CMN 574 Final Exam Questions And 100%
Correct Answers
What is the most common cause of chest pain? -Answer Musculoskeletal
Is musculoskeletal pain described as gradual or sudden? -Answer Gradual onset
What is something you could ask the patient to do regarding assessing the pain?
-Answer Localized pain; point with 1 finger where you are hurting
Remember: reproducible is a GOOD thing
Are any tests required for musculoskeletal chest pain? -Answer no tests unless hx of
trauma
What is the treatment for musc chest pain? -Answer rest, NSAIDs, ice/heat
2nd most common cause of chest pain? -Answer GI
What risk factors accompany GI chest pain? -Answer Hx of ulcers, smoking, ETOH,
NSAID or ASA overuse
Always ask about OTC MEDS!
What are the descriptors of GI chest pain? -Answer 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 describe 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? - Answer Urea breath test:
H. pylori
PUD: EGD to evaluate for ulcers
What is the treatment for GI chest pain? -Answer Lifestyle modifications: Diet, elevate
HOB when sleeping
PPIs: GERD or PUD
Antibiotics: +H.pylori
What is the 3rd most common cause of chest pain? -Answer Psych
What are some risk factors for psych as the cause of chest pain? -Answer 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? - Answer heaviness that is either sudden or gradual
A patient presents with chest pain. Hx of anxiety. What might this patient look like? -
Answer Hyperventilating, numbness or tingling to BILATERAL extremities
What is a two important screening questions that are KEY in assessing a patient with
chest pain that will aid you in your differential of psych being the cause? - Response In
the past 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 answers YES to EITHER question, SUSPECT PSYCH and further evaluate
What risk factors does the patient have to put him/her at risk for a respiratory cause of
chest pain? - Answer 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 type of chest pain symptoms might this
patient report? - Answer dull ache (could have no pain at all)
A patient presents to the clinic with a chief complaint of pain, worse with inspiration,
and describes it as stabbing to posterior LL lobe. Vitals: tachycardia of 101hr. What do
you suspect?
What would you include in your workup for this patient?-Answer PE
You would want to do a Wells score to decide on imaging.
What Wells score indicates low risk? What would be your next NP action? -Answer <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? -Answer >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? - Answer
Pneumonia
Order a 2-view CXR
Treat with antibiotics
Woman presents to the clinic for routine examination. Constitutional: well-appearing,
thin, cooperative. CV: pansystolic murmur with mid-systolic click. Spine: pectus
excavatum.
What cardiac problem do you suspect in this patient? How do you diagnose definitively?
What is treatment? - Answer 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 examination technique is crucial to conduct? What do you suspect? What is your
treatment? -Answer BP in left and right arm
Difference in BP >15mmHg = positive
examination
Diff Dx: Abdominal aortic aneurysm
Diagnostics: Stat CT
Correct Answers
What is the most common cause of chest pain? -Answer Musculoskeletal
Is musculoskeletal pain described as gradual or sudden? -Answer Gradual onset
What is something you could ask the patient to do regarding assessing the pain?
-Answer Localized pain; point with 1 finger where you are hurting
Remember: reproducible is a GOOD thing
Are any tests required for musculoskeletal chest pain? -Answer no tests unless hx of
trauma
What is the treatment for musc chest pain? -Answer rest, NSAIDs, ice/heat
2nd most common cause of chest pain? -Answer GI
What risk factors accompany GI chest pain? -Answer Hx of ulcers, smoking, ETOH,
NSAID or ASA overuse
Always ask about OTC MEDS!
What are the descriptors of GI chest pain? -Answer 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 describe 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? - Answer Urea breath test:
H. pylori
PUD: EGD to evaluate for ulcers
What is the treatment for GI chest pain? -Answer Lifestyle modifications: Diet, elevate
HOB when sleeping
PPIs: GERD or PUD
Antibiotics: +H.pylori
What is the 3rd most common cause of chest pain? -Answer Psych
What are some risk factors for psych as the cause of chest pain? -Answer 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? - Answer heaviness that is either sudden or gradual
A patient presents with chest pain. Hx of anxiety. What might this patient look like? -
Answer Hyperventilating, numbness or tingling to BILATERAL extremities
What is a two important screening questions that are KEY in assessing a patient with
chest pain that will aid you in your differential of psych being the cause? - Response In
the past 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 answers YES to EITHER question, SUSPECT PSYCH and further evaluate
What risk factors does the patient have to put him/her at risk for a respiratory cause of
chest pain? - Answer 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 type of chest pain symptoms might this
patient report? - Answer dull ache (could have no pain at all)
A patient presents to the clinic with a chief complaint of pain, worse with inspiration,
and describes it as stabbing to posterior LL lobe. Vitals: tachycardia of 101hr. What do
you suspect?
What would you include in your workup for this patient?-Answer PE
You would want to do a Wells score to decide on imaging.
What Wells score indicates low risk? What would be your next NP action? -Answer <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? -Answer >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? - Answer
Pneumonia
Order a 2-view CXR
Treat with antibiotics
Woman presents to the clinic for routine examination. Constitutional: well-appearing,
thin, cooperative. CV: pansystolic murmur with mid-systolic click. Spine: pectus
excavatum.
What cardiac problem do you suspect in this patient? How do you diagnose definitively?
What is treatment? - Answer 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 examination technique is crucial to conduct? What do you suspect? What is your
treatment? -Answer BP in left and right arm
Difference in BP >15mmHg = positive
examination
Diff Dx: Abdominal aortic aneurysm
Diagnostics: Stat CT
