PM Instructor Study

Question 1

Differential Dx Chest pain

Answer 1

Cardiac: AMI, Pericarditis, Aortic dissection.

Pulmonary: Pleurisy, Pneumothorax, PE, Pneumonia

Gastrointestinal: GERD

Musculoskeletal: Costochondritis

Miscellaneous: Shingles (Pre-eruptive)

Question 2

Cardiac causes of chest pain and associated symptoms/risk factors.

Answer 2

AMI: Chrushing, substernal. Diaphoresis, nausea, radiation to neck or left arm. More common males over 50.

Pericarditis: Fever, diffuse ST/T wave changes, pain worse with reclining, improved with sitting up.

Aortic Dissection: Tearing pain, diminished pulses, abdominal/back pain, shortness of breath. More common in elderly.

Question 3

Pulmonary causes of chest pain and associated symptoms/risk factors.

4 P’s

Answer 3

Pleurisy: sharp pain increases with respiration, low-grade fever. young with hx of viral illness.

Pneumonia: sharp pain increases with respiration, fever, cough.

Pneumothorax: sharp pain, unilateral, anxiety, decreased breath sounds on affected side, tall & thin males.

Pulmonary Embolism: sharp pain, dyspnea, cough with rust-colored sputum, hx of immobility.

Question 4

Gastrointestinal causes of chest pain:

Answer 4

GERD: burning sensation, indigestion, belching, radiation to neck or jaw, sore throat.

Question 5

Musculoskeletal causes of chest pain:

Answer 5

Injury associated with trauma

Costochondritis: sharp pain with inspiration, tender to palpation. becomes worse with movement. more common in females.

Question 6

COPD and oxygen administration

Answer 6

Give oxygen and don’t hold back if the patient is in distress. Hypoxia demands treatment before we worry about retained CO2.

Question 7

Dyspnea differential dx general categories to consider:

MARC

Answer 7

Airway
Respiratory
Cardiac
Metabolic

Question 8

Breakdown of dyspnea differential dx categories: Airway

Answer 8

Croup: infection of upper airway that may, very rarely, cause airway obstruction: barking cough, fever. stridor.
Tx: humidified oxygen, nebulized epi (transport because it can rebound)
Foreign body airway obstruction
Epiglottitis: rapid onset fever and drooling, sore throat, inspiratory stridor.
Tx: Keep pt calm, administer O2. If respiratory failure occurs > needle cric.

Question 9

Breakdown of dyspnea differential dx: Respiratory

CAPPP

Answer 9

COPD - wheezing/rhonchi. blue bloater, pink puffer,
Asthma: wheezing
Pneumonia: rales and rhonchi. febrile. may present with pain.
Pleural effusion: symptoms similar to CHF
Pulmonary embolism: dyspnea, sharp pain, apprehension, cough, rust-colored sputum, syncope, diaphoresis, tachycardia, tachypnea, prolonged immobilization, obesity, smoking, hx fo DVT.

Question 10

Breakdown of dyspnea differential dx: Cardiac

Answer 10

CHF: rales (partial filled alveoli), wheezing (completely full alveoli), pedal edema, HTN, medications.

Cardiac dysrhythmias: SVT, A-fib with rapid ventricular response. (Rapid HR reduces filling time resulting in lower ejection fraction.

Question 11

Breakdown of dyspnea differential dx: Metabolic

Answer 11

DKA: Kussmaul respiration, acetone on the breath.

Thyroid storm: true medical emergency marked by tachycardia, HTN, pulmonary edema.

ETOH/Drug abuse?