TCD 3.5 - Central chest pain

Question 1

Define atherosclerosis

Answer 1

Atherosclerosis is a chronic inflammatory process triggered by the accumulation of cholesterol-containing low-density lipoprotein (LDL) particles in the arterial wall.

Question 2

Chest pain, first differential: Sudden onset pleuritic pain either left sided or right sided, with associated dyspnoea and syncope

Answer 2

Pneumothorax

Question 3

Chest pain, first differential: Pain typically persistent (typically days or longer), worsened with passive and active motion and sometimes reproducible chest tenderness

Answer 3

MSK

Question 4

Chest pain, first differential: Exertional pain/discomfort in the centre or left side of chest, throat, neck or jaw relieved by rest or GTN within a few minutes. May radiate to neck, jaw or left arm. Sometimes there may not be any pain but breathlessness (angina equivalent).

Answer 4

Angina

Question 5

Chest pain: first differential, Constant or intermittent central pleuritic sharp pain often aggravated by position (classically worse on lying down and relieved by sitting or leaning forward)

Answer 5

Pericarditis

Question 6

Chest pain: first differential, Recurrent, vague epigastric discomfort, that is relieved by food, antacids, or both

Answer 6

Peptic ulcer disease

Question 7

Chest pain: first differential, Sudden onset pleuritic pain with associated dyspnoea and tachycardia. Sometimes mild fever, haemoptysis and syncope

Answer 7

PE

Question 8

How can we calculate a pack year?

Answer 8

A year of smoking 20 cigarettes a year (e.g. 10 cigarettes a day for two years)