Chest Pain

Question 1

What are 5 pulmonary DD in a patient that presents with chest pain?

Answer 1

pneumothorax; hemothorax; Pulmonary embolism; pleuritic CPX; pneumonia

Question 2

What are 2 psychogenic DD in a patient that presents with chest pain?

Answer 2

anxiety; anxiety attack

Question 3

What are 4 musculoskeletal DD in a patient that presents with chest pain?

Answer 3

Pulled muscle; costochondritis; herpes zoster; sepsis

Question 4

What are 6 GI DD in a patient that presents with chest pain?

Answer 4

GI bleed; esophageal rupture; biliary cholangitis; obstructed bowel; GERD

Question 5

What three cardiac conditions fall under Acute coronary syndrome?

Answer 5

STEMI; NSTEMI: Unstable angina

Question 6

A patient presenting to the ED with chest pain should have an ECG within _____ of arrival to rule out what as your first differential diagnosis?

Answer 6

10 minutes
Rule out ACS

Question 7

What are the cardiac DD of a patient presenting with chest pain?

Answer 7

Ask me to define each :)
- Cardiac tamponade: increase in pressure around heart and the body cant get enough blood bc heart can expand and pump (caused by pericardial effusion)

• MI: heart attack; blood vessels that supply blood to heart tissue are blocked & heart muscle dies
• Pericardial effusion: fluid filling pericardial sac
• Stable Angina: heart doesn’t get enough O2; usually brought on by exertion

-Aortic dissection: tear of the inner lining of the aorta

Aortic rupture: tear through all layers of aorta; super deadly

Question 8

What labs should be drawn in a PT reporting chest pain?

Answer 8

CBC
BNP
BMP
Blood gas
Troponin
Tox/drug screen
D-dimer

Question 9

A 52y/o male presents to the ED with sudden onset chest pain, nausea, vomiting, SOB. His skin is cool and clammy and he states a 30 year HX of smoking. What is the likely dx and tx of this pT?

Answer 9

myocardial infarction
#1 get cardiac catheterization to revascularize the heart tissue
Administer chewable aspirin, O2

Question 10

If you are working in a hospital without a cath lab to revascularize a PT with an MI, what can you do in the mean time to help this PT?

Answer 10

give thrombolytics

Question 11

What is an indication for percutaneous coronary intervention?

Answer 11

in a case of ACS to open the blood vessel

Question 12

What is a thrombectomy?

Answer 12

the direct removal of a clot via mechanical catheter and US

Question 13

what is percutaneous coronary intervention?

Answer 13

use of a guided catheter to balloon and open an artery and possibly place a stent

Question 14

What is thrombolytic therapy?

Answer 14

also called thrombolysis; drug administered via IV or catheter to dissolve a blood clot

Question 15

What are the indications for administering thrombolytic therapy?

Answer 15

In a case of ACS, ischemic stroke, or any type of clot
(also if you don’t have a cath lab)

Question 16

What are the contraindications to administering thrombolytic therapy?

Answer 16

Active bleed;
recent brain hemorrhage;
malignant brain cancer;
severe HTN;
recent brain/spinal surgery;
TBI;
severe kidney disease;
aortic dissection

Question 17

What is the definition of hypertensive urgency?

Answer 17

Acute BP elevation without end organ damage
Systolic BP >160-180 -OR-
Diastolic BP >100-120

Question 18

What is the definition of hypertensive emergency?

Answer 18

Acutely elevated BP with end organ damage
Systolic BP >180 -OR-
Diastolic BP >120

Question 19

What is the treatment for hypertensive urgency?

Answer 19

Put on BP meds and send home

Question 20

What is the treatment for hypertensive emergency?

Answer 20

Admit to hospital and give IV BP meds

Question 21

A patient presents to the ED with gnawing epigastric pain, epigastric tenderness, and upon exam you feel an ABD aortic pulse and hear midline bruit. What is the DX & TX?

Answer 21

abdominal aortic aneurysm
Send to vascular surgery

Question 22

A patient presents to the ED with a complaint of acute onset chest pain that feels dull, & achy. They report trouble with their vision and a headache since the onset of the chest pain. The patient appears ill during the exam, has a 25 year smoking hx, and has a BMI of 33. What is the likely DX, what will you see on chest x-ray?

Answer 22

Aortic dissection
widening mediastina

Question 23

Aortic aneurysms have two types, A & B, how are these types classified and what is the treatment for each of them?

Answer 23

A: tear in ascending aorta: tx by sending to surgery now

B: tear in descending aorta; tx with BP control with beta blocker, Nitroprusside (vasodilator), pain management

Question 24

A patient presents to the ED with a complaint of chest px that’s worse when lying down and relieved when they sit up. The patients vitals are normal. What is the likely DX, what will you hear with your stethoscope, and what is the tx?

Answer 24

pericarditis
hear friction rub from irritated tissue
NSAIDS for pain - usueally goes away on own

Question 25

Chest PX DD: Chest pain, weakness, nausea, and fatigue, ill appearing PT with rales?

Answer 25

ACS

Question 26

Chest PX DD: Pleuritic chest pain, SOB, Tachycardia, clear lungs, unilateral leg swelling?

Answer 26

Pulmonary embolism

Question 27

Chest px DD: Sudden onset severe ripping pain to back with paresthesia or paralysis, unequal bp, weak pulses?

Answer 27

Aortic dissection

Question 28

Chest px DD: Sudden onset severe unilateral pleuritic chest pain, Hypotension, unequal breath sounds, tracheal deviation?

Answer 28

tension pneumothorax

Question 29

Chest px DD: Intense substernal chest pain after vomiting or endoscopic procedure & a crackle sound heard or felt in time w/ heart beat

Answer 29

Esophageal rupture