Cardiac tamponade sample paper for neet pg, usmle, plab, fmge (mci screening exam)
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Cardiac tamponade sample paper for neet pg, usmle, plab, fmge (mci screening exam)
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Cardiac tamponade sample paper for neet pg, usmle, plab, fmge (mci screening exam)
- 1. Q:1 Indication for tracheostomy are all, EXCEPT: A: Flail chest B: Head injury C: Cardiac Tamponade D: Foreign body Correct Ans:C Explanation Indications for tracheostomy are Flail chest, Head injury, Foreign body, Tetanus etc. Cardiac tamponade is not an indication for tracheostomy. Want To Solve More Such Question on Mobile without connecting to internet Download Our FREE Subjectwise Mobile Apps at www.medicoapps.org Q:2 A patient developed breathlessness and chest pain, on second postoperative day after a total hip replacement. Echocardiography showed right ventricular dilatation and tricuspid regurgitation. What is the most likely diagnosis? A: Acute MI B: Pulmonary embolism C: Hypotensive shock D: Cardiac tamponade Correct Ans:B Explanation The clinical history corresponding to the diagnosis of pulmonary embolism. For a patient presenting with acute breathlessness and chest pain and in whom right ventricular dilatation with tricuspid regurgitation and mild elevation of pulmonary artery pressure is noted, a pulmonary embolus should be the initial diagnosis to be considered. Ref: Deep Vein Thrombosis and Pulmonary Embolism, Page 253, 254; Feigenbaum's Echocardiography, 7th Edition, Page 762. Want To Solve More Such Question on Mobile without connecting to internet Download Our FREE Subjectwise Mobile Apps at www.medicoapps.org Q:3 All of the following are cardiovascular complications of HIV infection, EXCEPT: A: Aortic Aneurysm
- 2. B: Cardiomyopathy C: Pericardial Effusion D: Cardiac Tamponade Correct Ans:A Explanation The most common cardiac disease associated with HIV is coronary heart disease, it is associated with a CD4+ T cell count of <500/ L. Other cardiac manifestations include dilated cardiomyopathy associated with congestive heart failure (CHF) ( HIVassociated cardiomyopathy), pericardial effusions, cardiac tamponade and nonbacterial thrombotic endocarditis. Ref: Harrison’s Internal Medicine, 18th Edition, Page 189;Hospital Medicine By Robert.M.Watchter, Page 479 Want To Solve More Such Question on Mobile without connecting to internet Download Our FREE Subjectwise Mobile Apps at www.medicoapps.org Q:4 A 30 year old man with history of blunt trauma to the chest presents with dialated neck veins, BP 80/50mmHg and pulse rate of 100/ min. What is the most likely diagnosis? A: Cardiac tamponade B: Right ventricular failure C: Traumatic pneumothorax D: Hemothorax Correct Ans:A Explanation Cardiac tamponade may result from bleeding into the pericardial space after cardiac operations, trauma, and treatment of patients with acute pericarditis with anticoagulants. The accumulation of fluid in the pericardial space in a quantity sufficient to cause serious obstruction to the inflow of blood to the ventricles results in cardiac tamponade, giving rise to decrease in stroke volume and decreased cardiac output. Beck's triad are hypotension, soft or absent heart sounds, and jugular venous distention with a prominent x descent but an absent y descent. Paradoxical Pulse is an important clue to the presence of cardiac tamponade, consists of a >10mmHg inspiratory decline in systolic arterial pressure. Diagnosis by echocardiography. Pericardiocentesis carried out once manifestations of tamponade appear. Ref: Advance Assessment and Treatment of Trauma By Michael D. Pante, Page 146 ; Harrison’s Internal Medicine, 18th Edition, Pages 197274, 21792181 Want To Solve More Such Question on Mobile without connecting to internet Download Our FREE Subjectwise Mobile Apps at www.medicoapps.org Q:5 Kussmaul's sign is seen in all of the following, except:
- 3. A: Restrictive cardiomyopathy B: Right ventricular infarction C: Constrictive pericarditis D: Cardiac tamponade Correct Ans:D Explanation Kussmaul's sign is defined by either a rise or a lack of fall of the JVP with inspiration and is classically associated with constrictive pericarditis. It is also seen in patients with restrictive cardiomyopathy, massive pulmonary embolism, right ventricular infarction, and advanced left ventricular systolic heart failure. Ref: Harrison’s Internal Medicine, 18th Edition, Pages 1823, 197274 Want To Solve More Such Question on Mobile without connecting to internet Download Our FREE Subjectwise Mobile Apps at www.medicoapps.org Q:6 A postoperative cardiac surgical patient developed sudden hypotension, raised central venous pressure, pulsus paradoxus at the 4th post operative hour. Which of the following is the most probable diagnosis? A: Ventricular dysfunction B: Cardiac tamponade C: Congestive cardiac failure D: Excessive mediastinal bleeding Correct Ans:B Explanation This patient is showing features suggestive of cardiac tamponade, which occurred secondary to bleeding into the pericardial space following cardiac surgery. Cardiac tamponade occurs when fluid accumulate in the pericardial space in a quantity sufficient to cause serious obstruction to the inflow of blood to the ventricles. Etiology: The three most