Clinical Case 1: Cardiac Chest Pain

Question 1

What does SOCRATES stand for?`

Answer 1

Site
Onset
Character
Radiation
Associated symptoms
Time
Exacerbating and relieving factors
Severity

Question 2

What is meant by ‘character’ in SOCRATES?

Answer 2

whether the pain is dull, sharp, aching etc

Question 3

What is SOCRATES used for?

Answer 3

to assess pain when taking a history

Question 4

What is the classic site of cardiac chest pain?

Answer 4

centre of the chest

Question 5

What is the classic onset of cardiac chest pain?

Answer 5

sudden

Question 6

What is the classic character of cardiac chest pain?

Answer 6

dull or crushing

Question 7

What are the 3 classic radiation sites of cardiac chest pain?

Answer 7

1) left arm
2) neck
3) jaw

Question 8

Give 3 associated symptoms of cardiac chest pain (that are also associated with MIs and acute coronary syndrome)?

Answer 8

1) nausea
2) sweating
3) breathlessness

Question 9

What is the time range for classic cardiac chest pain?

Answer 9

10 mins - 1 hour

Question 10

Give two exacerbating features of classic cardiac chest pain:

Answer 10

1) exacerbation
2) cold air

Question 11

What drug is commonly used to relieve angina?

Answer 11

GTN spray

Question 12

True or false: acute coronary syndrome cannot be relieved by rest and GTN spray

Answer 12

True

Question 13

Does pain last for longer in angina or acute coronary syndrome?

Answer 13

acute coronary syndrome

Question 14

Give 4 key differences between angina and acute coronary syndrome:

Answer 14

1) angina is brought on by exertion whereas ACS can come on at rest
2) angina can be relieved by rest and GTN spray whereas ACS cannot
3) angina lasts for a short time while ACS lasts longer
4) ACS is more severe in pain and has associated symptoms

Question 15

Give 4 other common presenting symptoms in CVS disease (excluding the classic nausea and sweating)

Answer 15

1) dyspnoea
2) oedema
3) palpitations
4) syncope/ presyncope

Question 16

What is the name given to breathlessness experienced when lying flat?

Answer 16

orthopnoea

Question 17

What is the name given to sudden breathless when waking from sleep?

Answer 17

paroxysmal nocturnal dyspnoea

Question 18

Other than the ankle and leg, give another common site of oedema:

Answer 18

Sacral

Question 19

Give the 5 basic steps used when taking a history:

Answer 19

1) history of presenting complaint
2) past medical history
3) systematic enquiry (asking open questions)
4) drug history and allergies
5) social history

Question 20

What other issues should be ruled out when you are suspecting cardiac chest pain (4)?

Answer 20

1) respiratory (cough, temperature, PE risk factors, haemoptysis)
2) gastrointestinal issues (pain on eating, vomiting, reflux)
3) muscular skeletal issues (recent falls, trauma)
4) psychological issues (recent life events, anxiety)

Question 21

Give 6 key cardiovascular risk factors:

Answer 21

1) diabetes
2) smoking
3) hyperlipidaemia
4) hypertension
5) diet and exercise
6) family history

Question 22

Give four signs to look out for on the hands when completing a cardiovascular examination:

Answer 22

1) nicotine staining
2) clubbing
3) signs of endocarditis
4) pulses

Question 23

What is corneal acrus?

Answer 23

ring around iris

Question 24

What 2 signs should be looked for in the legs when completing a cardiovascular examination?

Answer 24

1) oedema
2) scars

Question 25

What produces the first heart sound?

Answer 25

closing of the mitral and tricuspid valves

Question 26

What produces the second heart sound?

Answer 26

closing of the aortic and pulmonary valves

Question 27

What two groups can murmurs be sorted into?

Answer 27

1) systolic
2) diastolic