Kussumaul’sing is not seen in-
**Core Concept**
Kussumaul's sign, also known as paradoxical pulsus paradoxus, is a clinical sign observed during physical examination where the pulse becomes weaker during inspiration and stronger during expiration. This phenomenon is associated with increased intrathoracic pressure and its effects on the cardiovascular system.
**Why the Correct Answer is Right**
The Kussumaul's sign is typically seen in conditions that lead to increased intrathoracic pressure, such as constrictive pericarditis, cardiac tamponade, or severe asthma. In these conditions, the increased intrathoracic pressure during inspiration leads to a decrease in venous return, resulting in a weaker pulse. On the other hand, during expiration, the intrathoracic pressure decreases, allowing for increased venous return and a stronger pulse.
**Why Each Wrong Option is Incorrect**
**Option A:** Kussumaul's sign is indeed seen in constrictive pericarditis, where the rigid pericardium prevents the heart from expanding during diastole, leading to increased intrathoracic pressure and its characteristic pulsus paradoxus.
**Option B:** While cardiac tamponade can cause pulsus paradoxus, Kussumaul's sign is more specifically associated with constrictive pericarditis.
**Option C:** Severe asthma can also cause pulsus paradoxus due to increased intrathoracic pressure, but it is not the best example of a condition where Kussumaul's sign is not seen.
**Option D:** This option is the correct answer because Kussumaul's sign is not typically seen in obstructive lung diseases such as COPD. In COPD, the increased intrathoracic pressure during inspiration is not as pronounced as in constrictive pericarditis or cardiac tamponade, and therefore, the characteristic pulsus paradoxus is not observed.
**Clinical Pearl / High-Yield Fact**
Kussumaul's sign is an important clinical sign that can help distinguish between constrictive pericarditis and other conditions that may cause pulsus paradoxus.
**Correct Answer:** D.