Chest pain

Question 1

Inferior MI leads + artery, Lateral MI leads + artery

Answer 1

Inferior MI leads + artery:
II, III, aVF
Right coronary artery

Lateral MI leads + artery:
I, aVL, V5, V6
Left Circumflex Artery

Question 2

CI to thrombolysis in MI

Answer 2

Active Bleeding
Aortic Dissection
Ischemic Stroke (last 3 months)
Closed Head or Facial Trauma (last 3 months)
Past Intracranial Hemorrhages
Structural Cerebral Vascular Lesions
Malignant Intracranial Neoplasms

Question 3

Causes of pericarditis

Answer 3

Idiopathic
Infectious (viral, bacterial)
Inflammation (RA, SLE, scleroderma)
Metabolic (renal failure, hypothyroidism, hypercholesterolemia)
CV (MI, post infarction (Dressler’s), aortic dissection)
Misc (neoplasm, drugs, radiation, trauma)

Question 4

Signs + sx of pericarditis

Answer 4

Sudden onset palpitations, retrosternal pain, pleuritic
Low grade fever, night sweats, wt loss
SOB, tachypnea, non-productive cough

Signs:
Ewart’s sign (dullness + bronchial breath sounds between tips of scapula and spine)
Pericardial friction rub

Question 5

Ix + results for pericarditis

Answer 5

ECG: PR depression, ST elevation
CXR: normal to water bottle shape heart
Echo: effusion
Labs: CBC, INR, lutes, urea, Cr, ESR, CRP, trop, LDH, AST
Consider CT/ MRI

Question 6

Rx for pericarditis

Answer 6

ASA 650mg Q4H or or ibuprofen 400mg Q6H x 2 weeks
PPI
Corticosteroids or colchicine for recurrent/ refractory

Question 7

Signs of tamponade

Answer 7

Hypotension
Tachycardia
Elevated JVP
Pulsus paradoxicus

Question 8

Causes of CP

Answer 8

CVS: pericarditis, dissection, valve disease, tamponade, HF, ACS
Resp: PE, PNA, pneumothorax, malignancy, pleuritis
GI: GERD, esophageal spasm, hiatal hernia, PUD, biliary colic
MSK: costochondritis, HSV infection (shingles), rib fracture, fibromyalgia
Psych: anxiety. panic, delusion, somatoform

Question 9

Sx of esophageal spasm

Answer 9

Globus
Dysphagia
GERD

Question 10

Ix for esophageal spasm

Answer 10

Barium swallow - tertiary waves
Esophageal manometry

Question 11

Rx for esophageal spasm

Answer 11

Diltiazem
Imipramine
Nitrates

Question 12

MSK causes of CP

Answer 12

costochondritis, HSV infection (shingles), rib fracture, fibromyalgiA

Question 13

Tool to work out disposition in MI

Answer 13

HEART score

Question 14

6-8 wks post MI, recurrent CP DDx + Ix to order

Answer 14

ACS, Dressler’s syndrome, anxiety, PNA, PE. Ix = CRP, echo, CXR

Question 15

Rx for Dressler’s syndrome

Answer 15

ASA, NSAIDs

Question 16

How to diagnose herpes zoster?

Answer 16

Viral swab

Question 17

Absolute CI to fibrinolytics in STEMI

Answer 17

prior intracranial hemorrhage, known cerebral vascular lesion, known malignant intracranial neoplasm, suspected aortic dissection, active bleeding, facial trauma within 3mo, ischemic stroke within 3 mo, severe uncontrolled hypertension

Question 18

Relative CI to fibrinolytics in STEMI

Answer 18

hx of chronic poorly controlled HTN, traumatic/ prolonged CPR, systolic BP >180