CMN 574 Unit 1 Exam Questions And Correct Answers
Common causes of chest pain in the primary care office - Answer Musculoskeletal/
chest wall pain
Gastrointestinal disorders
Anxiety/psychiatric disorders
Respiratory disorders
Stable angina
Non-ischemic cardiac disorders
Inflammatory disorders/infections
Causes of chest pain seen in Urgent care or ER - Answer Unstable angina/ Acute
coronary syndrome
Pulmonary embolism
Pneumothorax
Esophageal rupture
Aortic dissection
How to manage chest pain - Answer Careful History & Physical Exam
Risk assessment: what factors does this patient have that make a serious cardiac cause
more likely?
Focused testing
Referral to specialist or hospital
Non-cardiac causes of chest pain:
Musculoskeletal disorders - Answer Most common non-cardiac cause of chest pain:
,almost 40% of patients with CP have a MS disorder/ chest wall pain
Chest wall pain most commonly caused by muscle strain or costochondritis, less
common causes are broken rib, herpes zoster, fibromyalgia, fibrocystic breast, sickle
cell crisis, chest wall contusions, or protracted vomiting
More common in young, active patients involved in sports or work that involves lifting.
MS chest pain - Answer Risk factors: trauma, overuse injury, hx of Chicken pox
Character and location of pain: ranges from sharp to dull, usually more localized and
can point to area with a finger. Zoster pain described as burning and localized along a
dermatone.
Peril and Feat MS chest wall pain aggravated by arm movement or deep inspiration
Duration: gradual onset, longer duration Exam: pain often reproducible by palpation of
affected muscles, ligaments or costochondral junction Examine for rash associated with
zoster, pain may precede rash development Tests: usually none indicated, Xrays if hx of
trauma Treatment: rest, anti-inflammatories, ice/heat
Non-cardiac chest pain: Gastrointestinal disorders -Answer GI disorders account for
20-30% of patients with chest pain.
Causes include GERD, esophagitis, esophageal spasm, peptic ulcer disease, hiatal
hernia, and gallbladder disease
Factors increasing the likelihood are hx of ulcers, smokers, use of ETOH, and use of
NSAIDS or ASA.
Always ask about OTC pain medication use!
Gastrointestinal disorders - chest pain - Answer Character & Location: GERD be
described as substernal and burning pain, Eosphageal spasm may present as
substernal squeezing or pressure. PUD and pancreatitis may present as epigastric pain
radiating to the back.
Timing & duration: usually recurrent, may last minutes to hours.
Aggravating factors: worsened by meals, supine position
Relieved by: antacids, PPI, H2 blockers.
Associated symptoms: nocturnal cough, flatus, belching, dysphagia
Exam findings: pain on palpation of epigastruim
, Labs: test for H. pylori, EGD
Treatment: depends on cause: PPIs, antibiotics for H. pylori
Diet, elevate head of bed
Non-cardiac chest pain: Psychogenic causes - Answer Psychogenic causes account for
10-20% of chest pain
Causes include stress-related disorders, panic attacks and somatization
Stress also aggravates other conditions that cause CP such as GERD, asthma, and
angina
Psychogenic chest pain - Answer Character & location: varies. Panic disorder:
precordial CP, Depression: constant or intermittent heaviness unrelated to meals or
activity
Timing: sudden or gradual
Aggravating factors: stress, hx of panic disorder or depression
Associated symptoms: anxiety, dyspnea/ hyperventilation, tingling/numbness or limbs,
dizziness
Screening: 2 questions highly sensitive for panic disorder
1. "In the past 6 mo, did you ever have a spell or an attack when all of a sudden you felt
anxious, frightened, or very uneasy?"
2. " In the past 6 mo, did you ever has a spell or attack where for no reason your heart
suddenly began to race and you felt faint or couldn't catch you breath?
Yes to either is positive screen, no to both makes panic disorder unlikely.
