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CDM II > Eval of CP > Flashcards

Eval of CP Flashcards

1
Q

CP Differentials (5)

A

CP Is Overly Tough!
CV
Pulm
Infectious
Trauma
OTHER

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2
Q

CP Differential: CV

A

“AAAs”
ACS
AAA!!!!
AS

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3
Q

CP Differential: Pulm

A

PE

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4
Q

CP Differential: Infectious

A

“Please pardon my infection”
PNA
Pleurisy
Myocarditis

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5
Q

CP Differential: Trauma

A

“Bear Coughs cause Problems”
PTX
Chest Wall Fx/contusion
Boerhaaves syndrome
Costochondritis

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6
Q

CP Differential: Other

A

“GG & PEG Took Pills”
GI- GERD, PUD, Esophageal
GB
Psych
Toxicity

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7
Q

Triad of SAD

A

Syncope
Angina
Dyspnea

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8
Q

What % of CP have unstable Heart Dz?

A

1.5%

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9
Q

What is the MCC Dx of CP IN THE PCP OFFICE?

A

CWS: Chest Wall Syndrome

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10
Q

T/F: It is acceptable to document Nonspecific CP or Atypical CP

A

False! Atypical is typical of something!
Use Noncardiac CP of CWS

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11
Q

What is the MCC of CP?

A

MSK pain

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12
Q

Why do we not see the 13% of CP with ACS in the output clinic?

A

They usually go to the ER

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13
Q

True goals of CP w/u? (4)

A

*Who is stable v unstable
* Who is low risk
*Who needs further testing (high risk of unstable heart dz in next 90d)
*Who needs prompt transfer

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14
Q

Where to start in CP workup?

A

ABC’s

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15
Q

When to initially call 911

A

If pt is in resp distress or abnl VS
(Be lenient w/mild HTN or slight tachy)

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16
Q

What should you do immediately after ABC’s?

A

EKG

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17
Q

2 important HPI Q’s to ask w/CP

A

**“Have you had pain like this before?”
were you evaluated for it?
***“Have you ever had a heart exam/work up before?” stress testing in last 90d- low proability of event

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18
Q

7 Other important HPI Q’s

A

*“Are you currently having chest pain?”
*“What were you doing when this started?” or
*“What seems to bring the pain on?”
*“How long did it last, what made it go away?”
*“Is it worse with activity?”
*“Do you have a family h/o heart problems?”
*“Have you taken an aspirin today?”
baby or full? ACS- full dose

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19
Q

Worse w/Postprandial?

A

GI

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20
Q

Worse w/Exertion?

A

Cardiac

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21
Q

Worse w/cold, emotion, stress, sex?

A

Cardiac

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22
Q

Worse w/Swallowing?

A

Esophageal

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23
Q

Worse w/Body position, movement, deep breathing?

A

MSK

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24
Q

Relief w/Antacids or food?

A

Gastro-esophageal

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25
Q

Relief w/Sublingual nitro

A

Esophageal or cardiac

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26
Q

Is response to nitro diagnostic?

A

HELL NO

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27
Q

Relief w/GI cocktail

A

GI or Cardiac

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28
Q

Is response to GI cocktail (viscous lido & antacid) diagnostic?

A

Hell NO!

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29
Q

Relief w/rest

A

Cardiac

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30
Q

Relief w/sitting up & leaning forward?

A

Pericarditis

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31
Q

Assoc sx: Belching, bad taste in mouth, dysphagia

A

Esophageal dz

32
Q

Assoc Sx: Emesis

A

MI or GI

33
Q

Is diaphoresis a good indicator of MI?

A

YES! if they are diaphoretic, you should be diaphoretic.
**We cannot make ourselves sweat.

34
Q

Is syncope a good indicator of badness? Which one most of all?

A

YES- DISSECTION
PE, ruptured AAA, AS

35
Q

Is near syncope a good indicator of MI?

A

yeah

36
Q

What age group is fatigue an indicator of MI?

A

Presenting complaint in elderly

37
Q

Region of CP: which 2 are most indicating of MI?

A

Radiation to arm (1 or both)
Large areas of discomfort

38
Q

Which pain region is indicative of aortic dissection?

A

B/W scapulae

39
Q

T/F: severity is a useful predictor of CAD

A

nope. can have 6/10 with MI and 10/10 with anxiety.

40
Q

What 2 timings are indicative of ischemia?

