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Review of Clinical Signs Review Questions

Clinical Signs of Acute Pericarditis and Its Complications

Bernard M. Karnath, MD, and Roxana Narat, MD

Questions 1 and 2 are based on the following clinical vignette:

A 53-year-old man with a past medical history of hypertension and coronary artery disease presents to the emergency department complaining of chest pain and shortness of breath that started about 1 hour ago. Four weeks ago, he was admitted to the hospital after having a myocardial infarction (MI). Cardiac enzymes, chest radiograph, and an electrocardiogram (ECG) are ordered. The ECG (above) shows the following:

1. What is the most likely diagnosis?

  1. Acute MI
  2. Early repolarization
  3. Pulmonary embolus
  4. Acute pericarditis
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2. What medication is appropriate for treatment?

  1. Aspirin
  2. Indomethacin
  3. Ibuprofen
  4. Propranolol
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Questions 3 and 4 are based on the following clinical vignette:

A 47-year-old woman with end-stage renal disease who missed her last dialysis session presents to the emergency department with left-sided chest pain and dyspnea. On physical examination, she is tachycardic and hypotensive and has jugular venous distension and a friction rub.

3. What physical examination sign should be sought to confirm the diagnosis of cardiac tamponade?

  1. Kussmaul’s sign
  2. Pulsus paradoxus
  3. Phalen’s sign
  4. Chvostek’s sign
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4. What laboratory or diagnostic study should be ordered next?

  1. Echocardiogram
  2. Cardiac enzymes
  3. Sputum stain for mycobacterium
  4. Computed tomography
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