What is the normal amount of pericardial fluid?

1. 0
   
2. 20–50 cm³
   
3. 50–100 cm³
   
4. 100–200 cm³

Which of the following statements about pericardial anatomy is incorrect?

1. Visceral layer is thin and has a single layer of mesothelial cells adherent to epicardial fat and reflected at the base onto parietal pericardium
   
2. The parietal pericardium is tough and fibrous; it is flask-shaped and has attachments to sternum and diaphragm
   
3. The visceral and parietal layers are adherent to each other
   
4. There are two pericardial sinuses
   
5. The parietal pericardium is continuous with adventitia of great vessels

Which of the following statements about pericardial sinuses are correct?

1. The transverse sinus is between ascending aorta and pulmonary trunk anteriorly and superior vena cava posteriorly
   
2. The oblique sinus is posterior to the left atrium and lies between left and right pulmonary veins
   
3. Both A and B are correct
   
4. Neither A nor B are correct

What is the normal intrapericardial pressure?

1. 0 ± 3 mmHg
   
2. 5 ± 3 mmHg
   
3. 10 ± 3 mmHg
   
4. 15 ± 3 mmHg

A 24-year-old man presents with 5-day history of low-grade fever, malaise, and cough and recent chest pain. He has a triphasic pericardial rub and concave-up ST elevation in most of the electrocardiogram (ECG) leads. Erythrocyte sedimentation rate (ESR) is 96 mm at the end of first hour, and complete blood count is normal. Serum troponin I level is 15 times the normal. What is the most likely cause of his pericarditis?

1. Idiopathic
   
2. Viral
   
3. Bacterial
   
4. Tubercular

What is the most common type of pericardial rub in acute pericarditis?

1. Triphasic
   
2. Biphasic
   
3. Monophasic
   
4. Quadriphasic

Some of the characteristics of pericardial rub include which of the following?

1. Scratchy or grating superficial sound that is heard close to the ears; best heard with diaphragm with pressure
   
2. Best heard sitting up, leaning forward, in expiration
   
3. May vary with position and heartbeats
   
4. All of the above
   
5. None of the above

What is the most common etiology of acute pericarditis?

1. Idiopathic
   
2. Viral
   
3. Bacterial
   
4. Autoimmune

Some of the acute ECG changes during acute pericarditis include which of the following?

1. Concave-up ST elevation with upright T in most of the leads; ST depression in aVR
   
2. PR segment depression in most of the leads
   
3. PR segment elevation in aVR
   
4. All of the above

Acute pericarditis can be differentiated from early repolarization by which of the following features?

1. Progressive changes over days
   
2. PR segment depression
   
3. ST segment/T wave height ratio of >0.25
   
4. All of the above

A 52-year-old man underwent successful left anterior descending artery stent placement for acute anterior ST-elevation myocardial infarction (MI). The next day he complains of left-sided severe chest pain on inspiration and you hear a triphasic, grating sound at low left sternal border. What is the explanation likely to be?

1. Focal pericarditis due to transmural MI
   
2. Dressler’s syndrome
   
3. Ventricular septal rupture
   
4. Left anterior descending artery perforation

Which of the following would you suggest for the patient in Question 18.11?

1. Increase the dose of aspirin
   
2. Start indomethacin
   
3. Start corticosteroid
   
4. Start heparin

Three weeks after mitral valve repair, a 56-year-old patient presents with features of pericarditis, fever, and normal complete blood count. He is on aspirin 81 mg/day and warfarin for postoperative atrial fibrillation along with low-dose amiodarone. He is in sinus rhythm. What would you recommend?

1. Start corticosteroids
   
2. Stop warfarin and increase the dose of aspirin to 3 g/day with food, in divided doses for 2 weeks
   
3. Start colchicine
   
4. No change in treatment

A 30-year-old man with no other issues is admitted with a second episode of acute pericarditis in 2 months. The first episode was treated with a 10-day course of the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen, 400 mg TID. His autoantibodies were negative. What is your recommendation?

1. Start high-dose NSAID along with colchicine 0.6 mg BID
   
2. Start indomethacin because of ibuprofen failure
   
3. Start high-dose steroid with rapid taper
   
4. Start high-dose steroid with slow taper and low-dose maintenance for 3–6 months

In a patient with suspected tubercular pericarditis, which test is likely to give the highest diagnostic yield?

1. Acid-fast bacilli culture of pericardial fluid
   
2. Tuberculin test
   
3. Pericardial biopsy
   
4. Adenosine deaminase elevation in pericardial fluid

On pericardial biopsy, caseating granulomas are seen. What is the likely cause of pericarditis?

1. Tuberculosis
   
2. Sarcoid
   
3. Rheumatoid
   
4. Fungal

Which of these drugs can potentially result in pericarditis?

1. Hydralazine
   
2. Methyldopa
   
3. Penicillin
   
4. Sodium cromoglycate
   
5. All of the above
   
6. None of the above

What is the most common cause of malignant pericardial effusion with tamponade?

1. Lung cancer
   
2. Breast cancer
   
3. Lymphoma
   
4. Renal cancer

Indications for pericardiocentesis in a patient with pericarditis include which of the following?

1. Tamponade
   
2. Suspicion of pyogenic cause
   
3. Nonresolving, large effusion despite treatment
   
4. All of the above

What is the best approach for pericardiocentesis?

1. Subxiphoid with ECG monitoring of a lead connected to the needle
   
2. Echo guided
   
3. Magnetic resonance imaging (MRI) guided
   
4. Surgical

What is the normal pericardial thickness?

1. <3 mm on echo
   
2. <2 mm on computed tomography (CT)
   
3. <4 mm on MRI
   
4. All of the above