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POM unit 4 > chest pain > Flashcards

chest pain Flashcards

1
Q

somatic pain character

A

sharp or hot sensation that is well localized

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2
Q

visceral pain character

A

difficult to describe sensations that are poorly localized and oftren sensed remote from the source

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3
Q

specific test

A

positive in disease and few false positives

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4
Q

sensitive test

A

negative in health and few false negatives

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5
Q

five things to always ask when confronted with chest pain

A

nature, aggravating or alleviating factors, radiating pain, tome course, location

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6
Q

other things to always ask about chest pain?

A

fever, cough, dyspnea (exertional or night time), extremity or trunk pain

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7
Q

aortic disease that causes chest pain

A

aneurysms (thoracic, abdominal), dissecting aneurysms, traumatic rupture, intramural hematoma, aortic ulcer

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8
Q

what is the etiology of aortic dissection?

A

HTN, connective tissue disease, pregnancy, congenital cardiac abnormalities, aortic ulcers and crypts.

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9
Q

how does dissection present most commonly?

A

DIVERSE! sharp chest pain radiating to the back (85%).

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10
Q

other presentations of dissection

A

pain in back only, pain that moves, may radiate to the neck and jaw, arms or lumbar area. syncope (10-12%). end-organ ischemia. neurological defects are common

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11
Q

dissection on exam?

A

pulse defects (20%), aortic insufficiency, tamponade, altered mental status, hemiplegia/paraplegia, horner’s syndrome.

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12
Q

is a chest XR abnormal in dissection?

A

yes, commonly 87% but in nonspecific manner.

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13
Q

what does the CXR show on dissection

A

mediastinal widening, bulging aortic contour, pleural effusions, intimal calcium sign

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14
Q

EKG useful in dissection?

A

yes to R/O other causes

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15
Q

what are sensitive and specific tests for dissection

A

CT, angiogram, TEE

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16
Q

pleural diseases that cause chest pain?

A

spontaneous pneumo, pleural effusions, pleurisy

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17
Q

how is the pleura innervated?

A

somatically

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18
Q

what is normal intrapleural pressure?

A

-4 to -12

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19
Q

what does the lung normally do>

A

it recoils away from the chest wall and the intrapleural fluid keeps the lung inflated

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20
Q

what do most pneumo patients have?

A

a bleb. wall tension increases with radius

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21
Q

what does spontaneous pneumothorax imply?

A

primary, nontraumatic event

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22
Q

what does tension pneumo imply?

A

increased intrapleural pressure above the central venous pressure

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23
Q

which pneumo patients are asym?

A

many. but especially COPD patients/

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24
Q

which pneumo patients have a high mortality?

A

COPD 16%

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25
Q

who does spontaneous pneumo afflict most often?

A

tall, thin, males.

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26
Q

what is associated with pneumo

A

smoking, marfans, alpha-1 antitrypsin deficiency and changes in atmospheric pressure

27
Q

tension pneumo

A

a defect in the pleural barrier acts as a ball valve that accumulates pressure

28
Q

what happens if the pressure of tension exceeds central venous pressure?

A

decreased venous return and hypotension

29
Q

how does tension pneumo present?

A

subcut air, tracheal deviation, shock, EMD.

30
Q

how does pneumo present?

A

chest pain which is pleuritic, course is often subacute, mild dyspnea, decreased breath sounds unilaterally, tympanic hemithorax, absent tactile fremitis, hamman’s crunch

31
Q

how does a pleural effusion present

A

asymp, chest pain, dyspnea, decreased breath sounds, dullness to percussion, large effusions may show signs of mediastinal shift

32
Q

how much fluid from a pleural effusion is necessary to see before costphrenic angle is blunted on CXR?

A

500cc, 200cc on lateral film

33
Q

what organisms most likely cause empyema?

A

staph, strep and gram -

34
Q

when does empyema occur?

A

after pneumonia, lung infarction, resection, or abdominal infection

35
Q

how do we treat empyema?

A

drainage and antibiotics

36
Q

pericarditis presents how?

A

positional pain, always has some myocarditis, with the four stages of ECG progression.

37
Q

what can cause pericarditis?

A

viral, rheumatological, traumatic, post MI

38
Q

pneumomediastinum presents how?

A

air comes from the esophagus, trachea, bronchi, neck or abdomen and dissects along vascular or bronchial planes centrally. hammans sign. rarely causes compression and impairment of venous return

39
Q

PE risk factors

A

trauma, immobilization, cancer, surgery, BCP. well’s criteria

40
Q

well’s criteria score

A

> 6 high prob. <2 low prob.

41
Q

ischemic heart disease includes what for chest pain?

A

myocardial infarction, angina pectoris, heart failure.

42
Q

how sensitive is am H&P and EKG?

how about with serum marker

A

96%, 98%

43
Q

what percent of all infarcts are silent?

A

25-33%

44
Q

what is the first step in MI?

A

usually an atheroma ruptures and inflammation and acute clotting occurs. oxygen delivery is disrupted.

45
Q

what happens after the O2 delivery is disrupted to myocardium?

A

it becomes ischemia and then infarcted. contractility decreases.

46
Q

what is more likely in infarcted areas?

A

dysrhythmia and disorders of automaticity

47
Q

what can cause nonatheromatous MI?

A

arteritis, syphilis, amyloidosis, congenital anomalies of the heart, toxins, and emboli

48
Q

what is mandatory on the physical exam

A

heart, lung ands vascular exams

49
Q

ST elevation is characteristic of what?

A

injury

50
Q

ST depression is characteristic of what?

A

reciprocal change, or nonspecific.

51
Q

Q wave means what?

A

infarction!

52
Q

abnormal myocardium is what?

A

more positive at the end of depolarization than normal

53
Q

what percentage of AMI have ST elevations?

A

30-50%. 1-4% have normal EKG

54
Q

how fast must the initial EKG be taken and interpreted?

A

10 minutes.

55
Q

ST segment elevation without MI?

A

early depolarization, LVH, pericarditis/myocarditis, hypothermia, LV aneurysms,

56
Q

what percentage of STEMI codes have non-actionable coronary?

A

23%

57
Q

St depression without ischemia?

A

hypokalemia, digoxin effect, for pulmonale, LVH. IVCD/paced.

58
Q

what is cor pulmonale?

A

right ventricular hypertrophy and failure due to pulmonary HTN

59
Q

T wave inversions without ischemia

A

peds EKGs, IVCD/paced, intracranial pathology, cor, etc

60
Q

markers of MI?

A

CK/MB, troponin, myoglobin, myosin, inflammatory (only of intellectual interest), BNP in response to atrial stress?

61
Q

how long is the peak and duration of CK/MB?

A

P: 18-24 hrs duration: 2 days

62
Q

how long is the peak and duration of troponin I ?

A

P: 18 hrs. duration: 10 days

63
Q

ECG pericarditis

A

stage 1: widespread ST elevation, 2: ST normalization, with T wave flattening, 3: T waves invert, 4: resolution over several weeks

POM unit 4 (5 decks)

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