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|Explanation=The correct answer is constrictive pericarditis. The history of radiation for lymphoma treatment, likely caused pericardial scarring. Signs of right heart failure (hepatomegaly, ascitis, lower extremity edema) along with characteristic JVP findings suggest chronic constrictive pericarditis. | |Explanation=The correct answer is constrictive pericarditis. The history of radiation for lymphoma treatment, likely caused pericardial scarring. Signs of right heart failure (hepatomegaly, ascitis, lower extremity edema) along with characteristic JVP findings suggest chronic constrictive pericarditis. | ||
|AnswerA=Constrictive pericarditis | |AnswerA=Constrictive pericarditis | ||
|AnswerAExp=Constrictive pericarditis | |AnswerAExp=Constrictive pericarditis is caused by calcification and fibrosis of the pericardium, which prevents the filling of the right heart. Signs of right heart failure include: JVD, Kussmal sign, a knock heard in diastole, ascites, edema and hepato-splenomegaly. A CXR shows calcification of the pericardium. The best initial test is a CXR. CT and MRI are more accurate. Echocardiogram is used to exclude other causes of right heart failure, the myocardium moves normally in constrictive pericarditis. It is treated with diuretics and surgery. | ||
|AnswerB=Acute pericarditis | |AnswerB=Acute pericarditis | ||
|AnswerBExp=Acute [[pericarditis]] is associated with severe retrosternal chest pain aggravated with supine position and inspiration and alleviated when sitting. The history of increased abdominal girth, edema and hepatomegaly are findings of chronic pericarditis, rather than acute. | |AnswerBExp=Acute [[pericarditis]] is associated with severe retrosternal chest pain aggravated with supine position and inspiration and alleviated when sitting. The history of increased abdominal girth, edema and hepatomegaly are findings of chronic pericarditis, rather than acute. | ||
|AnswerC=Cardiac tamponade | |AnswerC=Cardiac tamponade | ||
|AnswerCExp=[[Cardiac tamponade]] is a life threatening condition, which presents with distant heart sounds, hypotension and jugular veins distention. It is caused by the presence of fluid in the virtual pericardial space, which compresses the heart causing cardiogenic shock | |AnswerCExp=[[Cardiac tamponade]] is a life threatening condition, which presents with distant heart sounds, hypotension and jugular veins distention, a triad called [[Beck's triad]]. It is caused by the presence of fluid in the ''virtual'' pericardial space, which compresses the heart chambers causing hypotension due to [[cardiogenic shock]]. Cold clammy skin, cyanotic extremities and decreased urine output can be noted. The history of increased abdominal girth, edema, and hepatomegaly are not characteristic findings of cardiac tamponade. | ||
|AnswerD=Cor pulmonale | |AnswerD=Cor pulmonale | ||
|AnswerDExp=The absence of history of a chronic pulmonary disease makes cor pulmonale a less likely diagnosis. Right heart failure is also used interchangeably with cor pulmonale when the pathology is caused by an underlying lung disease, such as emphysema or chronic bronchitis. | |AnswerDExp=The absence of history of a chronic pulmonary disease makes [[cor pulmonale]] a less likely diagnosis. [[Right heart failure]] is also used interchangeably with cor pulmonale when the pathology is caused by an underlying lung disease, such as emphysema or chronic bronchitis. | ||
|AnswerE=Hypertrophic cardiomyopathy | |AnswerE=Hypertrophic cardiomyopathy | ||
|AnswerEExp=[[Hypertrophic cardiomyopathy]] generally presents with dyspnea, palpitations, chest pain and fatigue. Hypertrophic cardiomyopathy can cause sudden cardiac death in young adolescents and adults due to cardiac arrhytmias. A past history of irradiation, distant heart sounds on auscultation, and prominent x and y descent on JVP are more consistent with the diagnosis of constrictive pericarditis. | |AnswerEExp=[[Hypertrophic cardiomyopathy]] generally presents with dyspnea, palpitations, chest pain and fatigue. Hypertrophic cardiomyopathy can cause sudden cardiac death in young adolescents and adults due to cardiac arrhytmias. A past history of irradiation, distant heart sounds on auscultation, and prominent x and y descent on JVP are more consistent with the diagnosis of constrictive pericarditis. | ||
|EducationalObjectives=[[Constrictive pericarditis]] can be caused by radiation therapy to the chest in a patient with lymphoma. It typically presents with distant heart sounds and fatigue and signs and symptoms of chronic right heart failure, such as: jugular veins distention, hepatomegaly, ascites and lower extremity edema. | |||
