PANRE Cardiology 5 — Questions and Answers
Question 1: A 48-year-old woman with lupus develops worsening dyspnea and JVD. Echo shows a large pericardial effusion. Pulsus paradoxus is 18 mmHg. What is the definitive treatment?
- High-dose IV corticosteroids
- Pericardiocentesis (Correct answer)
- NSAIDs and colchicine
- Urgent surgical pericardiectomy
Correct answer: Pericardiocentesis
Pericardiocentesis is the definitive treatment for cardiac tamponade causing hemodynamic compromise.
Question 2: Which finding differentiates restrictive cardiomyopathy from constrictive pericarditis on echocardiography?
- Reduced LVEF
- Septal bounce on M-mode
- Increased tissue Doppler E' velocity (Correct answer)
- Respiratory variation in mitral inflow <25%
Correct answer: Increased tissue Doppler E' velocity
Increased tissue Doppler E' velocity is seen in constrictive pericarditis (extrinsic constraint, normal myocardium); restrictive cardiomyopathy shows reduced E' due to abnormal myocardium.
Question 3: A 55-year-old man post-CABG develops new-onset fever, pleuritic chest pain, and pericardial rub on day 10. What is the most likely diagnosis?
- Sternal wound infection
- Post-cardiac injury syndrome (Dressler syndrome) (Correct answer)
- Pulmonary embolism
- Recurrent MI
Correct answer: Post-cardiac injury syndrome (Dressler syndrome)
Dressler syndrome is an autoimmune pericarditis occurring weeks after cardiac surgery or MI, presenting with fever, pleuritic pain, and friction rub.
Question 4: In a patient with chronic kidney disease and new-onset atrial fibrillation, which anticoagulant requires dose adjustment and should be used with caution as GFR declines below 30?
- Warfarin
- Apixaban
- Rivaroxaban
- Dabigatran (Correct answer)
Correct answer: Dabigatran
Dabigatran is renally cleared (80%) and is contraindicated with GFR <15-30; other DOACs have less renal dependence but still require dose adjustments.
Question 5: A 30-year-old athlete collapses during a basketball game and is found to be in ventricular fibrillation. After resuscitation, which condition is most likely?
- Dilated cardiomyopathy
- Long QT syndrome type 1
- Hypertrophic cardiomyopathy (Correct answer)
- Wolff-Parkinson-White syndrome
Correct answer: Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in young athletes in the United States.
Question 6: Which hemodynamic profile is characteristic of cardiogenic shock?
- Low CVP, low PCWP, high CO, low SVR
- High PCWP, low CO, high SVR (Correct answer)
- Low PCWP, high CO, low SVR
- High CVP, high CO, low SVR
Correct answer: High PCWP, low CO, high SVR
Cardiogenic shock is characterized by elevated filling pressures (high PCWP), reduced cardiac output, and compensatory increased systemic vascular resistance.
Question 7: A patient with stable angina is intolerant of beta-blockers and nitrates. Which agent is an appropriate alternative for angina prophylaxis?
- Aspirin 325 mg daily
- Ranolazine
- Ivabradine (if sinus rhythm and HR >70)
- Either B or C (Correct answer)
Correct answer: Either B or C
Both ranolazine (reduces late Na current, improving diastolic relaxation) and ivabradine (If channel blocker reducing HR) are approved alternatives for angina when first-line agents are not tolerated.
PANRE Cardiology 5
A 48-year-old woman with lupus develops worsening dyspnea and JVD.
Echo shows a large pericardial effusion.
Pulsus paradoxus is 18 mmHg.
What is the definitive treatment?