Primary care
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The majority of patients presenting to a primary care physician with acute chest pain will have non-life-threatening etiologies. Nevertheless, catastrophic cause of chest pain such as ACS, AD, PE, esophageal perforation, and pericarditis must be considered in the differential diagnosis. ⋯ Furthermore, the physical examination can be deceptively benign in patients harboring a catastrophic etiology of chest pain. By identifying these atypical presentations, recognizing the utility of the physical examination, and understanding of the limitations of traditional diagnostic imaging, primary care physicians can effectively diagnose patients who have life-threatening cause of acute chest pain.
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Acute abdominal pain is a complaint seen commonly in the outpatient setting that has a broad and often confusing differential diagnosis. Although many presentations can be managed on an outpatient basis, several gastrointestinal causes of abdominal pain demand thoughtful consideration with subsequent referral to a higher level of care for appropriate diagnosis and treatment. To achieve this goal, outpatient physicians must have an understanding of the mechanisms of abdominal pain, as well as the common gastrointestinal causes that carry potentially higher morbidity and mortality.
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Dyspnea is a nonspecific symptom of any disease involving the respiratory system. Although diseases of the lungs, chest wall, pleura, diaphragm, upper airway, and heart are most common, diseases of many other organ systems (eg, neuromuscular, skeletal, renal, endocrine, rheumatologic, hematologic, and psychiatric) may involve the respiratory system and present with dyspnea. ⋯ More sophisticated testing may be needed when the cause is not readily apparent from the initial work-up. Treatment is best and most effective when geared toward a specific etiology, but if this is not possible, nonspecific treatment of the symptom pf dyspnea may afford the patient some benefit.