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18 Cards in this Set
- Front
- Back
Key History -
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Location
quality radiation severity duration context - exertional postprandial positional cocaine use trauma associated Sxs - sweating nausea dyspnea palpitation sense of doom exacerbating and alleviating factors- esp. meds prior h/o similar Sxs known heart or lung disease h/o diagnostic testing cardiac risk factors - HTN hyperlipidemia smoking family h/o early MI PE risk factors - h/o DVT coagulopathy malignancy recent immobilization |
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Key PE -
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VS
BP in both arms complete CV exam - JVD PMI chest wall tenderness heart sounds pulses edema lung exam abdominal exam |
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60 y/o M
presents with sudden onset of substernal heavy chest pain that has lasted for 30 mins. and radiates to the left arm. The pain is accompanied by dyspnea, diaphoresis and nausea. He has a h/o HTN, hyperlipidemia and smoking. What is Differential? |
MI
GERD angina costochondritis aortic dissection pericarditis PE pneumothorax |
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60 y/o M
presents with sudden onset of substernal heavy chest pain that has lasted for 30 mins. and radiates to the left arm. The pain is accompanied by dyspnea, diaphoresis and nausea. He has a h/o HTN, hyperlipidemia and smoking. What is Workup? |
EKG
CPK-MB, troponin CXR CBC, electrolytes echocardiography cardiac catherization |
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20 y/o Black F
presents with acute onset of severe chest pain. She has a h/o sickle cell disease and multiple previous hospitalizations for pain and anemia management. What is Differential? |
Sickle cell disease -
pulmonary infarct pneumonia PE MI pneumothorax aortic dissection |
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20 y/o Black F
presents with acute onset of severe chest pain. She has a h/o sickle cell disease and multiple previous hospitalizations for pain and anemia management. What is Workup? |
CBC, retic count, LDH,
peripheral smear ABG CXR CPK-MB, troponin EKG V/Q scan CT - chest with IV contrast |
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45 y/o F
presents with a retrosternal burning sensation that occurs after heavy meals and when lying down. Her Sxs are relieved by antacids. What is Differential? |
GERD
esophagitis PUD esophageal spasm MI angina |
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45 y/o F
presents with a retrosternal burning sensation that occurs after heavy meals and when lying down. Her Sxs are relieved by antacids. What is Workup? |
EKG
barium swallow upper endoscopy esophageal pH monitoring |
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55 y/o M
presents with retrosternal squeezing pain that lasts for 2 mins. and occurs with exercise. It is relieved by rest and is not related to food intake. What is Differential? |
Angina
GERD esophageal spasm esophagitis |
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55 y/o M
presents with retrosternal squeezing pain that lasts for 2 mins. and occurs with exercise. It is relieved by rest and is not related to food intake. What is Workup? |
EKG
CPK-MB, troponin CXR CBC, electrolytes exercise stress test upper endoscopy/pH monitor cardiac catheterization |
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34 y/o F
presents with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI one week ago. What is Differential? |
Pericarditis
aortic dissection MI costochondritis GERD esophageal rupture |
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34 y/o F
presents with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI one week ago. What is Workup? |
EKG
CPK-MB, troponin CXR echocardiography CBC upper endoscopy |
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34 y/o F
presents with stabbing chest pain that worsens with deep inspiration and is relieved by aspirin. She had a URI one week ago. Chest wall tenderness is noted What is Differential? |
Costochondritis
pneumonia MI PE pericarditis muscle strain |
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34 y/o F
presents with stabbing chest pain that worsens with deep inspiration and is relieved by aspirin. She had a URI one week ago. Chest wall tenderness is noted What is Workup? |
EKG
CPK-MB, troponin CXR CBC |
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70 y/o F
presents with acute onset of SOB at rest and pleuritic chest pain. She also presents with tachy, hypotension, tachypnea and mild fever. She is recovering from hip replacement surgery. What is Differential? |
PE
pneumonia costochondritis MI CHF aortic dissection |
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70 y/o F
presents with acute onset of SOB at rest and pleuritic chest pain. She also presents with tachy, hypotension, tachypnea and mild fever. She is recovering from hip replacement surgery. What is Workup? |
EKG
CXR ABG CPK-MB, troponin CBC, electrolytes CT - chest with IV contrast doppler US - legs D-dimer |
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55 y/o M
presents with sudden onset of severe chest pain that radiates to the back. He has a h/o uncontrolled HTN. What is Differential? |
Aortic dissection
MI pericarditis esophageal rupture esophageal spasm GERD pancreatitis |
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55 y/o M
presents with sudden onset of severe chest pain that radiates to the back. He has a h/o uncontrolled HTN. What is Workup? |
EKG, CPK-MB, troponin
CXR CBC, amylase, lipase transesophageal echocardiography (TEE), MRI/MRA - aorta aortic angiography upper endoscopy |