FINAL FLASH CARD SET

Pulmonary edema — Giveaways

Severe dyspnea, crackles, orthopnea; severe cases have pink frothy sputum.

Pulmonary edema — Differentiator

Fluid collects inside alveoli, often from left-sided CHF; unlike mucus-related COPD.

Pulmonary edema — Scenario

A patient with heart disease wakes gasping, cannot lie flat, has crackles and pink foam at the mouth.

Congestive heart failure (CHF) — Giveaways

Poor cardiac pumping, dyspnea, fatigue, crackles, sometimes neck-vein distention and leg edema.

Congestive heart failure (CHF) — Differentiator

Pump failure causes fluid backup; pulmonary edema is a lung manifestation of CHF, not the whole disease.

Congestive heart failure (CHF) — Scenario

A patient with prior heart attacks has swollen ankles, nighttime breathlessness and crackles.

Chronic obstructive pulmonary disease (COPD) — Giveaways

Long smoking history, progressive dyspnea, prolonged expiration, wheezes or rhonchi.

Chronic obstructive pulmonary disease (COPD) — Differentiator

Broad chronic airflow-obstruction category encompassing emphysema and chronic bronchitis; not fully reversible.

Chronic obstructive pulmonary disease (COPD) — Scenario

A longtime smoker uses home oxygen and has gradually worsening breathlessness and prolonged exhalation.

Emphysema — Giveaways

Thin appearance, barrel chest, pursed-lip breathing, tripod positioning, reduced breath sounds.

Emphysema — Differentiator

Alveolar walls and capillary beds are destroyed; unlike chronic bronchitis, often little sputum.

Emphysema — Scenario

A thin older smoker leans forward, breathes through pursed lips and has a barrel-shaped chest.

Chronic bronchitis — Giveaways

Chronic productive cough with excess mucus, rhonchi or wheezing, possible cyanosis.

Chronic bronchitis — Differentiator

Mucus production and airway irritation dominate; emphysema mainly destroys alveoli.

Chronic bronchitis — Scenario

A longtime smoker has a persistent mucus-producing cough, noisy breath sounds and bluish lips.

Asthma — Giveaways

Episodic wheezing, prolonged expiration, dyspnea and chest tightness after triggers.

Asthma — Differentiator

Bronchiolar spasm, swelling and mucus; episodes may be reversible with bronchodilators, unlike fixed COPD.

Asthma — Scenario

A teen develops wheezes and prolonged expiration after exposure to a cat and has an inhaler.

Status asthmaticus — Giveaways

Severe prolonged asthma attack not relieved by usual treatments; fatigue and possible silent chest.

Status asthmaticus — Differentiator

Unlike an ordinary asthma flare, obstruction persists and respiratory failure is imminent.

Status asthmaticus — Scenario

A child has used a prescribed rescue inhaler repeatedly but becomes exhausted with minimal air movement.

Pneumonia — Giveaways

Fever, productive cough, pleuritic pain, dyspnea; crackles or rhonchi possible.

Pneumonia — Differentiator

Lung infection; fever and infectious symptoms favor it over cardiogenic pulmonary edema.

Pneumonia — Scenario

An older adult develops fever, cough with sputum and sharp pain on inspiration over several days.

Pulmonary embolism — Giveaways

Abrupt dyspnea, pleuritic chest pain, tachycardia, hypoxia; recent immobility or surgery.

Pulmonary embolism — Differentiator

Clot blocks pulmonary blood flow; unlike pneumonia, onset is often sudden without infectious prodrome.

Pulmonary embolism — Scenario

A patient two days after hip surgery suddenly has sharp chest pain, tachypnea and cyanosis.

Spontaneous pneumothorax — Giveaways

Sudden one-sided pleuritic pain and dyspnea with reduced breath sounds.

Spontaneous pneumothorax — Differentiator

Air enters pleural space without external trauma; tension type additionally impairs circulation.

Spontaneous pneumothorax — Scenario

A previously well tall young adult suddenly feels sharp one-sided chest pain and shortness of breath.

Pleural effusion — Giveaways

Progressive dyspnea with diminished breath sounds from fluid around a lung.

Pleural effusion — Differentiator

Fluid lies in pleural space outside lung; pulmonary edema fills alveoli within lung.

