WBR0021

Author	PageAuthor::Aarti Narayan MBBS, Raviteja Reddy Guddeti MBBS
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Oncology, SubCategory::Cardiovascular, SubCategory::Oncology
Prompt	[[Prompt::A 50 yr old male presents to the clinic with history of fatigue, weakness, weight gain, increased abdominal girth, and swelling. History of present illness reveals orthopnea and paroxysmal nocturnal dyspnea. Past history is significant for having undergone radiotherapy for lymphoma. Blood pressure is found to be 100/60 mm Hg, respiratory rate of 15/min and HR 100 beats/min. JVP shows a prominent x and y descent. Abdominal examination shows hepatomegaly and ascites. Auscultation demonstrates distant heart sounds and EKG shows low voltage QRS complexes and fattened T wave. What is the most likely diagnosis?]]
Answer A	AnswerA::Constrictive pericarditis
Answer A Explanation	AnswerAExp::Constrictive pericarditis is the correct answer.
Answer B	AnswerB::Acute pericarditis
Answer B Explanation	AnswerBExp::Acute pericarditis is associated with severe retrosternal chest pain. History of increased abdominal girth, edema and hepatomegaly are not findings one would expect with the diagnosis of acute pericarditis.
Answer C	AnswerC::Cardiac tamponade
Answer C Explanation	[[AnswerCExp::Cardiac tamponade is a life threatening condition where in the pericardial fluid surrounding the heart compresses the heart causing cardiogenic shock and hypotension. 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::Absence of history of a chronic pulmonary disease makes cor pulmonale a less likely diagnosis.
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. 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 patients past history of irradiation for lymphoma likely caused scarring of the pericardium. Signs of right heart failure along with characteristic JVP findings suggest chronic constrictive pericarditis. Educational Objective: References: ]]
Approved	Approved::Yes
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