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Clin Med 4 > Approach to Chest Pain > Flashcards

Approach to Chest Pain Flashcards

1
Q

associated sxs w/ typical anginal CP?

atypical?

A

typical- diaphoresis, nausea, dyspnea

atypical- none

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2
Q

what specific things do you need to ask about social hx when interviewing pt w/ chest pain

A

illicit drug use

tobacco use

ETOH use

travel (long car/ plane)

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3
Q

if the CP is relieved by GI cocktail, what is the likely etiology

A

GI causes but does not satisfactorily distinguish from cardiac pain

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4
Q

cough

dyspnea

pleuritic CP

calf/leg pain

A

PE

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5
Q

onset of PE

abrupt/gradual?

A

abrupt

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6
Q

hypotension

JVD

distant muffled heart sounds

A

becks triad-

associated w/ cardiac tamponade

911!

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7
Q

onset of aortic dissection

abrupt/gradual?

A

abrupt

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8
Q

if the CP is aggravated by palpation, what is the likely etiology

A

MSK

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9
Q

if the CP is associated with syncope, what is the likely etiology

A

ischemia

aortic dissection

PE

psychogenic causes

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10
Q

idiopathic or viral causes of CP

A

pericarditis

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11
Q

what are some additional studies you should get on a pt w/ CP

A

CBC

CMP

coagulation indices

cardiac enzumes (troponin, CK-MB)

D-Dimer

BNP

CXR (PA and lateral(

EKG

CT chest

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12
Q

if the CP is sharp, what is the likely etiology

A

pulmonary

chest wall

neuropathic

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13
Q

PE pt education

A

compression socks

smoking cessation

D/C oral contraceptives

avoid sitting for a long time

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14
Q

if the CP is worse with respiration, what is the likely etiology

A

(pleuritic chest pain)

pulmonary

chest wall

cardiac tamponade

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15
Q

becks triad

A

hypotension

JVD

distant muffled heart sounds

(associated w/ cardiac tamponade)

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16
Q

MSK causes of CP

(less critical)

A

costochondritis

rib fracture

cervical stenosis

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17
Q

onset of esophageal rupture

abrupt/gradual?

A

abrupt

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18
Q

if the CP is associated with belching/ dysphagia/ unpleasant taste, what is the likely etiology

A

GI

MI can also cause indigestion/ belching

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19
Q

postprandial CP

A

GERD

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20
Q

what are some things you should look for in the

abdominal physical exam of CP

A

tenderness

gaurding

masses

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21
Q

westermarks sign

A

PE

(on CXR)

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22
Q

is typical anginal CP reproducible?

atypical?

A

typical- not reproducible

atypical- reproducible w/ palpation

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23
Q

typical anginal CP location?

atypical?

A

typical- substernal, radiating to neck/ jaw shoulders

atypical- lateral chest wall/ back

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24
Q

critical GI causes of CP

A

esophageal rupture

perforated ulcer

acute cholecystitis

acute pancreatitis

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25
Q

EKG shows diffuse ST elevation and PR depression in multiple leads

A

pericarditis

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26
Q

if the CP is aggravated by exertion, what is the likely etiology

A

angina

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27
Q

onset of pneumothorax

abrupt/gradual?

A

abrupt

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28
Q

narrow PP

A

cardiac tamponade

aortic stenosis

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29
Q

risk factors for PE

A

recent sx

oral contraceptives/ estrogen

DVT

long time sitting

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30
Q

why would you have an MI secondary to a trauma

A

thrombosis (throw a clot)

coronary artery rupture

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31
Q

avascular markings distal to embolus is

A

hamptons hump

(PE)

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32
Q

if the CP is tearing/ ripping/ searing, what is the likely etiology

A

aortic dissection

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33
Q

onset of esophageal perf

abrupt/gradual?

A

abrupt

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34
Q

what specific things do you need to ask about family hx when interviewing pt w/ chest pain

A

family hx of CAD

family hx of coagulation disorders

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35
Q

if the CP lasts for more than 15 minutes, what is it more likely to be

A

unstable angina

acute MI

36
Q

is typical anginal CP affected by exertion?

atypical?

A

typical- worse w/ exertion and relieved by rest

atypical- unaffected by exertion or rest

37
Q

wedge shape on CXR

A

westermarks sign

(PE)

38
Q

onset of MSK problem

abrupt/gradual?

