WBR0021
| 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 |
| 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. It is caused by the presence of fluid in the virtual pericardial space, which 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::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: |
| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
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