DDX II Quiz 4

Herpes Zoster/Shingles

• history of chicken pox

• vesicular pattern following dermatomal pattern

Muscular strain

• pain upon contraction

• involves pectorals, intercostals and serratus anterior

Tietze Syndrome

• older individuals, unilateral pain 

• 2nd/3rd costochondral junction 

Costochondritis 

• bilateral pain, younger individuals 

• crowing rooster exacerbates 

Myocardial infraction

• lower leg swelling, progressive weakness, profuse sweating, restlessness

• Pain lasts longer than 30 minutes

• increased JVD, atrial gallops (S4), and rales

• CK-MB, troponin

Orthostatic HTN

• difference of 20/10 mmHg for BP supine vs seated

• history of underlying condition

Carotid sinus syndrome

• tight collars, turning head to one side

subclavian steal syndrome

• history/dx of TIA

• supraclavicular fossa bruit, unequal radial pulses, different BP in each arm

vasovagal syncope

• sweating, lightheadedness, queasiness

• avoid situations, counterpressure maneuver

Hyperventilation

• numbness, paresthesia, cold hands prior to fainting spell

Hypertrophic cardiomyopathy 

• chest pain, dyspnea, syncope (exertion related)

• young athletes

• loud systolic heart murmur left parasternal border when standing

• triple apical impulse, loud S4

• increased left ventricle thickness

Pericarditis

• recent history of respiratory infection, renal failure, cancer

• worse lying down and better seated

• friction rubs on auscultation

• symptoms improve in days-weeks

Pleural inflammation/Pleural effusion/Pleurisy

• sharp pains in the chest related to coughing/sneezing/bending to the side

• past or present upper respiratory infection

• increased percussive dullness, breath sounds

Intercostal neuritis

• preceding chicken pox or shingles or diabetes

• unilateral pain extending in band around chest

Esophageal spasm

• substernal chest pain, heartburn 

• dietary recommendations

• can use PPIs as test 

Atrial fibrillation 

• older than 65

• fatigue or very uncomfortable ryhthm

• history of CHF, HTN, DM, old, stroke 

• no p-wave, hard to tell QRS segments

Mitral valve prolapse syndrome

• woman of child-bearing years 

• associated chest wall deformity 

• ejection click, late systolic murmur 

Wolff-Parkinson-White Syndrome

• MC in males

• palpitation that occur suddenly and without warning

• delta wave