Chest Pain Flashcards
A 67-year-old male with Marfan’s syndrome presents with sudden onset of tearing chest pain. He is sweating and has a feeling of “impending doom.” On examination, his BP is 100/60 and his left radial pulse is weaker than the right. Chest x-ray shows a widening of the superior mediastinum.
Dissecting thoracic aorta
A 36-year-old female presents with sudden onset of shortness of breath, sticking right-sided chest pain and hemoptysis shortly after arriving at the airport from an 8-hour flight from Alaska. She has been on the contraceptive pill for the past ten years. On examination, her left leg is warm and swollen. D-diner test is positive. Spiral CT scan shows a clot in one of the branches of the right pulmonary artery. Venogram of her left leg shows a large clot in her left popliteal vein.
Pulmonary embolism
A 56-year-old overweight male smoker presents with episodes of squeezing precordial chest pain whenever he is angry. There is no family history of heart disease, but his father died at age 73 from a stroke. On examination, there are bilateral diagonal ear lobe creases. BP is 180/110. ECG shows depressed ST segments during a stress ECG test, but his Troponin I and CK-MB levels are normal.
Angina pectoris with HTN
A 59-year-old female presents with pleuritic chest pain for the past three days and a rash along the right side of the chest since yesterday. On examination, there is a vesiculopustular rash along the T5 dermatome. No tests were done.
Herpes Zoster
A 61-year-old male presents with acute onset of fever, cough and headache. He also complains of muscle pains. Exam reveals a temperature of 102. Mild redness of the pharynx. Lungs are clear and no neck stiffness or tenderness on percussion of the sinuses. CBC shows a mild leukocytosis with elevated lymphocytes.
Influenza
A 47-year-old female presents with multiple aches and pains all over her body. In addition she complains of fatigue and not being able to sleep well. On examination, there are 14 tender spots in specific areas on both sides of her body. CBC, CMP and TFTs are all normal.
Fibromyalgia
A 28-year-old male smoker presents with chills, fever, pleuritic chest pain and a cough with rust-colored sputum. On examination, the percussion note dull on the lower left side of the chest. There is bronchial breathing and egophony. CBC shows marked elevation of the neutrophils and a leukocytosis. Chest x-ray shows consolidation in the lower lobe on the left side.
Pneumonia
A 19-year-old male army private presents with pain over the left side of his chest. The pain started a day after he returned from boot camp. On examination, there is tenderness and swelling of his 2nd left costochondral junction. He is worried about having a heart attack because his father died from a heart attack at age 45. No tests were done.
Tietze syndrome (aka Costochondritis or Chondropathia tuberosa)
A 48-year-old overweight male smoker presents with sudden onset of squeezing precordial chest pain after an argument with a coworker. On examination, his BP is 136/84 and he is sweating. There are bilateral diagonal ear lobe creases present. ECG shows elevation of the ST segment with T wave inversion and deep Q waves. Troponin and CK-MB levels are elevated.
Myocardial infarction
A 42-year-old overweight hospital administrator complains that he is experiencing sticking chest pain on and off for the past three weeks. He has paresthesia sometimes in both hands with the occasional headache. On examination, there is restricted motion at T4. Springing of the vertebra reproduces the pain. Chest x-ray, CBC and ECG are all normal.
T4 syndrome
A 34-year-old migrant farm worker complains of right sticking chest pain, night sweats and hemptysis. Chest examination reveals apical crackles and bronchial breathing. There are red swollen bumps on her shins. Chest x-ray shows right apical consolidation and several cavities. Sputum contains Ziehl Neelsen positive staining bacilli.
Tuberculosis
A 40-year-old female presents with sharp, stabbing chest pain that has only occurred in the last week or so. She reports that it gets worse when she lays down, but is relieved when she sits up. She also says her left shoulder is painful. On examination, both areas are tender to touch and a midsystolic click is heard on auscultation of the heart. Her BP is 112/72. Pericardial rub test is positive. Chest x-ray reveals cosolidation in the left lower lobe of the lung. Cardiac CT scan was normal.
Pericarditis with accompanying mitral valve prolapse.
Cardiac tamponade if BP was dangerously low, or chronic constrictive pericarditis if it was a long-term complaint
