Description

A 55-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should you consider because of her gesture? A. Bronchitis B. Costochondritis C. Pericarditis D. Angina pectoris Feedback: The clenched fist of Levine's sign, while not completely specific for ischemic pain, should definitely cause you to consider this etiology. Bronchitis is usually painless, and pericarditis can produce a sharp pain which worsens with inspiration. This is called pleuritic pain and can be associated with pneumonia and other chest diseases. Costochondritis is a parasternal pain, usually well localized. It is exquisitely tender Retinal detachment may be associated with all of the following EXCEPT: A. painless, unilateral loss in vision B. Spontaneous recovery C. Flashes of light D. Context of trauma Optic neuritis may be associated with all the following conditions EXCEPT: A. Sudden, painful loss in unilateral vision B. Associated with autoimmune disease C. Early sign of multiple sclerosis D. Common incidental finding on fundoscopic exam Mrs. Fletcher comes to your office with unilateral pain during chewing, which is chronic. She does not have facial tenderness or tenderness of the scalp. Which of the following is the most likely cause of her pain? A. Trigeminal neuralgia B. Temporomandibular joint syndrome C. Temporal arteritis D. Tumor of the mandible Feedback: Temporomandibular joint syndrome is a very common cause of pain with chewing. Ischemic pain with chewing, or jaw claudication, can occur with temporal arteritis, but the lack of tenderness of the scalp overlying the artery makes this less likely. Trigeminal neuralgia can be associated with extreme tenderness over the