Doc750
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Female patient, with several weeks of pain localized on left side. No relation of pain to physical activity, inspiration, or expiration. Pain does increase with stress, and lasts for several hours, and remits on it's own. Denies, alcohol, tobacco, illicit drugs. NKDA, no medications. ECG findings normal. BP 110/70, HR 78, pulse 80, respiratins 16. Next BEST step in this patient's management?
A. Reassurance
B. Thalium stress testing
C. Treadmill stress testing
D. Transesophogeal echo
E. 2-D Echo of lower extremities
F. Chest X-ray
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| GOGETA
I'm Dr. GOGETA
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I will say C
if that is inconclusive or something then I go with B thalium.
Interesting I was talking with my friend last night and he said that in that case in the hospital they admit the lady and do serial troponin.
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| doyoudig
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agree w/ C
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| drdg
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Young woman, chest pain associated with stress. Benign chest pain. the treatment is A. Reassurance
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| ing
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Well stress can cause stomacache, but it's not one of the choices. So I chose A.
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| Ivonne
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tricky, It doesn't sound like a a cardiac pain, so next step, get more detail in the clinical history at least the age of the patient, then palpate for local tenderness to r/o costochondritis, make sure that the patient is not pregnant so we can order and x-ray to work up the differentials but since i don't have that info i just will go with A: reassurance
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| GOGETA
I'm Dr. GOGETA
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so you will send her home.
you must rule out the bad stuff unless you want a lawsuit
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| neuroblastoma
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Benign chest pain--Pain does increase with stress, and lasts for several hours,
if i wanna take excercise treadmill test for unstable angina...well history doesnt indicate angina ( should be in minutes not several hours pain) .
AGE aint mention in ques.
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| Ivonne
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GOGETA wrote:
so you will send her home.
you must rule out the bad stuff unless you want a lawsuit
In a real case I will do a complete clinical history
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| Doc750
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Correct answer is A
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| arlete
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In real life, I would do an echo, it could be MVP. But there's no such an option...
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| Doc750
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D was echo .. and in real life if she was cute, I'd probably ask her out.  But unfortunetly no real life here.
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| arlete
Intern in 2009!!!!!
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D was transesophageal echo. I wouldn't order it for a mere MVP suspition, just the transthoracic, regular, cheaper bidimensional one.
Hey, the age was not given, are you sure...????
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| me007
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Try to reassure female pt with chest pain for several hours.
And tell her that it is based not on solid tests but on your knowledge that this kind of pain is not consistent with whatever disease.
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