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Approaching Chest Pain

Total questions: 14

Worksheet time: 7mins

Name
Class
Date
1.

52 F, 3/7 hx of chest pain and SOB, "feels like a stitch"

B/G Breast cancer in remission, last treatment 2/12 ago

HR 112, RR 18, sats 97% RA

a)

Radiation pneumonitis

b)

Anxiety

c)

Pneumothorax

d)

PE

2.

88 F, 2/24 hx central chest pain radiating to back, 10/10

Unrelieved by GTN, requiring IV fentanyl

B/G HTN, hypercholesterolaemia, GORD

a)

Aortic Dissection

b)

Reflux

c)

MI

d)

Borehaave Syndrome

3.

24 M 1/7 pleuritic chest pain, worse on lying down, "had my booster 5/7 ago"

ECG: Widespread STE and PR depression

a)

PE

b)

Myopericarditis

c)

STEMI

d)

MSK Pain

4.

28 F, 1/24 hx retrosternal chest pain

14/40 pregnant, hyperemesis gravidarum

Subcut emphysema present

a)

Pneumothorax

b)

Borehaave Syndrome

c)

PE

d)

MSK Pain

5.

55 M - 5/24 L) sided chest pain, SOB, diaphoresis

Tried to go to work, sent in by boss

Nil PMHx

a)

GORD

b)

Costochondritis

c)

STEMI

d)

Pneumonia

6.

21 F, passenger in MVA hit on passenger side c/o R) sided chest pain and SOB

Haemodynamically unstable and appears very anxious

a)

Costochondritis

b)

Haemothorax

c)

Tension pneumothorax

d)

Bruised ribs

7.

73 M, 2/7 hx R) lower rib pain radiating across and around to the back

B/G Prostate cancer on chemo

Requiring PO opiates

Area looks "a little red"

a)

Pneumonia

b)

Aortic dissection

c)

Radiation pneumonitis

d)

Shingles

8.

19 M 2/7 increasing SOB and tearing R) sided chest pain

B/G Asthma

Favourite hobby: Smoke bongs

a)

Pneumothorax

b)

Asthma attack

c)

Pericarditis

d)

Pleurisy

9.

36 M, 4/7 L) sided chest pain and epigastric pain, assoc nausea and vomiting

Been on a bender (again)

ECG and CXR NAD

a)

Gastritis

b)

Pericarditis

c)

Aspiration pneumonia

d)

Pancreatitis

10.

67 F, 12/24 L) sided chest pain radiating to L) arm and jaw

B/G HTN, hypercholesterolaemia, 2x stents insitu with known TVD

ECG: NSR

a)

STEMI

b)

GORD

c)

NSTEMI

d)

Oesophageal rupture

11.

44 M, Penetrating stab wound to chest wall, knife removed by patient

"Not a bikie"

Muffled heart sounds, distended neck vessels, hypoTNive

a)

Cardiac tamponade

b)

Superficial laceration

c)

Tension pneumothorax

d)

Borehaave Syndrome

12.

17 M 1/12 hx central chest pain and SOB

African ethnicity

42 degree day, decided it would be a good day to run his first half marathon

a)

Heat stroke

b)

MSK Pain

c)

Sickle Cell Crisis

d)

Asthma

13.

78 M 4/7 dull, mildly pleuritic, R) sided chest pain + fevers + productive cough with yellow sputum

ECG: NSR

T 39.0

Wells 0

a)

PE

b)

Pneumonia

c)

URTI

d)

Costochondritis

14.

19 M, Cat 1 post MVA c/o severe L) sided chest pain and SOB

Paradoxical chest wall movements

Sats 82% RA, RR 31, palpable bony crepitus

a)

Haemothorax

b)

Cardiac tamponade

c)

Rib fractures

d)

Flail chest