common causes are neoplastic disease, idiopathic pericarditis, and renal failure. It can also result from bleeding into the pericardial space after cardiac operations, trauma, and treatment of patients with acute pericarditis with anticoagulants. Clinical features: The three principal features are hypotension, soft or absent heart sounds, and jugular venous distention with a prominent x descent but an absent y descent(Beck's triad). Pulsus paradoxus is present. X ray chest shows enlarged cardiac silhouette ECG shows reduction in amplitude of the QRS complexes, and electrical alternansof the P, QRS, or T waves. Ref: Harrison’s Internal Medicine, 18th Edition, Chapter 239 Want To Solve More Such Question on Mobile without connecting to internet Download Our FREE Subjectwise Mobile Apps at www.medicoapps.org
- 4. Q:7 Following cardiac surgery a patient developed sudden hypotension, raised central venous pressure, pulsus paradoxus at the 4th post operative hour. The patient is suffering from? A: Excessive mediastinal bleeding B: Ventricular dysfunction C: Congestive cardiac failure D: Cardiac tamponade Correct Ans:D Explanation Cardiac tamponade is characterized by Beck’s triad 1. Hypotension 2. Jugular venous distension 3. Soft or absent cardiac sounds Pulsus paradoxus is also described in Cardiac tamponade. In excessive mediastinal bleeding there will not be, raised central venous pressure and pulsus paradoxus. Other features of Cardiac tamponade are prominent x descent absence of Kussmaul’s sign, low voltage complexes and electrical alternans in ECG. Pulsus paradoxus is not seen in Ventricular dysfunction and Congestive cardiac failure Ref: Harrisons principles of internal medicine, 18th edition, Page: 1972 Want To Solve More Such Question on Mobile without connecting to internet Download Our FREE Subjectwise Mobile Apps at www.medicoapps.org Q:8 35 year old male presents with dyspnea and ascites over 3 days. O/E there is neck vein distension with no inspiratory decrease in JVP. CXR shows plaque like calcification over RV with dilated SVC and small atria. He is suffering from A: Cardiac Tamponade B: Restrictive Cardiomyopathy C: Right Ventricular MI D: Constrictive Pericarditis Correct Ans:D Explanation • CXR Features: Linear Plaquelike Pericardial calcifications(5070%) predominantly over RV and posterior LV • Dilatation of SVC(77%) and Azygos Vein • Small Atria • Normal Lung Vasculature • Differntiate Between RVMI, CP and RCM
- 5. Want To Solve More Such Question on Mobile without connecting to internet Download Our FREE Subjectwise Mobile Apps at www.medicoapps.org Q:9 Cardiovascular complications of HIV infection include all of the following, except‑ A: Pericardial effusion B: Cardiac tamponade C: Cardiomyopathy D: Aortic Aneurysm Correct Ans:D Explanation Aortic Aneurysm [Ref: Harrison 17th/e p. 1173; Braunwald 8th/e p179495] Patient with HIV share traditional cardiovascular disease risk factors with the general population. In addition, HIV itself significantly increases the risk of cardiovascular disease. Control of viremia with potent and durable regimens can help reduce overall risk. Although there is evidene that HAART (Highly Active Antiretroviral Therapy) may have negative effects on the serum lipid prolife, these are modest and the incremental cardiac risk associated with HAART is small and they may be easily managed with current guidelines that recommend lifestyle treatment and pharmacotherapy currently used by general population. Cardiovascular complications in order of frequency Complications Comments • Pericardial effusions (21%) /Pericardial tamponade (9%) Pericardial effusion is one of the most common clinically relevant cardiac complication. It can have a wide range of manifestations including asymptomatic effusion, cardiac tamponade, acute or chronic pericarditis and uncommonly constrictive pericardial disease. Possible risk factors are T.B., cryptococcal infection, Kaposi sarcoma, pulmonary infection. • Lymphocytic interstitial Myocarditis • Dilated cardiomyopathy (15%) May be drug related or due to infection itself • Infective endocarditis Occurs at a similar rate as in other group of individuals. • Malignancy Kaposi sarcoma, Non hodgkin's lymphoma, Leiomyosarcoma • Non bacterial thrombotic
- 6. Endocarditis • Primary pulmonary hypertension • Right ventricular and pulmonary disease • Accelarated Atherosclerosis Due to drugs protease inhibitors • Autonomic dysfunction • Arryhthmias • Lipodystrophy Due to drugs/protease inhibitors Want To Solve More Such Question on Mobile without connecting to internet Download Our FREE Subjectwise Mobile Apps at www.medicoapps.org Q:10 Causes of raised J.V.P. with hypotension are allexcept A: >Cardiac tamponade B: >Right ventricular M.I. C: >Heart failure D: >2nd degree A.V. block Correct Ans:D Explanation 2nd degree A.V. block [Ref Harrison 16'h/e p 1416] Differential diagnosis of increased venous pressure with hypotension Cardiac tamponade Constrictive pericarditis Right ventricular wall M.I. Restrictive cardiornyopathy Right heart failure Want To Solve More Such Question on Mobile without connecting to internet Download Our FREE Subjectwise Mobile Apps at www.medicoapps.org Q:11 Ddimer is the most sensitive test for A: Pulmonary embolism B: Acute pulmonary edema C: Cardiac tamponade