1 Chest Pain

Question 1

For patients with any abrupt, new, or severe chest pain, obtain an ECG within

Answer 1

10 minutes

Question 2

For chest pain patients, administer oxygen if ambient saturation is

Answer 2

<94%

Question 3

Nonclassic presentaitons ofr ACS occur more frequently in

Answer 3

Psychiatric patients
Altered mental status
Women
Diabetics
Elderly
Racial minorities

Question 4

In these patients, include an ECG in routine evaluation of abdominal pain

Answer 4

Patients >50 y/o
Or those with known CAD

Question 5

What is Boerhaave’s syndrome

Answer 5

Esophageal rupture
Classically presents with a history of sudden-onset sharp substernal chest pain following forceful vomiting.

When suspecting esophageal rupture, obtain a CT with oral-water soluble contrast

Question 6

This refers to audible crepitus that varies with the heartbeat on auscultation of the precordium

Answer 6

Hamman’s crunch
A rare finding associated with pneumomediastinum.

Question 7

Most specific physical examfinding for pericarditis

Answer 7

pericardial friction rub

Question 8

chest pain of pericariditis

Answer 8

Worst with supine
Worsened by inspiration
Relieved by sitting and leaning forward

Question 9

Classic ECG findings in pericarditis

Answer 9

Diffuse ST-segment elevation with PR depression

Question 10

What is another name for costochondritis

Answer 10

Tietze syndrome

Question 11

Panic disorder is characterized by:

Answer 11

recurrent, unexpected, and discrete periods of intense fear or discomfort with at least 4 of the following symptoms:

chest pain
dyspnea
palpitations
diaphoresis
nausea
tremers
choking
dizziness
fear of losing control
fear of dying
paresthesia
chills
hot flashes

Question 12

Remarks with panic disorder

Answer 12

Do not assume panic disorder in a patients with chest pain in the ED until further testing allows better risk stratification.

Question 13

Some conditions with elevated cardiac troponin levels in the absence of ischemic heart disease

Answer 13

Pulmonary hypertension
Arrhythmias
Pulmonary embolism
Aortic dissection

Burns
Extreme exertion (e.g., endurance athletes)
Acute neurologic disease (e.g., stroke, SAH)
Respiratory failure
Sepsis

Question 14

In the setting of renal failure, elevation of ______ is more common than troponin I elevation

Answer 14

Troponin T

Patients with renal disease often have an elevated troponin T (15-50%), whereas Troponin I eleveations are less common (<10%)