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Peptic ulcer disease — USMLE Step 2 CK MCQ

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HardInternal MedicinePeptic ulcer diseaseUSMLE Step 2 CK

A 59-year-old man previously treated with mediastinal radiation has progressive edema, ascites and exertional dyspnea. Imaging shows dense pericardial calcification, septal bounce and respirophasic ventricular interdependence without active pericardial inflammation. Diuretics provide only transient relief. What is the definitive treatment?

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Correct answer: C — Refer for surgical pericardiectomy at an experienced center

Chronic calcific constrictive pericarditis mechanically limits diastolic filling and causes systemic venous congestion. Without active inflammation and with persistent limiting symptoms, complete surgical pericardiectomy is the definitive therapy, although prior radiation increases operative risk and warrants expert-center evaluation. Anti-inflammatory therapy is useful for transient inflammatory constriction, not burned-out calcification. Pericardiocentesis treats fluid tamponade, a pacemaker does not remove the constricting shell, and pulmonary vasodilators do not correct pericardial restraint.

Reference: American College of Cardiology: Calcific constrictive pericarditis. https://www.acc.org/education-and-meetings/patient-case-quizzes/2021/04/09/12/31/calcific-constrictive-pericarditis