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Cardiac tamponade — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsCardiac tamponadeSCE Acute Medicine

A 48-year-old woman is assessed on the acute medical unit. She has metastatic breast cancer, dyspnoea and hypotension. JVP is elevated, heart sounds are soft and bedside ultrasound shows a large pericardial effusion with right atrial collapse. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: A — Cardiac tamponade

Cardiac tamponade is the best answer because hypotension, raised JVP and echo evidence of chamber collapse indicate tamponade. Acute pulmonary oedema is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Pulsus paradoxus and electrical alternans can support the diagnosis, but echo is decisive.

Reference: ESC pericardial disease guideline