What Is the Best Test for This Patient With Distended Neck Veins?

Welcome to the next episode of The Reveal, where we take you inside the mind of a test taker to deconstruct and connect the dots of a board-style question so you can become a better student, transform how you learn, and excel not only on high-stakes exams but also in your general medical knowledge. Let’s get started.

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A 76-year-old man presents to the emergency department with shortness of breath and lightheadedness. Vital signs include blood pressure 70/56 mm Hg, heart rate 124 beats/minute, respiratory rate 22 breaths/minute, and temperature 37.6°C. He has distended neck veins and occasional dropped radial beats. His lungs are clear to auscultation, but his heart sounds are distant. He has some fullness to palpation of the right upper quadrant of his abdomen. Which of the following is the most appropriate diagnostic test?

A) Bedside echocardiography

B) Chest radiograph

C) Computed tomography angiogram of the chest

D) Electrocardiogram

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