WBR0024

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Author Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS
Exam Type USMLE Step 3
Main Category Emergency Room
Sub Category Cardiovascular
Prompt A 65 year old male presents with fever, weakness, and chest pain that is pleuritic in nature. The pain is relieved by sitting up and leaning forward. The patient describes the pain as sharp and brief. Auscultation reveals friction rub. What is the best initial test in this patient?
Answer A Echocardiogram
Answer A Explanation Echocardiogram is not the best initial test in a person suspected of having pericarditis or acute coronary syndrome.
Answer B EKG
Answer B Explanation EKG is the correct answer.
Answer C Chest CT
Answer C Explanation Chest CT is not indicated in a person suspected of having pericarditis or acute coronary syndrome.
Answer D Cardiac MRI
Answer D Explanation Cardiac MRI is not indicated in a person suspected of having pericarditis or acute coronary syndrome.
Answer E Troponins
Answer E Explanation Cardiac troponins are often ordered to evaluate for myocardial infarction in any patient with chest pain, however an EKG gives a quicker result, and is the best answer for this scenario where pericarditis is suspected.
Right Answer B
Explanation The correct answer is an EKG. The pain described by this patients suggests a pericardial pathology, but his age and male gender makes him a high risk patient for ischemic heart disease. EKG is the best initial test to evaluate for coronary heart disease as well as for other cardiac conditions. The EKG in acute pericarditis shows ST segment elevation in all leads and PR segment depression.

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