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M103 T3 > M103 T3 L19 > Flashcards

M103 T3 L19 Flashcards

1
Q

Which groups of structures in the chest can produce pain?

A 
Cardiac 
Pericardial 
Oesophageal 
Pleural
Vascular
Musculoskeletal 
Neural
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2
Q

What are examples of cardiac conditions that can cause chest pain?

A

muscle death / infarction, ischaemia, infection

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3
Q

What are examples of Pericardial conditions that can cause chest pain?

A

inflammation, infection

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4
Q

What are examples of Oesophageal conditions that can cause chest pain?

A

spasm, inflammation, rupture, varices

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5
Q

What are examples of Pleural conditions that can cause chest pain?

A

infection, infarction, embolism, rupture / collapse

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6
Q

What are examples of Vascular conditions that can cause chest pain?

A

rupture, inflammation [vasculitis], infection

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7
Q

What are examples of Musculoskeletal conditions that can cause chest pain?

A

strain, spasm, tear, rupture, fracture

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8
Q

What are examples of Neural conditions that can cause chest pain?

A

‘precordial catch, referred pain, neuropathy

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9
Q

What are the two different types of structures that can cause chest pain?

A

superficial structures

deep structures

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10
Q

What are examples of superficial structures that can cause chest pain?

A

skin
breast tissue
ribs

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11
Q

What are examples of deep structures that can cause chest pain?

A 
oesophagus
respiratory tract
lungs / pleura
heart
aorta
spine
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12
Q

What areas is chest pain often referred to?

A 
face
liver
arms
neck
(FLAN)
chest pain generally moves UP
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13
Q

What are life threatening causes of chest pain?

A 
Myocardial infarction / ischaemia
myocarditis / pericarditis
Pneumothorax
Massive pulmonary embolus & infarction
Ruptured aortic aneurysm
Ruptured oesophagus
Aortic dissection
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14
Q

What is the spectrum for the severity of chest pain under ACS?

A

stable angina
unstable angina
NSTEMI

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15
Q

What type of pain is described by patients with typical ACS chest pain?

A

central chest pain

usually accompanied by a squeezing or crushing sensation radiating up to the neck in the left arm

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16
Q

What symptoms is ACS chest pain usually associated with?

A

Diaphoresis

grey colour or pallor

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17
Q

Why are women more likely to experience a silent MI?

A

women often experience different classic symptoms to those of men - which are usually the only ones explained in the text books

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18
Q

What symptoms are women much more likely to experience when having a heart attack?

A

shortness of breath, dizziness or nausea

abdominal pain, tachycardia

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19
Q

What are words used to describe chest pain when taking histories?

A

Stabbing, knife-like, sharp
Gnawing, burning, numbing
Strangling, tightness, crushing, squeezing, constricting
Tearing, piercing

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20
Q

What does SOCRATES stand for?

A 
Site 
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbation
Severity
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21
Q

When might chest pain radiate into the right arm of a patient having a myocardial infarction rather than into the left arm?

A

if it is a rare case of the patient having Dextracardia

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22
Q

What are two terms associated with Acute Coronary Syndrome?

A

myocardial infarction

angina

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23
Q

In what order does an examination into ACS occur?

A

Inspection, Auscultation, Palpatation - IAP
BP, HR, RR
SaO2

24
Q

What are the three types of investigations done in ACS?

A

bloods
CXR
ECG

25
Q

What is chest pain in ACS usually relieved by?

A

nitrates

26
Q

If nitrates aren’t working, why wouldn’t you give the patient morphine?

A

opiates can drive oxidative stress which is harmful

instead, statins to help stabilise plaques

27
Q

What are the markers for ACS in the blood?

A

troponins - troponin T
C reactive protein or urea - indicates a lower respiratory tract infection
D-dimer - pulmonary embolism

28
Q

When are D-dimers helpful?

A

when the result is negative bc they have a low false negative rate
has quite a high false positive rate bc it’s not very specific to blood clots (e.g. poor renal function, infection, post surgery after many weeks)

29
Q

What signs would you look for on a CXR of a MI patient?

A 
consolidation
changes in the cardiac shadow 
changes in the the aortic notch
inflation of the lungs
trauma
30
Q

What features would you expect on a ECG from an MI patient?

A

ST elevation is classical, but NSTEMI is also completely normal

31
Q

What is the purpose of performing serial ECGs on a patient?

A

looking for dynamic changes
can indicate that there’s some cardiac stress
this is suggestive of ischaemia

32
Q

What does the Oxford Handbook of Clinical Medicine state about all MI patients with a large PE?

A

that they will have the S1Q3T3 pattern, but that’s actually rare clinically

33
Q

What is a potential indicator of pericarditis?

A

periodic or sharp sounding central chest pain

dynamic change on the serial ECGs surrounding a saddle-shaped ST segment

34
Q

How many squares would the PR segment be on an ECG normally?

A

about 3 squares

35
Q

What is the PR interval on an ECG indicative of?

A

delay at the AV node

36
Q

What might be the cause for changes to the PR interval over serial ECGs?

A

if damage is sustained to the AV node. if it is defective in way it works
and if the patient has a condition like heart block (of first, second or third degree)

37
Q

What are the effects of different degrees of heart block on the PR interval?

A

first - a delay

second & third - more complicated changes

38
Q

What conditions might be associated with dyspensia?

A

gastritis
esophagiti
mucosal ulcers (might be the only symptom experienced)

39
Q

What are some non-life threatening causes of chest pain in the heart?

A

heart burn
GORD
palpitations

40
Q

What are some non-life threatening causes of chest pain in the musculoskeletal system?

A

Costochondritis
Tietze’s disease
non-penetrating trauma

41
Q

How are palpitations usually described by patients?

A

bubbles in the chest / like they’ve been thumped in the chest
but they don’t tend to be painful
usually are quite self limiting, short lived and self resolving

42
Q

What can the effects of non-penetrating trauma be if it is of sufficient force?

A

a pneumothorax

43
Q

What combination of factors make it very likely that the patient is having a spontaneous pneumothorax?

A

young, slender, tall, male, active

44
Q

What makes it more likely to be musculoskeletal in origin?

A

if the pain is reproducible on pressing or spraying of the chest

45
Q

What makes it more likely to be musculoskeletal in origin?

A

if the pain is reproducible on pressing or spraying of the chest

46
Q

What can pericarditis be caused by?

A

Can happen after an MI (Dressler’s)
Viral infection in context of ‘flu like illness
Coxsackie virus, mumps, herpes, HIV

47
Q

How is osophageal pain usually described by patients?

A

burning, crushing, sharp, continuous, wave-like, or acute

48
Q

When does osophageal pain usually get worse?

A

after eating
on bending forward / lying flat
raising head of bed
smoking

49
Q

What can cause oesophageal rupture?

A

mediastinitis

spontaneous (following violent vomiting)

50
Q

How is pleuritic pain usually described by patients?

A

Severe ‘sharp’, ‘stabbing’ or ‘knife-like’
usually one sided
worse on inspiration

51
Q

What are the risk factors of pleuritic pain?

A

immobility, pregnancy, oestrogen therapy, obesity

52
Q

What is the most common symptom of PE?

A

dysponea

53
Q

What is shingles otherwise known as?

A

Herpes zoster

54
Q

How does shingles usually present?

A

accompanied by a blistering rash with a dermatomal distribution – classically not passing the midline

55
Q

What can nerve roots become compressed or irritated by?

A

vertebral body collapse (secondary to trauma or metastases)
metastatic growth and invasion
infection (including discitis)

M103 T3 (21 decks)

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