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Review
of Clinical Signs

Pulsus Paradoxus

Series Editor and Author: Frank L. Urbano, MD

1. Which of the following statements about the pathophysiology of pulsus paradoxus is true?
  1. Changes in intrathoracic pressure associated with breathing consequently lead to changes in the pressure gradients along which blood leaves or enters the thorax.
  2. 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)
  3. The decrease of pleural pressures causes a concomitant decrease in the gradient from the venous system to the right ventricle.
  4. 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:

  1. The sphygmomanometer is inflated above systolic blood pressure.
  2. 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.
  3. Peak systolic blood pressure during inspiration is identified and reconfirmed.
  4. The blood pressure at which Korotkoff sounds become audible during both inspiration and expiration is measured.
  5. 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:
  1. Asthma
  2. Emphysema
  3. Cardiac tamponade secondary to pericardial effusion
  4. Pericarditis
  5. Myocardial infarction
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4. Which of the following is the most common noncardiac cause for pulsus paradoxus?

  1. Asthma
  2. Pulmonary embolism
  3. Emphysema
  4. Bronchiectasis
  5. Hypovolemia
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