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Cardiology I > Chest Px Differential Dx > Flashcards

Chest Px Differential Dx Flashcards

1
Q

Px described as ripping or tearing suggests what condition?

A

Aortic Dissection

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2
Q

Pleuritic or dull pain is most likely associated with what condition?

A

Pneumothorax

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3
Q

Px that is worse lying down and better when leaning forward leads you to suspect…

A

A pericardial effusion

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4
Q

Px worsened upon inspiration clues you into what condition?

A

Pulmonary Embolism (PE)

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5
Q

Substernal Px described as burning may indicate what kind of condition?

A

GI or Cardiac

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6
Q

An abrupt and acute onset of chest Px should include what conditions in your initial DDx?

A

Aortic Dissection
Esophageal Perforation
Pneumothorax
Pulmonary Embolism

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7
Q

Px radiating to the patients abdominal region could indicate what Dz pathophysiology?

A

Esophageal rupture

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8
Q

Pain that radiates across the chest and/or to the back should raise suspicion of what condition?

A

Aortic Dissection

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9
Q 
T/F 
Chest Px can radiate to the... Arm
Neck
Jaw
Shoulders
Abdomen
Back
Chest?
A

True

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10
Q

T/F

You can rule out cardiac origin of Px if a PT has had a recently negative stress test.

A

False
You can only r/o Cardiac origin in PT’s who have recently had negative results with CARDIAC CATH and CORONARY CT ANGIOGRAM

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11
Q

Acute Coronary Syndrome

What are some risk factors?

More common in women or men?

A

Men

Smoking, HTN, Diabetes
Cocaine
Family Hx of MI <55y.o.
Obesity, hyperlipidemia, inactivity

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12
Q

Marfan’s syndrome is associated with which particular Cardiac condition?

A

Acute Aortic Dissection

Pregnancy, cocaine abuse, HTN, and congenital bicuspid aortic valve also risk factors

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13
Q

Risk factors for a pneumothorax include?

A 
"HESS"  
HIV infxn (P. jirovecii)
Endometriosis
SCUBA Diving
Smoking
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14
Q

Trauma, hemostasis, pregnancy, oral contraceptives, and hypercoagulable states are associated risk factors with what condition?

A

PE

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15
Q

What is the Modified Wells Criteria used for?

What are some of the criteria?

A 
Clinical signs of DVT (+3)
DVT most likely Dx (+3)
Recent surg (+1.5)
Hx of DVT or PE (+1.5)
Recent surg/immobilization (+1.5)
Hemoptysis (+1)
Cancer (+1)

Greater than 6 is high risk

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16
Q

Pulmonary Embolism Rule out Criteria (PERC)

BREATHSS pneumonic device…

What criteria must be met to r/o PE?

A 
B- Blood in sputum (hemoptysis)
R- Room air O2 < 95%
E-  ESTROGEN USE
A-  Age >50y.o.
T-  Thromb. Hx i.e. DVT/PE
H-  HR >100bpm
S-  Surg/ w.in last 4wks
S-  Swollen leg (UNILATERAL)
17
Q

If an oncology patient presents to you with uremia and low TSH values and a recent Hx of radiation therapy; what condition should remain at the top of your Dx/DDx?

A

Pericardial Tamponade

Risk factors:
Hypothyroid
Autoimmune Dz
Cancer
Uremia
Injury during procedures
Radiation therapy
Tb
18
Q

Unilateral breath sounds should always raise suspicion of…

A

Pneumothorax

19
Q

Asymmetrical leg swelling, focal wheezing… You must r/o what condition?

A

Pulmonary embolism

20
Q

A diaphoretic patient presents to your clinic with difficulty breathing and is extremely anxious. Your physical exam should revolve around r/o what cause/origin?

A

CARDIAC

21
Q

Your PT presents with a >20mmHg difference in BP and the radial and carotid pulses are only palpable unilaterally… The patient is also displaying confusion and other neurologic findings; what remains your most likely cause of their S/Sx?

A

Aortic Dissection

22
Q

POINT TENDERNESS in the chest indicates what condition? The pain/TTP is reproducible.

A

Musculoskeletal origin.

23
Q

Your PT’s hemoccult card comes back positive for blood in the stool and they have epigastric tenderness. Your exam MUST include this ROS….

A

Gastrointestinal b/c it is the most likely etiology/origin of PT S/Sx

24
Q

When reviewing an EKG you note several abnormalities… There is a prominent S wave in lead I, a prominent Q wave in lead III, and an INVERTED T wave in lead III…

What condition does this lead you to suspect your PT has?

A

Right Heart strain or PE

S1Q3T3

25
Q

Electrical alternans visualized on EKG. What condition does this suggest?

A

Pericardial tamponade

26
Q

Diffuse ST elevation across the EKG suggests what condition?

A

Pericarditis

27
Q

What is the most sensitive cardiac enzyme marker for an MI/ischemia?

What are other labs you can order?

A

Cardiac Troponin I and T

Other labs:
CK-MB (Creatine Kinase Muscle Brain) Less cardiac sensitivity

CBC: Elevated WBC w/ myocarditis, pericarditis, mediastinitis, pneumonia
Anemia –> ischemia or aortic dissection

BNP (Brain Natriuretic Peptide) –> Heart failure

D-Dimer –> PE, many other causes though; non-specific

28
Q

A widened mediastinum and aortic knob appearance are visualized on X-ray. What is your preliminary Dx?

A

Aortic Dissection

29
Q

Generalized cardiomegaly and diffuse-white vasculature congestion surrounding the heart is noted on PT CXR. What basic condition does this X-ray suggest?

A

Heart Failure

30
Q

A Hampton Hump (wedge shaped opaque defect is observed in the lungs on CXR). What condition does this suggest?

A

Pulmonary Emboli

Westermark sign is also a possible finding where there is the absence of vascular marking distal to embolus

31
Q

Mediastinal emphysema is noted upon CXR. The mediastinum additionally appears to be widened; what condition are you suspecting?

A

Esophageal rupture (include Mediastinitis on DDx)

32
Q

When an aortic dissection or PE are suggestive; what imaging modality is recommended?

A

CT Angiography

(A transesophageal ECG can also be utilized for Aortic dissection)

(PE –> nuclear vent perfusion scan or Pulm. angiography also available but RARE)

33
Q

If esophageal rupture or a mediastinitis is suggested; what imaging modality is suggested?

A

CT of the Chest

34
Q

A pericardial effusion noted by friction rub or suggested cardiac tamponade can be evaluated using what imaging study?

A

Bedside Ultrasound

Anything with fluid; hemothorax, pneumothorax, pleural effusions, tamponade, and WALL ABNORMALITIES

Cardiology I (8 decks)

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