Differentials Flashcards
Where can chest pain radiate?
Epigastrium
Arm
Neck
Jaw
What is the character of pneumothorax chest pain?
Sudden onset pleuritic pain either left or right-sided with associated dyspnoea and syncope. Often young males.
What is the character of musculoskeletal chest pain?
Pain typically persistent (typically days or longer), worsened with passive and active motion and sometimes reproducible chest tenderness.
What is the character of angina chest pain?
Exertional pain/discomfort in the centre or left side of the chest, throat, neck or jaw is relieved by rest or GTN within a few minutes. May radiate to the neck, jaw or left arm. Sometimes there may not be any pain but breathlessness.
What is the character of pericarditis chest pain?
Constant or intermittent central pleuritic sharp pain often aggravated by position (classically worse on lying down and relived by sitting or leaning forward).
What is the character of peptic ulcer disease pain?
Recurrent, vague epigastric discomfort, that is relieved by food, anatacids or both.
What is the character of pulmonary embolism chest pain?
Sudden onset pleuritic chest pain with associated dyspnoea and tachycardia. Sometimes mild fever, syncope and haemoptysis.
What is the symptoms of ACS?
- Acute, crushing pain radiating to the jaw or arm
- Exertional pain relieved by rest
What are the clinical signs of ACS?
- Sinus tachycardia
- Xanthelasma
- Tar staining on fingers
- New murmur (mitral regurgitation - pan-systolic)
What are the symptoms of aortic dissection?
- Sudden, tearing pain radiating to the back
- Some patients have syncope, stroke or leg ischaemia
- PMH of HTN and/or FHx of connective tissue disease e.g. Marfan syndrome
What are the clinical signs of aortic dissection?
- Pulsus paradoxus (BP falls on inspiration)
- Difference in BP in both arms
- Distended neck veins
- Muffled heart sounds
- Radio-radial delay
What are the symptoms of myocarditis?
- Fever
- Dyspnoea
- Fatigue
- Chest pain (if myopericarditis)
- May be pleuritic
- Recent viral or other infection
- Fever
- Tachycardia
What are the clinical signs of pericarditis?
- Tachycardia
- Pericardial rub
- Recent viral infection
What are the risk factors for a pulmonary embolism?
- Tachycardia
- Red, swollen, painful leg
- Immobile for a long period
- Inherited conditions such as blood clotting disorders
- Recent surgery or bone fracture
- History of cancer or receiving chemotherapy
- Acute medical illness e.g., DKA, sepsis
What are the clinical signs of pneumothorax?
- Hypotension
- Neck vein distension
- Tracheal deviation
- Unilateral diminished breath sounds
- Hyperresonance to percussion
What are the symptoms of pneumonia?
- Pleuritic chest pain
- Fever
- Productive cough
- Purulent sputum - green/blood stained
What are the clinical signs of pneumonia?
- Reduced air entry
- Bronchial breathing
- Crepitations
- Immunosuppression or elderly
What are the symptoms of pancreatitis/gallstones/hepatitis?
- Pain in the epigastrium or lower chest that is often worse when lying flat and is relived by leaning forward
- Vomiting
- Upper abdominal tenderness
What is the pain character in GORD?
Recurrent burning pain radiating from epigastrium to throat, exacerbated by bending down or lying down and relieved by antacids.
What are the symptoms of shingles?
- Sharp, band-like pain in the thorax unilaterally
- Classic linear, vesicular rash
- Pain may precede rash by several days
- Rash on chest with vesicles - dermatomal distribution
- Pain made worse by contact with clothing
What is the Stanford classification for aortic dissection?
Type A - involves ascending aorta
Type B - does not involve ascending aorta
What is the underlying pathology of aortic dissection?
- Atherosclerosis
- HTN
- Aortic aneurysm
- Bicuspid aortic valve
- Connective tissue disease
- Marfan’s syndrome
What can be seen on a CXR for aortic dissection?
False lumen - this enlarges and occludes the true lumen, potentially compromising the blood supply of organs distal to dissection tear.
Describe unstable angina
Patients present with ischaemic symptoms with no elevation in troponins, often treated as NSTEMI due to troponin rise occurring later.
