USMLE Step 2 CS Chest pain
These are the blue sheet, physical exam, diagnostic studies and differential diagnosis needed for a chest pain case in the USMLE Step 2 CS exam:
Before initiating the case, write just the blue letters, not the entire words.
PHYSICAL EXAMINATION
1. HEENT:
Neck: Inspection for JVD, carotid pulses.
Auscultation for bruits, thyroid exam.
2. Lungs:
Inspection of thoracic expansion and bruises
Palpation: Tactile fremitus.
Percussion: Look for tympanic or else.
Auscultation: Usually patients can move the thorax without inspiration, simulating decreased breath sounds uni or bilaterally.
3. Heart:
Inspection: for bruises or lesions
Palpation: Heaves, PMI, and chest wall tenderness
Auscultation: Rhythm, heart sounds, murmurs, rubs or gallops.
4. Extremities:
Inspection: for cyanosis, edema, or tremors (hyperthyroidism).
Palpation: Edema, peripheral pulses.
POSSIBLE DIAGNOSTIC STUDIES:
- CBC.
- Cardiac enzymes: Troponins, CK-MB.
- EKG/Echocardiogram.
- CXR (Chest X-ray).
- Urine toxicology.
- Upper endoscopy.
- ABG (Arterial blood gas analysis).
- V/Q scan or Chest angiography (Pulmonary embolism).
- Cholesterol, triglycerides, glucose.
DIFFERENTIAL DIAGNOSIS:
Cardiac/aortic causes:
- Acute coronary syndrome: STEMI, NSTEMI, unstable angina.
- Stable angina.
- Pericardial disease: Pericarditis.
- Cocaine induced myocardial ischemia.
- Cardiac arrhythmia.
- Aortic dissection.
Pulmonary cause:
- Pulmonary embolism.
- Pneumothorax/Hemothorax.
Chest wall causes:
- Costochondritis.
- Rib fracture
Others:
- GERD.
- Panic attacks.
- Hyperthyroidism.
- Anemia.
- Esophageal rupture.
I hope you find this helpful. Study hard!
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