Chest Pain

Question 1

Sources of chest pain in respiratory

Answer 1

Parietal pleura
Chest wall
Mediastinal structure

Question 2

Why no pain in visceral pleura

Answer 2

No specific nociceptors

Question 3

Cause of inspiratory pain

Answer 3

Stretching of pleura

Question 4

Mechanism of pain in pah

Answer 4

Rv strain and ischemia
Stretching of pulmonary artery
Compresses left coronary artery

Question 5

Mechanism of pain in pte

Answer 5

Infarction

Question 6

Cutaneous pain is seen in

Answer 6

Peripheral diaphragm and costal margins - innervated by intercostal nerves

Question 7

Chest wall pain characteristics

Answer 7

History of #
Change in posture
Tenderness
Flexing

Question 8

Character of pain in pah

Answer 8

Substernal
Om exertion
Dyspnoea

Question 9

Pain and symptoms in embolism

Answer 9

Retrosternal
Central cyanosis
Sinus tachy/af
Hypotension with elevated jvp

Question 10

Cvs chest pain
Angina
Pericarditis
Aortic dissection

Answer 10

Angina- constriction around chest, heaviness , retrosternal , radiation
Pericarditis- throbbing /sharp
Increased on movt
Relieve ib bending foward, analgeics
Ad: inter scapular , sudden 
Ripping , tearing , stabbing

Question 11

Pain in gastro
Character , position,
Gall stones

Answer 11

Buring , retrosternal
Pain in recumbent
Gall stones - lower chest / shoulder
Post prandial chest pain , radiation tk back or abdomen and nausea

Question 12

Character of pleuritic pain

Answer 12

Stabbing throbbing

Question 13

Radiation of pain in outer diaphragm

Answer 13

Abdomen

Question 14

Chest pain plus breathlessness

Answer 14

Pah
Embolism.- peripheral- parietal
Mi
Pneumo

Question 15

Hemoptysis plus chestpain

Answer 15

Embolism
Ca- infiltrates pleural and cw
Lvf - hemoptysis
Trauma
Dissecting aneurysm

Question 16

Chest pain plus fever

Answer 16

Inflammatory process
Tb
Abcess 
Pneumonia
Cw infection
Subdiaphragmatic abcess
Liver abcess

Question 17

Chest pain plus palpitation

Answer 17

Mi
Pe
Pah

Question 18

Cyanosis plus chest pain

Answer 18

Mi
Pte
Pneumo

Question 19

What is pulsus paradoxus

Answer 19

Fall if sbp more than 8 during inspiration

Tamponade , severe constrictive Pericarditis, massive embolism

Question 20

Chest pain with enlarged, non pulsatile neck vein

Answer 20

Mediastinal tumor causing compression , svc syndrome

Question 21

One side restriction with pain

Answer 21

Pneumo , lung mass infiltrating cw

Question 22

Friction fremitus ass with chest pain

Answer 22

Pleurisy. Infarct

Question 23

Investigations in chest pain

Answer 23

Xray- pneumo / other 
Ecg- pte- right axis deviation 
Pericarditis- depression/elevation of st segments 
Blood- lipd , enzymes,  basic
Ct- embolism 
Echo
D dimer

Question 24

Socrates

Answer 24

Site
Onset
Character 
Radiation 
Ass symptoms 
Timing
Exacerbation/ relieving factor
Severity

Question 25

Ass symptoms in chest pain

Answer 25

N /v/ sweating
Resp
Gerd
Cough

Question 26

Timing

Answer 26

Stable - 2-10 in
Unstable- 10-20 m8n
Mi more than 30 min

Question 27

Canadian grading of chest pain

Answer 27

Grade 4:at rest
3: on less than normal physical activity
2- normal physical activity
1- angina on severe exertion

Question 28

Auto splinting

Answer 28

Patient catches his own chest

Question 29

Levines sign

Levines maneuver

Answer 29

Fist in heart

Carotid sinus massage relieves pain

Question 30

Aggravating factor 3e

Relieving

Answer 30

Eating
Exercuse
Emotion

Drugs- ppi. Nitrates
Posture - Pericarditis on bending down