Symptoms

Question 1

Chest pain - Alarming and Increasing over mins-hours - Differential

Answer 1

Heart - (Angina, ACS, N/STEMI) Oesophagus - (-itis, spasm), Lung - (PE or infarction, Pneumothorax incl. tension), Dissecting thoracic aortic aneurism, Chest wall pain

Question 2

Angina suggested by

Answer 2

Central pain +/- radiation to jaw or arm, usu left. Intermittent, relieved by rest or nitrates. Lasts

Question 3

N/STEMI

Answer 3

Central pain +/- radiation to jaw or arm, usu left. Continuous, usu. >30 mins, NOT relieved by rest or nitrates.
Can present in many ways, upper abdominal pain may indicate inferior MI.

Question 4

Oesophagitis or spasm

Answer 4

Past episodes of pain when supine or after food, alcohol or NSAIDS. Relieved by antacids

Question 5

Pulmonary embolism/infarction

Answer 5

Sudden Breathlessness, other respiratory signs (pleural rub, cyanosis, tachycardia, loud P2), history of DVT or other embolic risk factors - recent surgery, immobility, previous history, cancer etc.

Question 6

Pneumothorax (tension, moderate or mild)

Answer 6

Pain in centre or side of chest + abrupt breathlessness. Examination shows reduced breath sounds and hyperresonance to percussion.

Question 7

Dissecting aortic aneurism

Answer 7

‘tearing’ pain, usu. radiating to back. Abnormal or absent pulses, early diastolic murmur, Low BP

Question 8

Chest wall pain

Answer 8

Pain and tenderness when twisting neck or ribcage - usu. found if no other cause for chest pain is positive

Question 9

Severe lower chest/upper abdo pain - Differential

Answer 9

Stomach - Gastro-oesophageal reflux, gastritis
Liver - biliary colic i.e gallstones
Pancreas - itis, oft due to gallstone impaction in common bile duct
Heart - oft inferior MI

Question 10

Gastro-oesophageal reflux/gastritis

Answer 10

Central or epigastric, burning pain. Onset over hours, worse lying flat and by food, alcohol or NSAIDS

Question 11

Biliary colic

Answer 11

Chest pain, onset over minutes-hours after food, esp. fatty food. Severe, colicky (waves), central to right upper quadrant, radiating to right scapula.

Question 12

Pancreatitis

Answer 12

Mid epigastric pain, radiating to back. Onset over hours. Usu. associated with nausea and vomiting, gallstones.

Question 13

Sudden breathlessness onset in seconds - differential

Answer 13

Vascular - i.e pulmonary embolism/infarction
Lung/plerual - i.e pneumothorax
Allergic/toxicity - i.e anaphylaxis
Mechanical - inhalation of foreign body

Question 14

Anaphylaxis

Answer 14

Dramatic onset over minutes with recent allergen exposure. Flush, sweating, facial oedema, urticaria (rash), warm and clammy extremities, tachypnea, bronchospasm, wheeze, tachycardia and hypotension.

i.e inflammatory symptoms - swelling, rash, redness, heat
+ related respiratory and cardiac symptoms

Question 15

Inhalation of foreign body

Answer 15

History of object in mouth, shows sudden stridor, severe cough, low pitched monophonic wheeze, reduced breath sounds (more often on right)