Hey folks, just a quick reminder that this podcast is not meant to be used for medical advice, just good old-fashioned education, and all-patient information has been modified to protect our identity.

Welcome back, clinical problem solvers. Thanks for joining us for another installment of our space learning series in which we revisit

schemas previously discussed on the podcast.

I'm super excited to be here with my good friends, Dan and Steph, today.

Hey, guys, it's great to be with you again. I have a nice case to tell you about today, and it's one of my recent favorites. I am so excited about this, Steph. Jack, how do you feel I feel like Steph. I feel like Steph always has the best cases. She's very sly and kind of sneaky about, and she's like, oh yeah, I think I have a case that we can talk about. And then all of a sudden, we're, you know, four hour clots deep with no idea what's going on. So I'm looking forward to this one, if not, if not a little bit stressed out about it. Let's get out those jitters, Jack. I'm excited. Shake it off. Shake it off. All right, I will get started. So you have a 27-year-old man with exercise-induced asthma, and he presents to his primary care doctor with three days of mid, right-sided back pain. The pain started several days after riding his bicycle, although he notes that the bike ride itself was not strenuous and he did not endure any trauma.

He describes the pain as sharp, worse when he takes deep breaths, and does not improve or worsen with positional changes like sitting forward or lying back.

He also reports a dry cough for the past two days, but denies fevers, chills, shortness of breath,

radiation of pain to the lower extremities, weakness, or paracetias. He also denies bowel or bladder

problems. He's been taking naproxin for his back pain with only minor improvement. And what is most concerning to him is the

inability to take a deep breath due to the pain. Wow. What a start to this case. Steph, you're

the consummate historian. Thank you for all that information. Well, maybe I'll start by tackling

the chest pain. So while, you know, chest pain is such a gargantuan topic,

it encompasses a variety of life-threatening pathologies. I think it's important to highlight a few

contextual clues that take this discussion of chest pain in a young, otherwise healthy person

away from our classic four plus two plus two schema from that Robbie and Reza mentioned all the time that is,

you know, discussing four life-threatening causes that are cardiac in nature, two that are

pulmonary in nature and two that are GI in nature.

And I'd refer you back to our initial chest pain schema episode.

The description of the pain in this case is as sharp and worse with breath. For me, that translates to

pleuritic chest pain and adds a layer of specificity to the syndrome. So I think rather than just

starting at, you know, chest pain in OS, maybe we can get a little bit further and more specific

in our schemas and start with pleuritic chest pain. So pleuritic chest pain at its base

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