A trauma patient presents with hypotension, distended neck veins, and muffled heart sounds. Heart rate is 118/min. Which additional finding would most strongly support cardiac tamponade as the cause of shock?

• A Widened pulse pressure
• B Bounding peripheral pulses
• C Exaggerated pulsus paradoxus greater than 10 mmHg ✓
• D Fall in central venous pressure with inspiration

Explanation

Cardiac tamponade produces equalization of diastolic pressures, so systemic systolic pressure falls more than 10 mmHg during inspiration, giving an exaggerated pulsus paradoxus. Kussmaul's sign (a rise, not a fall, in CVP with inspiration) suggests constrictive pericarditis rather than tamponade, killing option D. Tamponade narrows the pulse pressure due to a low stroke volume, so widened pulse pressure and bounding pulses point toward distributive or high-output states instead.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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