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  • OSCE - Chest Pain

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    cgalong
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    This document provides a differential diagnosis and assessment for a patient presenting with chest pain. It lists potential cardiac, respiratory, gastrointestinal, musculoskeletal, and psychogenic causes. For each diagnosis, it describes typical symptoms, risk factors, examination findings, and initial investigations. The assessment should include an ECG, cardiac enzymes, and consideration of further tests depending on suspected diagnoses and risk factors identified from the history and examination.

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    This document provides a differential diagnosis and assessment for a patient presenting with chest pain. It lists potential cardiac, respiratory, gastrointestinal, musculoskeletal, and psychogenic causes. For each diagnosis, it describes typical symptoms, risk factors, examination findings, and initial investigations. The assessment should include an ECG, cardiac enzymes, and consideration of further tests depending on suspected diagnoses and risk factors identified from the history and examination.

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    870 views2 pages

    OSCE - Chest Pain

    Uploaded by

    cgalong
    This document provides a differential diagnosis and assessment for a patient presenting with chest pain. It lists potential cardiac, respiratory, gastrointestinal, musculoskeletal, and psychogenic causes. For each diagnosis, it describes typical symptoms, risk factors, examination findings, and initial investigations. The assessment should include an ECG, cardiac enzymes, and consideration of further tests depending on suspected diagnoses and risk factors identified from the history and examination.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 2

    OSCE

    Chest Pain
    Differential diagnosis
    Cardiac Stable angina Acute coronary syndrome Aortic dissection Acute pericarditis Respiratory Pneumonia Pulmonary embolism Pneumothorax Pleuritis Lung cancer Gastrointestinal Pancreatitis Biliary colic PUD Oesophagitis (reflux) Oesophageal spasm Musculoskeletal and skin Costochondritis Herpes zoster Psychogenic

    History
    HOPC
    Time, onset, context, duration, frequency Quality, location, radiation, severity Progression and previous episodes Aggravating and relieving factors o A exertion o R rest, nitrates Associated features

    R/O DDx
    Angina Central crushing chest pain radiating to neck, jaw, left arm lasting less than 20 minutes occurring on exertion and relieved by rest and nitrates a/w SOB, syncope, presyncope, palpitations a/w nausea, vomiting, sweating, pale, clammy RF for IHD HTN, DM, hypercholesterolaemia, smoking, family history ACS Like angina except lasting >20minutes and occur at rest and not relieved by nitrates

    Same a/w as angina Aortic dissection Central sharp chest pain radiating to the back or only in the back region that is decrescendo in nature c.f. IHD pain which is crescendo then decrescendo Similar a/w with angina, except RFs are previous aneurysm, hypertension, smoking, Marfan, Ehler- Danlos, congenital heart disease biscuspid valve and coarctation, vasculitis (Takayasus) Acute pericarditis Central pleuritic chest pain Recent viral illness (fever, myalgia, althralgia, malaise, sore throat) Other causes (AMI Dresslers, renal failure, CTD, RA) a/w previous AMI/chest pain, generalised pruritus, rash, arthralgia Trauma, radiation, surgery Pneumonia Fever, chills, sweats, rigors Cough, sputum, colour, amount, haemoptysis Immunocompromised steroids, DM, transplant, immunosuppressants Aspiration risk alcoholics, neuromuscular disease, neurological disease, throat disease Pulmonary embolism Recent immobilization including travel and surgery Cancer, chemotherapy, OCP/HRT, pregnancy, coagulopathy (thrombophilia), previous history or family history, smoking Hypertension, surgery, trauma Pneumothorax Sudden onset of chest pain Trauma, surgery, drain, intubation, breathing apparatus Previous history Underlying lung condition e.g. emphysema Lung cancer LOA, LOW, malaise Pancreatitis Sharp epigastric pain that radiates to the back A/w nausea, vomiting, alcohol binge, jaundice, pale stool, dark urine, previous biliary colic, gallstone disease, steatorrhoea Biliary colic Dull pain in RUQ that radiate around to back A/w nausea, vomiting, meal related Oesophageal spasm Reflux disease or oesophageal disease Dysphagia

    Musculoskeletal Localised chest pain Trauma or surgery recently Rashes

    Panic attack

    Medications and allergies


    Any drugs, prescribed, OTC, OCP, multivitamins, complementary medicine Any allergies

    Past medical history


    Other medical diseases

    Family history
    Other family history

    Social history
    Smoking Alcohol Impact on life

    Questions
    Examination, investigation and management depends on the most likely cause but should ALWAYS include: o ECG o Cardiac enzymes What investigations would you like to order? o Routine ECG, cardiac enzymes CXR Full blood examination anaemia, infection TFT thyrotoxicosis o Consider ESR, CRP LFTs Amylase, lipase Ultrasound of leg

    Likely Stations
    Angina Acute myocardial infarction Gastro-oesophageal reflux disease Pneumonia Pleurisy Pulmonary embolus MSK complaint

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