Chest Pain

Question 1

stable angina plan

Answer 1

Stress test, angiogram, labs for blood glucose and lipid panel

Question 2

stable angina pt explanation

Answer 2

It sounds like you might have a problem called stable angina. This means there is a plaque narrowing one of the vessels that gives oxygen to your heart. To get a better understanding of what’s going on, we should plan for you to get a stress test, where doctors look at your heart while you exercise on a treadmill. You might also need imaging of the vessels around your heart, called an angiogram. We are also going to draw your blood to check your sugar and cholesterol to see what could be causing this.

Question 3

GERD plan

Answer 3

Treat with 8 weeks of PPI and follow up to assess response

Question 4

GERD pt explanation

Answer 4

I think that you have GERD, gastroesophageal reflux disease. Some people call this acid reflux, it is when acid from the stomach gets into your throat. We treat this with a medicine called a proton pump inhibitor that will help lower the levels of acid in your throat. We will try the medicine for 8 weeks and follow up to see if it is helping you.

Question 5

MI plan

Answer 5

EKG within 10 minutes of arrival to ER, CK-MB and troponin, catheterization or anticoagulant meds

Question 6

MI pt explanation

Answer 6

I’m worried that you might be having a heart attack. This is when a clot blocks blood and oxygen from getting to a part of your heart. You should go to the emergency room right away - we will make sure you get there safely. Once you are in the ER they will do an EKG, which will tell them about the electrical activity of your heart. They will also take your blood to see if your heart has been damaged. You will either get medicine or a procedure to remove the clot from the vessel in your heart.

Question 7

unstable angina plan

Answer 7

oxygen, enoxaparin, aspirin, clopidogrel, beta blocker, nitrates

Question 8

unstable angina pt explanation

Answer 8

I think that you have a condition called unstable angina. This is when one of the vessels bringing oxygen to your heart is blocked part of the way. You should go to the emergency room to get this evaluated more - we will make sure you get there safely. They will likely give you medicine to help get rid of the clot, and they will also give you oxygen there.

Question 9

aortic dissection plan

Answer 9

Imaging to diagnose (usually CT or TEE, although angiography is gold standard), then surgery

Question 10

aortic dissection pt explanation

Answer 10

I think you are having something called an aortic dissection. This is when two layers of a big blood vessel in your body separate and blood goes in between them. You should go to the emergency room right away - we will make sure you get there safely. You will have imaging done, like a CT scan, and then you will likely have to get a surgery.

Question 11

pleural effusion plan

Answer 11

Imaging to diagnose (CXR, ultrasound), test fluid LD, protein, albumin, pH and cell count (transudative vs exudative), and thoracentesis if >1cm

Question 12

pleural effusion pt explanation

Answer 12

It sounds like you have a pleural effusion. This is when fluid builds up between your lung and your chest. To get this evaulated, you will need to get imaging, like an x-ray or ultrasound of your chest. Doctors will also need to take a little bit of fluid with a needle to test it and see what is causing you to have this. They may need to drain it if there is a lot of fluid.

Question 13

pericarditis plan

Answer 13

Echo to exclude tamponade, chest radiograph, BUN and Cr, TB test, antinuclear antibodies, blood cultures

Question 14

pericarditis pt explanation

Answer 14

It sounds like you have a condition called pericarditis. This is when the tissue that surrounds your heart becomes irritated and inflamed. This condition usually gets better on its own with rest, but we need to do a few tests to rule out more serious problems. First, you will get a special ultrasound of your heart called an echocardiogram. We will also need to get an x-ray of your chest, and you will need to get blood drawn for a few labs looking to see if you have an infection or other condition.

Question 15

MSK chest pain plan

Answer 15

Supportive care

Question 16

MSK chest pain pt explanation

Answer 16

It sounds like you have injured a muscle in your chest, and that is what is causing your pain. You can take medicine like Motrin to get your pain under control, and make sure you rest the muscles as much as possible to heal quickly.

Question 17

pulmonary embolism plan

Answer 17

“D-dimer, CT-PA to diagnose.

Thrombolytics/anticoagulants or catheterization to remove clot”

Question 18

pulmonary embolism pt explanation

Answer 18

I think you have a pulmonary embolism, which is when a blood clot gets stuck in one of the arteries in your lungs. You should go to the ER. You will need to get a blood test done, and you might also need to get a special scan called CT-pulmonary angiography. If you do have a clot in your lungs, you will either be given medication to dissolve the clot, or you will need to get an operation to remove it.

