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OSCE related > Chest 1-2 > Flashcards

Chest 1-2 Flashcards

1
Q

Noncardiac chest pain can be due to?

A

visceral musculoskeletal skin psychogenic referred local

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2
Q

what do you do with someone with noncardiac chest pain?

A

auscultate, obtain a screening ECG, consider chest radiography incorporate a mechanical challenge (stretch, compression, palpation in an attemmpt to reproduce the complaint

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3
Q

where should someone with cardiac caused pain go?

A

emergent care

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4
Q

how is angina described?

A

gripping squeezing pressure

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5
Q

history of someone with pleural/pulmonary chest pain

A

history: pneumonia, pneumothorax, TB, bronchogenic carcinoma

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6
Q

provocation of pleural/pulmonary chest pain

A

deep breathing bending toward the same side may aggarvate complaint auscultation/radiographs

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7
Q

history of someone with esophageal pain

A

may or may not have dysphasia substernal pain or radiates to central back

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8
Q

provocation/examination of someone with esophageal chest pain

A

hot or cold food barium study may be needed

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9
Q

history of someone with herpes zoster

A

often unilateral dermatomal hypersensitivity followed by vesicle formation, burning, sharp pain, recurrent

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10
Q

provocation of herpes zoster

A

hypersensitivity to palpation

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11
Q

history of someone with intercostal neuritis

A

similar to herpes presentation without vesicles may have osteophytes or be diabetic

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12
Q

provocation/examination of intercostal neuritis

A

may reproduce on rib separation or compression of intercostal space

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13
Q

history of someone with a rib fracture

A

usally history of trauma

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14
Q

provocation/examination of rib fracture

A

reproduce on compression A-P tuning fork xray

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15
Q

history of someone with pain in the costochondral junction

A

Tietze’s syndrome found in older women unilateral sharp pain

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16
Q

provocation/examination of costochondral junction pain

A

direct pressure of junction or between ribs

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17
Q

costovertebral/costotransverse pain history

A

may or may not be traumatic pain radiates along

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18
Q

provocation/examination of costovertebral/costotransverse pain

A

pressure over affected joint causes radiation

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19
Q

history of someone with pain in the chest from the cervical region

A

referral from osteophyte involvement

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20
Q

provocation/examination of chest pain from cervical spine

A

compression/distration test

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21
Q

history of someone with chest pain from anxiety

A

anxious or depressed pain is often over heart and is often either quick/stabbing or heavy/constant

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22
Q

provocation/examination of someone with chest pain from anxiety

A

psychological evaluation may be necessary, may be aggravated by deep breathing

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23
Q

history of someone with chest pain from a sprain

A

overuse or trauma usually pectoralis, serratus anterior or intercostals

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24
Q

provocation/examination of someone with chest pain from a sprain?

A

stretch, contract, combination

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25
Q

history of someone with chest pain from trigger pain

A

no neurological changes SCM, pectoralis, SCM, scalens

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26
Q

provocaiton/examination of someone with chest pain from trigger point

A

sustained pressure on trigger points

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27
Q

CAD

A

chest pain described as pressure sensation, fullness or squeezing in the mid portion of the thorax

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28
Q

where might the pain radiate in CAD?

A

jaw or teeth, shoulder, arm and/or back

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29
Q

other symptoms of someone with CAD

A

dyspnea/shorteness of breath epigastric discomfort with or without nausea and vomiting diaphoresis (sweateing) syncope or near syncope without other cause

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30
Q

angina

A

squeezing or pressure senation in the chest lasting for several minutes to 30 minutes with possible ratiation to arm or jaw

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31
Q

angina typically follows…?

A

exertion

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32
Q

how is angina relieved

A

resting for several minutes

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33
Q

what is angina due to?

A

atherosclerosis (a variation of angina is related to vasospasm)

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34
Q

unstable angina

A

extensive atherosclerosis chest pain without provocation tend to warn of an impending MI

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35
Q

people with angina may have?

A

HTN valve abnormalities

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36
Q

what does someone with angina have?

A

valve abnormalities ECG findings nonspecific scintigraphy or electrocardiographic studies may need coronary angiography

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37
Q

nitroglycerin

A

used for symptomatic management of angina decreases contraction of heart and causes vasodilation

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38
Q

myocardial infarction is often preceded by a history of?