A

gradual

39
Q

if the CP is associated with diaphoresis, what is the likely etiology

A

ischemia

GI causes

40
Q

if the CP is burning, what is the likely etiology

A

neuropathic (herpes zoster, radiculopathy)

GI

ischemia

41
Q

critical cardiac causes of CP

A
  • Myocardial ischemia
    • angina
    • ACS (MI and unstable angina)
  • Non-ischemic
    • aortic dissection
    • cardiac tamponade
    • aortic anuerysm
42
Q

pericardial friction rub on auscultation

elevated CRP

A

pericarditis

43
Q

ruptured aorta on CXR will show

A

enlarged mediastinum

hemothorax

44
Q

what are some things you should look for in the

neck physical exam of CP

A

JVD

carotid bruits

45
Q

hamptons hump

A

PE

(on CXR)

46
Q

if the CP is relieved by nitroglycerin, what is the likely etiology

A

ischemic causes

esophageal spasm

47
Q

PE drugs

A

LMWH

warfarin

factor Xa

48
Q

what are some things you should look for in the

cardiac physical exam of CP

A

rate

rhythm

murmurs

rubs

muffled heart sounds

49
Q

if the CP is aggravated by positional changes, what is the likely etiology

A

MSK most likely

pericarditis- worse w/ laying down, better w/ sitting or leaning forward

50
Q

if the CP is associated with dyspnea, what is the likely etiology

A

ischemia

non-ischemic cardiac causes

pulmonary causes

51
Q

for CP complaints, who should you take special considerations w/

A

women

diabetics

elderly

52
Q

water bottle sign

A

CHF

53
Q

what specialized exam should you do w/ CHF

A

hepatojugular reflux

54
Q

if the CP lasts for a few seconds, what is it more likely to be

A

MSK

GI

not ischemic pain

55
Q

if the CP is aggravated by eating (during/ after), what is the likely etiology

A

GI

56
Q

what are some things you should look for in the

skin physical exam of CP

A

pallor

cyanosis

hyperesthesia

57
Q

if the CP lasts for less than 15 minutes, what is it more likely to be

A

angina

58
Q

kerley B-lines

A

CHF

59
Q

less critical cardiac causes of CP

A
  • Non-ischemic
    • HF
    • pericarditis
    • stress cardiomyopathy
    • aortic stenosis
    • mitral valve prolapse
60
Q

if the CP is dull/ heavy/ tightness/ pressure/ ache/ squeezing,

what is the likely etiology

A

ischemia

61
Q

if the CP is relieved by rest, what is the likely etiology

A

angina

62
Q

drugs for pericarditis

A

NSAIDS +/- omeprazole

colchicine

steroids for refractory

63
Q

if the CP is associated with diaphoresis, what is the likely etiology

A

GI causes

ischemia

64
Q

onset of esophageal disease

abrupt/gradual?

A

gradual

65
Q

if the CP is associated with cough, what is the likely etiology

A

HF

PE

PNA

asthma

66
Q

derm causes of CP

(less critical)

A

herpes zoster

67
Q

CP is sharp and pleuritic

febrile

recent viral infxn

A

pericarditis

68
Q

less critical GI causes of CP

A

GERD

esophagitis

esophageal spasm

PUD

gastritis

69
Q

typical anginal CP duration?

atypical?

A

typical- more than 15 minutes and is progressive

atypical- a few seconds or days to months

70
Q

typical anginal CP quality?

atypical?

A

typical- progressive pressure, achy pain

atypical- sharp/ pleuritic/ positional pain

71
Q

if the CP is associated with psych sxs, what is the likely etiology

A

ischemia

panic

anxity

72
Q

less critical causes of CP

A

PNA

pleurisy

pleural effusion

73
Q

pt education for pericarditis

A

rest (activity worsens sxs)

74
Q

less critical psych causes of CP

A

anxiety

panic attack

panic disorder

75
Q

if the CP lasts for days to months, what is it more likely to be

A

not ischemic

76
Q

what are some things you should look for in the

extremities physical exam of CP

A

edema

peripheral pulses

77
Q

if the CP is relieved by antacids/foods, what is the likely etiology

A

GI

78
Q

critical pulm causes of CP

A

PE

pneumothorax

79
Q

what are some things you should look for in the

resp physical exam of CP

A

wheezes

rales

flail chest

chest wall tenderness

absent or unequal breath sounds

80
Q

critical psych causes of CP

A

cocaine/ substance abuse

81
Q

what are some things you should look for in the

general physical exam of CP

A

anxiousness

diaphoresis

alertness

82
Q

if the CP is associated with palpitations, what is the likely etiology

A

ischemia (secondary AFib, PVCs, PACs)

PE w/ arrhythmias

HF w/ arrhythmias

83
Q

CP caused by _____ is diffuse and poorly localized

CP caused by ____ is well localized (+/- point tenderness)

A

diffuse- ischemia/ cardiac

localized- MSK/ GI/ pulmonary

84
Q
A
85
Q

CP worse w/ lying down, better w/ sitting up and leaning forward

A

pericarditis

86
Q

onset of acute MI

abrupt/gradual?

A

either abrupt of gradual

87
Q

pitting edema

SOB

CP

JVD

HTN

A

CHF

Clin Med 4 (9 decks)

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