|References=Master the Boards for Step 2CK, 2013 edition, page 101 | |||
|RightAnswer=A | |RightAnswer=A | ||
|WBRKeyword=Constrictive pericarditis, Pericarditis, Pericardium, right heart failure | |||
|Approved=Yes | |Approved=Yes | ||
}} | }} | ||
{{WBRImage}} | {{WBRImage}} | ||
Revision as of 20:28, 15 March 2014
| Author | PageAuthor::Aarti Narayan MBBS, Raviteja Reddy Guddeti MBBS (Reviewed by Gonzalo Romero) |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Oncology, SubCategory::Cardiovascular, SubCategory::Oncology |
| Prompt | [[Prompt::A 50-year-old male presents to the clinic due to fatigue, weakness and weight gain. Upon interrogration, he has orthopnea, paroxysmal nocturnal dyspnea, abdominal swelling and lower extremity edema. His past medical history is significant for lymphoma treatment with radiotherapy. On physical examination, his vitals are: BP 100/60 mmHg, RR 15/min and HR 100bpm. He has distant heart sounds and a prominent x and y descent on jugular examination. Abdominal examination shows hepatomegaly and ascites. EKG shows low voltage QRS complexes and flattened T waves. What is the most likely diagnosis?]] |
| Answer A | AnswerA::Constrictive pericarditis |
| Answer A Explanation | [[AnswerAExp::Constrictive pericarditis is caused by calcification and fibrosis of the pericardium, which prevents the filling of the right heart. Signs of right heart failure include: JVD, Kussmal sign, a knock heard in diastole, ascites, edema and hepato-splenomegaly. A CXR shows calcification of the pericardium. The best initial test is a CXR. CT and MRI are more accurate. Echocardiogram is used to exclude other causes of right heart failure, the myocardium moves normally in constrictive pericarditis. It is treated with diuretics and surgery.]] |
| Answer B | AnswerB::Acute pericarditis |
| Answer B Explanation | [[AnswerBExp::Acute pericarditis is associated with severe retrosternal chest pain aggravated with supine position and inspiration and alleviated when sitting. The history of increased abdominal girth, edema and hepatomegaly are findings of chronic pericarditis, rather than acute.]] |
| Answer C | AnswerC::Cardiac tamponade |
| Answer C Explanation | [[AnswerCExp::Cardiac tamponade is a life threatening condition, which presents with distant heart sounds, hypotension and jugular veins distention, a triad called Beck's triad. It is caused by the presence of fluid in the virtual pericardial space, which compresses the heart chambers causing hypotension due to cardiogenic shock. Cold clammy skin, cyanotic extremities and decreased urine output can be noted. The history of increased abdominal girth, edema, and hepatomegaly are not characteristic findings of cardiac tamponade.]] |
| Answer D | AnswerD::Cor pulmonale |
| Answer D Explanation | [[AnswerDExp::The absence of history of a chronic pulmonary disease makes cor pulmonale a less likely diagnosis. Right heart failure is also used interchangeably with cor pulmonale when the pathology is caused by an underlying lung disease, such as emphysema or chronic bronchitis.]] |
| Answer E | AnswerE::Hypertrophic cardiomyopathy |
| Answer E Explanation | [[AnswerEExp::Hypertrophic cardiomyopathy generally presents with dyspnea, palpitations, chest pain and fatigue. Hypertrophic cardiomyopathy can cause sudden cardiac death in young adolescents and adults due to cardiac arrhytmias. A past history of irradiation, distant heart sounds on auscultation, and prominent x and y descent on JVP are more consistent with the diagnosis of constrictive pericarditis.]] |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::The correct answer is constrictive pericarditis. The history of radiation for lymphoma treatment, likely caused pericardial scarring. Signs of right heart failure (hepatomegaly, ascitis, lower extremity edema) along with characteristic JVP findings suggest chronic constrictive pericarditis. Educational Objective: Constrictive pericarditis can be caused by radiation therapy to the chest in a patient with lymphoma. It typically presents with distant heart sounds and fatigue and signs and symptoms of chronic right heart failure, such as: jugular veins distention, hepatomegaly, ascites and lower extremity edema. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Constrictive pericarditis, WBRKeyword::Pericarditis, WBRKeyword::Pericardium, WBRKeyword::right heart failure |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
Image [[WBRImage::|]] Caption WBRImageCaption::no-display Position [[WBRImagePlace::|]]