WBR0025
| Author | PageAuthor::Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS (Reviewed by Gonzalo Romero) |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Cardiovascular |
| Prompt | [[Prompt::A 62-year-old male presents to the ER with fever, fatigue, and sharp chest pain. The pain is relieved by sitting up and leaning forward. The patient describes the pain as "sharp and short". Auscultation reveals a friction rub. What is the most specific EKG finding in this patient?]] |
| Answer A | AnswerA::Universal ST segment elevation |
| Answer A Explanation | AnswerAExp::Although universal ST segment elevation is commonly seen in acute pericarditis, it is not a specific finding. |
| Answer B | AnswerB::T wave inversion and poor R wave progression. |
| Answer B Explanation | AnswerBExp::T wave inversion and poor R wave progression suggests ischemia, and is not pathognomonic for acute pericarditis. |
| Answer C | AnswerC::PR depression |
| Answer C Explanation | AnswerCExp::PR depression is the correct answer. |
| Answer D | AnswerD::Presence of a Q wave |
| Answer D Explanation | AnswerDExp::Presence of a Q wave suggests an old infarct, and is not specific for acute pericarditis. |
| Answer E | AnswerE::Poor R-wave progression |
| Answer E Explanation | AnswerEExp::Poor R-wave progression can imply an old anterior MI. |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::The correct answer is PR depression, as the patient has acute pericarditis. PR depression is an EKG finding which is more specific in acute pericarditis. Although diffuse ST elevations are seen in multiple leads, ST segment elevation is seen in other cardiac conditions such as STEMI, pulmonary embolism, therefore this finding is not specific.
Pericarditis presents with sharp chest pain, which changes with respiration and position. The pain intensifies in a supine position and decreases when sitting up. This may be due to the stretching of the pericardium. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Pericarditis, WBRKeyword::EKG |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |