What did you think about Mondays Challenger? Easy? Hard? We love - TopicsExpress



          

What did you think about Mondays Challenger? Easy? Hard? We love feedback! Let us know. Here are the answers, rationales, and references: Rationale Question 1. ) B. Costochondritis The correct answer is costochondritis. Costochondritis is a common cause of chest wall pain that most commonly occurs as a result of inflammation at the junction of the sternum, ribs, and/or cartilage. It is differentiated from cardiac pain by the ability to reproduce the pain with movement of the chest wall, arms or deep breaths. Palpation at the site of inflammation can reproduce the pain. Causes of costochondritis may include: injury, physical strain, arthritis, joint infection, and tumors; however, most cases have no cause. The chest pain associated with costochondritis may mimic angina or acute coronary syndrome; however, with acute coronary syndrome the pain is not reproducible with movement of the arms and does not have point tenderness on the chest wall when palpated. Cardiac pain associated with angina is not relieved by ibuprofen. Symptoms associated with acute coronary syndrome may include nausea, vomiting, diaphoresis, weakness, and syncope. Hypotension or hypertension may be present depending on the severity. Chest pain associated with esophageal spasm presents as a squeezing type pain in the chest. Other symptoms may include dysphagia, regurgitation, and/or globus (feeling that something is stuck in the throat). It may be mistaken for angina. This patient has no history or symptoms consistent with this cause of chest pain, so it is unlikely. Finally, the patient has a normal EKG while chest pain is occurring. A cardiology consult may be in order depending on the frequency of the PACs and in light of the long-standing elevated lipids, but is not urgent at this time. Question 2.) A. Ibuprofen 600 mg TID, heat to the chest wall at the site of pain, avoid provocative movements This scenario is unlikely to be cardiac related. She should be treated conservatively with analgesics, gently stretching. Since costochondritis is a self limited condition, conservative management is prudent. Refefences Bickley, MD, Lynn. Bates’ Guide to Physical Examination and History Taking (2013). Philadelphia, PA. Wolters, Kluwer Health/Lippincott Williams and Wilkins Hollier, Amelie and Hensley, Rhonda. (2011). Clinical Guidelines in Primary Care: A Reference and Review Book. Lafayette, LA. Advanced Practice Education Association, Inc. Mayo Staff. (2014). Diseases and Conditions Anxiety. Retrieved 5/6/2014 from mayoclinic.org/diseases-conditions/anxiety/basics/symptoms/CON-20026282 Mayo Staff. (2012). Diseases and Conditions Costochondritis. Retrieved 5/6/2014 from mayoclinic.org/diseases-conditions/costochondritis/basics/definition/con-20024454 Mayo Staff. (2012). Diseases and Conditions Esophageal Spasms. Retrieved 5/6/2014 from mayoclinic.org/diseases-conditions/esophageal-spasms/basics/symptoms/CON-20025653
Posted on: Wed, 14 May 2014 18:51:46 +0000

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