Chest conditions

Question 1

Intercostal mm strain -ss, px, pom

Answer 1

ss- pain and spasm in intercostal area, swinging club/over activity

px- reproduction of pain with rot towards and lat bending away

Question 2

Intercostal neuralgia- ss/px

Answer 2

ss- pain/numbness/tingling with intercostal nerve pattern

px- Schelpelmanns sign (pt will endorse increased pain when bending towards side)

Question 3

Asthma ss/px

Answer 3

ss- airways narrow and swell and may produce extra musus making it difficult to breath and coughing spells

px- spirometry to assess lung function, chest xray, wheezing/coighing

Question 4

chronic bronchitis- ss/px

Answer 4

ss- lower respiratory passages become inflamed and fibroses (blue bloater). Cough, production of mucus, SOB, cyanosis

px- auscultate, sputum `

Question 5

Pneumonia ss, Px

Answer 5

ss- cough w phlegm/pus, fever/chills, difficult breathing

px- xray will show lobar consolidation, crackling on auscultation

pom- antibiotics/antivirals

Question 6

COPD- ss, px, pom

Answer 6

ss- dyspena, coughing, sputum production, 80% have hx of smoking

px- chest xray

pom- quit smoking, bonchodialators

Question 7

Angina Pectoralsis ss, px

Answer 7

ss- chest pain due to restricted blood flow to heart, dizziness, fatigue, nausea

px- ECG

Question 8

Chronic stable angina vs unstable angina

Answer 8

stable- precipitated by 3 ‘e’s; exertion, emotion, eating, relived by rest

Unstable- new onest, accelerating, occurs at rest

Question 9

congestive heart failure ss/px/pom

Answer 9

ss- when heart doesnt pump as well as it should due to narrow coronary vessels or HBP. SOB, swelling/edema in legs, increased need to urinate

px- fluid edema, enlarged heart

pom- ace inhibitors, beta blockers, diuretics

Question 10

Myocardial infarction ss/px/pom

Answer 10

ss- pressure, tightness, aching in chest or arms that may spread to neck, unstable angina + cardiac enzymes

px- ECG, Blood markers (cardiac troponin, creatine kinase, myoglobin)

Question 11

Pericarditis- ss, px,

Answer 11

ss- sharp chest pain, that may spread to left shoulder and neck, gets worse w coughing, laying down (sitting up feels better)

px- pericardial friction rub on auscultation, enlarged heart shadow

Question 12

acute vs congestive pericarditis

Answer 12

acute= chest pain + pericardial friction rub + ecg changes, improved by sitting up+ leaning forward

congestive- fibroses, thickened pericardium, fatigue, palpations, increased JVP

Question 13

pulmonary embolism- ss/px/pom

Answer 13

ss- SOB, chest pain, cough, in addition to leg pain. Excessive sweating, blue nails/lips

px- blood tests show high levels of D Dimer

Question 14

Endocarditis-ss, px

Answer 14

ss- due to bac/fungi. aching joints/muscles/chest pain w deep inhalation, fatigue, new or changed heart murmur

px- blood culture, CBC

Question 15

Signs of infective endocarditis (4)

Answer 15

1. Splinter hemorrhage
2. Janewy lesion (hemorrhagic macules located on the palms, soles, thenar and hypothenar eminences of the hands)
3. Osler nodes
4. Roths spots (white centered retinal hemorrhage)

Question 16

myocarditis ss, px

Answer 16

ss- contitutional symptoms, acute CHF, chest pain, arrhythmias

px- ECG, Increased CK, troponin

Question 17

Hypertrophic cardiomyopathy (what’s it the mc cause of death in)- which heart sound will you hear

Answer 17

mc of sudden cardiac death in young athlete (genetic defect)

ss- usually asymptomatic, SOB, angina

px- S4 gallop ECG