2.Theme: chest pain – Diagnosis and Initial Management Options: A. Acute pericarditis B. Aortic dissection C. Acute ST-elevation myocardial infarction (STEMI) D. Non-ST elevation myocardial infarction (NSTEMI) E. Stable angina F. Gastro-oesophageal reflux disease (GORD) G. Pulmonary embolism (PE) H. Musculoskeletal chest pain I. Esophageal rupture (Boerhaave syndrome) J. Subarachnoid haemorrhage K. Panic attack L. Costochondritis Stems: 1. A 68-year-old man presents with sudden onset severe chest pain radiating to the back. He is hypertensive, diaphoretic, and distressed. On examination, there is a difference in blood pressure between the arms. 2. A 60-year-old woman presents with retrosternal chest discomfort after climbing stairs. It is relieved by rest and worsened by exertion. ECG is normal, and troponins are negative. 3. A 55-year-old man presents to A&E with crushing central chest pain for 30 minutes. ECG shows ST-elevation in leads II, III, and aVF. 4. A 34-year-old woman presents with left-sided chest pain and shortness of breath. She had a long-haul flight 2 days ago. Pulse oximetry shows SpO2 89% on air. 5. A 45-year-old man presents with sharp chest pain that worsens when lying flat and improves when sitting forward. There is a pericardial rub on auscultation. Instructions: For each of the following patients, select the most likely diagnosis from the list of options above. Answers and Explanations: 1 → B. Aortic dissection Sudden tearing chest pain radiating to the back, unequal arm BPs — classic for dissection. 2 → E. Stable angina Exertional chest discomfort, relieved by rest, normal ECG and troponin – stable angina. 3 → C. Acute ST-elevation myocardial infarction (STEMI) Classic MI presentation with ST elevation in inferior leads – urgent PCI/thrombolysis needed. 4 → G. Pulmonary embolism (PE) Recent immobility, hypoxia, and pleuritic chest pain suggest PE – needs CTPA and anticoagulation. 5 → A. Acute pericarditis Pleuritic chest pain relieved by sitting forward + pericardial rub – typical of pericarditis.
