Pericardial disease: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Pericardial disease

Sample item

A patient with lung cancer develops dyspnoea, hypotension, distended neck veins and muffled heart sounds. The systolic blood pressure falls by 20 mmHg during inspiration. What is the most appropriate immediate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Echo-guided pericardiocentesis

This is cardiac tamponade with Beck triad and pulsus paradoxus. Pericardial pressure exceeds filling pressure so cardiac output falls. Definitive emergency treatment is drainage by pericardiocentesis, ideally echo-guided, with fluids as a temporising measure.

Option by option

  • A. Intravenous diuretic therapy

    Diuretics reduce preload and worsen haemodynamics in tamponade.

  • B. Echo-guided pericardiocentesis (correct)

    Correct. Removing even a small volume of fluid rapidly restores filling and cardiac output.

  • C. Thrombolysis with alteplase

    Thrombolysis does not address pericardial fluid and risks bleeding into the pericardium.

  • D. Intravenous beta-blocker to slow the heart rate

    Beta-blockers would blunt the compensatory tachycardia on which cardiac output depends.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Echo-guided pericardiocentesis. This is cardiac tamponade with Beck triad and pulsus paradoxus.

Why is "Intravenous diuretic therapy" not the answer?

Diuretics reduce preload and worsen haemodynamics in tamponade.

Why is "Thrombolysis with alteplase" not the answer?

Thrombolysis does not address pericardial fluid and risks bleeding into the pericardium.

Why is "Intravenous beta-blocker to slow the heart rate" not the answer?

Beta-blockers would blunt the compensatory tachycardia on which cardiac output depends.

What concept does this question test?

It tests Pericardial disease in General Medicine. Pericardial pressure exceeds filling pressure so cardiac output falls. Definitive emergency treatment is drainage by pericardiocentesis, ideally echo-guided, with fluids as a temporising measure.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pericardial disease?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.