chest pain

Question 1

immediate life threatening causes of CP

Answer 1

Acute myocardial infarction/ Acute
coronary syndrome
Pulmonary embolism
Aortic dissection
Tension Pneumothorax
Pericardial tamponade
Esophageal rupture

Question 2

wells criteria

Answer 2

clinically suspected DVT — 3.0 points
alternative diagnosis is less likely than PE — 3.0 points
tachycardia (heart rate > 100) — 1.5 points
immobilization (≥ 3d)/surgery in previous four weeks — 1.5 points
history of DVT or PE — 1.5 points
hemoptysis — 1.0 points
malignancy (with treatment within six months) or palliative — 1.0 points

Question 3

what does pain from aortic dissection feel like and where does it radiate?

Answer 3

tearing

between scapulae

Question 4

what are signs and symptoms of a tension pneumothrorax?

Answer 4

acute SOB, hyper resonance over the pneumothorax but no breath sounds

Question 5

true or false: no combination of history and physical exam with an EKG can exclude ACS with certainty

Answer 5

true

Question 6

angina pectoris

Answer 6

discomfort induced by exercise and relieved with rest

and/ or nitroglycerin

Question 7

new onset angina

Answer 7

angina that develops

within a 2 month time frame

Question 8

unstable angina

Answer 8

angina
that occurs with more frequent occurrence
of anginal episodes, longer lived episodes
or more easily provoked angina.

Question 9

atypical or prinzmetal angina

Answer 9

angina that occurs at rest

Question 10

stable angina

Answer 10

anginal
symptomatology that occurs with the same
degree of exertion and resolves with the same
degree of rest and/ or same dosage strength
and frequency of NTG

Question 11

true or false: CP and low BP is a candidate for nitro

Answer 11

false—> may be a worse outcome

Question 12

bradycardia in the setting of CP should raise the concern of

Answer 12

inferior MI
(always consider the possibility of a
medication induced bradycardia with
supra-therapeutic level of an AV node
blocking medication)

Question 13

what is the leading cause of death for both men and women worldwide?

Answer 13

ischemic heart disease

Question 14

aortic dissection ssx

Answer 14

unequal pulses
pain radiating to the back
development of a new murmur of aortic insufficiency

Question 15

what do you hear in a pneumothorax?

Answer 15

decreased breath sounds

Question 16

what are the components of Beck’s Triad?

Answer 16

distended neck veins (JVD)
distant heart sounds
hypotension

Question 17

what is Beck’s Triad a sign of?

Answer 17

cardiac tamponade

Question 18

what is the most common symptom that prompts evaluation of possible acute coronary syndrome?

Answer 18

anterior chest pain

Question 19

what are the three most common causes of acute coronary syndrome?

Answer 19

ST elevation myocardial infarction (STEMI)- 30% of ACS
Non-ST elevation myocardial infarction (non-STEMI)- 25% of ACS
Unstable angina- 38% of ACS

Question 20

what does MONA stand for?

Answer 20

morphine, oxygen, nitroglycerin, aspirin

Question 21

cardiac tamponade

Answer 21

caused by the buildup of fluid inside the pericardium

Question 22

which patients have high risk for tamponade?

Answer 22

cancer, uremia, pericarditis, cardiac surgery

Question 23

what are the major diagnostic tests to run with a suspected PE?

Answer 23

CT-pulmonary angiography
ventilation-perfusion scanning
D-dimer testing
conventional pulmonary angiography

Question 24

in whom might you suspect a pneumothrax?

Answer 24

thin male, 20-30s, smoker

Question 25

what are the sequelae of pneumothorax?

Answer 25

worsening levels of arterial oxygen concentration low BP significant impairment of respiraton death

Question 26

signs of pneumothroax

Answer 26

displacement of trachea away from affected side quieter breath sounds on one side of the chest low oxygen levels diminished BP