Step 2

Cardiovascular 14

A 63-year-old man presents to his primary care physician for evaluation of fatigue, shortness of breath while walking, and swelling in his legs, which have gotten worse over the last several months. Past medical history is significant for radiation therapy to the base of the neck 10 years ago for squamous cell carcinoma. Physical examination reveals peripheral edema in the legs, hepatomegaly, and mild ascites. Chest radiograph reveals pericardial calcifications.

Which of the following additional features is most likely present in this patient?

  • A) Audible S3 heart sound
  • B) Biventricular enlargement
  • C) Kussmaul sign
  • D) Pericardial knock in early systole
  • E) Proteinuria

Authors

Alexandra Conway

Editor

Dr. Ted O'Connell

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