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A 22-year-old man is brought to the ED 30 minutes after a stab wound to the left fifth intercostal space. Pulse 128/min, BP 78/50 mmHg. Neck veins are distended, heart sounds are distant. ECG shows electrical alternans and low voltage. Bedside echo reveals a large pericardial effusion with right ventricular diastolic collapse. Which of the following hemodynamic findings is most likely present?
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NBME-style vignettes, Anki cloze cards, structured summaries, or topic outlines. Adjust difficulty to match your level.
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Multi-step clinical vignettes with realistic distractors, written using few-shot prompting on real Step exam patterns.
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A real NBME-style question generated from a paragraph of cardiology notes.
A 58-year-old man with a 30-pack-year smoking history and chronic productive cough is brought to the ED after an episode of syncope. Temperature 37.1°C, pulse 88/min, BP 95/60 mmHg. Physical examination shows facial plethora, jugular venous distension that does not vary with respiration, and bilateral upper extremity edema. Chest CT reveals a large central mass encasing the mediastinal vasculature. Serum sodium is 128 mEq/L and serum osmolality is 268 mOsm/kg. Which of the following is the most likely cause of this patient's hyponatremia?
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