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Mr Q, a 45 year old accountant, consults his GP about sudden-onset right sided chest pain. His pain is located to the right of his breastbone (sternum).
The following is a summary of the GP's medical notes:
Sudden-onset right sided chest pain; pain not radiating; described as dull, occasionally sharp pain; started a day ago
Pain worse when breathing in and out
No history of shortness of breath, excessive sweating or nausea and vomiting
Had bronchitis one week ago; used antibiotic; infection cleared
History
Family history: mother suffers from hypertension; father passed away due to heart attack (myocardial infarction)
Medical history: anti-hypertensive treatment (patient unsure what medication he is using)
Surgical history: none
Social: smoker, uses alcohol once a week
On Examination
Generally calm, only complains of pain on breathing in
Not pale, not dehydrated, no oedema
Chest: clear, good, equal, air-entry both sides of chest
Normal heart rhythm, no signs of heart failure
Tender over right side of rib cage : especially over ribs 4 and 5
Rest of examination clear
Side room: heart rate: 88; blood pressure: 160/89; urine: clear
Based on the above information, answer the following questions to make a possible diagnosis:
1. Is the pain typically what you would expect with cardiac disease?
2. What structures make up the:
- Chest wall
- Chest cavity
3. What special investigation will help you make a diagnosis? Choose two:
-CT Scan
-ECG
-Chest X-ray
-Bloods, including a full blood count, electrolyte panel and cardiac markers
4. Should Mr Q be admitted to hospital?
5. What is the most likely cause of Mr Q's symptoms?
6. How would you approach his treatment plan?
What's your diagnosis? Join the guesswork on our Facebook page, or comment below.
NOTE: Health24's on-site GP Dr Owen Wiese will reveal new cases on Thursdays. We'll post the answer with the story on Mondays, or you can get it via the Daily Tip – sign up here.
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Image: chest pain, Shutterstock
