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Pulsus Paradoxus
Series Editor and Author: Frank L. Urbano, MD
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1. Which of the following statements about the pathophysiology of pulsus
paradoxus is true?
- Changes in intrathoracic pressure associated with breathing consequently lead to
changes in the pressure gradients along which blood leaves or enters the thorax.
- Pulsus paradoxus results from the intimate association between the left
ventricle and the systemic circulation (ie, distension of the arterial system
affects filling of the left ventricle)
- The decrease of pleural pressures causes a concomitant decrease in the gradient
from the venous system to the right ventricle.
- The small increase in venous return causes an increase in preload of the right
ventricle and an increase in left ventricular inflow.
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2. All of the following are components of the elicitation of pulsus paradoxus
EXCEPT:
- The sphygmomanometer is inflated above systolic blood pressure.
- The cuff is deflated at a rate of 2 to 3 mm Hg per beat, and Korotkoff sounds
are searched for over the brachial artery.
- Peak systolic blood pressure during inspiration is identified and reconfirmed.
- The blood pressure at which Korotkoff sounds become audible during both
inspiration and expiration is measured.
- The difference between the blood pressure levels at which Korotkoff sounds occur
in both inspiration and expiration is measured.
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3. All of the following are causes for pulsus paradoxus EXCEPT:
- Asthma
- Emphysema
- Cardiac tamponade secondary to pericardial effusion
- Pericarditis
- Myocardial infarction
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4. Which of the following is the most common noncardiac cause for pulsus
paradoxus?
- Asthma
- Pulmonary embolism
- Emphysema
- Bronchiectasis
- Hypovolemia
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Updated 1/04/08 kkj
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