A

angina substernal pain is more severe and often bulds up over minutes pain may be diffuse and radiate to medial left arm or jaw

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39
Q

does nitroglycerin help with an MI?

A

no

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40
Q

MIs are usually due to?

A

coronary thrombus or vasospasm

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41
Q

elevated cardiac enzymes during an MI

A

creatine kinase aspartate aminotransferase/serum glutamate oxaloacetic transaminase lactate dehydrogenase troponin

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42
Q

Tietze’s syndrome

A

females over 50 moderate to severe pain in upper part of chest one one side unknown etiology

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43
Q

tietze’s syndrome appears to be?

A

an inflammtory reaction, overexertion and prolonged coughing or exertion

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44
Q

how do you deal with tietze syndrome

A

benign and self resolving

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45
Q

GERD demographics

A

30-60 year women stress, diet, caffeine, smoking or alcohol may provoke symptoms diagnosis usually based on hisotry and physical and trial of empiric therapy

46
Q

heartburn

A

senation of discomfort or burning behind sternum rising up to neck, worse after meals or in reclining position, eased by antacids

47
Q

regurgitation

A

perception of flow of refluxed gastric contents into mouth or hypopharynx

48
Q

pulmonary embolism demographics

A

middle aged male sudden onset of chest pain after having calf apin may have been immoblilzed

49
Q

signs and symptoms of pulmonary embolism

A

low grade fever may be present, more commonly with an infartion chest pain is pleuritic with dyspnea

50
Q

signs/symptoms of pleurisy

A

sharp pains in the chest that seem related to coughing, sneezing, or position such as bending to the side or lying on the involved side recent history of respiratory infection pleural friction rub decreased fremitus dullness to percussion increase or decrease in breath sounds

51
Q

when might you take chest films?

A

chronic cough, hemoptysis, expectoration, shortness of breath cyanosis clubbing of fingers pain in chest thoracic spine upper extremities

52
Q

when is a CT useful for chest complaints?

A

additional procedure especially for chest wall, pleural, lung, hilum or mediastinal and used to delineate and assess neoplastic disease

53
Q

MRI for chest complaints

A

distinguish pathology in hilar and medistinal lymph nodes from adjacent vascular anatomy

54
Q

ventilation and perfusion scans valuable in diagnosis of?

A

pulmonary embolism

55
Q

the left hilum should___ be lower than the right hilum

A

never

56
Q

Chest pain with tenderness suggests ?

A

self limiting Tietze’s syndrome (OHB pg.88)

57
Q

enlargement of hili is usually due to?

A

lymphadenopathy or enlarged vessels tumor sarcoid

58
Q

air bronchogram sign

A

uninvolved airways surrounded by water density pathology consistent with an airspace pathology, usually pneumonia or pulmonary edema

59
Q

S sign of Golden

A

collapse of upper R lobe with superior migration of horizontal fissure medial portion of displaced fissure may be bulged inferiorly by a hilar mass causing the fissure to have a slanted and reversed S configuration

60
Q

silhouette sign

A

loss of anatomic border intrathoracic lesion touching a border of the heart, aorta or diaphragm will obliterate that border on the xray intrathoracic lesion not anatomically contiguous with a border of one of these structures will not obliterate the border

61
Q

general pulmonary radiology

A

increased densty decreased density consolidation interstitial atelectasis nodules or masses

62
Q

consolidation

A

any pathologic process taht fills the alveoli with fluid, pus, blood cells (including tumor cells) or other substances resulting in lobar, diffuse or multifocal ill-defined opacities

63
Q

interstitial

A

involvement of the supporting tissue of the lung parenchyma resulting in fine or coarse reticular opacities or small nodules

64
Q

nodule or mass

A

any space occpuying lesion either solitary or multple

65
Q

atelectasis

A

collapse of part of the lung due to a decrease in the amount of air in the alveoli resulting in volume loss and increased density

66
Q

most common cause of consolidation

A

pneumonia

67
Q

key findings on the xray for consolidation are

A

ill-defined homogeneous opacity obscuring vessels solhouette sign air bronchogram sign extension to pleura or fissure, but not crossing it no volume loss

68
Q

what can cause consolidation?

