CP

Question 1

What are the goals for CP in primary care?

Answer 1

• Don’t kill patients
• Exclude things that make people die
• Find those at risk and intervene NOW

Question 2

What is clutching of the chest called?

Answer 2

Levine sign

Question 3

What are differenttial for CP?

Answer 3

• CV
• Trauma/MS
• Pulmonary
• Infectious
• Other

Question 4

What are the CV disorders?

Answer 4

• ACS
• AAA
• AS

Question 5

What are the Trauma/MS disorders?

Answer 5

• Chest wall fx/contusion
• PTX
• Boehaaves syndrome
• Costchondritis

Question 6

CP differential for pulmonary

Answer 6

PE

Question 7

CP differential for infection

Answer 7

• Pleurisy
• PNA
• Myocarditis

Question 8

What are other CP differential

Answer 8

• GI (GERD, esophageal, PUD, GB, psych, toxicity)

Question 9

what is the most common cause of CP in office?

Answer 9

Chest wall syndrome

Question 10

Whats the most common cause of CP?

Answer 10

• MSK
• Nonspecific CP
• GI

Question 11

If its non of the dx listed on the chart, what can you call it?

Answer 11

Chest wall syndrome

Question 12

if there is any concerns for ABC what should you do?

Answer 12

Emergent transfer to the ER

Question 13

what should you obtain in CP visit?

Answer 13

ECG

Question 14

Aggravating factors postprandial?

Answer 14

GI

Question 15

Aggravating factors exertion?

Answer 15

Cardiac

Question 16

Aggravating factors cold, emotional stress, sexual intercourse?

Answer 16

cardiac

Question 17

Aggravating factors worse with swallowing?

Answer 17

esophageal origin

Question 18

Aggravating factors body position, movement, deep breathing?

Answer 18

MSK

Question 19

Alleviating factors w/ antacids/food?

Answer 19

GI

Question 20

Sublingual nitro alleviating factors?

Answer 20

Esophageal or cardiac

Question 21

“GI cocktail” alleviating factors?

Answer 21

GI or cardiac

Question 22

cessation of pain with rest?
alleviating factors?

Answer 22

Cardiac

Question 23

Sitting up and leaning forward alleviating factors?

Answer 23

Pericarditis

Question 24

Bleching, bad taste in mouth, dysphagia HPI assocaited sx?

Answer 24

Esophageal dz

Question 25

Vomiting HPI assocaited sx?

Answer 25

MI or GI

Question 26

Diaphoresis HPI associated sx?

Answer 26

MI, possibly esophageal dz

Question 27

Syncope HPI associated sx?

Answer 27

dissection, PE, AS, ruptured AAA

Question 28

Near syncope HPI associated sx?

Answer 28

MI

Question 29

Fatigue HPI associated sx?

Answer 29

MI in elderly

Question 30

HPI region/location

Answer 30

larger areas of discomfort more likely ischemic etiolgoy

Question 31

T/F severity is useful in predictor for presence of CAD?

Answer 31

False, not useful predictor

Question 32

Whats the timing of HPI, Abrupt onset with greatest intensity in beginning

Answer 32

PTX, dissection, acute P

Question 33

Whats the timing of HPI, gradual increasing onset overtime

Answer 33

Ischemic

Question 34

Whats the timing of HPI, crescendo pattern

Answer 34

esophageal dz

Question 35

Whats the timing of HPI, lasts for seconds or constant over weeks

Answer 35

not related to ischemic

Question 36

Whats the timing of HPI, circadian rhythm?

Answer 36

correlating with increase sympathetic tone- more likely ischemia

Question 37

What are PE that point towards ACS?

Answer 37

- S3 or S4 - Systolic BP <80 mm/Hg - Crackles on auscultation

Question 38

T/F Absence of S3 or S4, Systolic BP <80 mm/Hg, Crackles on auscultation exclude ACS

Answer 38

False!! it does not exclude ACS

Question 39

if the ECG shows no signs and cp suspicious for CAD, what should you do?

Answer 39

- get cardiac biomarkers to eval for non-ST elevation MI - consider c-xray if they have resp disease

Question 40

what is the standard of care in the ED?

Answer 40

Only an initial trop if >3 hours from onset If under 3 hours need a second one an hour later

Question 41

outpt troponin for pt with sx suggestive of acute coronary syndrone is?

Answer 41

transfer for eval w/o troponin testing

Question 42

is it reasonable to use single troponin test to exclude acute MI?

Answer 42

Only with asymptomatic patients whose symptoms resolved at least 12 hours prior, so long as they have no high-risk features and a normal electrocardiogram.

Question 43

if a pt is better with nitro, can they go home?

Answer 43

NOOO

Question 44

can post-parandial pain be ischemic?

Answer 44

yes!