Question 19

peptic ulcer disease plan

Answer 19

“Lab tests for H pylori (breath test), endoscopy, or barium study to diagnose
Abx to kill H pylori if present, PPI, H2 blockers, antacids”

Question 20

peptic ulcer disease pt explanation

Answer 20

It sounds like you have peptic ulcer disease, which happens when you get a sore (or an ulcer) on the inside of your stomach or intestines. This is sometimes caused by a bacterial infection caused by H. pylori, or by long-term use of medications like Motrin (NSAIDs). We will do some tests to see whether you have this bacteria or whether you have an ulcer caused by something else. This might involve using a camera to look at your throat and stomach. We might give you antibiotics if you are infected with the bacteria, or another kind of medication to reduce the amount of acid around the sore.

Question 21

acute herpes zoster plan

Answer 21

“diagnose based on symptoms and rash, may need to take a sample of skin cells to look for microscopic changes usually caused by herpes zoster
treat w antivirals”

Question 22

acute herpes zoster pt explanation

Answer 22

I think your pain is being caused by a virus called herpes zoster, which is sometimes called shingles. People who have chicken pox when they are kids can have this happen when they are older and the virus gets reactivated. You will need to get antiviral medications to treat this. Once you are healed, we should look into getting you vaccinted against shingles with the Shingrix vaccine, because it is possible to get shingles more than once.

Question 23

costochondritis plan

Answer 23

EKG, xray or other imaging to rule out more serious conditions

Question 24

costochondritis pt explanation

Answer 24

I think you have a condition called costochondritis. This is when the cartilage between your ribs and breastbone gets inflamed and can cause pain. We will likely do an EKG and get some imaging to rule out more serious causes. If you have costochondritis, we will help you get medications to control your pain. This problem heals on its own within a few weeks.

Question 25

Mallory-Weiss plan

Answer 25

upper endoscopy to diagnose

if bleeding does not stop on its own - epinephrine @ site of tear to reduce bleeding, cauterization, or vasopressin “

Question 26

Mallory-Weiss pt explanation

Answer 26

I think you have a condition called Mallory-Weiss syndrome. This occurs when there is a tear in the spot between your esophagus (food tube) and your stomach. It usually heals on its own, but there can be some bleeding when this happens. You will likely need to get a procedure called endoscopy where they look down your throat with a special camera to see what is going on. They might give you further treatment if the bleeding there does not stop on its own.

Question 27

tension pneumothorax plan

Answer 27

“Diagnose w physical exam findings (hyperresonant to percussion, breath sounds decr or absent), maybe CXR
Treat with decompression (needle)”

Question 28

tension pneumothorax pt explanation

Answer 28

It sounds like you have a tension pneumothorax, or a collapsed lung. We should get a chest X-ray to make sure this is what’s going on. If you do have a collapsed lung, we will need to insert a needle into your chest to relieve the pressure on the lung.

Question 29

esophageal perforation plan

Answer 29

CT or Xray to diagnose,

Surgical repair

Question 30

esophageal perforation pt explanation

Answer 30

It sounds like you have an esophageal perforation, or a tear in the tube that carries food down to your stomach. We will do either a CT or an X-ray to make sure this is the problem, and you will likely need a surgery to repair this.

Question 31

cardiac tamponade plan

Answer 31

Diagnose with Beck’s triad (hypoTN/weak pulse + distended neck veins + rapid heartbeat/muffled heart sounds) + echo
Treat by draining fluid from the pericardial sac + more diagnostic tests to find underlying cause

Question 32

cardiac tamponade pt explanation

Answer 32

It sounds like you are having cardiac tamponade. This is when the pericardium, or the sac of tissue that surrounds your heart, fills with fluid. This makes it hard for the heart to pump blood around your body. We will do a special ultrasound to look at your heart to diagnose this, and then the fluid will have to be drained using a needle. You will also need more testing afterward to figure out what the underlying cause of this problem is.

Question 33

heart failure plan

Answer 33

“BNP, echo, EKG, stress test, etc. to diagnose

ACE/ARB, B-blocker, diuretics, inotropes, etc. to treat”

Question 34

heart failure explanation

Answer 34

It sounds like you are having heart failure. This is when your heart is not working as well as it should to pump blood to your body. We will need to do tests to make sure this is the problem. You will need to get your blood drawn for labs, and you will need to get a special ultrasound of your heart called an echocardiogram. You might also need an EKG or a stress test, where you exercise while your heart activity is being monitored. You will likely need to take one or more medicines to treat this.