Non-cardiac chest pain: respiratory disorders - Answer Respiratory disorders account
for 5-10% of chest pain patients
Causes include bronchitis, pneumonia, asthma, COPD, pneumonitis, pleurisy, and
pulmonary embolism
Risk factors for PE: prolonged immobilization, pregnancy, pelvic or lower leg trauma,
hypercoagulability, estrogen use, smoker, and cancer
Common causes of chest pain in the primary care office - Answer Musculoskeletal/
chest wall pain
Gastrointestinal disorders
Anxiety/psychiatric disorders
Respiratory disorders
Stable angina
Non-ischemic cardiac disorders
Inflammatory disorders/infections
Causes of chest pain seen in Urgent care or ER - Answer Unstable angina/ Acute
coronary syndrome
Pulmonary embolism
Pneumothorax
Esophageal rupture
Aortic dissection
How to manage chest pain - Answer Careful History & Physical Exam
Risk assessment: what factors does this patient have that make a serious cardiac cause
more likely?
Focused testing
Referral to specialist or hospital
Non-cardiac causes of chest pain:
Musculoskeletal disorders - Answer Most common non-cardiac cause of chest pain:
,almost 40% of patients with CP have a MS disorder/ chest wall pain
Chest wall pain most commonly caused by muscle strain or costochondritis, less
common causes are broken rib, herpes zoster, fibromyalgia, fibrocystic breast, sickle
cell crisis, chest wall contusions, or protracted vomiting
More common in young, active patients involved in sports or work that involves lifting.
MS chest pain - Answer Risk factors: trauma, overuse injury, hx of Chicken pox
Character and location of pain: ranges from sharp to dull, usually more localized and
can point to area with a finger. Zoster pain described as burning and localized along a
dermatone.
Peril and Feat MS chest wall pain aggravated by arm movement or deep inspiration
Duration: gradual onset, longer duration Exam: pain often reproducible by palpation of
affected muscles, ligaments or costochondral junction Examine for rash associated with
zoster, pain may precede rash development Tests: usually none indicated, Xrays if hx of
trauma Treatment: rest, anti-inflammatories, ice/heat
Non-cardiac chest pain: Gastrointestinal disorders -Answer GI disorders account for
20-30% of patients with chest pain.
Causes include GERD, esophagitis, esophageal spasm, peptic ulcer disease, hiatal
hernia, and gallbladder disease
Factors increasing the likelihood are hx of ulcers, smokers, use of ETOH, and use of
NSAIDS or ASA.
Always ask about OTC pain medication use!
Gastrointestinal disorders - chest pain - Answer Character & Location: GERD be
described as substernal and burning pain, Eosphageal spasm may present as
substernal squeezing or pressure. PUD and pancreatitis may present as epigastric pain
radiating to the back.
Timing & duration: usually recurrent, may last minutes to hours.
Aggravating factors: worsened by meals, supine position
Relieved by: antacids, PPI, H2 blockers.
Associated symptoms: nocturnal cough, flatus, belching, dysphagia
Exam findings: pain on palpation of epigastruim
, Labs: test for H. pylori, EGD
Treatment: depends on cause: PPIs, antibiotics for H. pylori
Diet, elevate head of bed
Non-cardiac chest pain: Psychogenic causes - Answer Psychogenic causes account for
10-20% of chest pain
Causes include stress-related disorders, panic attacks and somatization
Stress also aggravates other conditions that cause CP such as GERD, asthma, and
angina
Psychogenic chest pain - Answer Character & location: varies. Panic disorder:
precordial CP, Depression: constant or intermittent heaviness unrelated to meals or
activity
Timing: sudden or gradual
Aggravating factors: stress, hx of panic disorder or depression
Associated symptoms: anxiety, dyspnea/ hyperventilation, tingling/numbness or limbs,
dizziness
Screening: 2 questions highly sensitive for panic disorder
1. "In the past 6 mo, did you ever have a spell or an attack when all of a sudden you felt
anxious, frightened, or very uneasy?"
2. " In the past 6 mo, did you ever has a spell or attack where for no reason your heart
suddenly began to race and you felt faint or couldn't catch you breath?
Yes to either is positive screen, no to both makes panic disorder unlikely.
Non-cardiac chest pain: respiratory disorders - Answer Respiratory disorders account
for 5-10% of chest pain patients
Causes include bronchitis, pneumonia, asthma, COPD, pneumonitis, pleurisy, and
pulmonary embolism
Risk factors for PE: prolonged immobilization, pregnancy, pelvic or lower leg trauma,
hypercoagulability, estrogen use, smoker, and cancer
