cardiac tamponade sample paper for neet pg, usmle, plab, fmge (mci screening exam)

Q:1 Indication for tracheostomy are all, EXCEPT:

A: Flail chestB: Head injuryC: Cardiac TamponadeD: 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 internetDownload Our FREE Subjectwise Mobile Apps at www.medicoapps.org

Q:2A patient developed breathlessness and chest pain, on second postoperative dayafter a total hip replacement. Echocardiography showed right ventriculardilatation and tricuspid regurgitation. What is the most likely diagnosis?

A: Acute MIB: Pulmonary embolismC: Hypotensive shockD: Cardiac tamponade

Correct Ans:B

Explanation

The clinical history corresponding to the diagnosis of pulmonary embolism. For apatient presenting with acute breathlessness and chest pain and in whom rightventricular dilatation with tricuspid regurgitation and mild elevation of pulmonaryartery pressure is noted, a pulmonary embolus should be the initial diagnosis to beconsidered.

Ref: Deep Vein Thrombosis and Pulmonary Embolism, Page 253, 254; Feigenbaum'sEchocardiography, 7th Edition, Page 762.


Q:3 All of the following are cardiovascular complications of HIV infection, EXCEPT:

A: Aortic Aneurysm

B: CardiomyopathyC: Pericardial EffusionD: Cardiac Tamponade

Correct Ans:A

Explanation

The most common cardiac disease associated with HIV is coronary heart disease, it isassociated with a CD4+ T cell count of <500/ L. Other cardiac manifestations includedilated cardiomyopathy associated with congestive heart failure (CHF) ( HIVassociatedcardiomyopathy), pericardial effusions, cardiac tamponade and nonbacterial thromboticendocarditis.

Ref: Harrison’s Internal Medicine, 18th Edition, Page 189;Hospital Medicine ByRobert.M.Watchter, Page 479


Q:4A 30 year old man with history of blunt trauma to the chest presents with dialatedneck veins, BP 80/50mmHg and pulse rate of 100/ min. What is the most likelydiagnosis?

A: Cardiac tamponadeB: Right ventricular failureC: Traumatic pneumothoraxD: Hemothorax

Correct Ans:A

Explanation

Cardiac tamponade may result from bleeding into the pericardial space after cardiacoperations, trauma, and treatment of patients with acute pericarditis withanticoagulants. The accumulation of fluid in the pericardial space in a quantitysufficient to cause serious obstruction to the inflow of blood to the ventricles results incardiac tamponade, giving rise to decrease in stroke volume and decreased cardiacoutput.

Beck's triad are hypotension, soft or absent heart sounds, and jugular venousdistention with a prominent x descent but an absent y descent. Paradoxical Pulse is animportant clue to the presence of cardiac tamponade, consists of a >10mmHginspiratory 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


Q:5 Kussmaul's sign is seen in all of the following, except:

A: Restrictive cardiomyopathyB: Right ventricular infarctionC: Constrictive pericarditisD: Cardiac tamponade

Correct Ans:D

Explanation

Kussmaul's sign is defined by either a rise or a lack of fall of the JVP with inspirationand is classically associated with constrictive pericarditis. It is also seen in patientswith restrictive cardiomyopathy, massive pulmonary embolism, right ventricularinfarction, and advanced left ventricular systolic heart failure.

Ref: Harrison’s Internal Medicine, 18th Edition, Pages 1823, 197274


Q:6A postoperative cardiac surgical patient developed sudden hypotension, raisedcentral venous pressure, pulsus paradoxus at the 4th post operative hour. Whichof the following is the most probable diagnosis?

A: Ventricular dysfunctionB: Cardiac tamponadeC: Congestive cardiac failureD: Excessive mediastinal bleeding

Correct Ans:B

ExplanationThis patient is showing features suggestive of cardiac tamponade, which occurredsecondary to bleeding into the pericardial space following cardiac surgery. Cardiactamponade occurs when fluid accumulate in the pericardial space in a quantitysufficient 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 aftercardiac operations, trauma, and treatment of patients with acute pericarditis withanticoagulants. Clinical features: The three principal features are hypotension, soft or absent heartsounds, and jugular venous distention with a prominent x descent but an absent ydescent(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 theP, QRS, or T waves. Ref: Harrison’s Internal Medicine, 18th Edition, Chapter 239


Q:7Following cardiac surgery a patient developed sudden hypotension, raised centralvenous pressure, pulsus paradoxus at the 4th post operative hour. The patient issuffering from?

A: Excessive mediastinal bleedingB: Ventricular dysfunctionC: Congestive cardiac failureD: Cardiac tamponade

Correct Ans:D

Explanation

Cardiac tamponade is characterized by Beck’s triad

1. Hypotension2. Jugular venous distension3. Soft or absent cardiac soundsPulsus paradoxus is also described in Cardiac tamponade. Inexcessive mediastinal bleeding there will not be, raised centralvenous pressure and pulsus paradoxus. Other features of Cardiactamponade 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


Q:835 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 plaquelike calcification over RV with dilated SVC and small atria. He is suffering from

A: Cardiac TamponadeB: Restrictive CardiomyopathyC: Right Ventricular MID: 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


Q:9 Cardiovascular complications of HIV infection include all of the following, exceptâ€‘

A: Pericardial effusion

B: CardiactamponadeC: CardiomyopathyD: 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 thegeneral 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) mayhave negative effects on the serum lipid prolife, these are modest and theincremental cardiac risk associated with HAART is small and they may be easilymanaged with current guidelines that recommend lifestyle treatment andpharmacotherapy currently used by general population.

Cardiovascular complications in order of frequencyComplications Comments

• Pericardial effusions(21%)

/Pericardial tamponade(9%)

Pericardial effusion is one of the most common clinicallyrelevant cardiac

complication. It can have a wide range of manifestationsincluding asymptomatic

effusion, cardiac tamponade, acute or chronic pericarditis anduncommonly

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 bacterialthrombotic

Endocarditis

• Primary pulmonaryhypertension

• Right ventricular andpulmonary

disease

• AccelaratedAtherosclerosis Due to drugs protease inhibitors

• Autonomic dysfunction • Arryhthmias • Lipodystrophy Due to drugs/protease inhibitors


Q:10 Causes of raised J.V.P. with hypotension are allexcept

A: >Cardiac tamponadeB: >Right ventricular M.I.C: >Heart failureD: >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 tamponadeConstrictive pericarditisRight ventricular wall M.I.Restrictive cardiornyopathyRight heart failure


Q:11 Ddimer is the most sensitive test for

A: Pulmonary embolismB: Acute pulmonary edemaC: Cardiac tamponade

D: Acute MI

Correct Ans:A

Explanation

Ans. is 'a' i.e., Pulmonary embolism

o Ddimer is a fibrin degradation product, a small protein fragment present in theblood after blood clot is degraded by fibrinolysis.

o It is so named because it contains two crosslinked D fragments of the fibrinogenprotein.

Ddimer concentration may be determined by a blood test to help diagnosethrombosis.

Ddimer testing is of clinical use when there is a suspician of deep vein thrombosis(DVT) or pulmonary thromboembolism (PE).

In patient suspected of disseminated intravascular coagulation (DIC), Ddimersmay aid in diagnosis.


cardiac tamponade sample paper for neet pg, usmle, plab, fmge (mci screening exam)

Health & Medicine