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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS
|QuestionAuthor=Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS (Reviewed by Gonzalo Romero)
|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 pathognomonic EKG finding in this patient?
|ExamType=USMLE Step 2 CK
|Explanation=The correct answer is PR depression, as the patient has acute pericarditis. PR depression is an EKG finding which is pathognomonic in acute pericarditis, even though ST elevation is often seen in all leads universally. ST segment elevation is seen in other cardiac conditions such as STEMI, pulmonary embolism, therefore this finding is not pathognomonic.
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|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?
|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.
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[[File:PtaDepressionPericarditis.png|700px]]
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Please see more [[Pericarditis EKG examples]] here.
|AnswerA=Universal ST segment elevation
|AnswerAExp=Although universal ST segment elevation is commonly seen in acute pericarditis, it is not a specific finding.
|AnswerB=T wave inversion and poor R wave progression.
|AnswerB=T wave inversion and poor R wave progression.
|AnswerBExp=T wave inversion and poor R wave progression suggests ischemia, and is not pathognomonic for acute pericarditis.
|AnswerBExp=T wave inversion and poor R wave progression suggests ischemia, and is not specific for acute pericarditis.
|AnswerC=PR depression
|AnswerC=PR depression
|AnswerCExp=PR depression is
|AnswerCExp=PR depression is the correct answer.
|AnswerD=Presence of a Q wave
|AnswerD=Presence of a Q wave
|AnswerDExp=Presence of a Q wave suggests an old infarct, and is not pathognomonic for acute pericarditis.
|AnswerDExp=Presence of a Q wave suggests an old infarct, and is not specific for acute pericarditis.
|AnswerE=Poor R-wave progression
|AnswerE=Poor R-wave progression
|AnswerEExp=Poor R-wave progression can imply an old anterior MI, and is not pathognomonic for acute pericarditis.
|AnswerEExp=Poor R-wave progression can imply an old anterior MI.
|Approved=No
|EducationalObjectives=The EKG in pericarditis shows ST segment elevation in all leads.  The most specific finding is the PR segment depression.
|References=Master the Boards for Step 2CK, 2013 edition, page 100
|RightAnswer=C
|WBRKeyword=Pericarditis, EKG, Pericarditis EKG examples
|Approved=Yes
}}
}}

Latest revision as of 23:05, 27 October 2020
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 specific 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.

Please see more Pericarditis EKG examples here.
Educational Objective: The EKG in pericarditis shows ST segment elevation in all leads. The most specific finding is the PR segment depression.
References: Master the Boards for Step 2CK, 2013 edition, page 100]]

Approved Approved::Yes
Keyword WBRKeyword::Pericarditis, WBRKeyword::EKG, WBRKeyword::Pericarditis EKG examples
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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