USMLE Step 1 Question 337

Question:

A 30-year-old woman presents with chest pain for one day. The pain is in the center of her chest and is worse with deep inspiration and coughing. She reports that it improves when she leans forward while sitting on the examing table. An ECG in the office shows ST segment elevation in all leads. What is the most likely diagnosis?

Correct Answer: D.  Pericarditis

This woman’s symptoms and ECG are typical of pericarditis. The other diagnoses may present with similar symptoms, but the ECG findings are diagnostic for pericarditis.
Aortic dissection (A) typically presents with a tearing pain radiating to the back. ST elevation in all leads would not likely be seen.
Myocardial infarction (B) presents with severe substernal pressure-like pain, often radiating to the left arm/jaw. Inspiration, coughing, and positional changes would be unlikely to change the quality of the pain.
Pancreatitis (C) usually presents with severe upper abdominal pain, nausea, vomiting, and anorexia.
Although one of the presenting symptoms of pulmonary embolism (E) can be chest pain that is pleuritic in nature, it is almost always characterized by sudden-onset dyspnea.