WBR0016

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Author Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS
Exam Type USMLE Step 2 CK
Main Category Internal medicine
Sub Category Cardiovascular
Prompt A 45 year old male presented to the office with complaints of dyspnea and mild retrosternal chest pain radiating to the back and the shoulders. It is aggravated with lying down and coughing, and is relieved by sitting up and leaning forward. Physical examination is essentially normal. EKG shows widespread ST elevations and PR segment depressions. Echocardiogram showed mild effusion in the pericardial sac. Over the subsequent days, he developed progressive dyspnea. A therapeutic pericardiocentesis showed bloody fluid. What is the most likely diagnosis?
Answer A Tuberculous pericarditis
Answer A Explanation This is the correct answer.
Answer B Coxsackie virus pericarditis
Answer B Explanation Coxsackie virus pericarditis will give a clear transudative pericardial effusion.
Answer C Collagen vascular disease induced pericarditis
Answer C Explanation Collagen vascular disease induced pericarditis will give a clear transudative pericardial effusion.
Answer D Myxedema
Answer D Explanation Myxedema induced pericarditis will give a clear transudative pericardial effusion.
Answer E Drug induced pericarditis
Answer E Explanation Drug induced pericarditis will give a clear transudative pericardial effusion.
Right Answer A
Explanation The correct answer is tuberculous pericarditis. Among all of the options given, TB pericarditis is the only cause of bloody pericardial effusion. Malignant pericarditis is another cause of bloody pericardial effusion. Other rare causes are rheumatic fever, post-cardiac injury, post-myocardial infarction and uremic pericarditis.

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