SCRIBE FINAL EXAM QUESTIONS WITH
COMPLETE SOLUTIONS 2024/2025
Uterine product removed - Answer-Dilation and Curettage (D&C)
Neck artery cleaned - Answer-carotid endarterectomy
Brain surgery - Answer-Craniotomy (brain bleed vs. brain CA)
shunt - Answer-Ventriculoperitoneal (VP) Shunt
Dialysis fistula - Answer-AV (arteriovenous) Fistula
Dialysis graft - Answer-AV graft
PICC line - Answer-Peripherally Inserted Central Catheter (PICC)
port - Answer-Port-a-cath or Medi-Port
Clot filter (lower abdomen) - Answer-IVC (inferior vena cava) filter
Clot filter (leg) - Answer-Greenfield Filter
Leg amputated - Answer-Above Knee Amputation (AKA)
Below Knee Amputation (BKA)
Joint repair - Answer-arthroplasty
Metal plates/pins - Answer-hardware
Neck fused - Answer-Cervical spinal fusion
Back fused - Answer-Lumbar spinal fusion
Hip surgery - Answer-Open Reduction with Internal Fixation (ORIF)
True allergy - Answer-rash, itching, swelling, or difficulty breathing
Social History - Answer-tobacco use, alcohol use, illicit drug use, occupation, living
circumstances
Drug routes of administration - Answer-oral, inhaled, injected
PMHx - Answer-past medical history
,PSHx - Answer-past surgical history
FHx - Answer-family history
SHx - Answer-social history
Differential Diagnosis (DDx) - Answer-A rule out, or an attempt to determine which one
of the several diseases can be causing the signs and symptoms that are present
Pertinent Positives - Answer-specific symptoms that raise the physician's suspicion for a
particular disease
pertinent negatives - Answer-specific symptoms that are not present which cause the
physician to doubt certain diagnoses
intermittent - Answer-(adj.) stopping and beginning again, sporadic
Waxing - Answer-getting worse
Waning - Answer-getting better
coronary artery disease (CAD) - Answer-Catch phrase: chest pain with physical exertion
Chief Complaint: Chest pain or pressure (improved by rest or NTG)
Assoc. Med: Aspirin, Nitroglycerin (NTG)
Diagnoses by: Cardiac catheterization (not diagnoses in ED)
Scribe Alert: Single greatest risk factor for MI, Stress test or catheterization assess
severity, A patient has CAD if they have a PMHx of Angina, MI, CABG, Cardiac stents,
or Angioplasty, every patient complaining of chest pain should receive aspirin unless
given PTA or contraindicated due to bleeding or allergy
Myocardial Infarction (MI) - Answer-Heart Attack
Catch phrase: chest pressure with diaphoresis, N/V, SOB
Risk Factors: CAD, HTN, HLD, DM, Smoker, FHx of CAD <55 yo
Chief Complaint: Chest pain or chest pressure
Assoc. Med: ASA, NTG, beta-blocker, thrombolytic (heparin)
Diagnoses by: EKG (STEMI) or elevated troponin (non-STEMI)
,Scribe Alert: acute MI patients must receive aspirin asap, STEMI patients must get to
cath-lab within 90 min of arrival so document ED arrival and depart times
Conjestive heart failure (CHF) - Answer-Catch phrase: SOB with pedal edema and
orthopnea
Chief Complaint: Shortness of breath (worse w/ lying flat, paroxysmal nocturnal
dyspnea PND, dyspnea on exertion DOE)
Physical exam: Rales (crackles) in lungs, Jugular vein distension (JVD) in neck, Pitting
pedal edema
Assoc. Med: Diuretics (lasix, furosemide) -> urinate extra fluid
Diagnoses by: CRX or elevated BNP (b-type natriuretic peptide)
Scribe Alert: like a fluid traffik jam in the heart where fluid gets backed up in the neck
(JVD) and down the legs (pedal edema)
Atrial Fibrillation (AFIB) - Answer-Electrical Problem
Risk Factors: Paroxysmal A Fib, Chronic A Fib
Chief Complaint: Palpitations (Fast, pounding, irregular)
Physical Exam: Irregularly irregular rhythm, tachycardia
Assoc. Med: Coumadin (warfarin) - blood thinner prevents blood clots in atria, Digoxin -
slows down heart rate
Diagnoses by: EKG (ECG)
Scribe Alert: ED Concern is rapid ventricular response (RVR) - patients often put back
