Angina

Question 1

What is myocardial ischemia?

Answer 1

Imbalance between myocardial oxygen supply and demand.

Question 2

Most common cause of myocardial ischemia.

Answer 2

Atherosclerotic coronary artery disease

Question 3

General definition of angina.

Answer 3

Chest discomfort.

Question 4

What is the Levine Sign?

Answer 4

A clenched fist held over the chest to describe ischemic chest pain. Referred pain associated with ischemia usually radiates to the the left shoulder or arm so the right, unaffected arm is used to produce the gesture.

Question 5

Patient presents with retrosternal feelings of pressure, heaviness, and tightness that radiates to the neck, jaw, and shoulder. The episodes last 10-20min and occur without exertion.

Answer 5

Unstable Angina

key factors: 10-20min duration, occur without exertion

Question 6

Patient presents with retrosternal feelings of pressure, heaviness, and tightness that radiates to the neck, jaw, and shoulder. The episodes last 2-10min and occur while climbing stairs or lifting heavy objects.

Answer 6

Angina

key factors: 2-10min duration, occurs on exertion, retrosternal discomfort and radiation

Question 7

Patient presents with severe retrosternal feelings of pressure, heaviness, and tightness that radiates to the neck, jaw, and shoulder. The episodes vary, some lasting more than 30 minutes. Nitrates do not have any affect.

Answer 7

Myocardial Infarction

key factors: nitrates have no effect, duration varies

Question 8

Patient presents with retrosternal feelings of pressure, heaviness, and tightness that radiates to the neck, jaw, and shoulder. The episodes last 2-10min and occur while climbing stairs or lifting heavy objects. PE reveals late-peaking systolic murmur radiating to the carotid arteries.

Answer 8

Aortic Stenosis

key factor: murmur radiating to carotids

Question 9

Patient presents with sudden tearing and ripping chest pain that radiates between the shoulder blades. PE reveals a murmur of aortic insufficiency.

Answer 9

Aortic Dissection

key factor: radiation between shoulder blades, abrupt onset, also related to CT disorders like Marfan syndrome

Question 10

Patient presents with sharp chest pain that radiates to the left shoulder. The episodes last hours and the pain is relieved by sitting upright and leaning forward.

Answer 10

Pericarditis

key factor: improved symptoms with position change, episodes lasting hours to days, SHARP pain

Question 11

Patient presents with retrosternal pressure, tightness, and burning sensation that lasts 2-30min and occurs with or without exertion.

Answer 11

Esophageal Spasm

key factor: with or without exertion

Question 12

Patient presents with sudden difficulty breathing and pain with breathing. PE reveals decreased breath sounds on the right thorax.

Answer 12

Spontaneous Pneumothorax

key factors: sudden onset, unilateral decreased breath sounds

Question 13

Patient presents with sudden difficulty breathing and pain with breathing. Sharp pain is localized to the right side inferior to the axilla.

Answer 13

Pulmonary Embolism

key factors: sudden onset, unilateral sharp pain along the lateral border of the rib cage.

Question 14

Patient presents with substernal pressure. PE reveals dilated jugular veins, trouble breathing, and increased venous pressure.

Answer 14

Pulmonary Hypertension

key factors: trouble breathing, JVD

Question 15

Patient presents with painful breathing on one side and a fever. PE reveals rails along with rubs, and consolidation on auscultation.

Answer 15

Pneumonia or Pleuritis

key factors: fever, auscultation findings

Question 16

Patient presents with burning chest pain that can last up to an hour and commonly occurs after eating.

Answer 16

Esophageal Reflux

key factor: after eating, improved with antacids

Question 17

Patient presents with burning substernal pain that is relieved after eating.

Answer 17

Peptic Ulcer Disease

key factor: improved w/ eating or antacids

Question 18

Patient presents with RUQ pain that occurs after eating a meal.

Answer 18

Gallbladder Disease

key factor: RUQ pain

Question 19

Patient presents with aching chest pain that is the worst while moving. PE reveals increased pain on palpation of the sternum.

Answer 19

Musculoskeletal Disease (possibly costochondritis)

key factors: pain while moving, pain reproduced on palpation

Question 20

Patient presents with sharp chest and axillary pain. PE reveals increased pain on palpation or anything that even touches the skin.

Answer 20

Varicella Zoster

Key factor: pain with anything touching the skin