A

*Gradual w/↑ onset over time
*Circadian rhythm (worse in the morning) correlating w/ ↑ SNS tone.

41
Q

Timing: crescendo pattern is indicative of?

A

Esophageal dz

42
Q

Timing: Abrupt onset w/greatest intensity in the beginning? (3)

A

PTX
Dissection
Acute PE

43
Q

If it lasts for seconds or constant over weeks, is it ischemic?

A

NO

44
Q

2 important parts of the PMHx

A

Prior CV hx
FHx

45
Q

Important risk factors

A

tobacco use
FHx
DM
HTN,
Lipids
Cocaine use

46
Q

Important risk factor for PE

A

DVTs

47
Q

Important risk factor for Aortic Dissection (2)

A

Marfans
Pregnancy

48
Q

Important risk factor for PUD (2)

A

ETOH
NSAIDS

49
Q

3 ACS exam findings

A

*S3 or S4 (S4 never normal)
*SBP <80mmHg (would rather have a htn pt-perfusion)
*Crackles on auscultation

50
Q

Likelihood ratio:
LR >1
LR<1

A

Likelihood of correlation
LR>1 result assoc w/dz
LR<1 result assoc w/absence of dz

51
Q

> ? LR is highly significant (Jaynstein says __)

A

10, 5

52
Q

7 Clinical features that inc. likelihood of MI

A

*Pain radiation to arms/shoulder
*S4
*Hypotension
*Prior MI
*Crackles
*Diaphoresis
*NV

53
Q

Features that decrease likelihood of MI

A

Pleuritic pn
“Sharp” “stabbing”
Positional
Reproducible

54
Q

High likelihood of ACS (5)

A

CP raditating to arms
CP assoc w/exertion,
CP assoc w/ nv
CP assoc w/diaphoresis
CP described as “worse than previous angina” or “like my last MI”

55
Q

Low likelihood of ACS (4)

A

Stabbing, positional, pleuritic CP
Inframammary CP
Not assoc w/exertion
Reproducible w/palpation

56
Q

Marburg Heart Score (5)

A

F>64, M>54
Known CAD, CVD, PVD
Pain worse w/exercise
Pain not reproducible w/palpation
Pt assumes pn is cardiac

57
Q

If ECG is nondiagnostic but CP is susp. for CAD….

A

→further testing with cardiac biomarkers
(troponin) is rec. to eval NSTEMI →to ER

58
Q

Consider CXR if there is evidence of ___ dz (3)

A

Pulm
=cough, dyspnea, or a hx of pulmonary disease

59
Q

Is there a guideline for Outpt troponins?

A

Nope

60
Q

How to check for BBB?

A

V1, V6 (R-R’)

61
Q

What is the standard of care in ED for troponin use (from sx onset)?
<3hrs
>3hrs

A

<3hrs. baseline trop & repeat in 1hr
>3hrs baseline trop only

62
Q

What is the default position for pts who have sx suggestive of ACS?

A

Undergo transfer for emergent eval w/o prior trop testing (DONT WASTE TIME)

63
Q

“It is reasonable to use a single troponin test in general practice to exclude the possibility of acute myocardial infarction (AMI) in …”

A

asx pts whose sx resolved at least 12hr prior, so long as they have no high-risk features and a nl ekg

64
Q

EKG AMI criteria:

A

ST ↑ >2mm in 2 cont leads

65
Q

EKG Ischemia criteria:

A

Large, >2mm Q waves in inferior leads
ST ↓ in cont leads,
T wave inversion in cont leads

66
Q

Lateral Leads

A

V5, V6, I, AVL
CircumfLex

67
Q

Septal Leads

A

V1, V2
LAD

68
Q

Anterior Leads

A

V3, V4
LAD

69
Q

Inferior Leads

A

II, III, AVF
RCA

70
Q

AV block is a PR interval…

A

> 1 large box

71
Q

Axis leads?

A

V1, AVF

72
Q

Will a PPI alter cardiac testing?

A

Nope

73
Q

What medication should be given for primary prevention of ACS

A

81mg ASA

74
Q

2 Indications to check a CBC in CP

A

if infectious or GI bleed

75
Q

ER HEART score
Low risk?

A

H- Hx of same
E-EKG
A-Age
R-Risk factors
T-Trop

0-3 is low risk

76
Q

Can post prandial pain be ischemic?

A

yes

77
Q

Value of careful __ & ___ to CYA w/CP

A

H&P!!

CDM II (6 decks)

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