Page Contents
OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is costochondritis. While this may seem a odd practice, it is useful to see multiple examples of how costochondritis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for costochondritis.
Chief Complaints:
- Chest Pain:
- Elicited by palpation/tender to touch: very few causes of chest pain demonstrate point tenderness (and this condition is one of them).
- Worsened with movement/changes in position: such as horizontal arm flexion, breathing, coughing.
Clinical Workup:
- No other explanation for chest pain: EKGs, chest X-rays, other studies will be negative
QUESTION EXAMPLES
Question # 1
A 40 year old woman comes to the clinic with complaints of chest pain. She explains that her pain is sharp, an localized just to the left of the sternum. The pain does not radiate anywhere, is worse with inspiration and movement. She first noticed the pain when she was exercising about 3 weeks ago, but has also noticed that it occurs when she is resting. She denies having any fevers, chills, dyspnea, swelling, or difficulty breathing at night. Her past medical history is unremarkable. She denies using tobacco products, alcohol, or illicit drugs. She does not have any known allergies. Her blood pressure is 115/70 mm Hg, pulse is 75 bpm, and BMI is 35 kg/m². A physical exam reveals tenderness to palpation over the sternum. A normal S1 and S2 sound are heard without any extra sounds/murmurs. An EKG and chest X-ray are unremarkable. What is the likely diagnosis in this patient?
Explanation # 1
Chest pain + pain with inspiration/movement + tender to palpation + no other explanation for chest pain (negative EKG/chest X-ray) = costochondritis
Question # 2
A 45 year old female comes to the ER because she is experiencing chest pain. She was moving boxes at work about one day ago when she experienced a sharp pain on the left side of her sternum that quickly went away. After this happened she has noticed that she has been experiencing chest pain with deep inspiration, and when she twists her torso around. Her past medical history is notable for hypertension, and the patient’s mother died of a MI at the age of 70. Currently the patient’s vitals are within normal limits. She has tenderness to palpation along the left sternal border. Her cardiac and pulmonary exams are unremarkable. The patent has no peripheral edema and pulses are palpated at the distal lower limbs bilaterally. What is the likely diagnosis in this patient?
Explanation # 2
Chest pain + pain with inspiration/movement + tender to palpation + no other explanation for chest pain (unremarkable cardiopulmonary exam) = costochondritis
Question # 3
A 25 year old female come sot the clinic because she has been experiencing a two week history of left sided chest pain that is associated with tenderness. She explains that the pain radiates to her back, and that it worsens when she reaches behind her, or above her head. She denies experiencing any shortness of breath, dizziness, or palpitations. Currently her temperature is 98.4°F, puss is 90 bpm, respirations are 15/in, and her blood pressure is 125/80 mm Hg. A cardiac and pulmonary exam ar unremarkable. A physical exam reveals an area that is tender to palpation along the left sternum. A chest X-ray and EKG are ordered, both of which are non-contributory to the workup. What si the likely diagnosis in this patient?
Explanation # 3
Chest pain + pain with movement + tender to palpation + no other explanation for chest pain (negative EKG/chest X-ray) = costochondritis
Question # 4
A 35 year old woman comes too the clinic complaining with pain in the left hemithorax that has been occurring for the past day. She explains that the pain began while she was struggling to uproot a stubborn weed in her garden. She explains that her pain is worse when she breathes in. Her past medical history is notable for a 20 pack year smoking history. Currently her temperature is 98.7°F, pulse is 105 ppm, respirations are 20/min, and her blood pressure is 115/65 mm Hg. A pulmonary exam is unremarkable, and she has normal heart sounds upon auscultation. She experiences pain when the left lateral aspect of her sternum is palpated. What is the likely diagnosis in this patient?
Explanation # 4
Chest pain + pain with inspiration+ tender to palpation + no other explanation for chest pain (unremarkable cardiopulmonary exam) = costochondritis
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Page Updated: 02.23.2017