QuestionSBA
QuestionChoice
This is a very important differential for chest pain. However, it is unlikely in this case because of the description of the pain and the duration of symptoms. Classically, acute coronary syndromes cause crushing, central chest pain which may radiate to the left jaw or shoulder. The duration of symptoms is also likely to be a lot shorter.
10027798
c
Acute coronary syndrome
QuestionChoice
The fever and feeling unwell with chest pain could suggest pneumonia. However, this is not a typical description of pleuritic chest pain, which would be sharp in nature and worse on breathing in. Also, there is no cough or difficulty breathing to suggest pathology within the lungs.
10027797
b
Community-acquired pneumonia
QuestionChoice
Costochondritis is inflammation of the cartilage between the ribs and the sternum. This causes sharp, well-localised pain in this area. As this patient describes a burning pain, this makes this less likely.
10027799
d
Costochondritis
QuestionChoice
The burning pain is a typical description of neuropathic pain, which is seen in shingles due to the reactivation of the varicella-zoster virus in the dorsal root ganglion of nerves. This patient may have the classical vesicular rash but be unable to see it due to it being beneath her breast, and often the pain may be present before the characteristic rash appears.
10027796
a
Shingles
QuestionChoice
The burning pain described could apply to GORD, however, this is more likely to be central and higher up the chest. It may also get worse after eating.
10027800
e
Gastro-oesophageal reflux disease (GORD)
Concept
Chapter
2693
6003
Varicella zoster virus
Topic
194
Infectious Diseases
17957
A 75-year-old woman presents complaining of chest pain. She describes a burning pain on the left side of her chest which has been there for three days now. When asked to point to where the pain is, she points to just below her breast. She has also been experiencing a headache and fever for the last few days.

What is the most likely diagnosis for this woman's chest pain?
a