Chest Pain

Question 1

What are the differentials for chest pain?

Answer 1

• Cardiac: MI, pericarditis, aortic stenosis
• GI: gastritis/ulcer secondary to naproxen, GI bleed, GORD, oesophageal malignancy, pancreatitis, biliary colic
• Respiratory: PE, pleurisy, pneumonia, lung cancer
• MSK: muscular, shingles, costochondritis, aortic stenosis, statins
• Vascular: dissecting aneurysm

Question 2

What are the risk factors for a gastric/peptic ulcer?

Answer 2

• Alcohol
• NSAIDs (especially with SSRI)
• If a patent has history of peptic ulcers, then NSAIDs and ibuprofen should be warned against. They should speak to a medical professional before taking these.

Question 3

What is anchoring bias?

Answer 3

A form of bias where an individual depends too heavily on an initial piece of information. For example, when patients are repetitively clerked in hospital we often refer to the initial diagnosis without questioning and checking.

Question 4

What is cognitive bias?

Answer 4

An error in thinking, reasoning or evaluating which in medicine can lead to the wrong diagnosis for a patient. We make errors more than we think - incorrect diagnoses happen in 10-15% of cases.

Question 5

What is availability bias?

Answer 5

The tendency to let an example that comes to mind easily (because you have recently seen or been taught about it, or you had a particularly vivid experience of the case) affect your decision making or reasoning.

Question 6

What are the side effects of ferrous sulphate (iron) tablets?

Answer 6

• Nausea
• Abdominal pain/cramps
• Constipation
• Diarrhoea
• Darkened stools

Question 7

Where would pain radiate in pancreatitis?

Answer 7

• Through to the back

- Starts central and radiates to the epigastrium

Question 8

What are symptoms of an upper GI bleed?

Answer 8

• Black stool
• Haematemesis
• Presyncope/syncope
• Epigastric pain

Question 9

What are the signs and symptoms of MI?

Answer 9

• Central chest
• Sudden onset
• Crushing, tight, heavy
• Radiate to neck/jaw/arms/back
• Associated factors: pain on effort (physical, emotional, cold wind, meals)
• Time: continuous pain >15 minutes
• Exacerbating / relieving factors: associated nausea, vomiting, SOB, sweatiness
• Severity: severe; not relieved by rest or GTN

Question 10

What are the signs and symptoms of pancreatitis?

Answer 10

• Epigastric pain/LUQ
• Sudden onset
• Severe, dull pain
• May radiate to back and L shoulder
• Associated nausea or vomiting, diarrhoea, fever
• Time: constant
• Exacerbating/relieving factors: eating or drinking may make worse, curling into a ball may help relieve pain
• Severity: severe

Question 11

What are the signs and symptoms of gastric erosions?

Answer 11

• Epigastric pain though can be retrosternal