Exam 2 CHEST PAIN Flashcards Preview

Q4 EM Surg > Exam 2 CHEST PAIN > Flashcards

Flashcards in Exam 2 CHEST PAIN Deck (76):
1

Typical vs Atypical Chest Pain:
Location?

T = substernal, radiation to neck, jaw, shoulder, back

A = L chest, neck, jaw

2

Typical vs Atypical Chest Pain:
Reproducible?

T = no

A = yes

3

Typical vs Atypical Chest Pain:
Exertional?

T = ↑ w/ exert, ↓ w/ rest

A = Not exertional, Not ↓ w/ rest

4

Typical vs Atypical Chest Pain:
Quality?

T = progressive pressure or ache

A = sharp, pleuritic, positional

5

Typical vs Atypical Chest Pain:
Duration?

T = minutes
If > 15 min and progressive = unstable angina

A = seconds or constant for hrs/days

6

Typical vs Atypical Chest Pain:
Associated sxs?

T = N, diaphoresis, SOB

A = none

7

C presenting sx for elderly?

dyspnea

8

C presentation for women or DM?

atypical sxs

9

Chest Pain from PE presentation? (2)

SOB, hemoptysis

10

Chest Pain from Aortic Diss presentation? (5)

ripping, tearing
radiation to back/legs/throat
acute onset
a/w HTN
50 - 70 yo M

11

Chest Pain from Tamponade presentation? (5)

↑ pain supine
hypoTN
muffled heart sounds
JVD
pulsus paradoxus

12

Chest Pain Labs? (5)

CBC
CMP
Troponin/CK-MB
D-Dimer
BNP (B-type Natriuretic Peptide a/w CHF)

13

Chest Pain studies?

Cardiac monitoring/telemetry
CXR (PA + lat)
EKG

14

Acute Coronary Syndromes include?

Angina
NSTEMI
STEMI

15

Stable Angina?

O2 supply/demand mismatch
On exertion
Relieved w/ rest/Nitro

16

Unstable Angina?

More severe/frequent/longer
At rest
Not relieved w/ rest/Nitro

17

NSTEMI from?

Causes what?

Non-occlusive thrombus

Ischemia w/ ↑ enzymes

18

STEMI from?

Causes what?

Occlusive thrombus

Transmural infarct

19

ACS presentation:

Onset?

Time?

Quality?

Location?

Onset = gradual, worse w/ exercise or stress

Time:
angina/isch = < 10 min, relief w/ rest
infar = longer, more severe, ↑ frequency

Quality = discomfort

Location = substern, L chest w/ radiation to arm, neck, jaw, shoulder, back

NOT related to position or respiration

20

ACS signs/sxs? (8)

Chest pain
N/V
Diaphoresis
Dyspnea
Palp, brady, tachy or irreg
Syncope, dizzy
Fatigue
Fluid overload

21

ACS best study?

12-lead w/i 10 min

22

Troponin false + caused by?

Sepsis
Renal fail
PE
Subarachnoid hemorr

23

Troponin vs CK-MB:

Onset?

Peak?

Duration?

Onset: Both 3-12 hrs

Peak: Both 18-24 hrs

Duration: T = up to 10 days, CK = 36-48 hrs

24

Myoglobin vs Lactate DH:

Onset?

Peak?

Duration?

Onset: M = 1-4 hrs, L = 6-12 hrs

Peak: M = 6-7 hrs, L = 24-48 hrs

Duration: M = 24 hrs, L = 8 days

25

ACS other labs?

CBC
BMP

26

ACS other studies?

CXR for cardiomeg, pulmonary edema

Echo for wall thick/enlarg, wall motion, valve fxn, EF

Nulcear for myocard perfusion/damage

27

ACS tx? (6)

IV access
Cardiac monitoring
MONA
β-block
Unfractionated Heparin
(P) ACE, CCB, clopidogrel

28

ACS reperfusion options? (5)

Angioplasty (w/ or w/o stents)
Atherectomy
Finrinolytic
Antiplatelet
CABG

29

Aortic Dissection presentation? (5)

Acute, severe tearing/ripping
Radiation to BACK, arms, throat
UNEQUAL pulses/BP in extrem
Aortic insuff murmur
Shock, neuro abnorm

30

Aortic Dissection risk factors? (6)

HTN
< 40yo w/ Marfans, CT disorders
Bicuspid aortic valve
Cocaine
Preggos
FHX

31

AD studies? (4)

EKG
CXR (90% show abn)
CT
TEE (Transesophageal Echo)

32

AD tx?

BP/HR w/ nitroprusside, β-block
Emergent CT/surgery

33

PE presentation?

Acute chest pain OR painless dyspnea

Tachycard/pnea
Hypoxia
Hemoptysis
SOB
Fever,
Syncope
Unilat edema

34

PE risk factors?

Virchow's triad:
Immobilization
Endothelial damage
Hypercoag

35

PE labs?

