Scribe America Final Overview Questions with correct Answers 2023

Scribe America Final Overview Questions with correct Answers 2023 Pertinent positives Specific symptoms that raise the physician's suspicion for a particular disease Pertinent negatives specific symptoms that are not present which cause the physician to doubt certain diagnoses CAD diagnosed by cardiac catheterization (not done in ED) MI diagnosed by EKG (STEMI) or elevated Troponin (non-STEMI) What meds are given for CAD? ASA 324 mg PO, NTG 0.4 mg SL CAD etiology narrowing of the coronary arteries limits blood supply to the heart muscle causing ischemia MI etiology Acute blockage of the coronary arteries results in ischemia and infarct of the heart muscle Meds given for MI ASA, NTG, Thrombolytic (Heparin) What are the PE findings for CHF? Rales (crackles) in lungs, JVD, pitting pedal edema CHF diagnosed by CXR or elevated BNP (B-type Natriuretic Peptide) Meds for CHF Diuretics (Laxis, Furosemide) Chief complaint for CHF SOB: Orthopnea, DOE, Paroxysmal Nocturnal Dyspnea (PND - severe SOB that occurs during sleep) Chief complaint for A-Fib palpitations (fast, pounding, irregular) A fib diagnosed by EKG Associated meds for A-Fib Coumadin (Warfarin) - blood thinner, prevents blood clots in atria Digoxin - slows down heart rate What is an ED concern for A-Fib? Rapid Ventricular Response (RVR) (Pt will be cardioverted via electricity/drugs back to NSR) 5 types of non-cardiac CP Pericarditis Pleurisy Costochondritis Chest Wall Pain Pleural effusion PE diagnosed by D-dimer, CTA Chest or VQ scan. "Catch phrase" of PE Pleuritic CP with tachycardia and hypoxia PNA etiology Infiltrate (bacterial infection) and inflammation inside the lung - infiltrate forms in lung when alveoli are filled w/ fluid CC and associated Sx of PNA SOB and productive cough w/ fever and CP CXR How is PNA diagnosed? Pneumothorax (PTX) etiology Collapsed lung due to trauma or a spontaneous small rupture of the lung PNA PE Rhonchi (rattling noise of mucous in the lungs) CXR PTX diagnosed by PTX PE Absent breath sounds unilaterally PE risk factors Known DVT, PMHx of DVT or PE, FHx, Recent surgery, Cancer, A-Fib, Immobility, Pregnancy, BCP, Smoking PNA risk factors elderly, bedridden, recent chest injury, recent surgery COPD etiology Long-term damage to the lung's alveoli (emphysema) along with inflammation and mucous production (chronic bronchitis) COPD PE decreased breath sounds, wheezes, rales CXR and Hx of smoking (CXR will show hyperinflation of lungs) COPD diagnosed by Reactive Airway Disease (RAD, aka asthma) etiology constricting of the airway due to inflammation and muscular contraction of the bronchioles, known as a "bronchospasm" RAD/asthma PE wheezes (inspiratory or expiratory) RAD/asthma associated meds inhalers, nebulizers, corticosteroids (bronchodilators) Ischemic CVA etiology Blockage of the arteries supplying blood to the brain resulting in permanent brain damage Ischemic CVA CC Unilateral focal neurological deficits: One-sided weakness/numbness or changes in speech/vision Ischemic CVA PE findings Neurological deficits: hemiparesis (one-sided weakness), unilateral paresthesias (one-sided numbness), aphasia, visual field deficits Clinically, potentially normal CT head Ischemic CVA diagnosed by Ischemic CVA scribe alert Document last known well time and source of information; assess tPA (tissue plasmogen activator, powerful blood thinner) eligibility Hemorrhagic CVA, Brain Bleed Traumatic or spontaneous rupture of blood vessels in the head leads to bleeding in the brain Hemorrhagic CVA CC Headache Sudden Onset (Thunderclap, Worst of life) CT head or LP Hemorrhagic CVA diagnosed by Hemorrhagic CVA scribe alert Document "tPA not indicated due to hemorrhage" TIA etiology Vascular changes temporarily deprive a part of the brain of oxygen (symptoms usually last less than 1 hour) TIA scribe alert Document tPA considered and not indicated due to the fact that symptoms are resolved Meningitis (bacterial/viral) etiology inflammation and infection of the meninges (the sac surrounding the brain and spinal cord) Headache and neck pain Meningitis CC Fever, neck pain, neck stiffness, AMS Meningitis associated Sx Lumbar Puncture (LP) Meningitis diagnosed by Spinal Cord Injury etiology Injury to the spinal cord may create weakness or numbness in the extremities past the site of the injury Spinal Cord Injury PE findings midline bony tenderness, deformities, or step-offs, bilateral extremity weakness, numbness, decreased rectal tone CT Cervical Spine CT Thoracic Spine CT Lumbar Spine Spinal Cord Injury diagnosed by Seizure (SZ) etiology Abnormal electrical activity in the brain leading to abnormal physical manifestations. Seizure (SZ) associated Sx injuries (tongue bite), confusion, headache, incontinence (urinary or fecal) Seizure (SZ) PE findings Somnolent, confused (postictal, or post-SZ) Seizure (SZ) meds Anticonvulsants, like Keppra and Depakote Bell's Palsy etiology Inflammation of viral infection of the facial nerve causes one-sided weakness of the entire face facial droop (sudden onset) Bell's Palsy CC Bell's Palsy associated Sx jaw or ear pain, increased tear flow of one eye Bell's Palsy pert. neg No extremity weakness, no changes in speech or vision (rules out CVA) Bell's Palsy PE findings Unilateral weakness of the upper and lower face Bell's Palsy scribe alert Bell's Palsy is the most common cause of facial droop in young patients who do not have CVA risk factors. Remember to document the absence of other FND. Headache (HA), Cephalgia etiology Various causes including hypertensive headaches (from high blood pressure), recurrent diagnosed migraines, Sinusitis, etc. Headache (HA), Cephalgia pert. neg No fever; no neck stiffness; no numbness/weakness; no changes in speech/vision 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 a physician AMS etiology Multiple causes: most common are hypoglycemia, infection, intoxication, and neurological AMS scribe alert AMS is generalized and is typically caused by things that affect the whole brain (drugs, low blood sugar). Syncope (fainting, passing out) Temporary loss of blood supply to the brain resulting in loss of consciousness. Vertigo etiology Caused by two etiologies: the vertigo may be from a harmless problem of the inner ear, or it may be caused due to damage in the brain (possible CVA) Vertigo PE findings Horizontal nystagmus, + Romberg, + Dix-Hallpike test Abdominal Quadrants and Regions Epigastrium, periumbilical, suprapubic, R/L flanks Vertigo Assoc. Sx N/V, Tinnitus (ringing in ears) Appendicitis etiology Infection of the appendix causes inflammation and blockage, possibly leading to rupture Appendicitis PE findings McBurney's point tenderness, RLQ tenderness