Question

A 27-year-old woman presents with a 3-day history of "sharp", diffuse chest pain. She states the pain is worse with movement and deep breathing. On examination, it is noted that the patient prefers to sit upright and lean forward; she states, "I feel better in this position". Vital signs include a BP of 126/72 mm Hg; HR is 82, RR is 18, O2 sat is 96% RA, and temp is 101.3? F. On exam, you appreciate a friction rub.

What set of diagnostics should you order?

CXR, EKG, ECHO, DDimer, and BHCG
2 CBC, BMP, BHCG, and EKG
3 CBC, BHCG, EKG, ECHO, and CXR
4 CXR, EKG, DDimer, and BHCG
5 CXR, CBC, BMP, BHCG, EKG, and ECHO

Answer 1

The patient's presentation suggests pericarditis, a condition requiring specific diagnostics for confirmation. The tests should include an EKG, ECHO, CXR, CBC, and BHCG to gain a full picture of the patient's health status and to rule out other conditions.

Step-by-step explanation:

The presentation of sharp, diffuse chest pain that is exacerbated by movement and deep breathing, preference for sitting upright, fever, and the presence of a friction rub, points toward a potential diagnosis of pericarditis. The immediate set of diagnostics should help rule out other conditions such as myocardial infarction, pulmonary embolism, pneumothorax, and pregnancy in case the chest pain is not cardiac-related.

Therefore, the recommended set of diagnostic tests to order includes an electrocardiogram (EKG) to check for electrical disturbances of the heart that are characteristic of pericarditis, an echocardiogram (ECHO) to visualize the heart structure and function which could reveal pericardial effusion, a chest radiograph (CXR) to visualize the chest cavity and rule out conditions such as pneumothorax or pneumonia, a complete blood count (CBC) to assess for infection or inflammation, and a beta-human chorionic gonadotropin (BHCG) to rule out pregnancy, as pregnancy can change the clinical approach. A D-dimer test might be considered if there is a high suspicion of pulmonary embolism, but it is not a primary test for pericarditis.

The correct answer to the given question, considering the most comprehensive diagnostic approach, is option 5 (CXR, CBC, BMP, BHCG, EKG, and ECHO).