NM 703- Exam 1 Blueprint || 100% Correct Solutions.
Clinical presentations of gastrointestinal, respiratory, musculoskeletal & psychiatric causes of
chest pain correct answers a. GI- Acid regurgitation, cough, difficult/painful swallowing,
belching, -symptoms related to eating, usually worse after a large meal or lying down after a
meal, might report some heartburn or acid reflux into the throat, sore or bitter tase in the mouth,
molar enamel erosion, usually a more "sub-sternal" chest pain, potential risk factors such as
obesity, pregnancy, etc.
b. Respiratory- cough, dyspnea, localized, positional, sharp and stabbing pain (pleuritic)
c. Musculoskeletal- Nagging chest pain with position changes, coughing and deep breathing
d. Psychiatric- related to depression, panic d/o, or anxiety in younger women with or without a
mental health history
Physical examination components of gastrointestinal, respiratory, musculoskeletal & psychiatric
causes of chest pain correct answers a. GI- Tenderness in the epigastric area or the right or left
upper quadrants causing irritation to the diaphragm
b. Respiratory- Lymphadenopathy in neck (cervical chains or supraclavicular fossa) indicates
volume overload. Tracheal deviation likely pneumothorax.
If costochondritis pain upon palpation or raising arms, deep breathing, coughing, pain when
palpating 3rd or 5th rib, sharp and localized pain
Dullness to percussion over posterior chest could be pleural effusion or pneumonia, may also
have asymmetric breath sounds, pleural friction rub, wheezing, crackles, absent or decreased
breath sounds
c. Musculoskeletal- range of motion of upper body and palpation of chest causes chest pain
d. Psychiatric- related to depression, panic d/o, or anxiety in younger women with or without a
mental health history
What is hemodynamic stability / instability? correct answers a. Hemodynamic stability- Patient
is conscious, clear and lucid, capillary refill is brisk < 2 sec, extremities are warm and pink,
peripheral pulse has good volume, HR is normal for rate and age, normal BP and pulse pressure
for age, normal RR for age, normal urine output
b. Hemodynamic instability-
i. HR <40/min or >140/min
ii. RR <8 or >36/min
iii. O2 <85%
iv. BP <80 or >200mm Hg systolic or > 110mm Hg diastolic
Steps of assessment of a patient presenting with chest pain, i.e. assess for red flag indicators first
and rule out life-threatening conditions before gathering further data. correct answers a. Rule out
red flag indicators (see below)
b. Assess for life threatening conditions (present as acute rather than chronic)
i. MI- sudden onset of pain unrelieved by nitro or rest, n/v, diaphoresis, dyspnea, dizziness, non-
localized pain lasting > 20 minutes that radiates to jaw, shoulders, neck, arms
, ii. Aortic dissection- sudden tearing pain located in the anterior or posterior chest, may radiate to
arms, legs abdomen or back
iii. Pulmonary embolism- Able to point to area of pain over lung, dyspnea, apprehension "I'm
going to die", hemoptysis, gripping or stabbing pain of moderate to severe intensity that may
increase with deep breathing, may radiate to neck or shoulder, bed rest and orthopedic surgery
are risk factors
c. Determine if any risk factors for CAD/CVD? (smoker, HTN, diet high in saturated fats, etc.)
d. Determine if anything that places them at higher risk of blood clots? (sedentary lifestyle,
CAD, pregnancy, contraceptive use, cancer)
e. Determine if family history of chest pain
f. Assess for chronic diseases
Red flag indicators of emergency conditions and actions if identified. correct answers -Non
localized pain
-Lasting > 20 minutes
-Associated with
a. Diaphoresis
b. Dyspnea
c. N & V
d. Dizziness
e. Radiation
i. Neck
ii. Jaw
iii. Shoulder
iv. arm
-Pulse ox and VS after initiating 911
First line treatment for each cause of non-cardiac chest pain. correct answers a. Costochondritis-
symptom management, NSAIDS, heat, ice avoid aggravating activities, f/u if unresolved after 6
weeks
b. Musculoskeletal- NSAIDS, possible PT, radiograph in 3-4 weeks if no improvement
c. Psychiatric- Trial of SSRI, refer to psych, CBT
d. Respiratory- CXR if pneumonia-abx (doxycycline, macrolides, fluroquinolones), if
pneumothorax- ER, if pleural- CT and refer to pulmonologist
e. GI- Trial of PPI x 6-8 weeks
CAD risk factors (family history, cholesterol levels [LDL, HDL harmful & protective levels],
comorbid conditions that raise risk). correct answers Nonmodifiable
a. Male >45, female >55
b. Family history of premature coronary heart disease
Modifiable
c. Cigarette smoking
d. Dyslipidemia
e. DM
f. Increased waist to hip ratio
Clinical presentations of gastrointestinal, respiratory, musculoskeletal & psychiatric causes of
chest pain correct answers a. GI- Acid regurgitation, cough, difficult/painful swallowing,
belching, -symptoms related to eating, usually worse after a large meal or lying down after a
meal, might report some heartburn or acid reflux into the throat, sore or bitter tase in the mouth,
molar enamel erosion, usually a more "sub-sternal" chest pain, potential risk factors such as
obesity, pregnancy, etc.
