Rosh Internal Medicine Boost Practice Exam

What is the most likely diagnosis for a patient with a knife wound to the chest, presenting with hypotension, tachycardia, and jugular venous distention?

1. Cardiac tamponade

2. Pericarditis

3. Pneumothorax

4. Pulmonary embolism

The correct answer is: Cardiac tamponade

The presentation of a knife wound to the chest coupled with hypotension, tachycardia, and jugular venous distention strongly suggests cardiac tamponade. In this scenario, the knife wound could have led to bleeding into the pericardial space, resulting in fluid accumulation or blood (hemopericardium) that exerts pressure on the heart, impairing its ability to fill and pump effectively. The symptoms of hypotension and tachycardia are indicative of shock, which occurs as the heart struggles to maintain an adequate cardiac output due to the constraints of the surrounding fluid. Jugular venous distention further supports this diagnosis, as it indicates increased venous pressure, commonly seen in cases of cardiac tamponade. This triad of hypotension, tachycardia, and jugular venous distention is known as Beck's triad, which is characteristic of cardiac tamponade. The other options do not align as closely with the acute presentation following trauma. Pericarditis, while related to inflammation of the pericardium, typically does not present acutely with hypotension unless it progresses to tamponade. Pneumothorax could cause hypotension and tachycardia, especially if it was tension