Week 9

Question 1

A diagnosis of costochondritis can typically be made as a clinical diagnosis (without confirmatory tests) in all of the following age groups EXCEPT:

a. children
b. adolescents
c. adults ≤35 years old
d. adults >35 years old

Answer 1

d. adults >35 years old

Question 2

Which of the following most accurately describes the physical exam findings in costochondritis?

a. redness over costochondral and/or chondrosternal junction(s)
b. tenderness to palpation over costochondral and/or chondrosternal junction(s)
c. swelling over costochondral and/or chondrosternal junction(s)
d. tenderness over costochondral junction(s) only
e. tenderness over chondrosternal junction(s) only

Answer 2

b. tenderness to palpation over costochondral and/or chondrosternal junction(s)

Question 3

Can you exclude a cardiac cause of chest pain if a patient has palpable tenderness chest wall tenderness?

Answer 3

no
- It is atypical for cardiac chest pain to be present when the chest wall is tender to palpation, making the diagnosis much LESS likely but you cannot completely rule it out.

Question 4

Chest pain due to costocondritis usually affects:

a. both sides of the anterior rib cage
b. anterior rib 2 only
c. unilateral, anterior ribs
d. posterior, bilateral thoracic ribs

Answer 4

c. unilateral, anterior ribs

Question 5

Which of the following is NOT a usual recommended treatment option for costochondritis?

a. exercise more
b. heat
c. ice
d. pain relievers

Answer 5

a. exercise more

Question 6

What is the most likely cause of lower chest pain that can be reproduced by slipping fingers under the anterior costal margin and pulling forward gently (a click may also be heard)?

a. slipping rib syndrome
b. tietze syndrome
c. painful xiphoid syndrome (xiphoidalgia)
d. fibromyalgia
e. costochondritis

Answer 6

a. slipping rib syndrome

Question 7

Which of the following causes of chest wall pain may result in actual destruction of cartilage?

a. costochondritis
b. tietze’s syndrome
c. muscle overuse injury
d. metastatic cancer
e. fibromyalgia

Answer 7

d. metastatic cancer

- infections may also lead to cartilage or bony destruction

Question 8

Which of the following findings is NOT a potential indication for chest imaging in a patient with chest pain?

a. fever and chills
b. persistent cough productive of sputum
c. vesicles in a unilateral, dermatomal distribution
d. chest wall tenderness and swelling

Answer 8

c. vesicles in a unilateral, dermatomal distribution

Question 9

Which of the following does NOT support a diagnosis of Tietze’s syndrome?

a. swelling at the 2nd sternochondral junction
b. tenderness at the 2nd sternochondral junction
c. drainage of pus at the 2nd sternochondral junction
d. the patient is younger than 40 years old

Answer 9

c. drainage of pus at the 2nd sternochondral junction

Question 10

Graded exercise is definitely recommended as treatment for which of the following causes of chest wall pain?

a. fibromyalgia
b. herpes zoster
c. costochondritis
d. painful xiphoid syndrome

Answer 10

a. fibromyalgia