into regular rhythm (cardioverted), or normal sinus rhythm (NSR)
Pericarditis - Answer-inflammation of the sac surrounding the heart causing CP
Pleurisy - Answer-Inflammation of the sac surrounding the lungs causing pleuritic CP
costochondritis - Answer-Irritation of the ribs causing CP worsened by pressing on the
sternum
Chest Wall Pain - Answer-Irritation of the chest wall causing pain with palpation of the
chest
, pleural effusion - Answer-Fluid collecting around the lungs causing SOB or CP
Angina - Answer-symptom of CAD diagnosed by exertional CP with Hx of CAD
pulminary embolism (PE) - Answer-Catch Phrase: Pleuritic chest pain with tachycardia
and hypoxia
Risk Factors: Known DVT, PMHx of DVT or PE, FHx. Recent Surgery, Cancer, A-fib,
immobility, pregnancy, BCP, Smoking
Chief Complaint: SOB or Pleuritic chest pain (CP worse with deep breaths)
Diagnoses by: CTA Chest (CT Chest w/ IV contrast) - CT PE at UCH, D-dimer aids in
detecting clots but cannot diagnose a PE
Pneumonia (PNA) - Answer-Catch Phrase: Productive cough with fever
Risk Factors: Elderly, bedridden, recent chest injury, recent surgery
Chief Complaint: SOB or productive cough
Assoc. Sx: cough with sputum, fever, chest pain
Assoc Med: Rocephin and Zithromax (antibiotics)
Physical Exam: Rhonchi
Assoc. Med: Coumadin (warfarin) - blood thinner prevents blood clots in atria, Digoxin -
slows down heart rate
Diagnoses by: CXR
Scribe Alert: CAP - community acquired pneumonia protocol requires documenting
antibiotics, vital signs, Sa02, mental status, and blood cultures
Pneumothorax (PTX) - Answer-CC: SOB and one-sided chest pain (sudden onset, often
trauma patients)
PE: Absent breath sounds unilaterally
Diagnosed by: CXR
Scribe alert: Document percentage of lung collapsed (eg 20%) - these patients will have
chest tube placed to reinflate the lung
chronic obstructive pulmonary disease (COPD) - Answer-Risk factors: Smoking
COMPLETE SOLUTIONS 2024/2025
Uterine product removed - Answer-Dilation and Curettage (D&C)
Neck artery cleaned - Answer-carotid endarterectomy
Brain surgery - Answer-Craniotomy (brain bleed vs. brain CA)
shunt - Answer-Ventriculoperitoneal (VP) Shunt
Dialysis fistula - Answer-AV (arteriovenous) Fistula
Dialysis graft - Answer-AV graft
PICC line - Answer-Peripherally Inserted Central Catheter (PICC)
port - Answer-Port-a-cath or Medi-Port
Clot filter (lower abdomen) - Answer-IVC (inferior vena cava) filter
Clot filter (leg) - Answer-Greenfield Filter
Leg amputated - Answer-Above Knee Amputation (AKA)
Below Knee Amputation (BKA)
Joint repair - Answer-arthroplasty
Metal plates/pins - Answer-hardware
Neck fused - Answer-Cervical spinal fusion
Back fused - Answer-Lumbar spinal fusion
Hip surgery - Answer-Open Reduction with Internal Fixation (ORIF)
True allergy - Answer-rash, itching, swelling, or difficulty breathing
Social History - Answer-tobacco use, alcohol use, illicit drug use, occupation, living
circumstances
Drug routes of administration - Answer-oral, inhaled, injected
PMHx - Answer-past medical history
,PSHx - Answer-past surgical history
FHx - Answer-family history
SHx - Answer-social history
Differential Diagnosis (DDx) - Answer-A rule out, or an attempt to determine which one
of the several diseases can be causing the signs and symptoms that are present
Pertinent Positives - Answer-specific symptoms that raise the physician's suspicion for a
particular disease
pertinent negatives - Answer-specific symptoms that are not present which cause the
physician to doubt certain diagnoses
intermittent - Answer-(adj.) stopping and beginning again, sporadic
Waxing - Answer-getting worse
Waning - Answer-getting better
coronary artery disease (CAD) - Answer-Catch phrase: chest pain with physical exertion
Chief Complaint: Chest pain or pressure (improved by rest or NTG)
