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Retired NBME 16 Answers

nbme16/Block 1/Question#28 (reveal difficulty score)
A 35-year-old woman comes to the physician ...
Pericarditis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—cassdawg(1781)
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This is acute pericarditis (FA2020 p313) for the following reasons:

  • Pain exacerbated by inspiration and decreased by leaning forward
  • Friction rub (harsh scratchy sound present in both systole and diastole)
  • Associated with rheumatoid arthritis (autoimmune conditions are associated with fibrinous pericarditis)
  • No true pulsus paradoxus (pulsus paradoxus is >10mmHg decrease in systolic blood pressure during inspiration and is associated with cardiac tamponade though it can be seen in consrtrictive pericarditis as well)
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leap1608  In contrast to pericarditis, there will be decreased heart sounds in cardiac tamponade (since the heart is now insulated by the fluid collection in the pericardial space) +



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