b. Respiratory- cough, dyspnea, localized, positional, sharp and stabbing pain (pleuritic)
c. Musculoskeletal- Nagging chest pain with position changes, coughing and deep breathing
d. Psychiatric- related to depression, panic d/o, or anxiety in younger women with or without a
mental health history
Physical examination components of gastrointestinal, respiratory, musculoskeletal & psychiatric
causes of chest pain correct answers a. GI- Tenderness in the epigastric area or the right or left
upper quadrants causing irritation to the diaphragm
b. Respiratory- Lymphadenopathy in neck (cervical chains or supraclavicular fossa) indicates
volume overload. Tracheal deviation likely pneumothorax.
If costochondritis pain upon palpation or raising arms, deep breathing, coughing, pain when
palpating 3rd or 5th rib, sharp and localized pain
Dullness to percussion over posterior chest could be pleural effusion or pneumonia, may also
have asymmetric breath sounds, pleural friction rub, wheezing, crackles, absent or decreased
breath sounds
c. Musculoskeletal- range of motion of upper body and palpation of chest causes chest pain
d. Psychiatric- related to depression, panic d/o, or anxiety in younger women with or without a
mental health history
What is hemodynamic stability / instability? correct answers a. Hemodynamic stability- Patient
is conscious, clear and lucid, capillary refill is brisk < 2 sec, extremities are warm and pink,
peripheral pulse has good volume, HR is normal for rate and age, normal BP and pulse pressure
for age, normal RR for age, normal urine output
b. Hemodynamic instability-
i. HR <40/min or >140/min
ii. RR <8 or >36/min
iii. O2 <85%
iv. BP <80 or >200mm Hg systolic or > 110mm Hg diastolic
Steps of assessment of a patient presenting with chest pain, i.e. assess for red flag indicators first
and rule out life-threatening conditions before gathering further data. correct answers a. Rule out
red flag indicators (see below)
b. Assess for life threatening conditions (present as acute rather than chronic)
i. MI- sudden onset of pain unrelieved by nitro or rest, n/v, diaphoresis, dyspnea, dizziness, non-
localized pain lasting > 20 minutes that radiates to jaw, shoulders, neck, arms
, ii. Aortic dissection- sudden tearing pain located in the anterior or posterior chest, may radiate to
arms, legs abdomen or back
iii. Pulmonary embolism- Able to point to area of pain over lung, dyspnea, apprehension "I'm
going to die", hemoptysis, gripping or stabbing pain of moderate to severe intensity that may
increase with deep breathing, may radiate to neck or shoulder, bed rest and orthopedic surgery
are risk factors
c. Determine if any risk factors for CAD/CVD? (smoker, HTN, diet high in saturated fats, etc.)
d. Determine if anything that places them at higher risk of blood clots? (sedentary lifestyle,
CAD, pregnancy, contraceptive use, cancer)
e. Determine if family history of chest pain
f. Assess for chronic diseases
Red flag indicators of emergency conditions and actions if identified. correct answers -Non
localized pain
-Lasting > 20 minutes
-Associated with
a. Diaphoresis
b. Dyspnea
c. N & V
d. Dizziness
e. Radiation
i. Neck
ii. Jaw
iii. Shoulder
iv. arm
-Pulse ox and VS after initiating 911
First line treatment for each cause of non-cardiac chest pain. correct answers a. Costochondritis-
symptom management, NSAIDS, heat, ice avoid aggravating activities, f/u if unresolved after 6
weeks
b. Musculoskeletal- NSAIDS, possible PT, radiograph in 3-4 weeks if no improvement
c. Psychiatric- Trial of SSRI, refer to psych, CBT
d. Respiratory- CXR if pneumonia-abx (doxycycline, macrolides, fluroquinolones), if
pneumothorax- ER, if pleural- CT and refer to pulmonologist
e. GI- Trial of PPI x 6-8 weeks
CAD risk factors (family history, cholesterol levels [LDL, HDL harmful & protective levels],
comorbid conditions that raise risk). correct answers Nonmodifiable
a. Male >45, female >55
b. Family history of premature coronary heart disease
Modifiable
c. Cigarette smoking
d. Dyslipidemia
e. DM
f. Increased waist to hip ratio
