Differential Diagnosis- Acute Chest Pain - Other Causes Flashcards
1
Q
Musculoskeletal - Classical History?
A
- Sharp chest pain
- Worse by movement and inspiration
- Can point to where worse
- Worse by pressure over area
2
Q
Musculoskeletal - Classical Examination Findings?
A
- Tenderness over area of pain
- Normal exam otherwise
3
Q
Musculoskeletal - Investigations?
A
Diagnosis of Exclusion:
- D Dimer - exclude PE
- CXR - exclude pneumathorax or infection
- Inflammatory markers - normal
4
Q
Musculoskeletal - Treatment?
A
- Analgesia
- Deep breathing to prevent infection
5
Q
Costochondritis - Classical History?
A
- focal chest wall pain,
- may have known precipitating injury;
- aggravated by sneezing, coughing,
- deep inspiration,
- twisting of the chest
6
Q
Costochondritis - Classic Examination Findings?
A
- reproducible pain, especially at the costochondral junctions
- Normal exam otherwise
7
Q
Costochondritis - Investigations?
A
Diagnosis of Exclusion:
- ECG/Troponin - exclude MI
- CXR - normal
8
Q
Costochondritis - Treatment?
A
- NSAIDS
- Physical therapy
9
Q
GORD - Classical History
A
- retrosternal burning with eating large or fatty meals
- that can be reproduced with lying supine and relieved by sitting up;
- relieved by antacids
10
Q
GORD - Classical Examination Findings?
A
- no specific physical findings
- maybe tenderness over area if associated gastritis
11
Q
GORD - Investigations?
A
- therapeutic trial: relief of symptoms with short trial of proton-pump inhibitors
- Oesophagogastroduodenoscopy:oesophageal inflammation or erosions
- oesophageal pH monitoring:persistently low pH (<4) may indicate reflux disease
12
Q
GORD - Treatment?
A
- Lifestyle advice
- Antacids
- Triple therapy
13
Q
Anxiety or Panic Attack - Classical History?
A
- sharp chest pain with anxiety,
- dizziness or faintness,
- palpitations, sweating, trembling or shaking,
- fear of dying or going insane, paraesthesiae,
- chills or hot flushes, breathlessness or choking sensation
14
Q
Anxiety or Panic Attack - Classic Examination Findings?
A
- hyperventilation,
- examination otherwise normal
15
Q
Anxiety or Panic Attack - Investigations?
A
- ECG: normal
- CXR: normal
- HADS (hospital anxiety and depression scale) score: score >11
