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Author Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS
Exam Type USMLE Step 2 CK
Main Category Internal medicine
Sub Category Cardiovascular
Prompt A 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 enquiry the patient states that the pain is aggravated by lying supine and relieved by sitting and leaning forward. What are the expected EKG findings in this patient?
Answer A ST elevation in leads V4-V6
Answer A Explanation ST elevation in leads V4 to V6 are seen in an anterolateral MI.
Answer B Tall, peaked T waves
Answer B Explanation Tall, peaked T waves are seen in hyperkalemia.
Answer C Inverted T waves
Answer C Explanation Inverted T waves are seen in a Non-ST elevation MI and in unstable angina.
Answer D ST elevations in all EKG leads and PR depression
Answer D Explanation This is the correct answer.
Answer E Q waves in lead aVF
Answer E Explanation Q waves in lead aVF indicate an old inferior MI.
Right Answer D
Explanation The correct answer is ST elevation seen in all leads, as well as PR depression. Diffuse ST elevation is due to ventricular current of injury and PR depression is due to concomitant atrial current of injury. These findings are typically seen in stage 1 (initial days) of the disease. After several days the ST elevations return to baseline (stage 2) and T wave inversions begin to appear (stage 3). Eventually in weeks to months the EKG findings will be normal (stage 4).

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