In non-traumatic pericardial tamponade, which ONE of the following is TRUE?
Answer: C: Patients with cardiac tamponade usually display tachycardia, low systolic BP and a narrow pulse pressure. Malignancy is the cause of about 40% of non-traumatic cases of pericardial tamponade.
Idiopathic, uraemic and infective causes are the next most common. CXR lacks both sensitivity and specificity in this diagnosis. Pulsus paradoxus is not peculiar to pericardial tamponade. Other cardiopulmonary diseases, such as acute asthma, may cause this finding.
Reference:
Regarding infective endocarditis, which ONE of the following statements is TRUE?
Answer: B Three major pathogens account for more than 80% of cases – Streptococcus species, Staphylococcus aureus and Enterococcus species. A single blood culture may not help in identifying the causative organism, especially when the patient is partially treated with antibiotics. The aortic valve is involved in 20% of intravenous drug use (IVDU)-related endocarditis. The Duke criteria has the following major and minor components (Box below).
DUKE criteria for infective endocarditis:
References:
Regarding endocarditis, which ONE of the following statements is TRUE?
Answer: C: Multiple sets of blood cultures prior to antibiotic treatment will yield a microbiological diagnosis in at least 95% of cases. In the toxic patient, empirical antibiotic treatment should be given after three sets of blood cultures from different sites. Otherwise antibiotics should be delayed until blood cultures are positive.
With respect to right-sided endocarditis in intravenous drug users, the most common valve involved is the tricuspid valve (tricuspid 45%, mitral 30% and aortic 20%), and Staphylococcus aureus is responsible for about three-quarters of cases.
Coagulase negative Staphylococcus is less common. Overall mortality of both native and prosthetic valve endocarditis is 20–25%.
In patients presenting to the ED with syncope, which ONE of the following is TRUE?
Answer: A: Clinical examination is the most useful part of diagnosis in patients with syncope. Up to 45% of patients will be diagnosed on clinical examination alone. Further tests are generally of low yield. This includes ECG, which although clearly important, is not often diagnostic in this group. Up to 50% of patients with syncope will not have a clear diagnosis after ED evaluation.
The San Francisco syncope rule is a tool for identifying patients at high risk of adverse outcomes in the following 7 days.
Five criteria are included:
Regarding patients presenting to the ED with syncope, which ONE of the following is TRUE?
Answer: D: Unexplained syncope (up to 50% of ED presentations with syncope) requires further investigation. Inpatient investigation is warranted for those at high risk of cardiac events. Most syncope risk stratification tools are developed for this purpose.
The diagnosis of orthostatic hypotension requires a suggestive history and demonstration of systolic BP reduction of >20 mmHg upon standing. It does not confer any change in mortality.
CT scan of the brain is a very low yield test in this patient population and should only be used for patients with abnormal neurological examination, with historical features suggestive of a neurological cause, or with complication of the syncopal event.
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