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CMN 574 Unit 1 Exam Questions and
Answers 100% Solved
Common causes of chest pain in the primary care office -
✔✔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 - ✔✔Unstable angina/
Acute coronary syndrome
Pulmonary embolism
Pneumothorax
Esophageal rupture
Aortic dissection
How to manage chest pain - ✔✔Careful History & Physical Exam
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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 - ✔✔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 - ✔✔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.
Aggravating factors: MS chest wall pain made worse with arm movement or
deep inspiration
Duration: gradual onset, longer duration
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Exam: chest wall pain often reproducible by palpation of the affected
muscles, ligaments or costochondral junction
Examine for rash associated with zoster, pain may occur before rash
develops
Tests: usually none indicated, Xrays if hx of trauma
Treatment: rest, anti-inflammatories, ice/heat
Non-cardiac chest pain: Gastrointestinal disorders - ✔✔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 - ✔✔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.
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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 - ✔✔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 - ✔✔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?"
