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Prioritising Pericardial Over Pleural Drainage — SCE Palliative Medicine MCQ

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HardRespiratory SymptomsPrioritising Pericardial Over Pleural DrainageSCE Palliative Medicine

A 64‑year‑old woman with advanced ovarian cancer develops bilateral pleural effusions and a pericardial effusion simultaneously. She is breathless, has a raised JVP, and muffled heart sounds. What is the most urgent intervention?

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Correct answer: C — Immediate pericardiocentesis under ultrasound guidance

The patient demonstrates classic features of cardiac tamponade (Beck’s triad: raised JVP, muffled heart sounds, breathlessness implying hypotension). Cardiac tamponade is a medical emergency that requires urgent pericardial decompression via pericardiocentesis. Although concurrent pleural effusions may contribute to mediastinal pressure, the immediate life‑threat is tamponade. Thoracentesis, diuresis, steroids, or staged drainage are inappropriate in this urgent setting.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/palliative-care