Chest Pain

Question 1

Name the mimics of myocardial ischemia pain

PPD and 4 little e’s

Answer 1

Pericarditis
Pulmonary emboli
Dissection of the aorta

mediastinal Emphysema
Esophageal rupture
Esophageal spasm
Esophageal reflux

Question 2

Name the cause of chest pain:

radiates to arms/sides of neck/mandible/interscapular

Answer 2

Myocardial ischemic pain

Question 3

Name the cause of chest pain:

may radiate to left trapezius ridge

Answer 3

Pericarditis

Question 4

T/F: Myocardial ischemic pain can be duplicated by movement of joint or muscles and tender to palpation

Answer 4

False. Not duplicated

NOT tender to palpation

Question 5

In pericarditis, pain (increases/decreases) when lying down or with deep inspiration and pain (increases/decreases) when seated/leaning forward.

Answer 5

increases

decreases

Question 6

Pericardial rub is seen in ___

Answer 6

pericarditis

Question 7

T/F: A large, central pulmonary emboli has clear lung fields upon physical exam.

Answer 7

True

Question 8

T/F: A smaller, peripheral pulmonary emboli has pleural rub upon physical exam.

Answer 8

True

Question 9

Which of the following is FALSE about smaller, peripheral pulmonary emboli?
A. pain usually increases or felt solely on expiration
B. associated with dyspnea, hemoptysis, leg edema/pain
C. pleural rub
D. sharper pain located peripherally over lung fields

Answer 9

A. solely on inspiration

Question 10

The lower it radiates down the back the more likely it is a ____

Answer 10

dissection of aorta

Question 11

Unequal pulses / BP (>20 mmHg BP difference R vs. L) and widened aorta or mediastinal shadow on CXR seen in ____

Answer 11

dissection of aorta

Question 12

Name the disease:

“crunch like feeling” on supraclavicular palpation that is synchronous with heartbeat

Answer 12

Mediastinal Emphysema

Question 13

Name the disease:

similar to pericardial pain but no radiation to trapezius

Answer 13

Mediastinal Emphysema

Question 14

Name the disease:

almost always preceded by marked vomiting

Answer 14

Esophageal rupture

Question 15

Name the disease:

sometimes triggered by swallowing large chunks of solid food or very cold liquids or anxiety

Answer 15

Esophageal spasm

Question 16

Which of the following is NOT a characteristic about Esophageal reflux?
A. associated with sour taste in mouth/throat
B. upper substernal burning that may radiate lower in the sternum
C. may be precipitated by lying down or bending over

Answer 16

B. lower substernal burning that may radiate higher in the sternum

Question 17

T/F: Presence or absence of a hiatal hernia is of valuable in differentiating one chest pain from another

Answer 17

False. No value in differentiating