Rosh Internal Medicine Boost Practice Exam

A patient with right upper quadrant pain, jugular venous distention, and echocardiographic findings suggestive of right ventricular hypertrophy is likely suffering from which condition?

1. Congestive heart failure

2. Cor pulmonale

3. Coronary artery disease

4. Ventricular septal defect

The correct answer is: Cor pulmonale

The presence of right upper quadrant pain, jugular venous distention, and echocardiographic findings of right ventricular hypertrophy points towards cor pulmonale. Cor pulmonale refers to the alteration in the structure and function of the right ventricle that occurs as a result of chronic lung disease and consequent pulmonary hypertension. In cases of cor pulmonale, the right ventricle must work harder to pump blood through the pulmonary arteries, leading to hypertrophy. The symptoms of right upper quadrant pain can sometimes be attributed to hepatomegaly or congestion in the liver, which is common when the right heart is failing and pressure increases throughout the venous system. Jugular venous distention reflects elevated central venous pressure, indicative of right heart strain or dysfunction. Therefore, given the combination of symptoms and echocardiographic findings, cor pulmonale is the most fitting diagnosis for this clinical scenario.