WBR0023

Author	PageAuthor::Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Infectious Disease, SubCategory::Cardiovascular, SubCategory::Infectious Disease
Prompt	[[Prompt::A 65 yr old male with a past medical history of tuberculosis presents to the clinic concerned about progressive shortness of breath for the past few months. He also complains of weakness, fatigue, and weight gain. Physical examination shows increased abdominal girth, bilateral pedal edema, hepatomegaly and an increase in jugular venous pressure on deep inspiration. Auscultation revealed an extra diastolic heart sound. Chest X-ray showed calcification in the precordial area and EKG showed diffuse low voltage QRS complexes with flattened T waves. What is the most important therapy to immediately treat this patient?]]
Answer A	AnswerA::Pericardiocentesis
Answer A Explanation	AnswerAExp::Pericardiocentesis is the treatment for a pericardial effusion.
Answer B	AnswerB::Pericardial resection
Answer B Explanation	AnswerBExp::Pericardial resection is the correct answer.
Answer C	AnswerC::Beta blockers
Answer C Explanation	AnswerCExp::Beta blockers are not indicated for the treatment of this patient.
Answer D	AnswerD::Antituberculous therapy
Answer D Explanation	AnswerDExp::Antitubercular therapy is used for treating constrictive pericarditis secondary to tuberculosis, however pericardial resection should be done first.
Answer E	AnswerE::Glucocorticoids
Answer E Explanation	AnswerEExp::Glucocorticoids are used when the pericarditis is secondary to a chronic inflammatory process.
Right Answer	RightAnswer::B
Explanation	[[Explanation::This patient has constrictive pericarditis as a result of tuberculosis. The correct therapy for this patient is pericardial resection. The pericardium is resected to relieve symptoms of systemic and pulmonary congestion, which causes the heart to relax effectively during diastole. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::

Image [[WBRImage::|]] Caption WBRImageCaption::no-display Position [[WBRImagePlace::|]]