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

1. Q:1 Indication for tracheostomy are all, EXCEPT:
A: Flail chest
B: Head injury
C: Cardiac Tamponade
D: 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.
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Q:2
A patient developed breathlessness and chest pain, on second postoperative day
after a total hip replacement. Echo­cardiography showed right ventricular
dilatation and tricuspid regurgitation. What is the most likely diagnosis?
A: Acute MI
B: Pulmonary embolism
C: Hypotensive shock
D: Cardiac tamponade
Correct Ans:B
Explanation
The clinical history corresponding to the diagnosis of pulmonary embolism. For a
patient presenting with acute breathlessness and chest pain and in whom right
ventricular dilatation with tricuspid regurgitation and mild elevation of pulmonary
artery pressure is noted, a pulmonary embolus should be the initial diagnosis to be
considered.
Ref: Deep Vein Thrombosis and Pulmonary Embolism, Page 253, 254; Feigenbaum's
Echocardiography, 7th Edition, Page 762.
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Q:3 All of the following are cardiovascular complications of HIV infection, EXCEPT:
A: Aortic Aneurysm

2. B: Cardiomyopathy
C: Pericardial Effusion
D: Cardiac Tamponade
Correct Ans:A
Explanation
The most common cardiac disease associated with HIV is coronary heart disease, it is
associated with a CD4+ T cell count of <500/ L. Other cardiac manifestations include
dilated cardiomyopathy associated with congestive heart failure (CHF) ( HIV­associated
cardiomyopathy), pericardial effusions, cardiac tamponade and nonbacterial thrombotic
endocarditis.
Ref: Harrison’s Internal Medicine, 18th Edition, Page 189;Hospital Medicine By
Robert.M.Watchter, Page 479
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Q:4
A 30 year old man with history of blunt trauma to the chest presents with dialated
neck veins, BP 80/50mmHg and pulse rate of 100/ min. What is the most likely
diagnosis?
A: Cardiac tamponade
B: Right ventricular failure
C: Traumatic pneumothorax
D: Hemothorax
Correct Ans:A
Explanation
Cardiac tamponade may result from bleeding into the pericardial space after cardiac
operations, trauma, and treatment of patients with acute pericarditis with
anticoagulants. The accumulation of fluid in the pericardial space in a quantity
sufficient to cause serious obstruction to the inflow of blood to the ventricles results in
cardiac tamponade, giving rise to decrease in stroke volume and decreased cardiac
output.
Beck's triad are hypotension, soft or absent heart sounds, and jugular venous
distention with a prominent x descent but an absent y descent. Paradoxical Pulse is an
important clue to the presence of cardiac tamponade, consists of a >10mmHg
inspiratory 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
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Q:5 Kussmaul's sign is seen in all of the following, except:

3. A: Restrictive cardiomyopathy
B: Right ventricular infarction
C: Constrictive pericarditis
D: Cardiac tamponade
Correct Ans:D
Explanation
Kussmaul's sign is defined by either a rise or a lack of fall of the JVP with inspiration
and is classically associated with constrictive pericarditis. It is also seen in patients
with restrictive cardiomyopathy, massive pulmonary embolism, right ventricular
infarction, and advanced left ventricular systolic heart failure.
Ref: Harrison’s Internal Medicine, 18th Edition, Pages 1823, 1972­74
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Q:6
A post­operative cardiac surgical patient developed sudden hypotension, raised
central venous pressure, pulsus paradoxus at the 4th post operative hour. Which
of the following is the most probable diagnosis?
A: Ventricular dysfunction
B: Cardiac tamponade
C: Congestive cardiac failure
D: Excessive mediastinal bleeding
Correct Ans:B
Explanation
This patient is showing features suggestive of cardiac tamponade, which occurred
secondary to bleeding into the pericardial space following cardiac surgery. Cardiac
tamponade occurs when fluid accumulate in the pericardial space in a quantity
sufficient 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 after
cardiac operations, trauma, and treatment of patients with acute pericarditis with
anticoagulants.
Clinical features: The three principal features are hypotension, soft or absent heart
sounds, and jugular venous distention with a prominent x descent but an absent y
descent(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 the
P, QRS, or T waves.
Ref: Harrison’s Internal Medicine, 18th Edition, Chapter 239
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4. Q:7
Following cardiac surgery a patient developed sudden hypotension, raised central
venous pressure, pulsus paradoxus at the 4th post operative hour. The patient is
suffering from?
A: Excessive mediastinal bleeding
B: Ventricular dysfunction
C: Congestive cardiac failure
D: Cardiac tamponade
Correct Ans:D
Explanation
Cardiac tamponade is characterized by Beck’s triad
1. Hypotension
2. Jugular venous distension
3. Soft or absent cardiac sounds
Pulsus paradoxus is also described in Cardiac tamponade. In
excessive mediastinal bleeding there will not be, raised central
venous pressure and pulsus paradoxus. Other features of Cardiac
tamponade 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
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Q:8
35 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 plaque
like calcification over RV with dilated SVC and small atria. He is suffering from
A: Cardiac Tamponade
B: Restrictive Cardiomyopathy
C: Right Ventricular MI
D: 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

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Q:9 Cardiovascular complications of HIV infection include all of the following, except‑
A: Pericardial effusion
B:
Cardiac
tamponade
C: Cardiomyopathy
D: 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 the
general 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) may
have negative effects on the serum lipid prolife, these are modest and the
incremental cardiac risk associated with HAART is small and they may be easily
managed with current guidelines that recommend lifestyle treatment and
pharmacotherapy currently used by general population.
Cardiovascular complications in order of frequency
Complications Comments
• Pericardial effusions
(21%)
/Pericardial tamponade
(9%)
Pericardial effusion is one of the most common clinically
relevant cardiac
complication. It can have a wide range of manifestations
including asymptomatic
effusion, cardiac tamponade, acute or chronic pericarditis and
uncommonly
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 bacterial
thrombotic

6. Endocarditis
• Primary pulmonary
hypertension
• Right ventricular and
pulmonary
disease
• Accelarated
Atherosclerosis
Due to drugs protease inhibitors
• Autonomic dysfunction
• Arryhthmias
• Lipodystrophy Due to drugs/protease inhibitors
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Q:10 Causes of raised J.V.P. with hypotension are allexcept
A: >Cardiac tamponade
B: >Right ventricular M.I.
C: >Heart failure
D: >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 tamponade
Constrictive pericarditis
Right ventricular wall M.I.
Restrictive cardiornyopathy
Right heart failure
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Q:11 D­dimer is the most sensitive test for­
A: Pulmonary embolism
B: Acute pulmonary edema
C: Cardiac tamponade

7. 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 the
blood after blood clot is degraded by fibrinolysis.
o It is so named because it contains two crosslinked D fragments of the fibrinogen
protein.
D­dimer concentration may be determined by a blood test to help diagnose
thrombosis.
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), D­dimers
may aid in diagnosis.
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