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Clinical Review Quiz

Purulent Pericarditis

Joseph R. Shiber, MD

Dr. Shiber is an attending physician, Florida Emergency Physicians, Orlando, FL.

The questions below are based on the article
“Purulent Pericarditis: Acute Infections and Chronic Complications”.

Choose the single best answer for each question.

1. What is the leading cause of death for patients with purulent pericarditis?
  1. Acute myocardial infarction
  2. Cardiac tamponade
  3. Infection and excessive hydration
  4. Respiratory failure
  5. Sepsis
Click here to compare your answer.

2. The pericardial sac normally contains what volume of fluid?

  1. 5-10 mL
  2. 20-50 mL
  3. 100-200 mL
  4. 250-500 mL
Click here to compare your answer.

3. A 40-year-old man diagnosed with viral pericarditis experiences worsened chest pain and becomes bradycardic when reclining. Which of the following is the most likely cause of his bradycardia?

  1. Aortic compression
  2. Cardiac tamponade
  3. Complete heart block
  4. Vagally-mediated reflex
Click here to compare your answer.

4. What is the most common presenting complaint for acute pericarditis?

  1. Hemoptysis
  2. Lightheadedness
  3. Positional or pleuritic chest pain
  4. Shortness of breath
  5. Syncope
Click here to compare your answer .

5. A 73-year-old woman on hemodialysis presents with fever, chest pain, leukocytosis, and an enlarged cardiac silhouette. What would be the most common sign indicating impending tamponade?

  1. Bradycardia
  2. Hypertension
  3. Pericardial rub
  4. Tachycardia
  5. Tachypnea
Click here to compare your answer.

6. A 22-year-old woman diagnosed with pericarditis has an elevated cardiac troponin value on initial testing. What is the appropriate next step?
  1. Administer thrombolytics
  2. Arrange emergent cardiac catheterization
  3. Do not check another value
  4. Follow serial troponin values
  5. Perform bed-side pericardiocentesis
Click here to compare your answer.

7. A 53-year-old homeless man with a history of alcoholism has hemoptysis and cavitary lung disease on chest radiograph with an enlarged, calcific pericardial shadow. Which test has the highest sensitivity to make the diagnosis of tuberculous pericarditis?

  1. Acid-fast stain of pericardial fluid
  2. Culture of pericardial fluid
  3. Pericardial biopsy
  4. Polymerase chain reaction for Mycobacterium tuberculosis of pericardial fluid
  5. Purified protein derivative skin test for tuberculosis
Click here to compare your answer.

8. A 37-year-old man with advanced HIV infection presents with chest pain, dyspnea, hypotension, tachycardia, and muffled heart sounds. What is the best test to rapidly diagnose cardiac tamponade?

  1. Cardiac magnetic resonance imaging
  2. Chest computed tomography
  3. Chest radiograph
  4. Echocardiography
  5. Electrocardiogram
Click here to compare your answer.

9. The patient in question 8 is confirmed to have cardiac tamponade and becomes less responsive as his systolic blood pressure drops to 60 mm Hg. What is the most effective treatment?

  1. Blood product transfusion
  2. Immediate pericardiocentesis
  3. Initiation of positive pressure ventilation
  4. Intravenous fluid bolus
  5. Vasopressor infusion
Click here to compare your answer.


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