Pleural effusion — Scenario

A patient with chronic heart failure gradually becomes short of breath with reduced sounds at a lung base.

Croup — Giveaways

Child with barking seal-like cough, hoarse voice, inspiratory stridor, often low fever.

Croup — Differentiator

Viral upper-airway inflammation with a barky cough; epiglottitis more often drools and lacks barking cough.

Croup — Scenario

A toddler has a hoarse seal-bark cough and noisy inhalation that worsens overnight.

Epiglottitis — Giveaways

Sudden severe sore throat, high fever, drooling, tripod posture and stridor.

Epiglottitis — Differentiator

Swollen epiglottis threatens abrupt obstruction; drooling and toxic appearance distinguish from croup.

Epiglottitis — Scenario

A very ill child sits upright drooling, refuses to swallow and has high-pitched inspiration.

Bronchiolitis (often RSV) — Giveaways

Child under 2 years with wheezing, nasal secretions, cough, retractions and feeding difficulty.

Bronchiolitis (often RSV) — Differentiator

Inflammation of tiny bronchioles in infants; differs from barking-cough upper-airway croup.

Bronchiolitis (often RSV) — Scenario

An eight-month-old in winter has cough, nasal mucus, rapid breathing and poor feeding.

Pertussis — Giveaways

Repeated forceful coughing fits followed by inspiratory whoop; sometimes vomiting after coughing.

Pertussis — Differentiator

Distinctive paroxysmal cough/whoop rather than barking cough of croup.

Pertussis — Scenario

A young child has repeated coughing spells and then draws a noisy whooping breath.

Tuberculosis (TB) — Giveaways

Persistent cough, night sweats, fever, weight loss, sometimes blood in sputum.

Tuberculosis (TB) — Differentiator

Chronic infectious course with weight loss and night sweats; unlike acute pneumonia.

Tuberculosis (TB) — Scenario

A patient reports weeks of coughing, fatigue, weight loss and night sweats.

Cystic fibrosis — Giveaways

Young patient with recurrent lung infections, thick mucus and chronic respiratory difficulty.

Cystic fibrosis — Differentiator

Inherited disorder with abnormally thick secretions; not smoking-related COPD.

Cystic fibrosis — Scenario

A teenager with lifelong respiratory problems has recurrent infections and thick airway secretions.

Anaphylaxis — Giveaways

Rapid hives, facial or tongue swelling, wheezing or stridor, possible hypotension.

Anaphylaxis — Differentiator

Systemic life-threatening allergic reaction involving breathing or circulation; unlike local allergy.

Anaphylaxis — Scenario

Minutes after a bee sting, a patient develops hives, wheezing, swollen lips and BP 82/48.

Mild localized allergic reaction — Giveaways

Itching, localized redness, hives or swelling without breathing trouble or shock.

Mild localized allergic reaction — Differentiator

No systemic airway or cardiovascular compromise; unlike anaphylaxis.

Mild localized allergic reaction — Scenario

After an insect sting, a patient has itching and a small rash but normal breathing and BP.

Acute coronary syndrome (ACS) — Giveaways

Pressure-like chest discomfort, diaphoresis, nausea, dyspnea; possible radiation to arm or jaw.

Acute coronary syndrome (ACS) — Differentiator

Umbrella for acute coronary ischemia, including unstable angina and MI; field findings overlap.

Acute coronary syndrome (ACS) — Scenario

An adult has new crushing chest pressure, sweating and nausea at rest.

Angina pectoris — Giveaways

Chest pressure on exertion or stress that may improve with rest or prescribed nitroglycerin.

Angina pectoris — Differentiator

Temporary myocardial ischemia without infarction; MI causes sustained muscle injury.

Angina pectoris — Scenario

A man develops chest pressure climbing stairs that resolves after resting.

Acute myocardial infarction (MI) — Giveaways

Persistent pressure/crushing chest pain, sweating, nausea and possible referred jaw or arm pain.

Acute myocardial infarction (MI) — Differentiator

Heart-muscle death from prolonged ischemia; may not resolve with rest or nitroglycerin.

Acute myocardial infarction (MI) — Scenario

A patient has 35 minutes of chest pressure radiating to left arm with cold sweating.

Cardiogenic shock — Giveaways

Hypotension, weak pulse, altered mentation, cool clammy skin after major cardiac dysfunction.

