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CDM2 - Midterm > Jaynstein - Chest Pain > Flashcards

Jaynstein - Chest Pain Flashcards

1
Q

what is levine sign

A

clutching of chest with severe pain

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2
Q

5 broad ddx for CP

A

CV
trauma/MS
pulmonary
infectious
other

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3
Q

3 CV do not miss causes of CP

A

ACS
AAA
AS

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4
Q

4 trauma/MSK causes of CP

A

chest wall fx/contusion
PTX
boerhaaves syndrome
costochondritis

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5
Q

aortic stenosis triad

A

SAD:
syncope
angina
dyspnea

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6
Q

pulmonary cause of CP

A

PE

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7
Q

3 infectious causes of CP

A

pleurisy
PNA
myocarditis

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8
Q

other causes of CP

A

GERD
esophageal
PUD
GB
psych -> severe anxiety
toxicity -> cocaine

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9
Q

t/f: vast majority of pt’s who are having an MI present to ED

A

t!

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10
Q

mc cause of CP in primary care setting

A

chest wall syndrome (CWS)

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11
Q

what is CWS

A

MSK related chest wall pain

not an emergent dx

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12
Q

ex of CWS

A

costochondritis

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13
Q

don’t diagnose CP as __

A

nonspecific or atypical CP

call it CWS or non coronary related CP

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14
Q

3 main goals of CP eval

A

determine stable vs unstable
low risk vs who needs referral/testing
who needs prompt transfer

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15
Q

indications for emergent ER transport

A

any concern for ABC’s outside of acceptable range (not necessarily “normal” range)

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16
Q

2 indications that pt likely does not need emergent care

A

no respiratory distress
vitals within acceptable range

just move on to complete H&P

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17
Q

management of unstable pt w. CP

A
  1. O2
  2. call 911
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18
Q

first step in op management of CP (stable pt)

A

ECG

if no ECG in office, get them somewhere else (probs ED)

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19
Q

2 commonly missed history questions w. CP

A

-have you had pain like this before
-have you ever had a heart exam/work up (if normal stress test in last 90 days, unlikely to be ACS)

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20
Q

how many baby ASA equals a full dose of ASA

A

4

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21
Q

sign pointing to GI CP

A

postprandial

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22
Q

red flags for cardiac CP

A

worse with:
exertion
cold
emotional stress
sex

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23
Q

CP worse with body position/movement/deep breathing is indicative of

A

MSK origin

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24
Q

relief w. sublingual nitro suggests CP related to (2)

A

cardiac
esophageal

NOT DIAGNOSTIC THO!

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25
Q

relief of CP w. GI cocktail is indicative of CP related to (2)

A

GI
cardiac

NOT DIAGNOSTIC

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26
Q

cessation of pain w. rest is indicative of CP related to

A

cardiac

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27
Q

relief of pain w. sitting up and leaning forward suggests

A

pericarditis

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28
Q

vomiting may indicate CP related to (2)

A

MI
GI

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29
Q

diaphoresis is most likely indicative of CP related to

A

MI

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30
Q

syncope w. CP is concerning for (4)

A

dissection
PE
critical AS
AAA

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31
Q

2 symptoms VERY concerning for MI

A

syncope
diaphoresis

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32
Q

near-syncope w. CP is most likely

A

myocardia ischemia

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33
Q

__ can be only presenting complaint of MI in elderly pt

A

fatigue

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34
Q

radiation of CP to __ is strong predictor of acute MI

A

arms

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35
Q

radiation of CP to scapula is concerning for __

A

aortic dissection

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36
Q

nonspecific CP radiation is concerning for __

A

ischemic etiology

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37
Q

what aspect of pain is NOT a useful predictor for presence of CAD

A

severity

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38
Q

abrupt onset of pain w. greatest intensity in the beginning is concerning for (3)

A

PTX
dissection
acute PE

39
Q

gradual CP that increases over time

A

ischemia

40
Q

crescendo CP pattern

A

esophageal dz

41
Q

CP that lasts for seconds or is constant over weeks is not __

A

ischemic

42
Q

CP associated w. circadian rhythm

A

ischemia

correlates w. sympathetic tone

43
Q

ischemic pain mc occurs during what time of day

A

morning

44
Q

3 hx red flags w. CP

A

prior CV hx
GI hx (ex biliary colic)
fam hx

45
Q

rf for cardiac causes of CP

A

age
tobacco use
fam hx
DM
HTN
HLD
cocaine
DVT/PE
marfans
pregnancy
etoh
NSAIDs

46
Q

red flag exam findings for ACS

A

S3 or S4
sbp < 80
crackles on auscultation

47
Q

t/f: hypotensive MI is more concerning than hypertensive MI

A

t!

