Rosh Cardio Quiz Study Guide Graded A+

An 8-year-old boy presents to the emergency department with a five-day history of low-grade fever, runny nose, and hacking cough. Yesterday, he started complaining of some chest pain that is worse with lying flat on his back. The patient appears non-toxic, and you note that while seated on the exam table, he is leaning forward in a tripod position. Physical exam reveals a pericardial friction rub on auscultation, and a chest radiograph shows a slightly enlarged heart. Which of the following is the most likely diagnosis? A) Bacterial endocarditis B) Constrictive pericarditis C) Systemic lupus erythematosus D) Viral pericarditis {Ans: Explanation: Infective pericarditis is an infection of the pericardium that can be caused by bacteria, fungi, parasites, or viruses. Viral pericarditis is the most common type in both children and adults, with coxsackievirus B being the most common cause. Infection of the pericardium can lead to pericardial effusion which can cause decreased cardiac output, hemodynamic instability, tamponade, and death. Patients present with fever and chest pain often radiating to the left shoulder that is relieved with sitting forward and worse with lying down and deep breathing. Patients may often present with a hacking cough, runny nose, diarrhea, and rash.