Quiz 17 Chest Pain

Front 1

A 15 year-old girl comes to the medical out patient department with history of severe chest pain, which is localised to the right upper part of anterior chest. Pulse and BP are normal and CVS and respiratory system examinations are also within normal limits. There is swelling and tenderness of the 2nd costo-chondral junction on the right side.

Back 1

Acute Costochondritis

Front 2

A 25 year-old man comes to the OPD with history of chest pain over the left lower part of the chest of three days duration. The pain is aggravated by local pressure over the site as well as turning the body torso. It did not increase during deep inspiration and coughing. Examination of CVS and Respiratory Systems are essentially normal.

Back 2

Myofascitis

Front 3

This 35-year-old woman is brought with history of right lower chest pain, localised to a small area. She had sustained a hit over the chest with a log of wood one day back. The pain was persistent and severe. There is local tenderness and the patient jumped with pain when antero-posterior compression of chest was applied, away from site of pain.

Back 3

Fracture Rib

Front 4

Chest pain in this 45 year-old male was abrupt in onset, localised to the left lower part of chest and associated with a dry cough. There was low grade fever, but no sputum production or hemoptysis. The pain was aggravated by deep inspiration. Nor there was any breathlessness. The pain subsided within a few days without treatment

Back 4

Acute Viral Pleurisy

Front 5

This 15 year-old boy came with abrupt onset of high grade fever with chills and rigor and a right lower chest pain. Chest pain was localised and catching in character and increasing with deep inspiration and coughing. It was also associated with sputum which was mucoid in nature initially; but later accompanied by streaky hemoptysis.

Back 5

Pnemonic Consolidation

Front 6

A 25 year-old woman developed a severe pain starting from the back near the upper thoracic spine radiating along the axilla to the front of the chest up to the level of the nipple. She applied some amruthanjan ointment over the area. This was soon followed by the appearance of 2-4 mm vesicles along the line of the chest pain.

Back 6

Herpes Zoster

Front 7

This 35 year-old man came with an epigastric discomfort radiating to the centre of the chest. This occurred when he went to lie down in bed after taking food. The character of the pain was burning in type. There was also history of acid eructation and bloating of the abdomen and the pain is relieved with cold liquids.

Back 7

Reflux Esophagitis

Front 8

This 45 year-old woman developed sudden retrosternal chest pain while eating at home. This was precipitated by the intake of a large bolus of cold liquid taken from the refrigerator which she swallowed suddenly. The patient felt very uncomfortable and she sweated profusely. The pain lasted for about 10 minutes and slowly subsided.

Back 8

Oesophageal Spasm

Front 9

This 25 year-old lady was having chronic cough productive of large quantities of yellow coloured foul smelling purulent sputum since one month. She has now developed a constant pain over the right upper part of the chest and two episodes of hemoptysis.. Clinical examination was not much revealing except for the grade III clubbing.

Back 9

Lung Abscess

Front 10

Chest pain in this patient, a 35 year-old woman was constant and retrosternal and associated with progressive exertional dyspnoea and palpitations. She gave history suggestive of rheumatic fever in the past and taking penicillin prophylaxis. Clinical examination of the patient shoed a prominent left para-sternal heave and loud P2.

Back 10

Pulmonary Artery Hypertension

Front 11

This 45 year-old woman developed a slowly progressive dull aching pain over the right side of the chest along with a low grade fever and progressive breathlessness. There was a pleuritic type of chest pain in the first 2 days, which disappeared afterwards. The patient found it difficult to lie on the left side because she felt more dyspnoeic.

Back 11

Right Pleural Effusion

Front 12

This 55 year-old woman was admitted to the hospital for an intra-abdominal surgery, after which she was comfortable in the post-operative period, except for the presence of slight oedema in the calf muscle region of the right leg. She suddenly developed a retrosternal discomfort and acute onset of dyspnoea which got aggravated, minute by minute.

Back 12

Acute Pulmonary Embolism

Front 13

The sub-sternal pain in this 35 year-old man was constant and dull aching in character. There was history of fever in the past two weeks. There was no radiation of the chest pain or associated sweating. He got some relief by sitting up and lying by side, but the pain recurred when was lying supine. Later he developed severe dyspnea

Back 13

Acute Pericarditis

Front 14

This 45 year-old woman developed a retrosternal chest pain while walking for about one kilometer distance from her residence to the place of work, which was her habit since several years. When she took rest for about five minutes the pain subsided and she could walk the rest of the distance. But the same pain recurred every day, and got relieved by same amount of rest.

Back 14

Stable Angina

Front 15

This 55 year-old chronic smoker used to get sub-sternal chest pain on occasions while he climbed the stairs of his office building. And one day he felt a bursting type of discomfort in the centre of the chest, which did not subside with the usual administration of sublingual isosorbide dinitrate tablet which he used to carry always and lasted about 15 minutes.

Back 15

Unstable Angina

Front 16

The chest pain in this 65 year-old man was precipitated by hearing catastrophic news about the death of his own son. He felt heaviness over the middle of the chest and jaws and collapsed to the ground. The pain was un-remitting and associated with a sense of impending doom. The heart rate was high and the blood pressure low.

Back 16

Acute Myocardial Infarction

Front 17

The chest pain in this 45 year-old hypertensive patient was characterised by the presence of severe tearing type of pain radiating from the front of upper chest to the back and downwards along the spine. There after the patient developed severe hematuria and claudicating pain in the lower limbs while he attempted to walk.

Back 17

Dissection of Aorta