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ST-elevation myocardial infarction — USMLE Step 2 CK MCQ

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ModerateInternal MedicineST-elevation myocardial infarctionUSMLE Step 2 CK

A 64-year-old White woman comes to the urgent care clinic because of chest discomfort or shortness of breath. History and focused examination are notable for crushing substernal chest pain radiating to the left arm with inferior ST-segment elevations. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most likely diagnosis?

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Correct answer: D — ST-elevation myocardial infarction

The vignette describes ST-elevation myocardial infarction, supported by crushing substernal chest pain radiating to the left arm with inferior ST-segment elevations. ST-elevation myocardial infarction is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: https://professional.heart.org/en/guidelines-and-statements#stage-9-order-84