157 - cardiac tamponade mcqs - part 4

18q: all of the following are true about low-pressure tamponade except ?

a. intrapericardial pressure is increased from its slightly subatmospheric levels to + 5 or + 10 mm Hg
b. central venous pressure is normal or only slightly elevated
c. arterial pressure is unaffected
d. paradoxical pulse is present

answer d . low-pressure tamponade is characterized by the absence of the paradoxical pulse .

19q: thickened pericardium and pericardial calcification is usually seen in which of the following ?

a. cardiac tamponade
b. constrictive pericarditis
c. restrictive cardiomyopathy
d. RVMI

answer b. constrictive pericarditis

20q: cardiac biopsy may be helpful sometimes in which of the following ?

a. cardiac tamponade
b. constrictive pericarditis
c. restrictive cardiomyopathy
d. RVMI

answer c. restrictive cardiomyopathy

21q: kussmaul’s sign is present in which of the following ?

a. cardiac tamponade
b. constrictive pericarditis
c. restrictive cardiomyopathy
d. RVMI

answer b and d are answers. constrictive pericarditis and RVMI

22q: prominent x descent is rare in which of the following ?

a. cardiac tamponade
b. RVMI
c. Constrictive pericarditis
d. Restrictive cardiomyopathy

answer b. RVMI

23q: prominent y descent is absent in which of the following ?

a. cardiac tamponade
b. RVMI
c. Restrictive cardiomyopathy
d. Constrictive pericarditis

answer cardiac tamponade . prominent y descent maybe present but is rare in restrictive cardiomyopathy and RVMI ( right ventricular myocardial infarction ).

24q: a young motorist suffered injuries in a major road traffic accident . he was diagnosed to have fracture of the left femur and left humerus. He was also having fracture of multiple ribs anteriorly on both sides. On examination the blood pressure was 80/60 mm Hg and heart rate was 140 / minute. The patient was agitated , restless and tachypneic . jugular veins are distended. Air entry was adequate in both the lung fields. Heart sounds were barely audible. Femoral pulses were weakly palpable but distally no pulsation could be felt. On priority basis , the immediate intervention would be ?

a. intercostal tube drainage on both the sides
b. rapid blood transfusion
c. urgent pericardial tap
d. fracture of left femur and repair of femoral artery

answer . urgent pericardial tap . ( this question was askedin AIIMS – all Indian institute of medical scienes – delhi - NOVEMEBER 2002 paper ) .

156 - cardiac tamponade mcqs - part 3

11q: what is the most common thoracotomy approach for echocardiography guided pericardiocentesis ?

a. apical
b. parasternal
c. subxiphoid
d. all are done with equal frequency

answer c . subxiphoid .

12q: what type of thoracotomy approach is most commonly done for recurrent cardiac tamponades ?

a. apical
b. parasternal
c. subxiphoid
d. all are done with equal frequency

answer c . subxiphoid thoracotomy approach, also called as limited thoracotomy is done when it is necessary to remove loculated effusions and/or when it is necessary to obtain tissue for diagnosis .

13q: pericardial fluid obtained from an effusion often has the physical characteristics of ?

a. transudate
b. exudate
c. blood stained fluid
d. none

answer b . exudate .

14q: what is the most common cause of bloody fluid in the pericardium in united states of America ?

a. neoplasm
b. tuberculosis
c. trauma
d. other infections

answer a . neoplasm .

15q: what is the most common cause of the bloody fluid in the pericardium in developing countries ( like India ) ?

a. tuberculosis
b. neoplasm
c. trauma
d. other infections

answer a . tuberculosis .

16q: transudative pericardial effusions can occur in which of the following conditions ?

a. neoplasms
b. heart failure
c. inflammatory conditions
d. infections

answer b . heart failure .

17q: elevated levels of which enzyme are present in pericardial fluid removed from a tubercular pericardial effusion patient ?

a. lactate dehydrogenase ( LDH )
b. adenosine deaminase
c. alanine transminase
d. aspartate transaminase

answer b . adenosine deaminase .

155 - cardiac tamponade mcqs - part 2

6q: which of the following raises the suspicion of cardiac tamponade ?

a. unexplained enlargement of the cardiac silhouette
b. reduction of the amplitude of the QRS complexes
c. electrical alterans of the P,QRS or T waves
d. all the above

answer d . all the above .

7q: what is pulsus paradoxus or paradoxical pulse ?

a. greater than normal ( 10 mm Hg ) inspiratory decline in systolic arterial pressure
b. greater than normal ( 10 mm Hg ) inspiratory increase in systolic arterial pressure
c. greater than normal ( 10 mm Hg ) expiratory decline in systolic arterial pressure
d. greater than normal ( 10 mm Hg ) expiratory increase in systolic arterial pressure

answer a . greater than normal ( 10 mm Hg ) inspiratory decline in systolic arterial pressure .

8q: paradoxical pulse or pulsus paradoxus is seen in which of the following conditions ?

a. hypovolemic shock
b. acute obstructive airway disease
c. chronic obstructive airway disease
d. pulmonary embolus
e. cardiac tamponade
f. constrictive pericarditis
g. all except b
h. all except f
i. all of the above

answer h. all of the above . pulsus paradoxus can be observed in one third of patients with constrictive pericarditis . it is also a feature of bronchial asthma .

9q: diagnostic procedure of choice to diagnose cardiac tamponade ?

a. echocardiography
b. X ray
c. ECG
d. MRI

answer a . echocardiography . since immediate treatment of cardiac tamponade can save the life of the patient , it is important to diagnose it early by echocardiography .

10q: what is the treatment of choice to treat a patient with pericardial tamponade ?

a. pericardiocentesis
b. defibrillation
c. conservative treatment
d. opening the thorax surgically and draining the fluid

answer a . pericardiocentesis . echocardiography guided pericardiocentesis using an apical , parasternal or subxiphoid approach must be carried out at once as reduction of the elevated intrapericardial pressure may be lifesaving .

154 - cardiac tamponade mcqs - part 1

1q: what is the characteristic appearance of heart in cardiac tamponade ?

a. figure of 8 appearance
b. wer vase heart
c. coren sabot
d. ter bottle heart

answer d. water bottle heart

2q: the three most common causes of cardiac tamponade are all except ?

a. neoplastic disease
b. idiopathic pericarditis
c. pericardial effusion
d. cardiac catheterization

answer d . cardiac catheterization is also a cause of cardiac tamponade but is less frequent when compared to the other three mentioned .

3q: what is the characteristic triad associated with cardiac tamponade ?

a. beck’s triad
b. sandblom’s triad
c. whipple’s triad
d. murphy’s triad

answer a . beck’s triad .

4q: all of the following are features of beck’s triad except ?

a. soft or absent heart sounds
b. hypotension
c. jugular venous distension
d. prominent y descent

answer d . prominent x descent and absent y descent,associated with jugular venous distension are characteristic of cardiac tamponade .

5q: all of the following are true about cardiac tamponade except ?

a. it can result by even 200 ml of fluid in the pericardial space , if it develops rapidly
b. in slowly developing effusions more than 2000 ml of fluid can exist in the pericardial space
c. the volume of fluid required to produce cardiac tamponade varies directly with the thickness of the ventricular myocardium
d. the volume of fluid required to produce cardiac tamponade varies directly with the thickness of parietal pericardium

answer d is a false statement . the volume of fluid required to produce cardiac tamponade varies inversely with the thickness of the parietal pericardium .