CMN 574 Final Exam Questions
What is the most common cause of chest pain? correct answers Musculoskeletal
Is musculoskeletal pain described as gradual or sudden? correct answers Gradual
onset
What is something you could ask the patient to do regarding assessing the pain?
correct answers Localized pain; point with 1 finger where you are hurting
Remember: reproducible is a GOOD thing
Are any tests required for musculoskeletal chest pain? correct answers no tests unless
hx of trauma
What is the treatment for musc chest pain? correct answers rest, NSAIDs, ice/heat
What is the 2nd most common cause of chest pain? correct answers GI
What risk factors accompany GI chest pain? correct answers Hx of ulcers, smoking,
ETOH, NSAID or ASA overuse
Always ask about OTC MEDS!
How is GI chest pain described? correct answers Recurrent episodes of SUBSTERNAL
BURNING pain; pain is WORSE WITH MEALS or when lying supine
Pain is WORSE with palpation to EPIGASTRIUM
If the patient has an esophageal spasm - they may characterize the pain as "squeezing
or pressure"
PUD will complain of epigastric pain that may radiate to their back
What tests would you order for to rule in/out GI chest pain? correct answers Urea
breath test: H. pylori
PUD: EGD to evaluate for ulcers
What is the treatment for GI chest pain? correct answers Lifestyle modifications: Diet,
elevate
HOB when sleeping
PPIs: GERD or PUD
Antibiotics: +H.pylori
What is the 3rd most common cause of chest pain? correct answers Psych
,What are some risk factors for psych as the cause of chest pain? correct answers
Acute stress (home, workplace, school)
Hx of panic disorder
Hx of depression
A patient presents with chest pain. Hx of depression. What might this patient describe
their chest pain as? correct answers heaviness that is either sudden or gradual
A patient presents with chest pain. Hx of anxiety. What might this patient look like?
correct answers Hyperventilating, numbness or tingling to BILATERAL extremities
What 2 screening questions are IMPORTANT when assessing a patient with chest pain
to help your differential in psych being the cause? correct answers In the last 6 months,
have you experienced either of the following:
- Spell or attack of feeling anxious
- Felt like your heart was racing or felt faint?
If patient responds with YES to EITHER question, SUSPECT PSYCH and investigate
further
What risk factors place the patient at risk for a respiratory cause of chest pain? correct
answers Recent immobility
Recent pregnancy
Pelvic or femur trauma (fracture, surgery)
Hypercoagulability
Estrogen use (HRT) or birth control
Are they a smoker
Hx or current cancer
A patient was recently dx with pneumonia. What chest pain symptoms might this patient
report? correct answers dull ache (could have no pain at all)
A patient presents to clinic with c/o pain worse with inspiration, characterized as
stabbing to posterior LL lobe. Vitals reveal tachycardia of 101hr. What do you suspect?
What should be included in your assessment of this patient? correct answers PE
(pulmonary embolism).
You should perform a Wells score to determine imaging.
What Wells score indicates low risk? What would be your next NP action? correct
answers <2 you would order a d-dimer
Depending on patient complaint, may order a lower extremity US to rule out DVT
What Wells score indicates high risk? What would be your next NP action? correct
answers >6 you would order a CT scan and LE US
, If a clot is found, begin anticoagulation.
Patient presents to clinic with cough, fever, and increased shortness of breath with
exertion.
What do you suspect in this patient? What would you order to rule in / out? correct
answers Pneumonia
Order a 2-view CXR
Treat with antibiotics
Woman presents to clinic for annual exam. Constitutional: healthy, thin, cooperative.
CV: pansystolic murmur with mid-systolic click. Spine: pectus excavatum.
What cardiac issue do you suspect in this patient? How do you diagnose definitively?
What is treatment? correct answers Mitral Valve Prolapse
Diagnose: Echo
Treatment: None required UNLESS symptomatic - this would be a beta-blocker "olol"
Patient presents to clinic with c/o abrupt onset of stabbing / ripping chest pain that is
radiating to his back. Hx of smoker. Patient appears anxious upon exam.
What assessment technique is important to perform? What do you suspect? What is
your treatment? correct answers BP in left and right arm
Difference in BP >15mmHg = positive
assessment
Diff Dx: Abdominal aortic aneurysm
Diagnostics: Stat CT
TX:prayer, surgery
Patient presents to clinic with c/o substernal chest pain, radiates to shoulders. Patient
reports increased pain when lying down. Vitals reveal 100.5 oral temp, 92hr, 22rr.
What information would be IMPORTANT to obtain from this patients hx? What do you
suspect? What are your orders? What is the treatment? correct answers HPI: Do you
have history of recent viral infection, SLE/RA? Cancer? Post-MI?
Diff Dx: pericarditis
Labs: ESR, CBC, cardiac enzymes
Diagnostics: ECG, Echo
Treatment: Bedrest, ASA/NSAIDs, possibly steroids
What is #1 cause of CAD? correct answers atherosclerotic disease
What are the risk factors for CAD? correct answers Male
What is the most common cause of chest pain? correct answers Musculoskeletal
Is musculoskeletal pain described as gradual or sudden? correct answers Gradual
onset
What is something you could ask the patient to do regarding assessing the pain?
correct answers Localized pain; point with 1 finger where you are hurting
Remember: reproducible is a GOOD thing
Are any tests required for musculoskeletal chest pain? correct answers no tests unless
hx of trauma
What is the treatment for musc chest pain? correct answers rest, NSAIDs, ice/heat
What is the 2nd most common cause of chest pain? correct answers GI
What risk factors accompany GI chest pain? correct answers Hx of ulcers, smoking,
ETOH, NSAID or ASA overuse
Always ask about OTC MEDS!
How is GI chest pain described? correct answers Recurrent episodes of SUBSTERNAL
BURNING pain; pain is WORSE WITH MEALS or when lying supine
Pain is WORSE with palpation to EPIGASTRIUM
If the patient has an esophageal spasm - they may characterize the pain as "squeezing
or pressure"
PUD will complain of epigastric pain that may radiate to their back
What tests would you order for to rule in/out GI chest pain? correct answers Urea
breath test: H. pylori
PUD: EGD to evaluate for ulcers
What is the treatment for GI chest pain? correct answers Lifestyle modifications: Diet,
elevate
HOB when sleeping
PPIs: GERD or PUD
Antibiotics: +H.pylori
What is the 3rd most common cause of chest pain? correct answers Psych
,What are some risk factors for psych as the cause of chest pain? correct answers
Acute stress (home, workplace, school)
Hx of panic disorder
Hx of depression
A patient presents with chest pain. Hx of depression. What might this patient describe
their chest pain as? correct answers heaviness that is either sudden or gradual
A patient presents with chest pain. Hx of anxiety. What might this patient look like?
correct answers Hyperventilating, numbness or tingling to BILATERAL extremities
What 2 screening questions are IMPORTANT when assessing a patient with chest pain
to help your differential in psych being the cause? correct answers In the last 6 months,
have you experienced either of the following:
- Spell or attack of feeling anxious
- Felt like your heart was racing or felt faint?
If patient responds with YES to EITHER question, SUSPECT PSYCH and investigate
further
What risk factors place the patient at risk for a respiratory cause of chest pain? correct
answers Recent immobility
Recent pregnancy
Pelvic or femur trauma (fracture, surgery)
Hypercoagulability
Estrogen use (HRT) or birth control
Are they a smoker
Hx or current cancer
A patient was recently dx with pneumonia. What chest pain symptoms might this patient
report? correct answers dull ache (could have no pain at all)
A patient presents to clinic with c/o pain worse with inspiration, characterized as
stabbing to posterior LL lobe. Vitals reveal tachycardia of 101hr. What do you suspect?
What should be included in your assessment of this patient? correct answers PE
(pulmonary embolism).
You should perform a Wells score to determine imaging.
What Wells score indicates low risk? What would be your next NP action? correct
answers <2 you would order a d-dimer
Depending on patient complaint, may order a lower extremity US to rule out DVT
What Wells score indicates high risk? What would be your next NP action? correct
answers >6 you would order a CT scan and LE US
, If a clot is found, begin anticoagulation.
Patient presents to clinic with cough, fever, and increased shortness of breath with
exertion.
What do you suspect in this patient? What would you order to rule in / out? correct
answers Pneumonia
Order a 2-view CXR
Treat with antibiotics
Woman presents to clinic for annual exam. Constitutional: healthy, thin, cooperative.
CV: pansystolic murmur with mid-systolic click. Spine: pectus excavatum.
What cardiac issue do you suspect in this patient? How do you diagnose definitively?
What is treatment? correct answers Mitral Valve Prolapse
Diagnose: Echo
Treatment: None required UNLESS symptomatic - this would be a beta-blocker "olol"
Patient presents to clinic with c/o abrupt onset of stabbing / ripping chest pain that is
radiating to his back. Hx of smoker. Patient appears anxious upon exam.
What assessment technique is important to perform? What do you suspect? What is
your treatment? correct answers BP in left and right arm
Difference in BP >15mmHg = positive
assessment
Diff Dx: Abdominal aortic aneurysm
Diagnostics: Stat CT
TX:prayer, surgery
Patient presents to clinic with c/o substernal chest pain, radiates to shoulders. Patient
reports increased pain when lying down. Vitals reveal 100.5 oral temp, 92hr, 22rr.
What information would be IMPORTANT to obtain from this patients hx? What do you
suspect? What are your orders? What is the treatment? correct answers HPI: Do you
have history of recent viral infection, SLE/RA? Cancer? Post-MI?
Diff Dx: pericarditis
Labs: ESR, CBC, cardiac enzymes
Diagnostics: ECG, Echo
Treatment: Bedrest, ASA/NSAIDs, possibly steroids
What is #1 cause of CAD? correct answers atherosclerotic disease
What are the risk factors for CAD? correct answers Male