A

water pus blood cells

69
Q

interstitial tissue

A

network of CT that invests the arteries, veins, bronchi and lymphatics skeleton of the lung, providing mechanical support

70
Q

4 types of interstitial lung patterns

A

linear reticular nodular reticulonodular

71
Q

linear

A

septal lines (Kerley lines)

72
Q

reticular

A

mesh like appearance, lines in all directions

73
Q

nodular

A

discrete opacities

74
Q

reticulonodular

A

combination of reticular and nodular

75
Q

atelectasis

A

volume, collapse, under inflation

76
Q

resorptive atelectasis

A

obstruction

77
Q

passive atelectasis

A

adjacent mass or pneumothorax

78
Q

adhesive atelectasis

A

surfactant inactivation

79
Q

cicatrization atelectasis

A

scar tissue

80
Q

what might you see on a film with atelectasis

A

increased density bronchovascular crowding displacement sings

81
Q

solitary pulmonary noduel

A

single intraparenchyma lesion less than 3cm in size and not associated with atelectasis or lymphadenopathy

82
Q

a lesion greater than 3cm in diameter is called?

A

mass

83
Q

most SPNs are found to be?

A

granulomas lung cancers hamartomas

84
Q

granuloma

A

small area of inflammation in tissue most often resulting from an infection

85
Q

what are the different disease that can cause a granuloma?

A

TB histoplasmosis coccidiodomycosis sarcoidosis (non-infectious)

86
Q

what is the most common cause of pneumonia?

A

streptococcus pneumoniae (bacteria MC)

87
Q

s/s of pneumonia

A

cough dyspnea fever chills chest pain sputum decreased breath sounds rales increased fremitus, egophony, pectoriloquy, dullness to percussion

88
Q

pneumonia caused by streptococcus pneumonia is associated with?

A

rusty colored sputum

89
Q

pneumonia caused by____may have a currant jelly sputum

A

Klebsiella

90
Q

hemoptysis can also occur with

A

TB gram negative pneumonia lung abscess acute bronchiits

91
Q

s/s of bacterial pneumonai

A

sudden onset chills fever pain with breahing cough dyspnea sputum production dry cough becomes productuive purulent, blood streaked or rust sputum leukocytosis with a shift to the left

92
Q

s/s of viral pneumonia

A

bronchitis bronchiolitis pneumonia interstitial pneumonia leukopenia/leukocytosis lymphocytosis

93
Q

MC symptoms of TB

A

fatigue fever weight loss coughing hemoptysis night sweats

94
Q

diagnosis of TB

A

skin tests chest xrays sputum analysis PCR tests

95
Q

primary TB is usually?

A

asymptomatic

96
Q

what iss seen in a chest xray of someone with TB

A

ranke complex ghon lesion ipsilateral calcified hilar node

97
Q

common presenting symptoms of tumor

A

dyspnea persistent cough hemoptysis

98
Q

non-small cell lung cancer (squamous cell carcinoma)

A

strongly associated with smoking poor prognosis

99
Q

non-small cell lung cancer (adenocarcinoma)

A

more common in women more common in non-smokers peripheral

100
Q

small cell carcinoma

A

strongly associated with smoking metastasizes early most common primary lung malignancy to cause paraneoplastic syndromes and SVC obstruction worst prognosis AKA oat cell carcinoma

101
Q

increased density in the apex of the lung

A

pancoast tumor

102
Q

COPD

A

represents a spectrum of obstructive airway diseases includes two key components which are chronic bronchitis- small ariways disease and emphysema

103
Q

blue bloaters

A

chonic bronchitis

104
Q

pink puffers

A

emphysema

105
Q

4 types of angina:

A

stable, unstable, decubitus, and variant(prinzmetal’s) anginas

OHB pg. 110

106
Q

pneumothorax

A

presence of air or gas in the pleural cavity

107
Q

how can you get pneumothorax

A

spontaneous underlying lung disease trauama tension pneumothorax catamenial pneumothorax pleuritic chest pain and dyspnea

108
Q

tension pneumothorax

A

caused by trauma to the lungs and/or chest cavity most serious type because it may affect the heart’s ability to pump blood

109
Q

catamenial pneumothorax

A

caused by small holes in the diaphragm muscle occurs within 72 hours of start or end of menstrual cyctle and most often associated with endometriosis

110
Q

Horner’s syndrome

A

miosis facial anhidrosis ptosis enophthalmos

111
Q

ddx of anterior mediastinal masses

A

lymphoma thyroid enlargement teratoma tumors of thymus

OSCE related (16 decks)

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