WBR0020
| Author | PageAuthor::Aarti Narayan, Raviteja Reddy Guddeti |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | |
| 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. An 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::Pulsus bisferiens |
| Answer A Explanation | AnswerAExp::Pulsus bisferiens is a sign where on palpation of the pulse, a double peak in the aortic waveform is observed with each cardiac cycle. |
| Answer B | AnswerB::Pulsus tardus |
| Answer B Explanation | AnswerBExp:: |
| Answer C | AnswerC::Pulses bigeminus |
| Answer C Explanation | AnswerCExp:: |
| Answer D | AnswerD::Pulsus paradoxus |
| Answer D Explanation | AnswerDExp:: |
| Answer E | AnswerE::Pulsus parvus et tardus |
| 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 called paradoxic or 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 |
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| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |