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Self-Assessment Questions

Cardiology

Pericardial Disease: Review Questions

Joseph J. Brennan, MD
Dr. Brennan is an associate professor of medicine and Director of the Interventional Cardiology Fellowship Program, Yale University School of Medicine, New Haven, CT.




Choose the single best answer for each question.

Questions 1 and 2 refer to the following case study.

A 19-year-old college student presents with chest pain. One week previously, she had a self-limited upper respiratory infection. The chest pain is central in location, with radiation to the neck and trapezius ridge. The discomfort intensifies with recumbency and inspiration and improves with sitting upright.


1. Which of the following physical findings/laboratory tests would be most specific in making a diagnosis of acute pericarditis?
  1. Elevated erythrocyte sedimentation rate
  2. Leukocytosis
  3. Low grade fever
  4. Pericardial friction rub
  5. Tachycardia
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2. Physical examination reveals tachycardia (heart rate, 106 bpm), blood pressure of 120/70 mm Hg, no pulsus paradoxus, clear lung fields, a flat jugular venous pulse, and a loud 3-component pericardial friction rub. Which examination would offer the most information regarding the presumed diagnosis of acute pericarditis?

  1. Arterial blood gas
  2. Cardiac enzymes
  3. Chest radiograph
  4. Electrocardiogram (ECG)
  5. Transthoracic echocardiogram
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Questions 3 and 4 refer to the following case study.

A 67-year-old woman presents to her primary care physician with complaints of progressive dyspnea, fatigue, generalized malaise, and lower extremity edema. Three weeks previously, she had undergone mitral valve replacement with a St. Jude’s mechanical prosthesis for mitral stenosis/mitral regurgitation. She is on chronic anticoagulant therapy with warfarin. Cardiac catherization preoperatively had revealed pulmonary hypertension and no evidence of significant epicardial coronary artery disease.


Physical examination reveals an afebrile patient with tachycardia (heart rate, 120 bpm), systolic blood pressure of 90 mm Hg with a pulsus paradox of 20 mm Hg, respiratory rate of 26 breaths/min, jugular venous pulse to angle of jaw, and diminished breath sounds bilaterally. Cardiac examination reveals muted heart sounds, a 2-component pericardial friction rub, no mitral regurgitation murmur, crisp prosthetic valve sounds, and no S3. Extremities are cool with 2+ edema. The ECG reveals sinus tachycardia and diffuse low voltage. She is urgently admitted to the hospital.

3. Which of the following tests would provide the most useful information to arrive at a prompt diagnosis?
  1. Chest radiograph
  2. Computed tomography
  3. Magnetic resonance imaging
  4. 2-D echocardiography with Doppler
  5. Ventilation/perfusion scan
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4. The echocardiogram reveals normal left ventricular systolic function and no evidence of a valvular or perivalvular leak. The prosthetic valve is well seated. There is a very large circumferential pericardial effusion with fibrinous strands and right ventricular and right atrial collapse. Initial therapeutic options would include all of the following EXCEPT:

  1. Diuresis
  2. Fluid resuscitation
  3. Inotropic support
  4. Pericardiocentesis
  5. Cardiothoracic surgical evaluation
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