1. A 44-year-old patient presents to the emergency department
with chest pain and hypotension. A chest x-ray reveals an
enlarged cardiac silhouette. The point of care troponin test
is 3.4 ng/dL. The emergency department physician orders a
stat echocardiogram suspecting tamponade to be the likely
reason of hypotension.
The most appropriate response would be:
A. An echocardiogram is not indicated now as the patient
needs to be taken for emergent pericardiocentesis, and
echocardiography could be performed at that time but
should not delay this procedure.
B. The cardiac silhouette is not usually enlarged on a chest
x-ray unless the pericardial effusion is at least 200 mL
in volume. However, urgent echocardiography is
indicated to conrm the presence of pericardial uid
and hemodynamic signicance.
C. Initially, an attempt of IV uid should be given. If
the BP increases, the echocardiogram is no longer
D. The abnormally elevated cardiac biomarker makes the
diagnosis of pericardial tamponade highly unlikely.
E. An immediate bedside pericardiocentesis should be
attempted prior to echocardiography.
2. Five different patients were referred to your echocardiography laboratory with a complaint of dyspnea on
exertion, and each was found to have a small- to moderatesized pericardial effusion. Which patient prole is least
likely to be associated with a pericardial effusion on
A. A 32-year-old female who is 34 weeks’ pregnant
B. A 55-year-old female with class III pulmonary
C. A 72-year-old male with hemodynamically severe
D. A 21-year-old male on conventional epilepsy therapy
E. A 45-year-old female with sarcoidosis
3. Which of the following is least likely to be associated with
an elevated cardiac biomarker (troponin) in a patient presenting with pericarditis?
A. Male sex
B. Older age at presentation
C. ST-segment elevation on EKG
D. Gastrointestinal symptoms
E. Echocardiographically demonstrated LV dysfunction
4. A 65-year-old patient undergoes echocardiography for the
evaluation of chest pain. Which of these is the least likely
cause for the anterior echo-free space shown in Figure 44.1?
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