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Q4 EM Surg > Exam 2 CHEST PAIN > Flashcards

Exam 2 CHEST PAIN Flashcards

1
Q

Typical vs Atypical Chest Pain:

Location?

A

T = substernal, radiation to neck, jaw, shoulder, back

A = L chest, neck, jaw

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2
Q

Typical vs Atypical Chest Pain:

Reproducible?

A

T = no

A = yes

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3
Q

Typical vs Atypical Chest Pain:

Exertional?

A

T = ↑ w/ exert, ↓ w/ rest

A = Not exertional, Not ↓ w/ rest

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4
Q

Typical vs Atypical Chest Pain:

Quality?

A

T = progressive pressure or ache

A = sharp, pleuritic, positional

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5
Q

Typical vs Atypical Chest Pain:

Duration?

A

T = minutes
If > 15 min and progressive = unstable angina

A = seconds or constant for hrs/days

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6
Q

Typical vs Atypical Chest Pain:

Associated sxs?

A

T = N, diaphoresis, SOB

A = none

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7
Q

C presenting sx for elderly?

A

dyspnea

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8
Q

C presentation for women or DM?

A

atypical sxs

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9
Q

Chest Pain from PE presentation? (2)

A

SOB, hemoptysis

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10
Q

Chest Pain from Aortic Diss presentation? (5)

A 
ripping, tearing
radiation to back/legs/throat
acute onset
a/w HTN
50 - 70 yo M
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11
Q

Chest Pain from Tamponade presentation? (5)

A 
↑ pain supine
hypoTN
muffled heart sounds
JVD
pulsus paradoxus
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12
Q

Chest Pain Labs? (5)

A 
CBC
CMP
Troponin/CK-MB
D-Dimer
BNP (B-type Natriuretic Peptide a/w CHF)
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13
Q

Chest Pain studies?

A

Cardiac monitoring/telemetry
CXR (PA + lat)
EKG

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14
Q

Acute Coronary Syndromes include?

A

Angina
NSTEMI
STEMI

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15
Q

Stable Angina?

A

O2 supply/demand mismatch
On exertion
Relieved w/ rest/Nitro

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16
Q

Unstable Angina?

A

More severe/frequent/longer
At rest
Not relieved w/ rest/Nitro

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17
Q

NSTEMI from?

Causes what?

A

Non-occlusive thrombus

Ischemia w/ ↑ enzymes

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18
Q

STEMI from?

Causes what?

A

Occlusive thrombus

Transmural infarct

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19
Q

ACS presentation:

Onset?

Time?

Quality?

Location?

A

Onset = gradual, worse w/ exercise or stress

Time:
angina/isch = < 10 min, relief w/ rest
infar = longer, more severe, ↑ frequency

Quality = discomfort

Location = substern, L chest w/ radiation to arm, neck, jaw, shoulder, back

NOT related to position or respiration

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20
Q

ACS signs/sxs? (8)

A 
Chest pain
N/V
Diaphoresis
Dyspnea
Palp, brady, tachy or irreg
Syncope, dizzy
Fatigue
Fluid overload
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21
Q

ACS best study?

A

12-lead w/i 10 min

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22
Q

Troponin false + caused by?

A

Sepsis
Renal fail
PE
Subarachnoid hemorr

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23
Q

Troponin vs CK-MB:

Onset?

Peak?

Duration?

A

Onset: Both 3-12 hrs

Peak: Both 18-24 hrs

Duration: T = up to 10 days, CK = 36-48 hrs

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24
Q

Myoglobin vs Lactate DH:

Onset?

Peak?

Duration?

A

Onset: M = 1-4 hrs, L = 6-12 hrs

Peak: M = 6-7 hrs, L = 24-48 hrs

Duration: M = 24 hrs, L = 8 days

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25
Q

ACS other labs?

A

CBC

BMP

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26
Q

ACS other studies?

A

CXR for cardiomeg, pulmonary edema

Echo for wall thick/enlarg, wall motion, valve fxn, EF

Nulcear for myocard perfusion/damage

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27
Q

ACS tx? (6)

A 
IV access
Cardiac monitoring
MONA
β-block
Unfractionated Heparin
(P) ACE, CCB, clopidogrel
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28
Q

ACS reperfusion options? (5)

A 
Angioplasty (w/ or w/o stents)
Atherectomy
Finrinolytic
Antiplatelet
CABG
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29
Q

Aortic Dissection presentation? (5)

A 
Acute, severe tearing/ripping
Radiation to BACK, arms, throat
UNEQUAL pulses/BP in extrem
Aortic insuff murmur
Shock, neuro abnorm
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30
Q

Aortic Dissection risk factors? (6)

A 
HTN
< 40yo w/ Marfans, CT disorders
Bicuspid aortic valve
Cocaine
Preggos
FHX
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31
Q

AD studies? (4)

A

EKG
CXR (90% show abn)
CT
TEE (Transesophageal Echo)

32
Q

AD tx?

A

BP/HR w/ nitroprusside, β-block

Emergent CT/surgery

33
Q

PE presentation?

A

Acute chest pain OR painless dyspnea

Tachycard/pnea
Hypoxia
Hemoptysis
SOB
Fever,
Syncope
Unilat edema
34
Q

PE risk factors?

A

Virchow’s triad:
Immobilization
Endothelial damage
Hypercoag

35
Q

PE labs?

