Miscelaneous and Pericardial Disease

Question 1

The vast majority of recurrent pericarditis cases respond to …, initially given in a high dose.

Answer 1

prednisone

Question 2

To diagnose a pleural effusion as exudates, 1/3 criteria has to be met:…

Answer 2

LDH>45, cholesterol >45, proteins >2.9

Question 3

… has typical ECG findings of PR depression and diffuse ST elevation.

Answer 3

Pericarditis

Question 4

The risk of postoperative complications declines if smoking was stopped for at least… before surgery.

Answer 4

8 weeks

Question 5

Perioperative ABx used for general skin flora coverage is… .

Answer 5

cefazolin (Ancef®) - 1 g given 30 minutes prior to surgery (repeat with 500 mg to 1 g during prolonged surgery); followed by 500 mg to 1 g every 6-9 hours for 24 hours postop

Question 6

Patients unable to achieve functional capacity equivalent to climbing up… are at increased risk for perioperative cardiac events.

Answer 6

one flight of stairs

Question 7

Patients with poor functional capacity or intermediate cardiac risk should have … before high-risk surgery.

Answer 7

noninvasive testing

Question 8

… are adequate screening in patients with no history of bleeding having procedures with moderate or high bleeding risk.

Answer 8

Platelets, PT and PTT

Question 9

Clopidogrel and ticlopidine should be discontinued for … before surgery.

Answer 9

one week

Question 10

NSAIDs should be discontinued for … before surgery.

Answer 10

3 days

Question 11

In a patient with acute pericarditis still complaining of CP after 2 weeks of treatment with an NSAID,… (intervention) or colchicine added.

Answer 11

a different NSAID should be given

Question 12

Patients with recurrent tamponade despite therapy in pericarditis should be considered for… (test).

Answer 12

pericardial biopsy.

Question 13

Patients with a relapse of pericarditis after a short-term course of steroids often obtain symptomatic relief when higher-dose prednisone therapy (1-1.5mg/Kg/day) is administered for… weeks.

Answer 13

4

Question 14

The fluid analysis in pericardiocentesis should consist in microscopic exam, culture, white and red cell counts, cytology and…

Answer 14

triglycerides.

Question 15

The preferred NSAID in acute pericarditis is…

Answer 15

ibuprofen.

Question 16

The stage I ECG changes in acute pericarditis occur in 80% of patients and consist of…

Answer 16

diffuse STE and PR depression.

Question 17

A rapidly collapsing y-descent in the jugular venous pulse with marked JVD is classical for…

Answer 17

constrictive pericarditis.

Question 18

If there is CP radiating to the trapezius ridge, the pain is nearly specific for…

Answer 18

pericarditis.

Question 19

The most common causes of acute pericarditis are idiopathic or due to the following viruses:

Answer 19

Coxsackie A and B, echovirus and adenovirus.

Question 20

… has been shown to be effective as prophylaxis in patients with chronic, recurrent idiopathic pericarditis.

Answer 20

1mg colchicine/day

Question 21

… is virtually pathognomonic of a large pericardial effusion and is caused by the curious phenomenon of the heart swinging with a frequency equal to half of the heart rate.

Answer 21

Electrical alternans

Question 22

CNS autoregulation of blood flow fails when the mean BP falls below…

Answer 22

55-60mmHg.

Question 23

Persistent upright T-waves or early normalization of inverted T following AMI are highly sensitive for…

Answer 23

postinfarction pericarditis (Dressler’s syndrome).

Question 24

Simultaneous… should be performed in most of the patients suspected of having constrictive pericarditis.

Answer 24

left and right heart catheterization

Question 25

The leading cause of cardiac tamponade in the developed countries is…

Answer 25

malignancy (lung, breast, lymphomas).

Question 26

… is the most common cardiac manifestation of HIV infection.

Answer 26

Pericardial dz (effusion)

Question 27

Pulsus paradoxus is an exaggeration of the normal, very small inspiratory decline in the LV stroke volume and systemic arterial pressure (>10 mmHg) in…

Answer 27

cardiac tamponade.

Question 28

Lack of a decrease or an increase in jugular venous pressure during inspiration, called Kussmaul’s sign, is abnormal and is observed in a number of conditions, the most common being…

Answer 28

constrictive pericarditis

Question 29

The therapy in fungal pericarditis is symptomatic (no amphotericin B except in disseminated dz) and associated with this measure…

Answer 29

admission due to the risk of rapidly developing tamponade.

Question 30

The management of uremic pericarditis is…

Answer 30

HD.

Question 31

… should be used cautiously during HD in patients with uremic pericarditis due to risks of hemorrhage with tamponade and chronic constriction.

Answer 31

Heparin

Question 32

… interferes with the normal sequence of right and left ventricular filling and results in early downward motion of the septum, followed by paradoxical motion.

Answer 32

Constrictive pericarditis

Question 33

Pericardial effusion occurs in approximately … % of patients with transmural myocardial infarction.

Answer 33

40

Question 34

Moderate pericardial effusions typically are … in dimension and tend to be more circumferential.

Answer 34

15 to 20 mm

Question 35

Large pericardial effusions are defined as those larger than … (width).

Answer 35

20 mm.

Question 36

The collapse of the right ventricular outflow tract during early diastole was described in … (the precise timing and duration of right ventricular collapse can best be determined with M-mode echocardiography).

Answer 36

cardiac tamponade

Question 37

An indirect sign of … is an exaggerated respiratory variation in septal position with marked bowing of the ventricular septum toward the left ventricle during inspiration.

Answer 37

pericardial constriction

Question 38

Abnormal septal motion, exaggerated respiratory variation, and an elevated E/A ratio provide the majority of the confirmatory evidence for …

Answer 38

constrictive pericarditis.

Question 39

The diagnosis of… requires documentation of pericardial thickening by means of MRI and confirmatory hemodynamic values by means of catheterization.

Answer 39

constrictive pericarditis

Question 40

Preoperative… (diagnostic test) is reserved for patients with high-risk results at noninvasive testing and for patients at high risk with equivocal results of noninvasive tests.

Answer 40

coronary angiography