Trauma: cardiac tamponade: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Trauma: cardiac tamponade

Sample item

A 26-year-old man with a stab wound in the left parasternal fourth intercostal space is hypotensive with distended neck veins and muffled heart sounds. FAST shows pericardial fluid. What is the best definitive management?

ALarge-volume crystalloid bolus aloneBNeedle decompression of the left chestCCT chest before any interventionDEmergency sternotomy or pericardial window with repair of the cardiac wound

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Emergency sternotomy or pericardial window with repair of the cardiac wound

Penetrating injury with Beck triad (hypotension, raised venous pressure, muffled heart sounds) and pericardial fluid on FAST indicates tamponade from a cardiac wound. Definitive treatment is urgent operative exploration with repair of the myocardial laceration. Pericardiocentesis can be a temporising manoeuvre but clotted blood limits its effectiveness.

Option by option

A. Large-volume crystalloid bolus alone
Fluid alone only transiently improves filling and does not relieve tamponade.
B. Needle decompression of the left chest
Needle decompression treats tension pneumothorax, which does not explain raised neck veins with muffled heart sounds and pericardial fluid.
C. CT chest before any intervention
Sending an unstable patient for CT wastes critical minutes.
D. Emergency sternotomy or pericardial window with repair of the cardiac wound (correct)
Correct. Surgical decompression and cardiac repair is the definitive treatment.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Emergency sternotomy or pericardial window with repair of the cardiac wound. Penetrating injury with Beck triad (hypotension, raised venous pressure, muffled heart sounds) and pericardial fluid on FAST indicates tamponade from a cardiac wound.

Why is "Large-volume crystalloid bolus alone" not the answer?

Fluid alone only transiently improves filling and does not relieve tamponade.

Why is "Needle decompression of the left chest" not the answer?

Needle decompression treats tension pneumothorax, which does not explain raised neck veins with muffled heart sounds and pericardial fluid.

Why is "CT chest before any intervention" not the answer?

Sending an unstable patient for CT wastes critical minutes.

What concept does this question test?

It tests Trauma: cardiac tamponade in General Surgery. Definitive treatment is urgent operative exploration with repair of the myocardial laceration. Pericardiocentesis can be a temporising manoeuvre but clotted blood limits its effectiveness.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Trauma: cardiac tamponade?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.