Case 1 - 46 yo M with chest pain

Question 1

Information gathering

Answer 1

CC
Onset
Precipitating events
Progression
Severity
Location
Radiation
Quality
Alleviating/exacerbating factors
SOB, N/V, sweating
Cough, wheezing, AP, diarrhea/constipation
Prior episodes
PMHx
PSHx
FHx
Social Hx (occupation, tobacco, alcohol, drug use, sexual activity, exercise, diet)
Current medications
Drug allergies

Question 2

Physical exam

Answer 2

Neck exam (JVD, carotid auscultation)
CV exam
Pulmonary exam
Abdominal exam
Extremities (checked peripheral pulses, checked BP in BOTH arms, looked for edema and cyanosis)

Question 3

Closure

Answer 3

Don’t forget to discuss lifestyle modification (e.g. stop using cocaine)
Ask if they have any other questions

Question 4

Differential diagnosis

Answer 4

MI
Cocaine-induced myocardial ischemia
GERD

Question 5

Diagnostic work-up

Answer 5

ECG
Cardiac enzymes
TTE (cardiac wall motion abnormalities)
Upper endoscopy (GERD)
Urine toxicology
Cardiac catheterization
TEE (aortic dissection)
CXR (aortic dissection, PNA)
CT - chest with contrast (aortic dissection, pneumothorax)
Cholesterol panel