus pocket)
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What procedure will be performed for every abscess?
Incision and drainage
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What is the main concern with an allergic reaction?
Anaphylaxis or respiratory failure
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What are the ONLY three symptoms of a true allergic reaction?
Rash, itching, swelling, SOB due to airway swelling
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How can Diabetic Ketoacidosis (DKA) be diagnosed?
Arterial Blood Gas showing low pH or Positive Serum Ketones
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What is the Emergency Physician’s main responsibility for psychiatric patients?
Medical clearance
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Name three important things to document for any trauma patient.
LOC, head injury, neck pain, back pain, numbness, weakness
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