48
Q

likelihood ratio > __ indicates test result is associated with dz

A

1

49
Q

likelihood ratio < __ indicates result is associated w. absence of dz

A

1

50
Q

LR of 2 increases probability of test result/dz association by __

A

15%

51
Q

LR of 5 increases probability of test result/dz association by __

A

30%

52
Q

LR of 10 increases likelihood of test result/disease association by

A

45%

53
Q

in medicine, LR > __ is considered very highly significant

A

10

54
Q

clinical feature most significantly associated w. MI

A

pain radiation to BOTH arms

not just left or right

55
Q

9 clinical features statistically significantly associated w. MI

A

pain radiation to both arms or either arm
non exertional pain
S4
hypotn
prior MI
crackles
diaphoresis/n/v
pain described as pressure
pain worse than previous MI

56
Q

7 clinical features significantly associated w. MI

A

pain radiation to both arms or either arm
S4
hypotn
prior MI
crackles
diaphoresis/n/v
pressure/crushing pain
pain worse than previous MI

57
Q

5 clinical features that statistically decrease likelihood of MI

A

pleuritic/sharp/stabbing/positional pain
reproducible pain
exertional pain
inframammary pain
pain reproducible w. palpation

58
Q

EKG AMI criteria

A

ST elevations > 2 mm in continuous leads

59
Q

ischemia EKG criteria (3)

A

> 2 mm Q waves in inferior leads
ST depression in continuous leads
T wave inversion in continuous leads

60
Q

if pt has concerning EKG, you will send them to ER, if EKG is wnl, what do you do

A

troponin to evaluate for NSTEMI
evaluate for non cardiac causes (ex CXR)

61
Q

ED troponin SOC

A

> 3 hr from onset of sx: initial trop only
< 3 hr from onset of sx: need 2nd trop 1 hr later

62
Q

safest management of ACS in op setting no matter the time from onset of sx

A

transfer to ER w.o trop testing

63
Q

when is it reasonable to order op trop

A

single trop if no rf and nl EKG and symptoms have resolved at least 12 hr prior

64
Q

should you ever order a trop if you are sending pt to ED

A

no!

65
Q

management of pt who has work up for CP that is not concerning for MI (4)

A

arrange for cardiac stress testing w.in 3-7 days
start PPI minimum of 2 wk trial)
start daily baby ASA
strict “to ER” precautions

66
Q

mc PE findings of pt w. ACS

A

normal

67
Q

2 helpful PE findings helpful to r.o MI

A

reproducible CP
pain w. palpation

68
Q

3 labs helpful in evaluation of CP

A

CBC (if you think there is an infectious cause)
CMP
trop

69
Q

t/f: you can use HEART Score in primary care setting

A

F!
you need troponin first

70
Q

what is included in the HEART score

A

history
ECG
age
RF
Troponin

71
Q

post prandial CP can be an atypical presentation of

A

ischemia

72
Q

4 emergent causes of CP

A

ACS
aortic dissection
PE
PTX

73
Q

7 urgent causes of CP

A

pericarditis
pulmonary HTN
myocarditis
esophageal rupture
biliary tract dz
pancreatitis
PNA

74
Q

other causes of CP (6)

A

GERD
PUD/gastritis
esophageal spasm
costochondritis/CWS
herpes zoster
anxiety

75
Q

3 classic PE findings of ACS

A

normal
tachy
new murmur

76
Q

EKG findings in aortic dissection

A

normal

77
Q

4 classic findings of aortic dissection

A

distressed
wide mediastinum on CXR
pulse defects
neuro findings

78
Q

3 EKG findings of PE

A

sinus tachy
RBBB
S1Q3T3

79
Q

3 classic findings of PTX

A

tracheal shift
lucency on CXR
shock if tension

80
Q

3 classic findings of pulmonary HTN

A

elevated JVP
loud S2, S4
increased markings on CXR

81
Q

5 classic findings of myocarditis

A

+/- elevated trop
leukocytosis
new murmur
tachy
HF

82
Q

2 classic findings of esophageal rupture

A

mediastinal air on CXR
crepitus

83
Q

4 classic findings of biliary tract dz

A

murphy sign
+/- jaundice
fever
abnl LFTs

84
Q

2 classic findings of pancreatitis

A

elevated amylase/lipase
elevated LFTs if gallstone

85
Q

4 classic findings of PNA

A

fever
leukocytosis
rhonchi/rales
infiltrates on CXR

86
Q

3 classic findings of GERD

A

relieved by GI cocktail
normal work up
esophagitis on EGD

87
Q

2 classic findings of PUD/gastritis

A

epigrastric tenderness
guaiac (+) stools

88
Q

classic finding of esophageal spasm

A

better w. nitro

89
Q

classic finding of costochondritis/CWS

A

localized tenderness
reproduced w. palpation

90
Q

classic finding of herpes zoster

A

CP before rash

91
Q

what do you think when you see unilateral, localized CP w. (or followed by) rash

A

herpes zoster

92
Q

pleuritic CP w. violent vomiting

A

esophageal rupture

93
Q

3 rf for aortic dissection

A

HTN
smoking
marfans

94
Q

aortic dissection symptoms can mimic ___ sx

A

stroke sx

CDM2 - Midterm (12 decks)

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