chest pain

Question 1

Acute, potentially life-threatening condition that warrants urgent evaluation and management

Answer 1

Unstable ischemic heart disease, aortic dissection, pneumothorax, pulmonary embolism

Question 2

chronic condition likely to lead serious complications?

Answer 2

Stable angina, aortic stenosis, pulmonary hypertension

Question 3

due to an acute condition that warrants specific treatment

Answer 3

pericarditis, pneumonia/pleuritis, herpes zoster

Question 4

another treatable chronic condition

Answer 4

Esophageal reflux, esophageal spasm, PUD, Gallbladder disease, other GI conditions, cervical disk disease, arthritis of the shoulder or spine, costochronditis, anxiety, other musculoskeleteal disorders

Question 5

Cardiovascular risk actors

Answer 5

hypertension, DM, dyslipidemia

Question 6

marfan syndrome

Answer 6

Acute aortic syndrome, spontaneous pneumothorax

Question 7

Thrombotic risk factors

Answer 7

Malignancy, thrombophilia, recent surgery

Question 8

significant tachycardia and hypotension are indicative of:

Answer 8

Acute MI with cardiogenic shock, massive pulmonary embolism, pericarditis with tamponade, tension pneumothorax

Question 9

tachycardia may be the only significant finding

Answer 9

Submassive pulmonary embolism

Question 10

Pulmonary exam:

Pulmonary edema

Answer 10

Left ventricular dysfunction
Acute valvular complications of MI
Aortic dissection

Question 11

useful in checking for right-sided heartfailure

Answer 11

jugular venous pulse

-normal in px wit AMI but may reveal characteristic patterns with: Pericardial tamponade, acute right ventricular dysfunctions

Question 12

mechanical complications of STEMI

Answer 12

mitral regurgitation or ventricular septal defect

Question 13

complication of proximal aortic dissection

Answer 13

murmur of aortic insufficiency

Question 14

tenderness in epigastric area

Answer 14

acute pancreatitis

Question 15

tenderness in right upper quadrant

Answer 15

right ventricular dysfunction due to hepatic congestion

Question 16

pulse deficits

Answer 16

chronic atherosclerosis– coronary artery disease

Question 17

loss of the pulse and pallor

Answer 17

acute limb ischemia– aortic dissection

Question 18

unilateral lower extremity swelling

Answer 18

venous thromboembolism

Question 19

sensory deficits

Answer 19

cervical disk diseases

Question 20

precipitated by an imbalance between myocardial oxygen and supply

Answer 20

myocardial ischemia/injury

Question 21

may be elevated by increases in heart rate, ventricular wall stress and myocardial contractility

Answer 21

myocardial oxygen consumption

Question 22

is determined by coronary blood flow and coronary arterial oxygen content

Answer 22

myocardial oxygen supply

Question 23

cardiac vagal afferent fibers synapse in the nucleus tractus solitarius of the medulla and then descend to the ________, and this route may contribute to anginal pain experienced in the neck and jaw

Answer 23

upper cervical spinothalamic tract

Question 24

caused by atheromatous plaque

Answer 24

Ischemic heart disease

Question 25

results from the gradual atherosclerotic narrowing of the coronary arteries

Answer 25

stable angina

Question 26

occurs when rupture or erosion of one or more atherosclerotic lesion triggers coronary thrombosis

Answer 26

unstable ischemic heart disease -classified clinically by the presence or absence of detectable myocardial injury and the presence or absence of ST-segment elevation

Question 27

marked by ischemic symptoms at rest, with minimal activity, or in an accelerating pattern

Answer 27

Acute coronary atherothrombosis

Question 28

when there is evidence myocardial necrosis with or without ST abnormalities. Increase in troponin level

Answer 28

NSTEMI

Question 29

overlapping sensory supply of central diaphragm with somatic sensory fibers from the 3rd to 5th cervical segments

Answer 29

neck and shoulder pain

Question 30

involves a tear in the aortic intima

Answer 30

acute aortic dissection

Question 31

severe, sudden in onset, and sometimes described as "tearing" in quality

Answer 31

acute aortic syndrome

Question 32

pain in the midline of the anterior chest

Answer 32

ascending aorta

Question 33

pain in the back

Answer 33

descending aortic syndromes

Question 34

compromise of the aortic ostia of the coronary arteries

Answer 34

MI

Question 35

disruption of the aortic valve

Answer 35

acute aortic insufficiency

Question 36

rupture of the hematoma in the pericardial space

Answer 36

pericardial tamponade

Question 37

scoring system that tell us the probability that the pain may be due to pulmonary embolism

Answer 37

modified well criteria low probability--> request for d dimer moderate to high probability--> CT angiogram

Question 38

intense squeezing retrosternal, may be relieved by ntroglycerin or Ca blocker (mimics pain of angina)

Answer 38

Esophageal spasm

Question 39

GERD and esophageal dysmotility

Answer 39

burning

Question 40

pain in dermatomal area

Answer 40

herpes zoster

Question 41

HR is more than 100. It can also lead to rightward shift of the ECG axis, the McGinn-white sign, there is a deep S-wave in the lead 1, Q wave in lead 3, and T wave inversion in a lead 3

Answer 41

pulmonary embolism

Question 42

most useful for identifying pulmonary processes, such as pneumonia or pneumothorax

Answer 42

chest radiography

Question 43

a widened mediastinum is observed

Answer 43

Acute aortic dissection

Question 44

A wedge-shaped pleural based infiltrate that's ocassionally seen with PE

Answer 44

Humpton's hump

Question 45

Enlarged right descending pulmonary artery

Answer 45

Palla's sign

Question 46

calcifications on the pericardial sac on chest xray

Answer 46

Pericarditis

Question 47

useful when considered in conjunction with the clinical history and examination for the diagnosis of heart failure

Answer 47

B-type natriuretic peptide