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Comprehensive Case Study: Florence Blackman - A Patient with Intermittent Chest Pain, Exams of Nursing

This comprehensive case study examines the medical condition of florence blackman, a patient presenting with intermittent squeezing chest pain. The document delves into various potential causes of chest pain, including severe infections such as pneumonia, pleurisy, and pericarditis, as well as conditions affecting the musculoskeletal system like costochondritis, tietze syndrome, rib fractures, and sternoclavicular joint injuries. It also highlights the importance of identifying and differentiating between serious cardiovascular and infectious disorders that should not be missed, such as unstable angina, aortic dissection, pulmonary embolism, and neoplasia. The case study provides a detailed overview of the clinical presentation, aetiology, and characteristics of these conditions, equipping healthcare professionals with the knowledge to effectively diagnose and manage patients with chest pain.

Typology: Exams

2024/2025

Available from 10/23/2024

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Severe infections:

  • Pneumonia, pleurisy, pericarditis Pneumothorax
  • Primary (most common, no apparent reason)
  • Secondary (collapse lung, injury ect) Define costochondritis and its aetiology Inflammatory condition affecting the sternocostal joints or costochondral junctions. Aetiology
  • No cause can be identified in many cases
  • May be a history of trauma or mechanical overloading e.g. strenuous exercise, recent URTI
  • Rheumatological conditions CF of costochondritis ~90% of patients: multiple painful joints
  • Pain is mild - moderate
  • Aggravated by breathing, physical activity or a specific position
  • Palpation of affected joints elicits tenderness
  • +/- radiation along chest, abdomen or to back
  • Not usually accompanied by swelling Define Tietze Syndrome
  • Often confused with costochrondritis
  • A rare condition associated with a visible, painful enlargement of the costochondral junction
  • ~70% cases: occurs in CC junction of a single rib (Rib 2++) What are the aetiology and characteristics of rib fractures Aetiology
  • Trauma: direct blow to ribcage or HVLA
  • Pathological: osteoporosis, malignancy
  • Stress fractures – due to excessive muscle traction at rib attachments
  • Rowers (excessive action of serratus anterior), golfers, fast bowlers, baseball pitchers Characteristics
  • Displacement, completeness, orientation, skin penetration
  • Displaced # = risk for visceral injury (lungs, spleen, liver, kidneys) CF of rib fracture
  • History: Trauma, health status
  • Pain aggravated by deep inspiration or coughing
  • Localised tenderness over affected rib(s)
  • +/- Bruising (direct blow)
  • Damage to underlying viscera:
  • Splenic rupture – can be life-threatening due to vascularity of the spleen
  • Traumatic pneumothorax – breach of the pleura List traumatic SC joint injuries grades Traumatic:
  • Usually associated with high-energy impact e.g. MVA, falls, sporting injuries
  • Grade 1: sprain with no joint laxity
  • Grade 2: subluxation
  • Grade 3: complete disruption of SC and CC ligs with instability
  • Ant dislocation more common than post dislocation CF of SC joint injuries
  • History: Trauma and health status
  • Localised pain: aggravated by movement of the SC
  • esp. high elevation
  • Palpable tenderness +/- laxity
  • +/- Soft tissue swelling, deformity/defect
  • Degeneration: stiffness, crepitus
  • Infection & rheumatological: fever? Signs of systemic illness?

List non-traumatic SC joint injuries Non-Traumatic:

  • Most commonly due to degeneration: SCJ OA is seen in 50-90% of adults >60 years
  • Infection: septic arthritis – Staphylococcus aureus is the most common organism
  • Rheumatological: rheumatoid arthritis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease Red flags associated with chest pain
  • (^) Dizziness/syncope
  • Pain in arms L>R, jaw
  • Thoracic pain
  • (^) Sweating
  • (^) Palpitations
  • (^) Dyspnoea
  • Pain on inspiration
  • (^) Pallor
  • Past history: ischaemia, diabetes, hypertension Some causes of musculoskeletal chest pain (there are 7)
  • Referred pain from CV/CT joints or thoracic facet joints
  • Muscle strains
  • (^) Costochondritis
  • Rib #
  • Vertebral #
  • Sternoclavicular joint dysfunction
  • Thoracic Outlet Syndrome (pec minor compression)

Serious disorders not to be missed with cardiovascular and severe infections Cardiovascular:

  • Unstable angina/AMI
  • Aortic dissection
  • Pulmonary embolism Neoplasia
  • Lung, spinal cord and meningeal tumor