The Anatomy of a Question
A 37-year-old man who received a liver transplant three years ago presents with a two-week history of progressively worsening dyspnea and dull chest pain that is somewhat alleviated by sitting upright and bending slightly forward. His ECG demonstrates global low voltage as well as an electrical alternans pattern. What are the expected findings on this patient’s physical exam?
Answer choice options
- A. Abdominal distention
- B. Auscultated crackles
- C. Chest wall tenderness on palpation
- D. Muffled S1 and S2
The incorrect options (distractors) are not totally wrong. These options can be diagramed as follows:
D.Muffled S1 and S2 Classically associated with tamponade due to fluid in the pericardial sac.
B.Auscultated crackles More closely associated with pneumonia on lung exam.
A.Abdominal distention May be seen in fluid overload state, but less common than muffled heart sounds.
C.Chest wall tenderness on palpation Seen with costochondritis.
The Anatomy of an Explanation
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