Free full flowchart · Emergency Medicine

Chest Pain: Step-by-Step Approach (Flowchart)

Q: What is the first question in the chest pain flowchart?

The flowchart starts with Exertional / pressure-like? Each answer leads to the next yes/no decision until you reach a likely diagnosis.

This is the complete chest pain flowchart from the USMLE Adviser e-book, shared free. It turns the presentation into a short series of yes/no questions, the way Step 2 CK and Step 3 vignettes are reasoned through. The same logic is written out as text below the image.

Chest Pain flowchart: step-by-step diagnostic approach for USMLE Step 2 CK and Step 3

The flowchart, step by step

Exertional / pressure-like?
- Yes → Angina / ACS
- No → Sudden tearing pain radiating to the back?
  - Yes → Aortic dissection
  - No → Pleuritic pain?
    - Yes → Sudden dyspnea?
      - Yes → Pulmonary embolism
      - No → Fever + cough?
        Yes → Pneumonia
        No → Unilateral ↓ breath sounds?
        Yes → Pneumothorax
        No → Consider other pulmonary causes
    - No → Meal related / burning / acid reflux?
      - Yes → GERD
      - No → Pain better leaning forward?
        Yes → Pericarditis
        No → Pain reproducible with palpation?
        Yes → Costochondritis
        No → Anxiety / panic?
        Yes → Panic attack
        No → Esophageal / other causes

Diagnoses covered

Angina / ACS, Aortic dissection, Pulmonary embolism, Pneumonia, Pneumothorax, Consider other pulmonary causes, GERD, Pericarditis, Costochondritis, Panic attack, Esophageal / other causes.

Practice this flowchart as a puzzle. Chest Pain is MedFlowdle No. 1, a free daily puzzle where you fill in the missing boxes. Play it in MedFlowdle →

FAQs

What is the first question in the chest pain flowchart?

The flowchart starts with Exertional / pressure-like? Each answer leads to the next yes/no decision until you reach a likely diagnosis.

Which diagnoses does this flowchart cover?

Angina / ACS, Aortic dissection, Pulmonary embolism, Pneumonia, Pneumothorax, Consider other pulmonary causes, GERD, Pericarditis, Costochondritis, Panic attack, Esophageal / other causes.

Is this the full flowchart from the e-book?

Yes. This is page 1 of the USMLE Adviser e-book, shared free. The full e-book has 232 flowcharts.

Related flowcharts

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The USMLE Adviser e-book has 232 one-page clinical flowcharts across 19 specialties for Step 2 CK, Step 3 and the Match. Instant digital download.

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From Clinical Algorithms: Volumes 1 & 2 by Dr. Adnan Memon, MD (page 1). Reviewed by the USMLE Adviser Team. For exam preparation only, not medical advice.