Common chest histories

Question 1

Tearing chest pain of very sudden onset?

Answer 1

Aortic dissection

Question 2

Retrosternal pain eased by sitting forward

Answer 2

Pericarditis

Question 3

Non cardiorespiratory causes of chest pain? (3)

Answer 3

GORD
Abdominal causes e.g. Pancreatitis/gastritis
Costochondritis

Question 4

Important questions to ask about breathlessness? (4)

Answer 4

Exertional tolerance
Orthopnoea
Paroxysmal nocturnal dyspnoea
Seasonal variation

Question 5

Pink frothy sputum

Answer 5

Acute left ventricular failure

Question 6

Importance of auscultating praecordium in shortness of breath?

Answer 6

Murmur of aortic stenosis- ejection systolic best heard in the aortic area with radiation to the carotids

Question 7

Management of PE?

Answer 7

Treatment dose LMWH (200 units/kg)

Question 8

Investigations in pneumonia to find causative organism? (3)

Answer 8

Sputum culture
Blood culture
Urinary legionella

Question 9

What does a rising PaCO2 indicate in asthma?

Answer 9

Patient is tiring

Question 10

Management of asthma exacerbation?

Answer 10

Salbutamol and ipratropium nebs

Steroids e.g. prednisolone

Question 11

Management of acute LVF? (3)

Answer 11

Sit up in bed, oxygen
Furosemide
GTN infusion

Question 12

Investigation which can rule out DVT (but not confirm it)?

Answer 12

D-dimer

Question 13

Pleuritic chest pain up to 3/12 post-MI

Answer 13

Dressler syndrome

Question 14

How can angina be differentiated from GORD?

Answer 14

Exercise ECG

Question 15

What length of elevation of the JVP is indicative of right heart failure?

Answer 15

<4cm

Question 16

Apex beat characteristics:

a) mitral or aortic regurgitation
b) aortic stenosis
c) mitral stenosis

Answer 16

a) displaced
b) heaving
c) tapping

Question 17

Maneouvres/additional points of auscultation to remember in cardiac examination (4)

Answer 17

Sat upright, listen at the sternum with the diaphragm for murmur of aortic regurgitation with breath held in expiration
Left lateral position, listening at the apex with the bell for the murmur of mitral stenosis with breath held in expiration
Auscultate over the carotids for radiation of aortic stenosis
Auscultate in the left axilla for the radiation of mitral regurgitation

Question 18

Signs of CABG? (2)

Answer 18

Vein harvesting scars in legs

Median sternotomy scar

Question 19

Why should the legs be inspected in a respiratory examination?

Answer 19

Signs of DVT (unilateral tender leg swelling) or signs of right heart failure (bilateral leg swelling)