Definitive question for Cardiac tamponade USMLE Step 2 /3
Cardiac tamponade USMLE question no 1.
- A 60-year-old man with a history of aortic stenosis who underwent surgical valve replacement 4 days ago presents for a follow-up visit. He complains of severe chest pain that woke him up that morning, as well as fatigue, dyspnea, and anorexia. On physical examination, he has elevated jugular venous pressure and soft heart sounds. The rest of her examination findings are benign, although his extremities feel slightly cool. His temperature is 37°C (98.6°F), the pulse is 94/min, blood pressure is 78/58 mmHg, respiratory rate is 24/min, and oxygen saturation is 100% on room air. An ECG is ordered. What ECG findings will support the suspected diagnosis in this patient?
A. Alternation of QRS complex amplitude between beats
B. An ECG cannot be used to support the diagnosis for this case
C. Diffuse ST-segment elevation on ECG
D. Irregularly irregular rhythm
E. ST-segment depression
Cardiac tamponade USMLE question no 2
2. A 35-year-old woman arrives at the emergency department after being stabbed. She was intubated by the emergency medical staff at the scene. On arrival, she is pale and diaphoretic, blood pressure is 74/54 mm Hg, and the pulse is 140/min. A quick initial survey reveals entry wounds in her left chest and upper abdomen. Breath sounds are equal bilaterally and the abdomen is non-tender. Her neck and forehead veins are enlarged and distended. As intravenous fluids are started, her systolic blood pressure drops to 40 mm Hg, no distal pulses can be felt, and she loses consciousness. Which of the following is the best next step in management?
A. Abdominal ultrasound
B. Administration of 2 units of packed RBCs
C. Chest tube placement
D. CT of chest and abdomen
Cardiac tamponade USMLE question no 3
3. A 48-year-old man with a history of stable angina and a positive exercise stress test presents for cardiac catheterization. During the procedure, he develops tachycardia and becomes hypotensive. The anesthesiologist notices that his systolic pressure falls even further on inspiration. His ECG shows QRS variation with each impulse. Which treatment will most likely lead to a resolution of this patient’s tachycardia and hypotension?
A. Chest tube placement
B. Emergent pericardiocentesis
C. Intravenous fluids
D. Loop diuretics