American Board of Internal Medicine (ABIM) Certification Practice Exam

In the case of acute pericarditis, which feature warrants hospitalization?

1. Stable vital signs

2. Low risk of complications

3. Evidence of cardiac tamponade

4. Patient under physician supervision

The correct answer is: Evidence of cardiac tamponade

In cases of acute pericarditis, the presence of cardiac tamponade is a critical indicator that hospitalization is necessary. Cardiac tamponade occurs when fluid accumulates in the pericardial space, leading to increased pressure on the heart and impaired cardiac function. This can manifest as hypotension, tachycardia, and distended neck veins, which require immediate medical intervention. Hospitalization allows for close monitoring of the patient's hemodynamics and provides access to treatments, which may include pericardiocentesis to relieve the pressure and restore normal heart function. Identifying cardiac tamponade is vital because it transforms the clinical urgency of the condition from a potentially manageable outpatient scenario to a life-threatening emergency. In contrast, having stable vital signs or being assessed as low risk for complications usually allows for outpatient management in cases of acute pericarditis. Similarly, being under physician supervision might imply adequate management in an outpatient setting, which does not necessitate hospitalization unless there are more severe underlying issues such as cardiac tamponade.