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(Created page with "{{WBRQuestion |QuestionAuthor=Aarti Narayan, Raviteja Reddy Guddeti |ExamType=USMLE Step 3 |Prompt=A 60 yr old female with chronic kidney disease presented to the ER with symp...") |
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|ExamType=USMLE Step 3 | |ExamType=USMLE Step 3 | ||
|Prompt=A 60 yr old female with chronic kidney disease presented to the ER with symptoms of breathlessness, orthopnea, chest pain, and dizziness. On auscultation, heart sounds were faint. EKG showed low voltage complexes. Blood pressure was 90/50 mm Hg. Lung fields were clear. What additional finding is expected on palpation of radial pulse? | |Prompt=A 60 yr old female with chronic kidney disease presented to the ER with symptoms of breathlessness, orthopnea, chest pain, and dizziness. On auscultation, heart sounds were faint. EKG showed low voltage complexes. Blood pressure was 90/50 mm Hg. Lung fields were clear. What additional finding is expected on palpation of radial pulse? | ||
|Explanation= The correct answer is Pulsus paradoxus (PP). The patient in this vignette is suffering from cardiac tamponade most likely secondary to uremic pericarditis. Tamponade is strongly suggested by the muffled hear sounds, low voltage EKG, dyspnea and chest pain. The hallmark of cardiac tamponade on physical exam is pulsus paradoxus. Pulsus paradoxus (PP), also paradoxic pulse and paradoxical pulse, is an exaggeration of the normal variation in the pulse and drop of systolic blood pressure during the inspiratory phase of respiration, in which the pulse becomes weaker as one inhales and stronger as one exhales. It is a sign that is indicative of several conditions including cardiac tamponade and lung diseases (e.g.asthma, COPD). | |||
|Approved=No | |Approved=No | ||
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Revision as of 20:00, 12 February 2013
| Author | PageAuthor::Aarti Narayan, Raviteja Reddy Guddeti |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
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| Sub Category | |
| Prompt | [[Prompt::A 60 yr old female with chronic kidney disease presented to the ER with symptoms of breathlessness, orthopnea, chest pain, and dizziness. On auscultation, heart sounds were faint. EKG showed low voltage complexes. Blood pressure was 90/50 mm Hg. Lung fields were clear. What additional finding is expected on palpation of radial pulse?]] |
| Answer A | AnswerA:: |
| Answer A Explanation | AnswerAExp:: |
| Answer B | AnswerB:: |
| Answer B Explanation | AnswerBExp:: |
| Answer C | AnswerC:: |
| Answer C Explanation | AnswerCExp:: |
| Answer D | AnswerD:: |
| Answer D Explanation | AnswerDExp:: |
| Answer E | AnswerE:: |
| Answer E Explanation | AnswerEExp:: |
| Right Answer | RightAnswer:: |
| Explanation | [[Explanation::The correct answer is Pulsus paradoxus (PP). The patient in this vignette is suffering from cardiac tamponade most likely secondary to uremic pericarditis. Tamponade is strongly suggested by the muffled hear sounds, low voltage EKG, dyspnea and chest pain. The hallmark of cardiac tamponade on physical exam is pulsus paradoxus. Pulsus paradoxus (PP), also paradoxic pulse and paradoxical pulse, is an exaggeration of the normal variation in the pulse and drop of systolic blood pressure during the inspiratory phase of respiration, in which the pulse becomes weaker as one inhales and stronger as one exhales. It is a sign that is indicative of several conditions including cardiac tamponade and lung diseases (e.g.asthma, COPD). Educational Objective: |
| Approved | Approved::No |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |