Chest Pain

Question 1

A patient comes to the ER with CP, what are the orders that need to be completed?

Answer 1

12-lead ECG

CBC

CXR

Troponins and CK-MB

Question 2

A patient’s CP is referred to the skin. What are some common causes of the CP related to the skin?

Answer 2

• lacerations
• bites
• stings
• herpes zoster

Question 3

A patient’s CP is determined to be SubQ. What are two common causes of the CP?

Answer 3

• cellulitis

- abscess

Question 4

A patient comes in with CP that is specifically tender upon palpation. What are some common causes of the CP?

Answer 4

• strains
• sprains
• costochondritis

Question 5

A patient comes in to the ER with CP and it is found to be related to the pleura. What are some common causes of this CP?

Answer 5

• Pneumothorax
• PNA
• PE
• Pulm Cancer
• Pleurisy
• Pleural Effusion

Question 6

How can you determine that a patient with CP is caused by something wrong with the pleural cavity?

Answer 6

A deep exhale makes the pain worse. This would cause irritation of the pleural cavity.

Question 7

If the patient comes to the ER with CP and you notice that the patient does better when lying forward, what would be your top dx on your differential?

Answer 7

Pericarditis

Question 8

If the heart is the source of the patient’s CP, what are your top two dx?

Answer 8

• MI

- Myositis

Question 9

A patient is having CP but the troponins were normal and there was no change in CK-MB, which organ would you want to check out next?

Answer 9

esophagus

Question 10

If the esophagus is causing CP in a patient, what causes may you consider?

Answer 10

• GERD
• Esophagitis
• Perforation

Question 11

You can rule out esophagus causes of CP in a patient by?

Answer 11

Giving them a GI cocktail that contains lidocaine. If the pain improves with it, then the pain was related to the esophagus as the lidocaine would have touched only the esophagus when being swallowed by the patient.

Question 12

Although it may be rare, the trachea can cause CP. What are your top two dx?

Answer 12

• tracheitis

- perforation of the trachea

Question 13

If the CP of the patient is determined to be the aorta, what are the top two dx on your differential?

Answer 13

• Aortic dissection

- Aortic aneurysm

Question 14

On physical exam with a patient with CP, what should you check in each arm?

Answer 14

Blood pressure- could be very useful in dx