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Chest 1 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
history of someone with chest pain from trigger pain
no neurological changes | SCM, pectoralis, SCM, scalens
26
provocaiton/examination of someone with chest pain from trigger point
sustained pressure on trigger points
27
CAD
chest pain described as pressure sensation, fullness or squeezing in the mid portion of the thorax
28
where might the pain radiate in CAD?
jaw or teeth, shoulder, arm and/or back
29
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
30
angina
squeezing or pressure senation in the chest lasting for several minutes to 30 minutes with possible ratiation to arm or jaw
31
angina typically follows...?
exertion
32
how is angina relieved
resting for several minutes
33
what is angina due to?
atherosclerosis (a variation of angina is related to vasospasm)
34
unstable angina
extensive atherosclerosis chest pain without provocation tend to warn of an impending MI
35
people with angina may have?
HTN | valve abnormalities
36
what does someone with angina have?
valve abnormalities ECG findings nonspecific scintigraphy or electrocardiographic studies may need coronary angiography
37
nitroglycerin
used for symptomatic management of angina | decreases contraction of heart and causes vasodilation
38
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
39
does nitroglycerin help with an MI?
no
40
MIs are usually due to?
coronary thrombus or vasospasm
41
elevated cardiac enzymes during an MI
creatine kinase aspartate aminotransferase/serum glutamate oxaloacetic transaminase lactate dehydrogenase troponin
42
Tietze's syndrome
females over 50 moderate to severe pain in upper part of chest one one side unknown etiology
43
tietze's syndrome appears to be?
an inflammtory reaction, overexertion and prolonged coughing or exertion
44
how do you deal with tietze syndrome
benign and self resolving
45
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
46
heartburn
senation of discomfort or burning behind sternum rising up to neck, worse after meals or in reclining position, eased by antacids
47
regurgitation
perception of flow of refluxed gastric contents into mouth or hypopharynx
48
pulmonary embolism demographics
middle aged male sudden onset of chest pain after having calf apin may have been immoblilzed
49
signs and symptoms of pulmonary embolism
low grade fever may be present, more commonly with an infartion chest pain is pleuritic with dyspnea
50
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 ```
51
when might you take chest films?
``` chronic cough, hemoptysis, expectoration, shortness of breath cyanosis clubbing of fingers pain in chest thoracic spine upper extremities ```
52
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
53
MRI for chest complaints
distinguish pathology in hilar and medistinal lymph nodes from adjacent vascular anatomy
54
ventilation and perfusion scans valuable in diagnosis of?
pulmonary embolism
55
the left hilum should___ be lower than the right hilum
never
56
enlargement of hili is usually due to?
lymphadenopathy or enlarged vessels tumor sarcoid
57
air bronchogram sign
uninvolved airways surrounded by water density pathology consistent with an airspace pathology, usually pneumonia or pulmonary edema
58
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
59
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
60
general pulmonary radiology
``` increased densty decreased density consolidation interstitial atelectasis nodules or masses ```

Diff Dx (17 decks)

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