Rosh Emergency Medicine Practice Test

What is the most likely diagnosis for a patient presenting with tachycardia, hypotension, and jugular venous distention after a motor vehicle accident?

1. Cardiac tamponade

2. Myocardial infarction

3. Rupture of the mitral chordae tendineae

4. Thoracic aortic aneurysm

The correct answer is: Cardiac tamponade

The presentation described in the scenario—tachycardia, hypotension, and jugular venous distention—suggests a situation where there is compromised circulation, which is often associated with conditions that impede the heart's ability to fill properly or create significant pressure changes in the heart or thoracic cavity. In the context of trauma, cardiac tamponade is a likely diagnosis. This condition occurs when fluid (which can be blood from injuries) accumulates in the pericardial space, exerting pressure on the heart. As a result, the heart's filling is restricted, leading to the observed hypotension (as the heart struggles to pump an adequate volume of blood) and tachycardia (as the body attempts to compensate for the reduced output by increasing heart rate). The jugular venous distention occurs due to increased central venous pressure as the heart does not efficiently pump blood forward, causing backup in the venous system. Other options may present with some overlapping signs but do not fit the full clinical picture as clearly. Myocardial infarction typically presents with chest pain and may not necessarily cause distinct jugular venous distention without other collateral findings or volume overload. Rupture of the mitral chordae tendineae