Chief complaints of cardiology

Question 1

Discuss your management of acute chest pain

Answer 1

ABCDE assessment

12 lead ECG - identify any ST elevations

Question 2

How do you manage acute chest pain with ST elevations on ECG?

Answer 2

Consult cardiology
Immediate revascularization
ASA 
ADP receptor inhibitor (clopidogrel)
Anticoagulation
Statin

Question 3

How do you manage acute chest pain without ST elevations on ECG?

Answer 3

IV access
Monitor vitals
O2 if hypoxemic
Investigations

Question 4

What do you suspect if a patient has acute chest pain, no ST elevation, increased troponin and CAD risk markers?

Answer 4

NSTEMI

Question 5

What do you suspect if a patient has acute chest pain, normal troponin and CAD risk markers?

Answer 5

Unstable angina

Question 6

What do you suspect if a patient has acute chest pain, mediastinal shift and absent lung marks?

Answer 6

Tension pneumothorax

Question 7

What do you suspect if a patient has acute chest pain, prominent cardiac shadow, JVD and muffled heart sounds?

Answer 7

Cardiac tamponade

Question 8

What do you suspect if a patient has acute chest pain, widened mediastinum and hypertension?

Answer 8

Aortic dissection

Question 9

What do you suspect if a patient has acute chest pain and pneumomediastinum?

Answer 9

Oesophageal rupture

Question 10

What do you suspect if a patient has acute chest pain, hypoxemia, elevated D dimer and Wells score>3?

Answer 10

PE

Question 11

Name the criteria for the Wells score

Answer 11

Clinical signs
HR >100bpm
Immobilization >3 days
Surgery within 4w
Haemoptysis
Malignancy
Previous DVT/PE
Alternative diagnosis less likely

Question 12

Name cardiovascular causes of chest pain

Answer 12

STEMI
NSTEMI
Aortic dissection
Cardiac tamponade
Pericarditis
Heart failure
Takotsubo cardiomyopathy

Question 13

Name the characteristic clinical features in a STEMI

Answer 13

Heavy, dull substernal pain
N+V
Diaphoresis
Anxiety
Syncope
Improves w/ nitroglycerin

Question 14

Name the diagnostic findings in a STEMI

Answer 14

ECG
- ST elevation
- T wave inversion
- Q waves
Bloods
- incr troponin
TTE
- hypokinesis
- regional wall abnormalities

Question 15

Name the characteristic clinical features in a NSTEMI

Answer 15

Heavy, dull substernal pain
N+V
Diaphoresis
Anxiety
Syncope
Improves w/ nitroglycerin

Question 16

Name the diagnostic findings in a NSTEMI

Answer 16

ECG
- nonspecific changes
- ST depression
- T wave inversion
Bloods
- incr/normal troponin
TTE
- regional wall abnormalities may be present

Question 17

Name the characteristic clinical features in an aortic dissection

Answer 17

Severe, sharp tearing chest/abdominal pain
Hypotension
Syncope
Neurological sx
Assymetrical BP
Pulse deficit
New diastolic murmur
MI sx

Question 18

Name the diagnostic findings in an aortic dissection

Answer 18

ECG
- nonspecific
Bloods
- elevated d dimer
CXR
- widened aorta
CTA
- intimal flap with false lumen
TEE
- proximal aortic dissection
- tamponade
- AR

Question 19

Name the characteristic clinical features in cardiac tamponade

Answer 19

Beck's triad
Pulsus paradoxus
Tachycardia
Dyspnea
Cardiogenic shock

Question 20

Name the diagnostic findings in cardiac tamponade

Answer 20

ECG
- low voltage
- electrical alternans
CXR
- cardiomegaly
TTE
- circumferential fluid layer
- collapsible chambers
- high EF
- dilated IVC
- inspiration, AV septa move left
- expiration AV septa move right

Question 21

Name the characteristic clinical features in pericarditis

Answer 21

Sharp, pleuritic restrosternal chest pain
Worse lying down
Pericardial rub

Question 22

Name the diagnostic findings in pericarditis

Answer 22

ECG
- ST elevation
- PR depression
- T wave inversion
Bloods
- incr ESR
- incr CRP
- leucocytosis
- incr troponin
CXR
- normal
TTE
- pericardial effusion

Question 23

Name the characteristic clinical features in heart failure exacerbation

Answer 23

Cough
Dyspnea
Hypoxemia
Crackles
JVD
Peripheral edema

Question 24

Name the diagnostic findings in heart failure exacerbation

Answer 24

Clinical diagnosis
Bloods
- incr BNP
- incr troponin
- hyponatremia
CXR
- diffuse opacities
- Kerley B lines
TTE
- wall abnormalities
- systolic/diastolic dysfunction
- decreased LVEF

