Chest Pain

Question 1

Name the chest pain ddx:

Substernal chest pressure post exercise/stress
N/V, SOB, diaphoresis
Relieved by rest/nitroglycerin

Answer 1

Stable angina

Question 2

Stable angina workup and tx

Answer 2

ECG during episodes, treadmill stress test

Beta blockers

Question 3

Name the chest pain ddx:

Chest pain
Hx fever, dyspnea
Murmur, friction rub

Answer 3

Myocarditis

Question 4

Myocarditis workup/tx

Answer 4

ECG, echocardiogram

Beta blockers/ACEi

Question 5

Name the chest pain ddx:

Sharp, stabbing pain referring to left shoulder or trapezius ridge
Worse during coughing/deep breathing
Relieved by sitting forward
Hx infection, AI disease
Fever before onset of pain
Tachycardia
Pericardial friction rub

Answer 5

Pericarditis

Question 6

Pericarditis workup/tx

Answer 6

CBC, ESR, ECG, echocardiogram

NSAIDS
Colchicine
Anti-inflammatory diet

Question 7

Name the chest pain ddx:

Productive cough of yellow, green, rust sputum
Dyspnea
Pleuritic chest pain
Fever
Tachycardia, tachypnea
Inspiratory crackles
Vocal fremitis

Answer 7

Pnemonia

Question 8

Pnemonia workup/tx

Answer 8

Chest radiograph, sputum cultures

Antibiotics
Lots of fluids

Question 9

Name the chest pain ddx:

Mild, localized chest pain
Worse with deep breathing
Recent URI
Shallow respirations, pleural friction rub

Answer 9

Pleuritis

Question 10

Pleuritis workup/tx

Answer 10

Chest radiograph

NSAIDs

Question 11

Name the chest pain ddx:

Substernal pain worse after eating and lying down
Sour taste in mouth
Epigastric pain with palpation

Answer 11

Esophagitis

Question 12

Esophagitis tx

Answer 12

Antacids
Bland diet, avoiding alcohol

Question 13

Name the chest pain ddx:

Pain along eternal border inc with deep breaths
Hx exercise, URI
Pain with palpation

Answer 13

Costochondritis

Question 14

Costochondritis tx

Answer 14

NSAIDs
Physical Therapy
Anti-inflammatory diet/herbs

Question 15

Name the chest pain ddx:

Epigastric pain 1-2 hours after eating, better antacids
Hemetemesis and Melena
Smoker/alcohol overuser
Tenderness to palpation in epigastric area
Signs of hypovolemia

Answer 15

Peptic ulcer disease

Question 16

Peptic ulcer disease workup/tx

Answer 16

Upper GI radiograph, upper endoscopy, CBC

Antacids, proton pump inhibitors
Stress management
Stop smoking/drinking

Question 17

Name the chest pain ddx:

Chest pain, SOB, cough, hemoptysis
Hx smoking, pneuomnia

Answer 17

Lung tumor

Question 18

Name the chest pain ddx:

Severe acute onset chest pain
Stabbing, paroxysmal, pleuritic pain over lower rib cage and Substernal edge
Headache, malaise, nonproductive cough
Pleural friction rub

Answer 18

Pleurodynia

Question 19

Name the chest pain ddx:

Sudden sharp, non distressing pain near heart apex

Answer 19

Precordial catch syndrome