D-dimer (+ for thrombus)

36

PE EKG findings?

Sinus tachy, S1 Q3 T3 pattern

37

PE CXR findings?

U normal
P Hampton or Westermark

38

PE diagnostic study of choice?

Pulmonary angio

39

PE tx?

Anticoags
P thrombolytics, embolectomy

40

Pneumothorax presentation?

Acute, severe, sharp, pleuritic pain
Dyspnea
Hypoxia
Trach deviation
↓/No ipsilateral BS
Hyperresonance

41

Pneumothorax labs?

ABG = high Aa gradient, hypoxemia

42

Pneumothorax studies?

CXR = air in pleural space, P trach deviation

43

Pneumothorax tx? (4)

High flow O2
+/- needle compression
Chest tubes
Serial CXR

44

Pericarditis pain presentation? (4)

Constant, sharp/stabbing, substernal, pleuritic
Radiation to shoulder, back
↑ w/ inspiration or supine
↓ w/ lean forward

45

Pericarditis other sings/sxs? (6)

Fever
Cough
Dyspnea
Abd pain
Dysphagia
P friction rub

46

Pericarditis caused by? (4)

Autoimmun
TB
CA
Purulent Pericarditis

47

Pericarditis labs?

CBC = Leukocytosis
ESR = ↑
Troponin = ↑
CK-MB = NOT ↑

48

Pericarditis EKG findings? (2)

diffuse ST elevation
PR depression

49

Pericarditis CXR/Echo findings?

pericardial fluid

50

Pericarditis tx? (3)

Pain mgmt
Anti-inflamm/ASA/Colchicine
P aspiration, bx, steroids

51

Tamponade caused by? (6)

Trauma
AD
Pericarditis
CA
MI
TB

52

Tamponade presentation? (2)

Beck's Triad: hypoTN, JVD, muffled heart sounds
Pulsus paradoxus

53

Tamponade studies?

CXR = enlarged heart silhouette

EKG = electrical alternans or low QRS

Echo/CT = best studies

54

Myocarditis is?

Inflamed heart mm C a/w pericarditis

55

Myocarditis presentation?

Fever
Tachy OFP to temp
Arrhy
Myalgia
HA
Rigor

56

Myocarditis most at risk?

M in 30s
Kids

57

Myocarditis caused by:

Viral?

Bacterial?

Systemic dz?

Other?

V = coxsackie, flu, paraflu, EBV, adeno, hep B/C

B = c. dipther, n. mening, m pneumo, β strep

Sys = Collagen vascular dz, sarcoidosis, thyrotoxicosis

Other = radiation, hypersens rxn

58

Myocarditis labs? (4)

CBC = Leukocytosis
Card Enz = ↑
Blood cx
ESR/CRP

59

Myocarditis EKG findings? (4)

non-spec ST/T ∆s
ST elev if w/ pericarditis
AV block
Wide QT

60

Myocarditis tx?

supportive
P abx
P immunsupp

61

Mediastinitis presentation? (7)

Chest/Abd pain
Cough
Hoarseness
Dysphagia
Forceful V
Look ill (shock, fever)
Hamman's Crunch (crackles over mediastinum)

62

Mediastinitis caused by? (3)

Dental infections
Esoph perf
Complication of cardiac, GI, airway surgery

63

Mediastinitis labs? (2)

CBC = Leukocytosis
Blood cx for source

64

Mediastinitis CXR findings? (2)

Mediastinal or free peritoneal air
Pleural effusion

65

Mediastinitis CT findings? (3)

Extra-esophageal air
Mediastinal widening
Abscess

66

Mediastinitis tx? (2)

Abx
CT surg

67

PNA presentation? (6)

Fever
Cough
Hypoxia
Pleuritic chest pain
Tachycard/pnea
Rales, ↓ BS

68

PNA labs?

Studies?

CBC = Leukocytosis or penia

CXR = consolidation or infiltrate

69

Esophagitis U from what?

Hard to distinguish from?

GERD

Myo ischemia

70

Esophagitis presentation?

Burning/gnawing chest pain
Lower chest

71

Esophagitis tx? (3)

GI cocktail:
viscous lido, maalox, donnatol

H2 block, PPI

72

Esophageal spasm presentation?

Tx?

Sudden onset dull/tight/gripping substernal pain,
U following hot/cold drinks or large food bolus

SL nitro

73

Pleuritis is?

Presentation?

Inflammed pleura

Sharp, reproducible pain
↑ w/ inspiration

74

Pleuritis a/w?

PE
Pericarditis
PNA

DIAGNOSIS OF EXCLUSION

75

Costochondritis is?

Inflammed costal cart and/or sternal articulations

76

Costochondritis presentation? (2)

Imaging?

Tx?

Sharp or dull chest pain
↑ w/ deep inspiration and palp

CXR to r/o

Anti-inflam