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Diff Dx > Chest 1 > Flashcards

Chest 1 Flashcards

1
Q

Noncardiac chest pain can be due to?

A 
visceral
musculoskeletal
skin
psychogenic
referred
local
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2
Q

what do you do with someone with noncardiac chest pain?

A

auscultate, obtain a screening ECG, consider chest radiography
incorporate a mechanical challenge (stretch, compression, palpation in an attemmpt to reproduce the complaint

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3
Q

where should someone with cardiac caused pain go?

A

emergent care

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4
Q

how is angina described?

A

gripping
squeezing
pressure

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5
Q

history of someone with pleural/pulmonary chest pain

A

history: pneumonia, pneumothorax, TB, bronchogenic carcinoma

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6
Q

provocation of pleural/pulmonary chest pain

A

deep breathing
bending toward the same side may aggarvate complaint
auscultation/radiographs

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7
Q

history of someone with esophageal pain

A

may or may not have dysphasia

substernal pain or radiates to central back

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8
Q

provocation/examination of someone with esophageal chest pain

A

hot or cold food

barium study may be needed

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9
Q

history of someone with herpes zoster

A

often unilateral
dermatomal
hypersensitivity followed by vesicle formation, burning, sharp pain, recurrent

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10
Q

provocation of herpes zoster

A

hypersensitivity to palpation

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11
Q

history of someone with intercostal neuritis

A

similar to herpes presentation without vesicles

may have osteophytes or be diabetic

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12
Q

provocation/examination of intercostal neuritis

A

may reproduce on rib separation or compression of intercostal space

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13
Q

history of someone with a rib fracture

A

usally history of trauma

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14
Q

provocation/examination of rib fracture

A

reproduce on compression A-P
tuning fork
xray

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15
Q

history of someone with pain in the costochondral junction

A

Tietze’s syndrome found in older women

unilateral sharp pain

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16
Q

provocation/examination of costochondral junction pain

A

direct pressure of junction or between ribs

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17
Q

costovertebral/costotransverse pain history

A

may or may not be traumatic

pain radiates along

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18
Q

provocation/examination of costovertebral/costotransverse pain

A

pressure over affected joint causes radiation

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19
Q

history of someone with pain in the chest from the cervical region

A

referral from osteophyte involvement

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20
Q

provocation/examination of chest pain from cervical spine

A

compression/distration test

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21
Q

history of someone with chest pain from anxiety

A

anxious or depressed

pain is often over heart and is often either quick/stabbing or heavy/constant

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22
Q

provocation/examination of someone with chest pain from anxiety

A

psychological evaluation may be necessary, may be aggravated by deep breathing

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23
Q

history of someone with chest pain from a sprain

A

overuse or trauma

usually pectoralis, serratus anterior or intercostals

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24
Q

provocation/examination of someone with chest pain from a sprain?

A

stretch, contract, combination

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25
Q

history of someone with chest pain from trigger pain

A

no neurological changes

SCM, pectoralis, SCM, scalens

26
Q

provocaiton/examination of someone with chest pain from trigger point

A

sustained pressure on trigger points

27
Q

CAD

A

chest pain described as pressure sensation, fullness or squeezing in the mid portion of the thorax

28
Q

where might the pain radiate in CAD?

A

jaw or teeth, shoulder, arm and/or back

29
Q

other symptoms of someone with CAD

A

dyspnea/shorteness of breath
epigastric discomfort with or without nausea and vomiting
diaphoresis (sweateing)
syncope or near syncope without other cause

30
Q

angina

A

squeezing or pressure senation in the chest lasting for several minutes to 30 minutes with possible ratiation to arm or jaw

31
Q

angina typically follows…?

A

exertion

32
Q

how is angina relieved

A

resting for several minutes

33
Q

what is angina due to?

A

atherosclerosis (a variation of angina is related to vasospasm)

34
Q

unstable angina

A

extensive atherosclerosis
chest pain without provocation
tend to warn of an impending MI

35
Q

people with angina may have?

A

HTN

valve abnormalities

36
Q

what does someone with angina have?

A

valve abnormalities
ECG findings nonspecific
scintigraphy or electrocardiographic studies
may need coronary angiography

37
Q

nitroglycerin

A

used for symptomatic management of angina

decreases contraction of heart and causes vasodilation

38
Q

myocardial infarction is often preceded by a history of?

A

angina
substernal pain is more severe and often bulds up over minutes
pain may be diffuse and radiate to medial left arm or jaw

39
Q

does nitroglycerin help with an MI?

A

no

40
Q

MIs are usually due to?

A

coronary thrombus or vasospasm

41
Q

elevated cardiac enzymes during an MI

A

creatine kinase
aspartate aminotransferase/serum glutamate oxaloacetic transaminase
lactate dehydrogenase
troponin

42
Q

Tietze’s syndrome

A

females over 50
moderate to severe pain in upper part of chest one one side
unknown etiology

43
Q

tietze’s syndrome appears to be?

A

an inflammtory reaction, overexertion and prolonged coughing or exertion

44
Q

how do you deal with tietze syndrome

A

benign and self resolving

45
Q

GERD demographics

A

30-60 year women
stress, diet, caffeine, smoking or alcohol may provoke symptoms
diagnosis usually based on hisotry and physical and trial of empiric therapy

46
Q

heartburn

A

senation of discomfort or burning behind sternum rising up to neck, worse after meals or in reclining position, eased by antacids

47
Q

regurgitation

A

perception of flow of refluxed gastric contents into mouth or hypopharynx

48
Q

pulmonary embolism demographics

A

middle aged male
sudden onset of chest pain after having calf apin
may have been immoblilzed

49
Q

signs and symptoms of pulmonary embolism

A

low grade fever may be present, more commonly with an infartion
chest pain is pleuritic with dyspnea

50
Q

signs/symptoms of pleurisy

A 
sharp pains in the chest that seem related to coughing, sneezing, or position such as bending to the side or lying on the involved side
recent history of respiratory infection
pleural friction rub
decreased fremitus
dullness to percussion
increase or decrease in breath sounds
51
Q

when might you take chest films?

A 
chronic cough, hemoptysis, expectoration, shortness of breath
cyanosis
clubbing of fingers
pain in chest
thoracic spine
upper extremities
52
Q

when is a CT useful for chest complaints?

A

additional procedure especially for chest wall, pleural, lung, hilum or mediastinal and used to delineate and assess neoplastic disease

53
Q

MRI for chest complaints

A

distinguish pathology in hilar and medistinal lymph nodes from adjacent vascular anatomy

54
Q

ventilation and perfusion scans valuable in diagnosis of?

A

pulmonary embolism

55
Q

the left hilum should___ be lower than the right hilum

A

never

56
Q

enlargement of hili is usually due to?

A

lymphadenopathy or enlarged vessels
tumor
sarcoid

57
Q

air bronchogram sign

A

uninvolved airways surrounded by water density pathology consistent with an airspace pathology, usually pneumonia or pulmonary edema

58
Q

S sign of Golden

A

collapse of upper R lobe with superior migration of horizontal fissure
medial portion of displaced fissure may be bulged inferiorly by a hilar mass causing the fissure to have a slanted and reversed S configuration

59
Q

silhouette sign

A

loss of anatomic border
intrathoracic lesion touching a border of the heart, aorta or diaphragm will obliterate that border on the xray
intrathoracic lesion not anatomically contiguous with a border of one of these structures will not obliterate the border

60
Q

general pulmonary radiology

A 
increased densty 
decreased density
consolidation
interstitial
atelectasis
nodules or masses

Diff Dx (17 decks)

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