Cardiogenic shock — Differentiator

Pump failure causes shock despite possible normal blood volume; unlike hemorrhagic shock.

Cardiogenic shock — Scenario

Hours after severe chest pain, a patient becomes pale, confused and hypotensive with a weak pulse.

Hypertensive emergency — Giveaways

Severely elevated BP with acute organ symptoms such as headache, neurologic deficits or chest pain.

Hypertensive emergency — Differentiator

End-organ injury matters more than a BP number alone; uncomplicated hypertension lacks these findings.

Hypertensive emergency — Scenario

A patient has extreme hypertension with sudden confusion and chest discomfort.

Aortic dissection — Giveaways

Sudden severe tearing chest or back pain, sometimes unequal peripheral pulses or BP.

Aortic dissection — Differentiator

Tear within aortic wall; distinct from MI's typical pressure sensation, though overlap occurs.

Aortic dissection — Scenario

A hypertensive patient describes abrupt ripping pain from chest to back with unequal arm pulses.

Abdominal aortic aneurysm (AAA) — Giveaways

Sudden abdominal or back pain, possible pulsatile abdominal mass and shock if ruptured.

Abdominal aortic aneurysm (AAA) — Differentiator

Enlarged aorta can rupture internally; unlike appendicitis, rapid collapse and back pain may occur.

Abdominal aortic aneurysm (AAA) — Scenario

An older patient has sudden deep abdominal/back pain, pale skin and falling blood pressure.

Ventricular fibrillation (VF) — Giveaways

Unresponsive, pulseless arrest; disorganized ventricular electrical activity; shockable rhythm.

Ventricular fibrillation (VF) — Differentiator

No effective contraction or cardiac output; unlike ventricular tachycardia, no organized complexes.

Ventricular fibrillation (VF) — Scenario

A patient suddenly collapses pulseless, and an AED advises shock for chaotic rhythm.

Ventricular tachycardia (VT) — Giveaways

Very rapid ventricular rhythm causing palpitations, weakness, chest pain or hypotension.

Ventricular tachycardia (VT) — Differentiator

May have a pulse or be pulseless; VF has completely chaotic activity without output.

Ventricular tachycardia (VT) — Scenario

A patient feels sudden racing heartbeat and dizziness and becomes hypotensive.

Cardiac tamponade — Giveaways

Chest trauma with shock, possibly muffled heart sounds and distended neck veins.

Cardiac tamponade — Differentiator

Blood in pericardial sac compresses heart; tension pneumothorax instead traps air in pleura.

Cardiac tamponade — Scenario

After a penetrating chest wound, a patient becomes hypotensive with distended neck veins.

Commotio cordis — Giveaways

Sudden collapse and cardiac arrest immediately after precisely timed blunt blow to chest.

Commotio cordis — Differentiator

Electrical arrest without necessarily severe structural damage; unlike myocardial contusion.

Commotio cordis — Scenario

A young baseball player is struck by a ball over the heart and immediately collapses pulseless.

Ischemic stroke — Giveaways

Sudden facial droop, arm weakness, speech difficulty or other focal deficit.

Ischemic stroke — Differentiator

Blocked cerebral artery, not bleeding; cannot reliably distinguish stroke type from symptoms alone.

Ischemic stroke — Scenario

A woman suddenly develops right arm weakness, facial droop and slurred speech.

Hemorrhagic stroke — Giveaways

Sudden severe headache, vomiting, altered consciousness and possible focal weakness.

Hemorrhagic stroke — Differentiator

Bleeding inside/around brain; severe abrupt headache suggests it, but field diagnosis is uncertain.

Hemorrhagic stroke — Scenario

A patient describes the worst headache of life and suddenly collapses with vomiting.

Transient ischemic attack (TIA) — Giveaways

Sudden stroke-like weakness, speech or vision changes that resolve.

Transient ischemic attack (TIA) — Differentiator

Temporary loss of cerebral blood flow with symptoms resolving; still warns of future stroke.

Transient ischemic attack (TIA) — Scenario

A patient's one-sided weakness and garbled speech disappear before EMS arrival.

Generalized tonic-clonic seizure — Giveaways

Whole-body stiffening and rhythmic jerking, impaired awareness, possible incontinence, postictal confusion.