Scenario 1 - MI

Question 1

Differentiate the site of radiation in MI vs aortic dissection

Answer 1

MI: jaw
AD: back

Question 2

What are the typical associated symptoms of cardiac-origin chest pain?

Answer 2

Nausea

Sweating

Question 3

Describe the location of pneumonia-related chest pain

Answer 3

Pleuritic

Question 4

Describe the location of pain caused by costochondritis

Answer 4

Gives a localised tenderness

Question 5

Recall one exacerbating and one alleviating factor for pericarditis chest pain

Answer 5

Exacerbating: inhalation
Alleviating: leaning forwards

Question 6

Cardiac-origin chest pain with flu-like symptoms is most likely to be due to what?

Answer 6

Pericarditis

Question 7

Recall one key sign in pericarditis

Answer 7

Pericardial friction rub

Question 8

Which drugs should be given in any MI (STEMI or NSTEMI)?

Answer 8

Aspirin

Clopidogrel

Question 9

What is a PCI?

Answer 9

Percutaneous coronary intervention: an angioplasty with a stent

Question 10

Recall the 1st, 2nd and 3rd-line investigations in suspected MI

Answer 10

1. ECG
2. Troponin (result indicates 4th-line)
3. Echo

Question 11

What investigation should be carried out if troponin is positive in a suspected MI?

Answer 11

Coronary angiography

Question 12

What investigation should be carried out if troponin is negative in a suspected MI?

Answer 12

Exercise tolerance test

Question 13

What information does troponin give in a suspected MI?

Answer 13

If positive suggests STEMI - as there has been muscle death

If negative suggests NSTEMI as there is less ischaemic damage resulting from partial coronary arterial occlusion

Question 14

What will be seen on echo if there has been an MI?

Answer 14

Regional Wall Motion Abnormality due to death of that region of cardiac muscle

Question 15

Recall 3 cardiac differentials for chest pain

Answer 15

1. IHD
2. Aortic dissection
3. Pericarditis

Question 16

Recall 4 respiratory differentials for chest pain

Answer 16

1. PE
2. Pneumothorax
3. Pneumonia
4. Pleuritic pain caused by connective tissue disease

Question 17

In a suspected aortic dissection, what 2 things would you find on examination that were abnormal?

Answer 17

1. Aortic regurgitation can be auscultated when they lean forwards
2. BP difference between arms

Question 18

What is the characteristic appearance of pericarditis on ECG?

Answer 18

Widespread saddle-shaped ST elevation

Question 19

Recall 3 GI differentials for chest pain

Answer 19

1. Oesophageal spasm
2. Gastritis/oesophagitis
3. Oesophageal candidiasis

Question 20

Recall 2 groups of people who are at high risk of oesophageal candidiasis

Answer 20

1. Those on immunosuppressant medication

2. Those on steroid medication eg. dexamethosone (due to its immunosuppressive effect)

Question 21

Recall a musculoskeletal differential for chest pain

Answer 21

Costochondritis

Question 22

Recall 3 exacerbating factors for costochondritis chest pain

Answer 22

Exercise
Posture
Deep breath/ sneeze

Question 23

In which leads is ST elevation seen in an anteriolateral STEMI?

Answer 23

I, aVL, V2-V6

Question 24

In which leads is ST elevation seen in an inferior STEMI?

Answer 24

II, III, aVF

Question 25

Occlusion of which coronary artery causes an anterior MI?

Answer 25

LAD

Question 26

In which leads is ST elevation seen in an anterior STEMI?

Answer 26

V1-V4

Question 27

In which leads is ST elevation seen in a lateral MI?

Answer 27

I, aVL, V5, V6

Question 28

Occlusion of which coronary artery causes a lateral MI?

Answer 28

Circumflex

Question 29

Occlusion of which coronary artery causes an inferior MI?

Answer 29

Right coronary artery