Chest Pain

Question 1

Abrupt severe pain that radiates between scapulae. Tearing, ripping pain. Most likely diagnosis:

Answer 1

aortic dissection

Question 2

Abrupt severe pain that radiates between scapulae. Tearing, ripping pain. Diagnostic test of choice:

Answer 2

CT Scan

Question 3

Abrupt severe pain that radiates between scapulae. Tearing, ripping pain. Initial treatment:

Answer 3

antihypertensives (esmolol), vasodilators, rapid referral to vascular surgeon

Question 4

dyspnea unexplained by pulmonary findings, ECG changes, chest Ian with pleuritic features, syncope possible, tachycardia, tachypnea, lowered pulse ox reading, mild fever, wheezing. Most likely diagnosis:

Answer 4

pulmonary embolism

Question 5

dyspnea unexplained by pulmonary findings, ECG changes, chest Ian with pleuritic features, syncope possible, tachycardia, tachypnea, lowered pulse ox reading, mild fever, wheezing. Diagnostic test:

Answer 5

Wells criteria: (+1 pt each)
- Active cancer
- Bedridden recently >3 days or major surgery within 12 weeks
- Calf swelling >3 cm compared to the other leg
- Collateral (nonvaricose) superficial veins present
- Entire leg swollen
- Localized tenderness along the deep venous system
- Pitting edema, confined to symptomatic leg
- Paralysis, paresis, or recent plaster immobilization of the lower extremity
- Previously documented DVT
- Alternative diagnosis to DVT as likely or more likely (-2 pts)

Question 6

dyspnea unexplained by pulmonary findings, ECG changes, chest Ian with pleuritic features, syncope possible, tachycardia, tachypnea, lowered pulse ox reading, mild fever, wheezing. Treatment?

Answer 6

O2 therapy, anticoagulation, analgesia. Avoid NSAIDs

Question 7

What leads show an inferior MI?

Answer 7

II, III, aVF

Question 8

What leads show a lateral MI?

Answer 8

I, aVL

Question 9

What leads show a septal MI?

Answer 9

V1, V2

Question 10

What leads shoe an anterior MI?

Answer 10

V3, V4

Question 11

Nitroglycerin is contraindicated in which type of MI?

Answer 11

anterolateral wall

Question 12

New LBBB in the setting of chest pain or acute MI warrants ____.

Answer 12

thrombolysis

Question 13

Pleuritic chest pain, dry cough, diffuse ST elevations, recent MI. Most likely diagnosis?

Answer 13

Dressler syndrome

Question 14

Pleuritic chest pain, dry cough, diffuse ST elevations, recent MI. Treatment?

Answer 14

NSAIDs

Question 15

Respiratory distress, tripod position, sore throat, drooling, muffled voice, toxic appearance, restless. What is the most common diagnosis?

Answer 15

Epiglottitis

Question 16

Respiratory distress, tripod position, sore throat, drooling, muffled voice, toxic appearance, restless. How do you treat?

Answer 16

Third gen cephalosporin (cefotaxime, ceftriazoxone) or beta lactase inhibitor (augmentin)

Question 17

What causes epiglottis?

Answer 17

H flu type B

Question 18

What causes croup?

Answer 18

Parainfluenza virus, RSV, adenovirus, influenza

Question 19

rhinitis, low grade fever, sore throat, seal-like barking cough worse at night, hoarseness, inspiratory stridor. Most likely diagnosis?

Answer 19

Croup

Question 20

X ray of someone with croup may show____.

Answer 20

steeple sign

Question 21

rhinitis, low grade fever, sore throat, seal-like barking cough worse at night, hoarseness, inspiratory stridor. How do you treat?

Answer 21

dexmethasone, nebulized racemic epinephrine as needed