Rosh Internal Medicine Boost Practice Exam

What electrocardiographic finding is characteristic of the suspected diagnosis in a patient presenting with sharp chest pain at rest, fever, and tachycardia?

1. Diffuse ST elevation

2. Irregularly irregular R-R intervals with no distinct P waves

3. Prolonged QT interval

4. Tall peaked T waves

The correct answer is: Diffuse ST elevation

The characteristic electrocardiographic finding of diffuse ST elevation is commonly associated with pericarditis, which often presents with sharp chest pain, fever, and tachycardia. In cases of pericarditis, the ST segment elevation is typically widespread across multiple leads, as opposed to being localized to a specific area, which helps distinguish it from other conditions such as myocardial infarction, where ST elevation is usually seen in specific leads corresponding to the affected myocardial territory. The fever and tachycardia noted in the patient's presentation further support the diagnosis of pericarditis, as these symptoms can occur due to the inflammatory nature of the condition. The sharp pain that often worsens with inspiration or changes in position is also a classic feature of pericarditis. Other findings from the options provided do not align with the context of pericarditis. For instance, an irregularly irregular rhythm with no distinct P waves is characteristic of atrial fibrillation, which typically does not present with fever or sharp chest pain in the same manner as pericarditis. A prolonged QT interval is associated with different electrolyte disturbances or drug effects, and tall peaked T waves might suggest hyperkalemia but would not fit the clinical picture involving fever and chest