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Med-Spot on Med-Source - Differential Diagnosis: Chest Pain

Med-Spot on Med-Source 6.13.07 - Differential Diagnosis: Chest Pain, the Quick & Dirty

Because half of your service will be ROMIs you should commit this list to memorization ... or at least keep it handy.

  • cardiac
    • angina - radiating SSCP +/- diaphoresis, N/V, dyspnea, relieved by nitro or rest, get an EKG
    • MI - angina > 30 min, get and EKG & enzymes (trop, CK)
    • pericarditis - sharp pleuritic pain, relieved w. leaning forward, +/- friction rub, get an EKG (look for diffuse concave ST )
    • aortic dissection - tearing SSCP, asymmetric bp, get a CXR (widened mediastinum)
  • pulomonary
    • pneumonia (PNA) - pleuritic pain, dyspnea, productive cough, fever, get a CXR
    • pleuritis - sharp pleuritic pain +/- friction rub
    • pneumothorax - unilateral acute pleuritic, ↓BS, get a CXR
    • PE - sudden pleuritic, tachypnea, tachycardia, hypoxemia, get a PE protocol CT &/or V/Q scan
    • pulm. HTN - dyspnea, exertional pressure, hypoxemia, loud P2, get a CXR, ECHO
  • GI
    • esophageal reflux - worse w. food, relieved w. antacids, pH probe, EGD
    • esophageal spasm - substernal pain worse w. swallowing, relieved by nitro/CCB, get an upper GI or manometry
    • mallory-weiss tear - vomiting, get an EGD
    • peptic ulcer dz (PUD) - epigastric pain better w. antacids, get an EGD +/- H.pylori
    • billiary dz - RUQ pain, worse s/p fatty foods, get a RUQ u/s & LFTs
    • pancreatitis - epigastric / back pain, elevated amylase & lipase, get an abd. CT
  • musculoskeletal
    • costochondritis - reproducible w. palpation
    • c-spine dz / OA - precipitated by motion, get x-rays
  • anxiety
  • zoster - don't forget to actually look at your patient's chest
Must have book on your medicine rotation: Pocket Medicine 2nd Ed.

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