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18 Cards in this Set

  • Front
  • Back
Key History -
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
Key PE -
VS
BP in both arms

complete CV exam -
JVD
PMI
chest wall tenderness
heart sounds
pulses
edema

lung exam
abdominal exam
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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