WBR0014

Author	PageAuthor::Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::30 yr old male presents to the ER with complaints of moderate grade fever associated with severe retrosternal chest pain that is referred to the back and the left trapezius ridge. Upon further inquiry the patient states that the pain is aggravated by lying supine and relieved by sitting and leaning forward. What is the most appropriate diagnosis?]]
Answer A	AnswerA::Angina
Answer A Explanation	AnswerAExp::The chest pain of angina is of sudden onset, often described as "squeezing", with a dull heavy pressure, and sometimes with radiation to left jaw, neck and arm and lasts for 2-10 minutes.
Answer B	AnswerB::Myocardial infarction
Answer B Explanation	AnswerBExp::The chest pain of a myocardial infarction is similar to that of angina, but severe and usually lasts for more than 20 minutes.
Answer C	AnswerC::Costochondritis
Answer C Explanation	AnswerCExp::The pain of costochondritis is associated with tenderness around the breast bone, and aggravated by coughing, deep inspiration and sneezing.
Answer D	AnswerD::Acute pericarditis
Answer D Explanation	AnswerDExp::Acute pericarditis is the correct answer, with retrosternal pain radiating to the back and the left trapezius ridge.
Answer E	AnswerE::Pleuritis
Answer E Explanation	AnswerEExp::The pain of pleuritis is sharp, localized, and is aggravated by deep inspiration and coughing. It is often associated with signs and symptoms of a respiratory infection.
Right Answer	RightAnswer::D
Explanation	[[Explanation::The correct answer is acute pericarditis. The typical characteristic retrosternal, left sided chest pain of pericarditis is more severe in acute infectious types. Often, the pain is sharp, constricting, aggravates on inspiration and on lying supine. It is relieved characteristically by sitting up and leaning forward. Educational Objective: References: ]]
Approved	Approved::Yes
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