Chest 1 Flashcards
Noncardiac chest pain can be due to?
visceral musculoskeletal skin psychogenic referred local
what do you do with someone with noncardiac chest pain?
auscultate, obtain a screening ECG, consider chest radiography
incorporate a mechanical challenge (stretch, compression, palpation in an attemmpt to reproduce the complaint
where should someone with cardiac caused pain go?
emergent care
how is angina described?
gripping
squeezing
pressure
history of someone with pleural/pulmonary chest pain
history: pneumonia, pneumothorax, TB, bronchogenic carcinoma
provocation of pleural/pulmonary chest pain
deep breathing
bending toward the same side may aggarvate complaint
auscultation/radiographs
history of someone with esophageal pain
may or may not have dysphasia
substernal pain or radiates to central back
provocation/examination of someone with esophageal chest pain
hot or cold food
barium study may be needed
history of someone with herpes zoster
often unilateral
dermatomal
hypersensitivity followed by vesicle formation, burning, sharp pain, recurrent
provocation of herpes zoster
hypersensitivity to palpation
history of someone with intercostal neuritis
similar to herpes presentation without vesicles
may have osteophytes or be diabetic
provocation/examination of intercostal neuritis
may reproduce on rib separation or compression of intercostal space
history of someone with a rib fracture
usally history of trauma
provocation/examination of rib fracture
reproduce on compression A-P
tuning fork
xray
history of someone with pain in the costochondral junction
Tietze’s syndrome found in older women
unilateral sharp pain
provocation/examination of costochondral junction pain
direct pressure of junction or between ribs
costovertebral/costotransverse pain history
may or may not be traumatic
pain radiates along
provocation/examination of costovertebral/costotransverse pain
pressure over affected joint causes radiation
history of someone with pain in the chest from the cervical region
referral from osteophyte involvement
provocation/examination of chest pain from cervical spine
compression/distration test
history of someone with chest pain from anxiety
anxious or depressed
pain is often over heart and is often either quick/stabbing or heavy/constant
provocation/examination of someone with chest pain from anxiety
psychological evaluation may be necessary, may be aggravated by deep breathing
history of someone with chest pain from a sprain
overuse or trauma
usually pectoralis, serratus anterior or intercostals
provocation/examination of someone with chest pain from a sprain?
stretch, contract, combination
history of someone with chest pain from trigger pain
no neurological changes
SCM, pectoralis, SCM, scalens
provocaiton/examination of someone with chest pain from trigger point
sustained pressure on trigger points
CAD
chest pain described as pressure sensation, fullness or squeezing in the mid portion of the thorax
where might the pain radiate in CAD?
jaw or teeth, shoulder, arm and/or back
other symptoms of someone with CAD
dyspnea/shorteness of breath
epigastric discomfort with or without nausea and vomiting
diaphoresis (sweateing)
syncope or near syncope without other cause
angina
squeezing or pressure senation in the chest lasting for several minutes to 30 minutes with possible ratiation to arm or jaw
angina typically follows…?
exertion
how is angina relieved
resting for several minutes
what is angina due to?
atherosclerosis (a variation of angina is related to vasospasm)
unstable angina
extensive atherosclerosis
chest pain without provocation
tend to warn of an impending MI
people with angina may have?
HTN
valve abnormalities
what does someone with angina have?
valve abnormalities
ECG findings nonspecific
scintigraphy or electrocardiographic studies
may need coronary angiography
nitroglycerin
used for symptomatic management of angina
decreases contraction of heart and causes vasodilation
myocardial infarction is often preceded by a history of?
angina
substernal pain is more severe and often bulds up over minutes
pain may be diffuse and radiate to medial left arm or jaw
does nitroglycerin help with an MI?
no
MIs are usually due to?
coronary thrombus or vasospasm
elevated cardiac enzymes during an MI
creatine kinase
aspartate aminotransferase/serum glutamate oxaloacetic transaminase
lactate dehydrogenase
troponin
Tietze’s syndrome
females over 50
moderate to severe pain in upper part of chest one one side
unknown etiology
tietze’s syndrome appears to be?
an inflammtory reaction, overexertion and prolonged coughing or exertion
how do you deal with tietze syndrome
benign and self resolving
GERD demographics
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
heartburn
senation of discomfort or burning behind sternum rising up to neck, worse after meals or in reclining position, eased by antacids
regurgitation
perception of flow of refluxed gastric contents into mouth or hypopharynx
pulmonary embolism demographics
middle aged male
sudden onset of chest pain after having calf apin
may have been immoblilzed
signs and symptoms of pulmonary embolism
low grade fever may be present, more commonly with an infartion
chest pain is pleuritic with dyspnea
signs/symptoms of pleurisy
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
when might you take chest films?
chronic cough, hemoptysis, expectoration, shortness of breath cyanosis clubbing of fingers pain in chest thoracic spine upper extremities
when is a CT useful for chest complaints?
additional procedure especially for chest wall, pleural, lung, hilum or mediastinal and used to delineate and assess neoplastic disease
MRI for chest complaints
distinguish pathology in hilar and medistinal lymph nodes from adjacent vascular anatomy
ventilation and perfusion scans valuable in diagnosis of?
pulmonary embolism
the left hilum should___ be lower than the right hilum
never
enlargement of hili is usually due to?
lymphadenopathy or enlarged vessels
tumor
sarcoid
air bronchogram sign
uninvolved airways surrounded by water density pathology consistent with an airspace pathology, usually pneumonia or pulmonary edema
S sign of Golden
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
silhouette sign
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
general pulmonary radiology
increased densty decreased density consolidation interstitial atelectasis nodules or masses
