CHEST PAIN + PALPITATIONS

Question 1

Myocardial infarction DDx:

7

Answer 1

1. GERD.
2. Angina.
3. Costochondritis.
4. Aortic dissection.
5. Pericarditis.
6. Pulmonary embolism.
7. PTX.

Question 2

Myocardial infarction workup:

9

Answer 2

1. ECG.
2. CPK-MB, troponin x3.
3. CXR.
4. CBC.
5. Electrolytes.
6. Echocardio.
7. Cardiac cath.
8. D-dimer.
9. Helical CT.

Question 3

Sickle cell disease DDx:

5

Answer 3

1. Pulmonary embolism.
2. Pneumonia.
3. MI.
4. PTX.
5. Aortic dissection.

Question 4

Sickle cell disease workup:

8

Answer 4

1. CBC with reticulocyte count and peripheral smear.
2. LDH.
3. ABG.
4. D-dimer.
5. CXR.
6. CPK-MB, troponin.
7. ECG.
8. CTA-chest with IV contrast.

Question 5

GERD DDx:

5

Answer 5

1. Esophagitis.
2. Peptic ulcer disease.
3. Esophageal spasm.
4. MI.
5. Angina.

Question 6

GERD workup:

4

Answer 6

1. ECG.
2. Barium swallow.
3. Upper endoscopy.
4. Esophageal pH monitoring.

Question 7

Stable angina DDx:

2

Answer 7

1. Esophageal spasm.

2. Esophagitis.

Question 8

Stable angina workup:

8

Answer 8

1. ECG.
2. CPK-MB, troponin.
3. CXR.
4. CBC.
5. Electrolytes.
6. Exercise stress test.
7. Upper endoscopy/pH monitor.
8. Cardiac cath.

Question 9

Pericarditis DDx:

5

Answer 9

1. Aortic dissection.
2. MI.
3. Costochondritis.
4. GERD.
5. Esophageal rupture.

Question 10

Pericarditis workup:

7

Answer 10

1. ECG.
2. CPK-MB, troponin.
3. CXR.
4. Echocardio.
5. CBC.
6. Upper endoscopy.
7. ESR.

Question 11

Costochondritis DDx:

6

Answer 11

1. Pneumonia.
2. MI.
3. Pulmonary embolism.
4. Pericarditis.
5. Pleurisy.
6. Muscle strain.

Question 12

Costochondritis workup:

4

Answer 12

1. ECG.
2. CPK-MB, troponin.
3. CXR.
4. CBC.

Question 13

Pulmonary embolism DDx:

5

Answer 13

1. Pneumonia.
2. Costochondritis.
3. MI.
4. CHF.
5. Aortic dissection.

Question 14

Pulmonary embolism workup:

9

Answer 14

1. D-dimer.
2. ECG.
3. CXR.
4. ABG.
5. CPK-MB, troponin.
6. CBC.
7. Electrolytes, BUN/Cr, glucose.
8. CTA—chest with IV contrast.
9. Doppler US—Legs.

Question 15

Aortic dissection DDx:

7

Answer 15

1. MI.
2. Pericarditis.
3. Esophageal rupture.
4. Esophageal spasm.
5. GERD.
6. Pancreatitis.
7. Fat embolism.

Question 16

Aortic dissection workup:

10

Answer 16

1. ECG.
2. CPK-MB, troponin.
3. CXR.
4. CBC.
5. Amylase, lipase.
6. CTA—chest with IV contrast.
7. TEE.
8. MRI/MRA—aorta.
9. Aortic angiography.
10. Upper endoscopy.

Question 17

Palpitations DDx:

7

Answer 17

1. Cardiac arrhythmia.
2. Angina.
3. Hyperthyroidism.
4. Hyperventilation episodes.
5. Panic attacks.
6. Pheochromocytoma.
7. Carcinoid.

Question 18

Palpitations workup:

8

Answer 18

1. Glucose.
2. CBC.
3. Electrolytes.
4. TSH.
5. ECG.
6. Holter.
7. 24h urinary catecholamines.
8. 5-HIAA.

Question 19

Panic attack DDx:

8

Answer 19

1. GAD.
2. Acute stress disorder.
3. Specific phobia.
4. Hyperthyroidism.
5. Agoraphobia.
6. Substance abuse/dependence.
7. MVP.
8. Pheochromocytoma.

Question 20

Panic attack workup:

7

Answer 20

1. CBC.
2. Electrolytes.
3. TSH, FT4.
4. ECG.
5. Echocardio.
6. Urine tox.
7. 24h urine catecholamines.

Question 21

Social phobia DDx:

6

Answer 21

1. Avoidant personality disorder.
2. Agoraphobia/specific phobia.
3. Panic attack.
4. GAD.
5. Substance abuse/dependence.
6. Hyperthyroidism.

Question 22

Social phobia workup:

6

Answer 22

1. CBC.
2. Electrolytes.
3. ECG.
4. Echocardiography.
5. TSH, FT4.
6. Mental status exam.

Question 23

MVP DDx:

3

Answer 23

1. Cardiac arrhythmia.
2. Panic attack.
3. Pheochromocytoma.

Question 24

MVP workup:

Answer 24

1. ECG.
2. Echocardio.
3. Holter monitor.
4. 24h urinary catecholamines.