Chest Pain - Overview

Question 1

What are the differentials when someone presents with ‘chest pain’ at a GP?

Answer 1

1. Cardiac causes e.g. MI, pericarditis, endocarditis
2. GI causes e.g. gastritis, GI bleed, GORD
3. Respiratory causes e.g. PE, pleurisy, pneumonia
4. MSK causes e.g. costochondritis. shingles, muscular strain
5. Vascular cause e.g. dissecting aneurysm

Question 2

How would a swollen ankle due to; cellulitis, present?

Answer 2

• Red and hot ankle
• Pyrexic patient
• Moveable joint

Question 3

How would a swollen ankle due to; septic arthritis present?

Answer 3

• Red, hot ankle
• Pyrexic patient
• Immovable joint (singular joint)

Question 4

How would a swollen ankle due to; DVT present?

Answer 4

• Red, hot ankle

- Swollen calf

Question 5

How would a swollen ankle due to; inflammatory arthritis, present?

Answer 5

• Red, hot ankle

- Involving several joints that are painful

Question 6

How would a swollen ankle due to; Gout, present?

Answer 6

• Red, hot ankle

- Involving a single painful joint

Question 7

How would a swollen ankle due to; oedema, present?

Answer 7

• Swollen ankles

- Lasting pitting when pressure is applied

Question 8

How would a swollen ankle due to; Sprain or fracture, present?

Answer 8

• ankle swelling post trauma that is painful

Question 9

How would a swollen ankle due to; osteoarthritis lymphoedema, present?

Answer 9

• A swollen ankle without trauma

Question 10

What information should we tell a patient when we are safety netting them about a condition?

Answer 10

1. Share uncertainty about diagnosis
2. Advise any symptoms to look out for that are worrying
3. Advise HOW to seek help
4. Advise WHEN to seek help (timeframe)

Question 11

What percentage of patients attending a GP will NOT know their diagnosis at the end of the consultation?

Answer 11

50%

Question 12

What 3 symptoms might be suggestive of an upper GI bleed out of the following;

a. Presyncope/syncope
b. Tea-leaf vomit
c. Epigastric pain
d. Pelvic pain
e. Fresh rectal bleeding
f. Haematemesis

Answer 12

a, c, f

Question 13

What are the causes of pancreatitis (think of the mnemonic)?

Answer 13

I - idiopathic
G - gallstones
E- ethanol (alcohol)
T- Trauma
S- steroids
M- mumps/malignancy
A- autoimmune
S- scorpion sting
H- hypercalcaemia or hypertriglyceridemia
E- ERCP
D- drugs

Question 14

What are the risk factors for gastric erosion?

Answer 14

• Alcohol use disorder
• Regular NSAID use (especially with SSRI and no gastric protection)
• Radiation therapy
• H-pylori

Question 14

What are the risk factors for gastric erosion?

Answer 14

• Alcohol use disorder
• Regular NSAID use (especially with SSRI and no gastric protection)
• Radiation therapy
• H-pylori