What is the most common cause of chest pain? - answer-Musculoskeletal
Is musculoskeletal pain described as gradual or sudden? - answer-Gradual onset
What is something you could ask the patient to do regarding assessing the pain? - answer-Localized pain; point with 1 finger where you are hurti...
What is the most common cause of chest pain? - answer-Musculoskeletal
Is musculoskeletal pain described as gradual or sudden? - answer-Gradual onset
What is something you could ask the patient to do regarding assessing the pain? - answer-Localized
pain; point with 1 finger where you are hurting
Remember: reproducible is a GOOD thing
Are any tests required for musculoskeletal chest pain? - answer-no tests unless hx of trauma
What is the treatment for musc chest pain? - answer-rest, NSAIDs, ice/heat
What is the 2nd most common cause of chest pain? - answer-GI
What risk factors accompany GI chest pain? - answer-Hx of ulcers, smoking, ETOH, NSAID or ASA
overuse
Always ask about OTC MEDS!
How is GI chest pain described? - answer-Recurrent episodes of SUBSTERNAL BURNING pain; pain is
WORSE WITH MEALS or when lying supine
Pain is WORSE with palpation to EPIGASTRIUM
If the patient has an esophageal spasm - they may characterize the pain as "squeezing or pressure"
PUD will complain of epigastric pain that may radiate to their back
What tests would you order for to rule in/out GI chest pain? - answer-Urea breath test: H. pylori
PUD: EGD to evaluate for ulcers
What is the treatment for GI chest pain? - answer-Lifestyle modifications: Diet, elevate
HOB when sleeping
PPIs: GERD or PUD
Antibiotics: +H.pylori
What is the 3rd most common cause of chest pain? - answer-Psych
What are some risk factors for psych as the cause of chest pain? - answer-Acute stress (home,
workplace, school)
Hx of panic disorder
Hx of depression
A patient presents with chest pain. Hx of depression. What might this patient describe their chest pain
as? - answer-heaviness that is either sudden or gradual
,A patient presents with chest pain. Hx of anxiety. What might this patient look like? - answer-
Hyperventilating, numbness or tingling to BILATERAL extremities
What 2 screening questions are IMPORTANT when assessing a patient with chest pain to help your
differential in psych being the cause? - answer-In the last 6 months, have you experienced either of the
following:
- Spell or attack of feeling anxious
- Felt like your heart was racing or felt faint?
If patient responds with YES to EITHER question, SUSPECT PSYCH and investigate further
What risk factors place the patient at risk for a respiratory cause of chest pain? - answer-Recent
immobility
Recent pregnancy
Pelvic or femur trauma (fracture, surgery)
Hypercoagulability
Estrogen use (HRT) or birth control
Are they a smoker
Hx or current cancer
A patient was recently dx with pneumonia. What chest pain symptoms might this patient report? -
answer-dull ache (could have no pain at all)
A patient presents to clinic with c/o pain worse with inspiration, characterized as stabbing to posterior
LL lobe. Vitals reveal tachycardia of 101hr. What do you suspect?
What should be included in your assessment of this patient? - answer-PE (pulmonary embolism).
You should perform a Wells score to determine imaging.
What Wells score indicates low risk? What would be your next NP action? - answer-<2 you would order
a d-dimer
Depending on patient complaint, may order a lower extremity US to rule out DVT
What Wells score indicates high risk? What would be your next NP action? - answer->6 you would order
a CT scan and LE US
If a clot is found, begin anticoagulation.
Patient presents to clinic with cough, fever, and increased shortness of breath with exertion.
What do you suspect in this patient? What would you order to rule in / out? - answer-Pneumonia
Order a 2-view CXR
Treat with antibiotics
, Woman presents to clinic for annual exam. Constitutional: healthy, thin, cooperative. CV: pansystolic
murmur with mid-systolic click. Spine: pectus excavatum.
What cardiac issue do you suspect in this patient? How do you diagnose definitively?
What is treatment? - answer-Mitral Valve Prolapse
Diagnose: Echo
Treatment: None required UNLESS symptomatic - this would be a beta-blocker "olol"
Patient presents to clinic with c/o abrupt onset of stabbing / ripping chest pain that is radiating to his
back. Hx of smoker. Patient appears anxious upon exam.
What assessment technique is important to perform? What do you suspect? What is your treatment? -
answer-BP in left and right arm
Difference in BP >15mmHg = positive
assessment
Diff Dx: Abdominal aortic aneurysm
Diagnostics: Stat CT
TX:prayer, surgery
Patient presents to clinic with c/o substernal chest pain, radiates to shoulders. Patient reports increased
pain when lying down. Vitals reveal 100.5 oral temp, 92hr, 22rr.
What information would be IMPORTANT to obtain from this patients hx? What do you suspect? What
are your orders? What is the treatment? - answer-HPI: Do you have history of recent viral infection,
SLE/RA? Cancer? Post-MI?
Diff Dx: pericarditis
Labs: ESR, CBC, cardiac enzymes
Diagnostics: ECG, Echo
Treatment: Bedrest, ASA/NSAIDs, possibly steroids
What is #1 cause of CAD? - answer-atherosclerotic disease
What are the risk factors for CAD? - answer-Male
Abdominal obesity, Stress
Diet low in fruits & veggies
Excessive ETOH use
>age
FHx of CAD
High LDL with low LDL
High trig [esp. women]
Hx of HTN, DM
Smoker
Inactivity
What can REDUCE CAD risk? - answer-- Initiate statin
- Manage HTN properly (meds, lifestyle modifications)
- Smoking cessation
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