1 Week Of Progressive in Medicine / Internal Medicine — 55yo Man | Nephrology | SMLE Q#11418
SMLE Question #11418
Medicine / Internal Medicine
Nephrology
Objective: OBJ-188
Last updated: February 2026
A 55-year-old man with end-stage kidney disease on maintenance hemodialysis presents with 1 week of progressive dyspnea, orthopnea, and bilateral leg swelling. Examination shows raised jugular venous pressure, muffled heart sounds, and bilateral pitting edema. Transthoracic echocardiography shows a large circumferential pericardial effusion with no right-sided diastolic collapse. What is the most appropriate next step in management?
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