Chapter 8, module 5; Chest Pain

Question 1

Substernal chest pressure following exercise or stress and relieved by rest or nitroglycerin; nausea, SOB, diaphoresis, sternal chest pressure

Answer 1

Stable angina

Question 2

Normal examination; possible transient S4

Answer 2

Stable angina

Question 3

Diagnostic studies for Stable angina are?

Answer 3

ECG during episode of chest pain, treadmill stress testing, myocardial perfusion imaging

Question 4

Chest pain; history of fever, dyspnea

Answer 4

Myocarditis

Question 5

Physical findings of this are heart murmur, friction rub, fever?

Answer 5

Myocarditis

Question 6

Diagnostic studies with myocarditis are?

Answer 6

ECG, chest radiograph, echocardiogram

Question 7

Sharp, stabbing pain referred to left shoulder or trapezius ridge, usually worse during coughing or deep breathing; can be relieved by sitting forward; history of viral or bacterial infection, autoimmune disease

Answer 7

Pericarditis

Question 8

Physical findings are fever before onset of pain, tachycardia, pericardial friction rub?

Answer 8

Pericarditis

Question 9

Diagnostic studies for pericarditis are?

Answer 9

WBC, ESR, ECG, chest radiograph, echocardiogram

Question 10

Chest pain on exertion, substernal and anginal in quality; fatigue, palpitations, DOE, dizziness, syncope

Answer 10

Aortic stenosis

Question 11

Radial pulse diminished; narrow pulse pressure; loud, harsh, crescendo-decrescendo murmur heard best at second right ICS with patient leaning forward; thrill

Answer 11

Aortic stenosis

Question 12

Diagnostic studies for aortic stenosis?

Answer 12

Echocardiogram, ECG, chest radiograph

Question 13

Exertional chest pain, fatigue, palpitations, dizziness, DOE, syncope

Answer 13

Mitral regurgitation

Question 14

Holosystolic, blowing, often loud murmur heard best at apex in left lateral position and decreases with inspiration; murmur can radiate to axilla and possibly back

Answer 14

Mitral regurgitation

Question 15

Mitral regurgitation diagnostic studies?

Answer 15

Chest radiograph, ECG, echocardiogram

Question 16

Productive cough of yellow or green or rust sputum, dyspnea, pleuritic pain

Answer 16

Pneumonia

Question 17

Fever; tachycardia, tachypnea; inspiratory crackles; vocal fremitus; percussion dull or flat over area of consolidation; bronchophony; egophony

Answer 17

Pneumonia

Question 18

Diagnostic studies of pneumonia?

Answer 18

Chest radiograph, sputum cultures, ABGs

Question 19

Chest pain, varies in location and intensity; palpitations; anxiety; nonexertional pain of short dura¬ tion; history of Marfan syndrome

Answer 19

Mitral valve prolapse

Question 20

Arrhythmias, possible midsystolic click heard over apex; heard best while patient is in sitting or squatting position; thoracoskeletal deformity common in children

Answer 20

Mitral valve prolapse

Question 21

Diagnostic test for Mitral valve prolapse?

Answer 21

ECG, echocardiogram

Question 22

Mild, localized chest pain, worse with deep breathing; recent URI

Answer 22

Pleuritis

Question 23

Shallow respirations, local tenderness, pleural friction rub

Answer 23

Pleuritis

Question 24

Diagnostic test for pleuritis?

Answer 24

chest radiograph

Question 25

Substernal  pain  worse  after  eating  and lying  down;  sour  taste  in  mouth

Answer 25

Esophagitis

Question 26

Epigastric  pain  with  palpitation

Answer 26

Esophagitis

Question 27

Diagnostic test Esophagitis?

Answer 27

Esophageal  pH

Question 28

History  of  injury  or  trauma;  pain with  deep  breaths;  splinting  of chest  wall

Answer 28

Chest  trauma (rib  fracture)

Question 29

Shallow  respirations;  chest  wall pain  on  palpitation

Answer 29

Chest  trauma (rib  fracture)

Question 30

Diagnostic test chest  trauma (rib  fracture)

Answer 30

chest  radiograph

Question 31

Pain  along  sternal  border,  increases with  deep  breaths;  history  of  exercise,  URI,  or  physical  activity

Answer 31

Costochondritis

Question 32

Pain  with  palpitation  over  costochondral  joints;  normal  breath sounds

Answer 32

Costochondritis

Question 33

Diagnostic test of Costochondritis?

