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Core Clinical Problems

Core Clinical Problems. CHEST PAIN. Jane presents to her GP with chest pain. What would you like to know?. Onset? Duration? Precipitating Factors? Relieving factors? Character? Site? Associations? Radiation?. Chest Pain. Onset? Duration? Precipitating Factors? Relieving factors?

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Core Clinical Problems

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  1. Core Clinical Problems CHEST PAIN

  2. Jane presents to her GP with chest pain What would you like to know?

  3. Onset? Duration? Precipitating Factors? Relieving factors? Character? Site? Associations? Radiation? Chest Pain

  4. Onset? Duration? Precipitating Factors? Relieving factors? Character? Site? Associations? Radiation? Intermittent? Chest Pain

  5. Onset? Duration? Precipitating Factors? Relieving factors? Character? Site? Associations? Radiation? Chest Pain

  6. Onset? Duration? Precipitating Factors? Relieving factors? Character? Site? Associations? Radiation? Emotion Exercise Food Weather Movement Cough Breathing Posture Chest Pain

  7. Onset? Duration? Precipitating Factors? Relieving factors? Character? Site? Associations? Radiation? Medicines Antianginal Antireflux Analgaesia Rest Posture Chest Pain

  8. Onset? Duration? Precipitating Factors? Relieving factors? Character? Site? Associations? Radiation? Sharp Heavy Tight Dull Gripping Chest Pain

  9. Onset? Duration? Precipitating Factors? Relieving factors? Character? Site? Associations? Radiation? Central Back Upper chest Side Chest Pain

  10. Onset? Duration? Precipitating Factors? Relieving factors? Character? Site? Associations? Radiation? Nausea Vomiting Sweating Presyncope Breathlessness Palpitations Ankle oedema Chest Pain

  11. Onset? Duration? Precipitating Factors? Relieving factors? Character? Site? Associations? Radiation? Jaw Arm(s) Back Epigastrium Chest Pain

  12. Which system might be responsible for Jane’s chest pain?

  13. Cardiac Respiratory Gastrointestinal Musculoskeletal Systems

  14. Cardiac Respiratory Gastrointestinal Musculoskeletal Central Heavy/Dull Radiates to jaw/arms/back Autonomic symptoms Exertional Relieved by GTN Systems

  15. Cardiac Respiratory Gastrointestinal Musculoskeletal Worse on inspiration and coughing suggests pleural irritation. Dull discomfort may suggest soft tissue mass, pleural mass or local invasion. Systems

  16. Cardiac Respiratory Gastrointestinal Musculoskeletal Indigestion Heartburn Spasms difficult to differentiate from cardiac Relation to posture and food Systems

  17. Cardiac Respiratory Gastrointestinal Musculoskeletal History of trauma Worse on breathing, movement and touch Systems

  18. Jane is 31 and suffers from systemic lupus erythematosis (SLE). She presents with left sided chest pain which is worse on inspiration and coughing. Movement or touch does not worsen the pain.

  19. What type of pain does she have? • Cardiac • Pericardial • Musculoskeletal • Pleuritic • Oesophageal

  20. She tells you that the pain came on suddenly earlier this morning and that she felt light headed and breathless with it. There was no sputum or fever

  21. What diagnosis should you consider? • Myocardial Infarction • Angina • Pneumonia • Costochondritis • Pulmonary Embolism

  22. John is 26 he presents to you with central chest pain. He has never smoked, has no family history of IHD and suffers from no medical illness.He recalls helping a friend move furniture two days ago

  23. What diagnosis is most likely? • Musculoskeletal • Pleurisy • Acute Coronary Syndrome • GORD • Pneumothorax

  24. He tells you that his pain is central, sharp in character and worsens when he lies down flat This is his ECG:

  25. The diagnosis is... • Pericarditis • Pneumonia • Atrial fibrillation • Pulmonary Embolism • Wolf Parkinson White type B

  26. John is 58. He is a smoker who presents to his GP with central chest pain. He is overweight and has suffered from heartburn and indigestion for a number of years. His pain can be brought on by stress, heavy meals and exercise.

  27. What could be causing his pain? • Angina • Myocardial Infarction • GORD • Oesophageal spasms • Pericarditis

  28. What would you like to do next? • Trial of proton pump inhibitor • Oesophageal manometry • Gastroscopy • Exercise Tolerance Test (ETT) (Treadmill) • Coronary Angiogram

  29. Michael is 61. He is a life long smoker and had worked in the shipyards in the past. He presents with mild chest ache that has occurred insidiously associated with breathlessness and weight loss

  30. Examination reveals reduced breath sounds, percussion note and vocal resonance over the left lung

  31. Which of the following diagnosis is likely? • Benign asbestos disease • Mesothelioma • Lymphoma • TB • Pneumonia

  32. End

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