AAAAA
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A 49-year-old man is evaluated in the emergency department for severe left precordial chest pain. The pain is sharp in quality and worsens with cough or deep breathing. The chest pain has waxed and waned for the last 3 days and was preceded by a 3-day history of nonproductive cough, chills, myalgias, and fatigue. He has a history of cocaine use and smokes 2 packs of cigarettes per day. He has hypertension and type 2 diabetes mellitus, both of which have been well controlled for 10 years. His medications include lisinopril, low-dose aspirin, and glyburide.
On physical examination, he is in acute distress from chest pain. He has a temperature of 37.2 °C (99 °F), pulse of 103/min, respiratory rate of 22/min, and blood pressure of 153/92 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. The oral mucosa is without erythema or exudates. Jugular veins are not distended. The lungs are clear. Heart sounds are distant with no evidence of murmur. A two-component rub is auscultated along the left lower sternal border. The abdomen is soft and bowel sounds are present. The lower extremities are without edema, and peripheral pulses are present. Musculoskeletal examination shows no palpable chest wall tenderness. Laboratory studies show a hematocrit of 40% and a leukocyte count of 10,600/μL (10.6 × 109/L). 12-lead electrocardiography is shown (;" name=tip tip="[img>'../figures/thumbs/mk14_a_cv_mcq_f015.jpg'/[/img]] Figure 15). The echocardiogram is unremarkable.
What is the most likely diagnosis?
A Acute myocardial infarction B Costochondritis C Acute pericarditis D Pleuritis E Aortic dissection
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| arlete
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D
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| AAAAA
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D is wrong
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| whiterabbit
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Cant see the ECG..pls tell me why D is wrong ?
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| AAAAA
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Pleuritis is wrong
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| whiterabbit
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Pray tell us the answer
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| arlete
Intern in 2009!!!!!
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I meant acute pericarditis, wrote the wrong letter. But could not see the EKG, either.
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| AAAAA
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C
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| PGI2alpha
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is it acute pericarditis coz of the distant heart sounds?
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