Question 25

Name the characteristic clinical features in Takustubo cardiomyopathy

Answer 25

Hx of recent stressful event Restrosternal pain Dyspnea Hypotensive shock

Question 26

Name the diagnostic findings in Takutsubo cardiomyopathy

Answer 26

``` ECG - ST elevation - T wave inversion Bloods - incr troponin - incr BNP TTE - decr LVEF - wall motion abnormalities - apical ballooning cMRI - wall abnormalities - myocardial edema Coronary angiogram - normal ```

Question 27

Name gastrointestinal causes of chest pain

Answer 27

``` Oesophageal perforation GERD Erosive oesophagitis PUD Acute pancreatitis Mallory-Weiss tears ```

Question 28

Name the characteristic clinical features in oesophageal rupture

Answer 28

``` Restrosternal chest pain Neck pain Epigastric pain Dyspnea Tachycardia Dysphagia Mackler triad Mediastinal crepitus History of recent gastroscopy History of severe emesis ```

Question 29

Name the diagnostic findings in oesophageal rupture

Answer 29

``` CXR - mediastinal/subdiphragmatic air - pneumothorax - pleural effusion NXR - subcutaneous emphysema Contrast esophography - contrast leak CT chest - extraluminal air - oesophageal thickening ```

Question 30

Name the characteristic clinical features in GERD

Answer 30

Postprandial chest pain Epigastric tenderness Aggravating factors (foods, supine)

Question 31

Name the diagnostic findings in GERD

Answer 31

EGD | 24h pH monitoring

Question 32

Name the characteristic clinical features in PUD

Answer 32

``` Epigastric pain Relieved by food = duodenal Exacerbated by food = gastric GI bleeding NSAID use ```

Question 33

Name the diagnostic findings in PUD

Answer 33

Anemia FOBT + Urea breath test EGD

Question 34

Name the characteristic clinical features in acute pancreatitis

Answer 34

``` Severe epigastric pain that radiates to the back N+V Guarding, rigidity Hypoactive bowel sounds History of gallstones History of alcohol use ```

Question 35

Name the diagnostic findings in acute pancreatitis

Answer 35

``` Bloods - incr lipase - incr amylase Abdominal U/S - pancreatic edema - peripancreatic fat stranding - gallstones ```

Question 36

Name the characteristic clinical features in Mallory-Weiss syndrome

Answer 36

``` Epigastric pain Severe vomiting Hematemesis Malena Dizziness Syncope ```

Question 37

Name the diagnostic findings in Mallory-Weiss syndrome

Answer 37

Anemia | EGD

Question 38

Name pulmonary causes of chest pain

Answer 38

``` PE Pneumonia Pneumothorax (tension, spontaneous) Asthma COPD Pleural effusion ```

Question 39

Name the characteristic clinical features in PE

Answer 39

``` Pleuritic chest pain Dyspnoea Hypoxemia Cough Haemoptysis Hypotension Shock ```

Question 40

Name the diagnostic findings in PE

Answer 40

``` Bloods - incr d dimer - incr troponin - incr BNP CTA chest - pulmonary aa filling defect V/Q scan - perfusion ventilation mismatch TTE - right ventricle hypokinesis Wells score ```

Question 41

Name the characteristic clinical features in tension pneumothorax

Answer 41

``` Severe, sharp chest pain Dyspnoea Hypoxemia Hx of trauma Hyperresonance Decr breath sounds Tracheal deviation Tachycardia Hypotension ```

Question 42

Name the diagnostic findings in tension pneumothorax

Answer 42

``` Clinical diagnosis CXR - absent lung markings - tracheal deviation - pneumomediastinum ```

Question 43

Name the characteristic clinical features in pneumonia

Answer 43

``` Fever Chills Cough Dyspnea Hypoxemia Crackles Egophony ```

Question 44

Name the diagnostic findings in pneumonia

Answer 44

``` Bloods - leucocytosis - incr ESR/CRP - incr procalcitonin Positive sputum culture CXR - consolidation - pleural effusion CT chest w/ contrast - hyperdense consolidation ```

Question 45

Name the characteristic clinical features in spontaneous pneumothorax

Answer 45

``` Sudden, sharp pain Dyspnea Hypoxemia Hyperresonance Decr breath sounds Crepitus ```