Assoc. Med: Aspirin, Nitroglycerin (NTG)
Diagnoses by: Cardiac catheterization (not diagnoses in ED)
Scribe Alert: Single greatest risk factor for MI, Stress test or catheterization assess
severity, A patient has CAD if they have a PMHx of Angina, MI, CABG, Cardiac stents,
or Angioplasty, every patient complaining of chest pain should receive aspirin unless
given PTA or contraindicated due to bleeding or allergy
Myocardial Infarction (MI) - Answer-Heart Attack
Catch phrase: chest pressure with diaphoresis, N/V, SOB
Risk Factors: CAD, HTN, HLD, DM, Smoker, FHx of CAD <55 yo
Chief Complaint: Chest pain or chest pressure
Assoc. Med: ASA, NTG, beta-blocker, thrombolytic (heparin)
Diagnoses by: EKG (STEMI) or elevated troponin (non-STEMI)
,Scribe Alert: acute MI patients must receive aspirin asap, STEMI patients must get to
cath-lab within 90 min of arrival so document ED arrival and depart times
Conjestive heart failure (CHF) - Answer-Catch phrase: SOB with pedal edema and
orthopnea
Chief Complaint: Shortness of breath (worse w/ lying flat, paroxysmal nocturnal
dyspnea PND, dyspnea on exertion DOE)
Physical exam: Rales (crackles) in lungs, Jugular vein distension (JVD) in neck, Pitting
pedal edema
Assoc. Med: Diuretics (lasix, furosemide) -> urinate extra fluid
Diagnoses by: CRX or elevated BNP (b-type natriuretic peptide)
Scribe Alert: like a fluid traffik jam in the heart where fluid gets backed up in the neck
(JVD) and down the legs (pedal edema)
Atrial Fibrillation (AFIB) - Answer-Electrical Problem
Risk Factors: Paroxysmal A Fib, Chronic A Fib
Chief Complaint: Palpitations (Fast, pounding, irregular)
Physical Exam: Irregularly irregular rhythm, tachycardia
Assoc. Med: Coumadin (warfarin) - blood thinner prevents blood clots in atria, Digoxin -
slows down heart rate
Diagnoses by: EKG (ECG)
Scribe Alert: ED Concern is rapid ventricular response (RVR) - patients often put back
into regular rhythm (cardioverted), or normal sinus rhythm (NSR)
Pericarditis - Answer-inflammation of the sac surrounding the heart causing CP
Pleurisy - Answer-Inflammation of the sac surrounding the lungs causing pleuritic CP
costochondritis - Answer-Irritation of the ribs causing CP worsened by pressing on the
sternum
Chest Wall Pain - Answer-Irritation of the chest wall causing pain with palpation of the
chest
, pleural effusion - Answer-Fluid collecting around the lungs causing SOB or CP
Angina - Answer-symptom of CAD diagnosed by exertional CP with Hx of CAD
pulminary embolism (PE) - Answer-Catch Phrase: Pleuritic chest pain with tachycardia
and hypoxia
Risk Factors: Known DVT, PMHx of DVT or PE, FHx. Recent Surgery, Cancer, A-fib,
immobility, pregnancy, BCP, Smoking
Chief Complaint: SOB or Pleuritic chest pain (CP worse with deep breaths)
Diagnoses by: CTA Chest (CT Chest w/ IV contrast) - CT PE at UCH, D-dimer aids in
detecting clots but cannot diagnose a PE
Pneumonia (PNA) - Answer-Catch Phrase: Productive cough with fever
Risk Factors: Elderly, bedridden, recent chest injury, recent surgery
Chief Complaint: SOB or productive cough
Assoc. Sx: cough with sputum, fever, chest pain
Assoc Med: Rocephin and Zithromax (antibiotics)
Physical Exam: Rhonchi
Assoc. Med: Coumadin (warfarin) - blood thinner prevents blood clots in atria, Digoxin -
slows down heart rate
Diagnoses by: CXR
Scribe Alert: CAP - community acquired pneumonia protocol requires documenting
antibiotics, vital signs, Sa02, mental status, and blood cultures
Pneumothorax (PTX) - Answer-CC: SOB and one-sided chest pain (sudden onset, often
trauma patients)
PE: Absent breath sounds unilaterally
Diagnosed by: CXR
Scribe alert: Document percentage of lung collapsed (eg 20%) - these patients will have
chest tube placed to reinflate the lung
chronic obstructive pulmonary disease (COPD) - Answer-Risk factors: Smoking
