Pericardial Disease

Question 1

MC pathologic involving the pericardium

Answer 1

Acute pericarditis

Question 2

Characteristic chest pain in acute pericarditis

Answer 2

Pleuritic, steady, constricting; relieved by sitting up and leaning forward and itensified by lying supine

Question 3

Pericarditis pain is usually absent

Answer 3

Slowly developing tuberculous
Postirradiation
Neoplastic
Uremic
Constrictive

Question 4

Pericardial friction rub frequently heard

Answer 4

High-pitched, rasping, scratching, grating; most frequently at END EXPIRATION with patient upright and leaning forward

Question 5

ECG pattern in acute pericarditis

Answer 5

Stage 1: widespread ST elevation
(upward concavity, 2-3 standard limb leads and V2-V6, reciprocal depressions ONLY in aVR and sometimes V1)

Stage 2: normal
Stage 3: T wave inversion
Stage 4: normal

Question 6

ECG finding in pericardial effusion

Answer 6

Electrical alternans

Question 7

Patch of dullness and increased fremitus and egophony beneath the angle of the left scapula

Answer 7

Ewart’s sign

Question 8

2nd line of treatment for Acute Pericarditis

Answer 8

Colchicine (may also reduce risk of recurrent pericarditis)

Resort to glucocorticoids if unresponsive to NSAIDS and colchicine

Question 9

MCC of tamponade

Answer 9

Idiopathic pericarditis

Pericarditis 2 to neoplastic disease

Question 10

Beck’s triad

Answer 10

Hypotension
Soft or absent heart sounds
Jugular Venous distention

Prominent x descent
Absent y descent

Question 11

Greather than normal (10mmHg) inspiratory decline in systolic arterial pressure

Answer 11

Pulsus paradoxus

Question 12

Doppler UTZ findings in tamponade

Answer 12

Tricuspid and pulmonic valve flow velocities increase during inspiration

Pulmonic vein, mitral and aortic flow diminishes

Question 13

May necessitate to diagnose loculated effusion

Answer 13

TEE
CT
Cardiac MRI

Question 14

Usual characteristic of pericardial fluid

Answer 14

Exudative

Question 15

May present as transudative pericardial effusion

Answer 15

Heart failure

Question 16

Bloody pericardial fluid

Answer 16

Neoplasm
Renal failure
Dialysis

Question 17

Most often cause of pericardial effusion in HIV

Answer 17

Lymphoma

Question 18

MC cause of pericarditis secondary to metastatic tumors

Answer 18

Lung
Breast
Malignant melanoma
Lymphoma
Leukemia

Question 19

Most prominent deflection in constrictive pericarditis

Answer 19

Presence of y descent: rapid early filling of the ventricles

vs tamponade

Question 20

Venous pressure declining during inspiration

Answer 20

Kussmaul’s sign

Question 21

Apical pulse reduced and may retract in systole in constrictive pericarditis

Answer 21

Broadbent’s sign

Question 22

MC radiographic finding in tuberculous pericarditis

Answer 22

Pericardial calcification

Question 23

Only definitive treatment if constrictive pericarditis

Answer 23

pericardial resection