Chest pain

Question 1

What are the five main systems a report of chest pain would give you cause to worry about?

Answer 1

Cardiac, GI, respiratory, MSK and vascular

Question 2

What are the three main cardiac differentials to consider for chest pain?

Answer 2

MI, pericarditis and aortic stenosis

Question 3

What are the six main GI differentials to consider for chest pain?

Answer 3

Gastritis/ulcer secondary to naproxen, GI bleed, GORD, oesophageal malignancy, pancreatitis and biliary colic

Question 4

What are the four main respiratory differentials to consider for chest pain?

Answer 4

PE, pleurisy, pneumonia, lung cancer.

Question 5

What are the five main MSK differentials to consider for chest pain?

Answer 5

muscular pain, shingles, costochondritis, aortic stenosis, side effects of statins

Question 6

What is the main vascular differential to consider for chest pain?

Answer 6

Dissecting aneurysm

Question 7

Where does pain typically radiate in pancreatitis?

Answer 7

To the back and left shoulder blade?

Question 8

What are the two largest risk factors that predispose one to pancreatitis?

Answer 8

High alcohol intake and previous history of gall stones

Question 9

What is naproxen how is it relevant to a chest pain history?

Answer 9

Naproxen is an NSAID which can cause gastritis and ulcers in some cases

Question 10

What might statins have to do with a complaint of chest pains?

Answer 10

Statins can have the side effect of muscular pain which can on occasion present in the chest.

Question 11

What other common medication can increase the risk of gastric erosions in someone who takes naproxen?

Answer 11

SSRIs

Question 12

What is the typical character of cardiac pain?

Answer 12

Crushing, tight, heavy

Question 13

What is the typical character of pain in pancreatitis?

Answer 13

severe and dull

Question 14

What is the character of pain in gastric erosions?

Answer 14

Burning

Question 15

What are the typical side effects that can come with Ferrous sulphate use?

Answer 15

Constipation, dark and or gritty stools, stomach cramps, diarrhoea, nausea and vomiting

Question 16

How does pericarditis typically present?

Answer 16

Heart palpitations and/or chest pain. Pain is typically precordial or retrosternal and refers to the trapezius ridge, neck, left shoulder or arm. Pain is usually pleuritic and intensity varies.

Question 17

What is the characteristic pathognomonic symptom of acute pericarditis? What is the best way to elicit this?

Answer 17

Pericardial friction rub. It can appear/disappear from one hour to the next. Auscultation of the diaphragm over the left sternal edge during end expiration with the patient sat up and leaning forward.

Question 18

What is the first line treatment for pericarditis?

Answer 18

Pericardiocentesis and systemic antibiotics (vancomycin first line). Possibly an NSAID in addition (ibuprofen 1st line)

Question 19

What is the first line treatment for an MI?

Answer 19

Antiplatelet therapy (aspirin and clopidogrel) and oxygen. Plus glyceryl trinitrate and morphine.

Question 20

What are three main ways aortic stenosis can present aside from chest pain?

Answer 20

Syncope, angina and microangiopathic hemolytic anemia

Question 21

What is the typical treatment for aortic stenosis?

Answer 21

replacement of the aortic valve.

Question 22

Aside from NSAID use what are the five other main risk factors for Gastritis?

Answer 22

H pylori infection, Alcohol use, previous gastric surgery, critical illness and autoimmune disease

Question 23

What are the three main diagnostic factors for gastritis?

Answer 23

Presence of risk factors, dyspepsia/epigastric discomfort and absence of malignancy.