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Acute pericarditis — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsAcute pericarditisSCE Acute Medicine

A 73-year-old man presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show positional pleuritic pain, rub, diffuse concave ST elevation and PR depression. What is the most likely diagnosis?

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Correct answer: C — Acute pericarditis

The key discriminator is that positional pleuritic pain, rub, diffuse concave ST elevation and PR depression, which makes Acute pericarditis the single best answer. Pulmonary embolism is less appropriate because it does not address the dominant acute risk in the vignette; Diabetic ketoacidosis would fit a different presentation or later stage of care. Decompensated cirrhosis and Toxic drug ingestion are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-31-1