Answer 33

none

Question 34

Unilateral  chest  pain;  painful  rash?

Answer 34

Herpes  zoster

Question 35

Normal  breath  sounds;  vesicular rash  along  dermatome?

Answer 35

Herpes  zoster

Question 36

Diagnostic test of Herpes  zoster

Answer 36

none

Question 37

Epigastric  pain  1  to  2  hr  after  eating,  can  be  relieved  by  antacids; hematemesis  and  melena;  risk factors  include  smoking  and alcohol  overuse

Answer 37

Peptic  ulcer disease

Question 38

Tenderness  to  palpitation  in epigastric  area;  signs  of hypovolemia

Answer 38

Peptic  ulcer disease

Question 39

Diagnostic test of Peptic ulcer disease

Answer 39

Upper  Gl  radiograph, upper  endoscopy,  CBC

Question 40

Right  upper  quadrant  abdominal pain  radiating  to  right  chest, often  after  eating  high-fat  meal; nausea  and  vomiting

Answer 40

Cholecystitis

Question 41

Positive  Murphy  sign;  palpable gallbladder

Answer 41

Cholecystitis

Question 42

Diagnostic test of Cholecystitis?

Answer 42

Gallbladder  ultrasound

Question 43

Severe  epigastric  or  left  upper  quadrant  abdominal  pain  radiating  into left  chest;  pain  worse  in  supine position;  nausea,  vomiting,  fever

Answer 43

Acute pancreatitis

Question 44

Left  upper  abdominal  pain  with palpation;  hypotension

Answer 44

Acute pancreatitis

Question 45

Diagnostic test of Acute pancreatitis?

Answer 45

Amylase,  lipase, pancreas  ultrasound  or CT  scan

Question 46

Chest  pain,  SOB,  cough,  hemoptysis,  history  of  cigarette  smoking; history  of  pneumonia

Answer 46

Lung  tumors

Question 47

Normal  examination  or  diminished breath  sounds  over  tumor  and dull  percussion  sound  over  tumor

Answer 47

Lung  tumors

Question 48

Diagnostic test of Lung  tumors?

Answer 48

Chest  radiograph, spiral  CT  of  chest, bronchoscopy

Question 49

Chest  pain,  SOB,  diaphoresis, nausea;  can  relate  to  substance use

Answer 49

Cocaine and  amphetamine  use

Question 50

Tachycardia,  hypertension

Answer 50

Cocaine and  amphetamine  use

Question 51

Diagnostic test of Cocaine and  amphetamine  use?

Answer 51

ECG,  serial  cardiac enzymes,  drug  screen

Question 52

Precordial  chest  pain,  history  of stressful  situations

Answer 52

Psychogenic origin

Question 53

Normal  examination

Answer 53

Psychogenic origin

Question 54

Diagnostic test of Psychogenic origin?

Answer 54

ECG,  chest  radiograph, treadmill  stress  test  if  car¬ diac  risk  factors  present.

Question 55

Severe,  acute  onset,  stabbing, paroxysmal,  pleuritic  pain  over lower  rib  cage  and  substernal edge;  headache,  malaise, nonproductive  cough

Answer 55

Pleurodynia

Question 56

Pleural  friction  rub  25%  of  time; chest  examination  normal;  fever usually  present

Answer 56

Pleurodynia

Question 57

Diagnostic test of Pleurodynia?

Answer 57

Chest  radiograph

Question 58

Sudden,  sharp,  nondistressing pain  near  apex  of  heart;  seen  in adolescents

Answer 58

Precordial catch syndrome

Question 59

Normal  examination

Answer 59

Precordial catch syndrome

Question 60

Diagnostic test of Precordial catch syndrome?

Answer 60

Chest  radiography,  ECG