PANCE Cardiology #2 Chest Pain

Question 1

Name 5 common risk factors for chest pain?
Most common risk factor for CAD?
which is the worst risk factor?
which when corrected will show the biggest improvement?

Answer 1

HTN, DM2, hyperlipidemia, smokr, fam hx

fam hx includes father <65yo

Question 2

Name what you COULD find on exam for LV dysfunction. 4 things

Answer 2

JVD
S3
S4
rales

Question 3

the is the most common exam finding for LV?

Answer 3

normal

Question 4

Ischemic pain duration?
Quality?
Character?

Answer 4

10-30 minutes (if its seconds or days=not ischemic)
dull, sore, squeezing (not sharp)
tightness, heaviness, pressure

Question 5

Inferior wall ischemia may present with vagal reflexes.

Answer 5

bradycardia, hypotension, dizziness/fainting

Question 6

ischemic pain is not? 3 things

Answer 6

positional, pluritic, tender to palpation

Question 7

can you rule out transient ischemia from esophagea; spasm with nitroglycerin?
What can you use as a response to therapy to make a diagnosis?
opioids?
esophageal candidasis?

Answer 7

NO!!!
nitro causes vaso-dilation of lower esophageal sphincter which makes GERD worse.
Narcan.
fluconazole.

Question 8

True infarction lasts?

Answer 8

20-30 minutes

Question 9

Initail impression,
diphoresis, tachypnea, anxious should alert PA to life threatening process.
example=tachy, tachy?
B/P difference of 20mmHg is present in?

Answer 9

PE

aortic dissection

Question 10

The most common physcial exam finding for MI?

Answer 10

nothing.

Question 11

What is a wide split of S2 indicative of? 4 things

What is a new paradoxic split of S2? 5 things

Answer 11

RBBB.
right ventricular hypertrophy/infarct
pulm HTN
pulmonic stenosis
q#2 LBBB, ant or lateral infarct, HTN, aortic stenosis, LVH

Question 12

What is the only thing that gives you a fixed split of the S2?

Answer 12

atrial septal defect.

Question 13

What is a S4 gallop indicative of ?
Patient comes in with 20yr hx of HTN what do you expect to find?
What will you do differently on the bases of this finding?

Answer 13

LVH (atrial systole=blood splashes against vent wall)

nothing. tx htn

Question 14

What do you do with a S3?

Answer 14

CHF, need meds quick, you gonna be sick!!!
INCREASE THEARAPY
splashy, splashy=fluid overload
tx=diuretic, ace

Question 15

with new onset aortic regurgitation, you will find 50% of patients with ?

Answer 15

mitral regurgitation

Question 16

new onset mitral regurge is attributed to

Answer 16

papillary musce detachment/dysfunction

Question 17

up to how many hours does it take CKMB and troponins to elevate?
up to how many hours after onset of chest pain are thromboilytic indicated?

Answer 17

4hrs

12hrs

Question 18

when do you initiate Tpa?

Answer 18

ST segemnt elevation. STEMI

Question 19

on an ekg, what is indicative of a st elevation mi?

Answer 19

st segment elevated >1mm, in 2 leads.

Question 20

pt who had mi 5 days ago presents with new onset chest pain. What cardiac enzyme do you want?
Troponin is also elevated in ?

Answer 20

CK-MB because they are out of the system in 3-4 days. Troponins are in your system for wks.
Renal dz

Question 21

How do you differentiate cardia chest pain from non-cardiac chest pain?

Answer 21

pleuritic, positional or tender

Question 22

sx of

1) costochondritis
2) GERD
3) peptic ulcer
4) gallbladder dz
5) MI
6) aortic stenosis
7) myocarditis
8) pericarditis
9) dissecting aortic aneurysm
10) mitral valve prolaps
11) PE
12) pneumothorax

Answer 22

1) pain exacerbated by inspiration; reproduced by chest wall palpation
2) acid reflux, relief with antacids
3) epigastric pain
4) RUQ abdo pain and tenderness
5) pain more sever, 20-30 minutes
6) systolic ejection murmur
7) pain is vague and mild
8) pain is sharp, worse when lying down, relieved when sitting up (positional and pleurtic)
9) pain is sharp and tearing, felt in the back
10) transient pain, midsystolic click
11) tachypnea, dyspnea, pleuritic pain
12) sudden onset of pain + dyspnea

Question 23

aortic dissection key characteristic 4things
first diagnostic test?
diagnosis confirmed by?

Answer 23

widened mediastinum
pain radiating to back
loss of pulses
test= x-ray
MRI, CT, TEE(transesophagealecho

Question 24

name causes of pleuritic pain? 4 P’s

Which of these can give you a fever?

Answer 24

PE
Pneumonia
pericarditis
pneumothorax
pleuritis
all of them can give you a fever.

Question 25

pregnant woman with PE what do you get

Answer 25

VQ scan

Question 26

pericarditis is precede by a…
what do you hear on auscultaion..
single most specific test for pericarditis?
treatment?

Answer 26

viral illness
friction rub
PR- segment depression, diffuse ST segment elevation
tx? NSAIDS, then steroids

Question 27

most specific test to diagnose myocarditis?

Answer 27

biopsy

Question 28

What comprises ACS?
What do you differentiate with these 2 dx’s?
Which gets thrombolytics/angioplasty

Answer 28

unstable angina/ MI
STEMI / NSTEMI
STEMI