bakpity
Forum Senior
Topics: 28
Posts: 71
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Hi Guys,
My Q. is the following>
Imagine a pt. having a chest pain that seems to be a pulmonary type and we are in the hospital. Suppose he has no risk facors for CAD.
What is the first dg step: ECG or X ray?
or with other words> In case of a chest pain is ECG always the first dg step?
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| Ouli Maty
Forum Elite
Topics: 33
Posts: 275
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If one have to choose between the clinical signs and the risk factors, I think it would be a good thing to eliminate the cardiac origin first by doing a ECG. You don't want to miss a CAD with atypical presentation. Beside, ECG is not an invasive procedure and there is a possibility of association .
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deep breathing...
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| vyseerx
Forum Guru
Topics: 165
Posts: 378
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I assume bakpity meant PLEURITIC type of chest pain , when he told pulmonary chest pain. PLEURITIC type of chest pain varies with breathing. we can rely on this.IMPORTANTLY, THERE IS AN ADVANTAGE OF TAKING A STANDARDISED TEST(USMLE) , in real life any thing can be anything, but if they want you to know that patient has angina, they give you CLASSICAL description. substernal chest pain, crushing or pressing type , radiation to shoulder,nausea, and if MI, duration, nausea, excessive diaphoresis, etc. other related clues in age, sex,and risk factors will be provided. likewise, if they want you to know they are asking for non-anginal type of chest pain they include terms like PLEURITIC, or tenderness on affected area, etc. so, there is no confusion. if sudden severe pleuritic chest pain, the investigation is not chest xray! penumothorax is clinical diagnosis,and you needto put in the needle ! if angina type of chest pain is offered in vignette, then obviously ECG is indiacated.
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vyseerx
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| meg
Forum Guru
Topics: 62
Posts: 806
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I agree with vyseerx. In real life, you can expect an MI though the patient describes a pleuritic. But in USMLE, if they mention pleuritic, then assume it is non-MI and pulmonary. Similarly, if they mention tenderness, then it is not MI and is more from chest wall causes.
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| bakpity
Forum Senior
Topics: 28
Posts: 71
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Hi Guys!
Just to clarify things. The idea to post this question came after I read DD of Chest Pain from Blueprints' s Medicine.
Althogh I would never suppose but at one point the text was suggesting that in case of Pulmonary type chest pain - not pleuritic because that involves Ptx and pericarditis- Chest X ray is the first initial test.
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