Question 1

When a patient reports experiencing chronic chest pain that occurs after meals, the provider suspects gastroesophageal reflux disease (GERD) and prescribes a proton pump inhibitor. After 2 months the patient reports improvement in symptoms. What is the next action in treating this patient?

A) Wean patient from proton pump inhibitor (PPI).
B) Order esophageal pH monitoring.
C) Refer the patient to a gastroenterologist.
D) Schedule an upper endoscopy.

A

Accepted Answer

Given the improvement in symptoms with PPI therapy, the next step is often to wean the patient off the medication to assess if symptoms recur without treatment, indicating the need for further intervention or long-term management.

Question 2

A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum that increases with pressure. What will the provider do next?

A) Order a chest radiograph.
B) Prescribe an antibiotic.
C) Recommend an NSAID.
D) Refer to a cardiologist.

C

Accepted Answer

The symptoms described are consistent with costochondritis, which is an inflammation of the cartilage connecting a rib to the sternum. This condition often presents with chest pain that worsens with deep breathing or physical activity, and can be confirmed by tenderness on palpation at the costochondral junctions. A normal electrocardiogram (ECG) helps rule out cardiac causes of chest pain. The treatment for costochondritis is typically conservative, including nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.

Question 3

A patient presents to an emergency department reporting chest pain. The patient describes the pain as being sharp and stabbing and reports that it has been present for several weeks. Upon questioning, the examiner determines that the pain is worse after eating. The patient reports getting relief after taking a friend's nitroglycerin during one episode. What is the most likely cause of this chest pain?

A) Aortic dissection pain
B) Cardiac pain
C) Esophageal pain
D) Pleural pain

C

Accepted Answer

The presence of sharp, stabbing pain that worsens after eating suggests esophageal pain. Additionally, relief after taking nitroglycerin is not a typical response for cardiac pain. Aortic dissection pain is usually described as tearing, and pleural pain is often described as a dull ache.

Deck 86: Chest Pain Noncardiac