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OSCE

PE III

Typical PresentationDDxWorkup
Retrosternal burning sensation After heavy meals and when lying down Sx relieved by antacids GERD Esophagitis Peptic ulcer Esophageal spasm ECG Barium swallow Upper endoscopy
Retrosternal squeezing pain Lasts for 2 min Occurs w/ exercise Relieved by rest and not related to food intake Angina Esophageal spasm Esophagitis ECG CXR CK-MB, troponin CBC, electrolytes Exercise stress test Upper endoscopy
Retrosternal stabbing pain Improves when leaning forward Worsens w/ deep inspiration Had URI 1 wk ago Pericarditis Aortic dissection MI Costochondritis GERD Esophagreal rupture ECG CXR, Chest CT CK-MB, troponin Echocardiography CBC Upper endoscopy
Stabbing pain Worsens w/ deep inspiration Relieved by aspirin Had URI 1 wk ago + chest wall tenderness Costochondritis Pneumonia MI PE Pericarditis Muscle strain ECG CXR CK-MB, tropnin CBC
Acute onset of SOB at rest Pleuritis CP tachycardia, hypotension, tachypnea, mild fever Long-term immobilization PE Pneumonia Costochondritis MI CHF Aortic dissection ECG CXR ABG
Sudden onset of severe CP Radiates to the back Hx of uncontrolled HTN Aortic dissection MI Pericarditis Esophageal rupture Pancreatitis ECG CKEMB, troponin CXR, MRI CBC, amylase, lipase TEE (transesophagreal echocardiography)
Sudden onset Substernal heavy CP Radiates to L arm dyspnea, diaphoresis, nausea MI ERD Angina Costochondritis Aortic dissection Pericarditis PE ECG CXR CK-MB, troponin CBC, electrolytes Echocardiography Cardiac catheterization
Created by: duanea00
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