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Old 03-14-2013
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Cool Chest pain question

A 40 year old enthusiastic male athlete comes to ER complaining of extensive chest pain while he was in the park doing his normal daily workout for the upcoming marathon 20 minutes ago. He rates the pain as 7/10. Vitals: HR: 65, RR: 24, BP: 130/85 mmHg. His mother aged 68 has a history of myocardial infarction. His father is 75 and patient of congestive heart failure & uncontrolled diabetes. His upper and lower extremities are warm and sweating. He points his pain on left lower border of chest cavity while lying on the hospital bed. He says it gets worse when he sits for rubbing the area. EKG shows Tall, peaked T waves and RR interval decreases. What is the most accurate test to diagnose this condition?

A. Detailed Physical Exam & genetic history
B. Chest X-ray
C. Spiral CT Scan
D. Endoscopy
E. Transesophgeal Echocardiography
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  #2  
Old 03-14-2013
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looks like pulmonary embolism
spiral ct
thanks
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  #3  
Old 03-16-2013
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A. Detailed Physical Exam & genetic history.

Musculoskeletal chest pain/costochondritis - reproducible by rubbing and change in position. Other options dont make sense to me but I might be wrong.
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  #4  
Old 03-18-2013
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Default detailed physical exam and genetic history.

Marathon player -> working out -> pointing pain -> pain increases on rubbing or massaging area -> costochondritis -> Most accurate test: detailed physical exam and genetic history.
Cannot be B. (aortic dissection) he is not claiming that pain is radiating to back neither is his BP very high
Cannot be C PE. lower extremity is warm and sweating coz he was working out 20 minutes ago. EKG findings are normal ekg findings related to exercise
Cannot be D. he has no history of GERD or sore throat or epigastric pain or heart burn. neither does he have weight loss to validate the use of endoscopy
Cannot be E. used for HOCM or Aortic dissection he doesn't presented with syncope. 2nd he is 40 and athletic if its HOCM it wud have presented much earlier.
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  #5  
Old 03-19-2013
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i think Musculoskeletal chest pain/costochondritis - reproducible by rubbing and change in position. Other options dont make sense to me but I might be wrong.
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