October 13, 2010

PLAB Question 9

A 14-year-old boy scout complains of exercise-induced sharp chest pain at the left lower sternal border that diminishes with resting and does not awaken him. He has never had anything like this before. Palpation along the sternal edge replicates the symptoms.

The most likely diagnosis is:

a) mitral insufficiency
b) aortic stenosis
c) pericarditis
d) tricuspid incompetence
e) costochondritic pain
f) hiatus hernia
g) perciardial tamponade
h) reflux esophagitis
i) aortic insufficiency
j) pleuritis








ANSWER
The correct answer is E



Explanation
To diagnose costochondritic pain one may palpate the fingers up the ribs alongside the sternum or compress or lift the rib cage. This would elicit chest wall pain. Chest wall problems and GI causes account for over 90% of the chest pain Primary Care Physicians see.

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