A

D-dimer (+ for thrombus)

36
Q

PE EKG findings?

A

Sinus tachy, S1 Q3 T3 pattern

37
Q

PE CXR findings?

A

U normal

P Hampton or Westermark

38
Q

PE diagnostic study of choice?

A

Pulmonary angio

39
Q

PE tx?

A

Anticoags

P thrombolytics, embolectomy

40
Q

Pneumothorax presentation?

A 
Acute, severe, sharp, pleuritic pain
Dyspnea
Hypoxia
Trach deviation
↓/No ipsilateral BS
Hyperresonance
41
Q

Pneumothorax labs?

A

ABG = high Aa gradient, hypoxemia

42
Q

Pneumothorax studies?

A

CXR = air in pleural space, P trach deviation

43
Q

Pneumothorax tx? (4)

A

High flow O2
+/- needle compression
Chest tubes
Serial CXR

44
Q

Pericarditis pain presentation? (4)

A

Constant, sharp/stabbing, substernal, pleuritic
Radiation to shoulder, back
↑ w/ inspiration or supine
↓ w/ lean forward

45
Q

Pericarditis other sings/sxs? (6)

A 
Fever
Cough
Dyspnea
Abd pain
Dysphagia
P friction rub
46
Q

Pericarditis caused by? (4)

A

Autoimmun
TB
CA
Purulent Pericarditis

47
Q

Pericarditis labs?

A 
CBC = Leukocytosis
ESR = ↑
Troponin = ↑
CK-MB = NOT ↑
48
Q

Pericarditis EKG findings? (2)

A

diffuse ST elevation

PR depression

49
Q

Pericarditis CXR/Echo findings?

A

pericardial fluid

50
Q

Pericarditis tx? (3)

A

Pain mgmt
Anti-inflamm/ASA/Colchicine
P aspiration, bx, steroids

51
Q

Tamponade caused by? (6)

A 
Trauma
AD
Pericarditis
CA
MI
TB
52
Q

Tamponade presentation? (2)

A

Beck’s Triad: hypoTN, JVD, muffled heart sounds

Pulsus paradoxus

53
Q

Tamponade studies?

A

CXR = enlarged heart silhouette

EKG = electrical alternans or low QRS

Echo/CT = best studies

54
Q

Myocarditis is?

A

Inflamed heart mm C a/w pericarditis

55
Q

Myocarditis presentation?

A 
Fever
Tachy OFP to temp
Arrhy
Myalgia
HA
Rigor
56
Q

Myocarditis most at risk?

A

M in 30s

Kids

57
Q

Myocarditis caused by:

Viral?

Bacterial?

Systemic dz?

Other?

A

V = coxsackie, flu, paraflu, EBV, adeno, hep B/C

B = c. dipther, n. mening, m pneumo, β strep

Sys = Collagen vascular dz, sarcoidosis, thyrotoxicosis

Other = radiation, hypersens rxn

58
Q

Myocarditis labs? (4)

A

CBC = Leukocytosis
Card Enz = ↑
Blood cx
ESR/CRP

59
Q

Myocarditis EKG findings? (4)

A

non-spec ST/T ∆s
ST elev if w/ pericarditis
AV block
Wide QT

60
Q

Myocarditis tx?

A

supportive
P abx
P immunsupp

61
Q

Mediastinitis presentation? (7)

A 
Chest/Abd pain
Cough
Hoarseness
Dysphagia
Forceful V
Look ill (shock, fever)
Hamman's Crunch (crackles over mediastinum)
62
Q

Mediastinitis caused by? (3)

A

Dental infections
Esoph perf
Complication of cardiac, GI, airway surgery

63
Q

Mediastinitis labs? (2)

A

CBC = Leukocytosis

Blood cx for source

64
Q

Mediastinitis CXR findings? (2)

A

Mediastinal or free peritoneal air

Pleural effusion

65
Q

Mediastinitis CT findings? (3)

A

Extra-esophageal air
Mediastinal widening
Abscess

66
Q

Mediastinitis tx? (2)

A

Abx

CT surg

67
Q

PNA presentation? (6)

A 
Fever
Cough
Hypoxia
Pleuritic chest pain
Tachycard/pnea
Rales, ↓ BS
68
Q

PNA labs?

Studies?

A

CBC = Leukocytosis or penia

CXR = consolidation or infiltrate

69
Q

Esophagitis U from what?

Hard to distinguish from?

A

GERD

Myo ischemia

70
Q

Esophagitis presentation?

A

Burning/gnawing chest pain

Lower chest

71
Q

Esophagitis tx? (3)

A

GI cocktail:
viscous lido, maalox, donnatol

H2 block, PPI

72
Q

Esophageal spasm presentation?

Tx?

A

Sudden onset dull/tight/gripping substernal pain,
U following hot/cold drinks or large food bolus

SL nitro

73
Q

Pleuritis is?

Presentation?

A

Inflammed pleura

Sharp, reproducible pain
↑ w/ inspiration

74
Q

Pleuritis a/w?

A

PE
Pericarditis
PNA

DIAGNOSIS OF EXCLUSION

75
Q

Costochondritis is?

A

Inflammed costal cart and/or sternal articulations

76
Q

Costochondritis presentation? (2)

Imaging?

Tx?

A

Sharp or dull chest pain
↑ w/ deep inspiration and palp

CXR to r/o

Anti-inflam

Q4 EM Surg (27 decks)

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