Questions

Question 1

Mr. Davis, a 70-year-old male, presents with a chief complaint of chest pain that occurs during physical activity and subsides with rest. He also experiences shortness of breath during these episodes. His medical history includes hypertension and hyperlipidemia.

Why is stable angina the top differential?

Answer 1

• Chest pain triggered by exertion
• Subsides with rest
• Risk Factors: include hypertension and hyperlipidemia. These risk factors increase the likelihood of atherosclerosis, which can lead to coronary artery (CAD) narrowing and angina.
• Older age is a risk factor

Question 2

Mrs. White, a 75-year-old female, presents with a sudden-onset severe headache, nausea, vomiting, and photophobia. She describes it as the “worst headache of her life.” On examination, you note neck stiffness. What is the most likely diagnosis?

A) Migraine headache
B) Cluster headache
C) Subarachnoid hemorrhage
D) Tension headache

What is the work-up to confirm?

What is the treatment?

Answer 2

Subarachnoid Hemmorhage

CT is imaging modality of choice - lumbar puncture if in nonfirmed after

Supportive: bed rest, stool softners to reduce ICP
Nimplodapine
If hydrocephalus, ventriculostomy