Question 46

Name the diagnostic findings in spontaneous pneumothorax

Answer 46

``` CXR (in inspiration) - increased lucency - displaced lung markings - subcutaneous emphysema U/S - absent lung sliding ```

Question 47

Name the characteristic clinical features in asthma

Answer 47

``` Dyspnea Cough Tachycardia Tachypnea Hypoxemia Wheezing Decr/absent breath sounds Incr work of breathing ```

Question 48

Name the diagnostic findings in asthma

Answer 48

Respiratory acidosis | Decr peak expiratory flow

Question 49

Name the characteristic clinical features in COPD

Answer 49

``` Dyspnea Cough Purulent sputum Tachypnea Hypoxemia Diffusing wheezing Decr breath sounds ```

Question 50

Name the diagnostic findings in COPD

Answer 50

``` Bloods - respiratory acidosis - incr CRP - incr procalcitonin CXR - hyperinflation ```

Question 51

Name the characteristic clinical features in pleural effusion

Answer 51

``` Unilateral, pleuritic chest pain Dyspnea Dry, non-productive cough Dullness to percussion Decr breath sounds Decr tactile fremitus Pleural friction rub ```

Question 52

Name the diagnostic findings in pleural effusion

Answer 52

``` CXR - homogenous opacity - costophrenic angle blunting U/S - hypoechoic space between pleura ```

Question 53

Name causes of dyspnea

Answer 53

``` Cardiac Respiratory - obstructive airway - lung parenchyma and pulmonary vessel - chest wall and pleural cavity Non-cardiorespiratory - CNS/neuromuscular - toxic/metabolic - other ```

Question 54

Name acute cardiac causes of dyspnea with a normal CXR

Answer 54

``` ACS Myocardial contusion Arrythmias Myocarditis Pericarditis ```

Question 55

Name chronic cardiac causes of dyspnea with a normal CXR

Answer 55

``` Arrythmias Non-dilated cardiomyopathy Valvular Cardiac shunt Physical deconditioning ```

Question 56

Name acute cardiac causes of dyspnea with an abnormal CXR

Answer 56

Acute decompensated HF Congestive HF Pericardial effusion Cardiac tamponade

Question 57

Name chronic cardiac causes of dyspnea with an abnormal CXR

Answer 57

Pericardial effusion Constrictive pericarditis Dilated cardiomyopathy

Question 58

Name acute upper airway obstructive disease causes of dyspnea

Answer 58

Anaphylaxis Infection FB aspiration Angioedema

Question 59

Name chronic upper airway obstructive disease causes of dyspnea

Answer 59

Head cancer | Neck cancer

Question 60

Name acute lower airway obstructive disease causes of dyspnea

Answer 60

Asthma COPD Infection

Question 61

Name chronic lower airway obstructive disease causes of dyspnea

Answer 61

COPD Bronchiolitis obliterans Lung cancer

Question 62

Name acute lung parenchyma and pulmonary vessel causes of dyspnea with a normal CXR

Answer 62

PE | Idiopathic pulmonary aa hypertension

Question 63

Name chronic lung parenchyma and pulmonary vessel causes of dyspnea with a normal CXR

Answer 63

Pulmonary right to left shunt

Question 64

Name acute lung parenchyma and pulmonary vessel causes of dyspnea with an abnormal CXR

Answer 64

``` PE ARDS Acute chest syndrome Pulmonary contusion Pulmonary hemorrhage ```

Question 65

Name chronic lung parenchyma and pulmonary vessel causes of dyspnea with an abnormal CXR

Answer 65

Interstitial lung disease | Lung cancer

Question 66

Name acute chest wall and lung cavity causes of dyspnea

Answer 66

Pneumothorax Chest wall injury Pleural effusion

Question 67

Name chronic chest wall and lung cavity causes of dyspnea

Answer 67

Pleural effusion Chest wall abnormality Diaphragm paralysis

Question 68

Name acute CNS/neuromuscular causes of dyspnea

Answer 68

Stroke Encephalitis TBI Neuromuscular disease

Question 69

Name chronic CNS/neuromuscular causes of dyspnea

Answer 69

Neuromuscular disease

Question 70

Name acute toxic/metabolic causes of dyspnea

Answer 70

Intoxication/overdose DKA Uremia

Question 71

Name chronic toxic/metabolic causes of dyspnea

Answer 71

Acidosis | Hypermetabolic state

Question 72

Name other acute causes of dyspnea

Answer 72

``` Psychogenic Acute renal failure Ascites Large hiatal hernia Chronic aspiration Hepatopulmonary syndrome ```

Question 73

Name other chronic causes of dyspnea

Answer 73

Psychogenic Anemia Chronic kidney disease