This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Miscellaneous, Subject name: Surgery
A 32-year-old male janitor complains of a swollen face during the past week. A CT scan reveals an expanding hematoma in the superior mediastinum. Mediastinal tamponade is most likely to manifest as which of the following? 
Select and explain. 
A. Hypertension, B. Increased pulse pressure during inspiration, C. Paresis of the right arm, D. Venous congestion in the upper extremity
D: Venous congestion in the upper extremity
Answer: D: Venous congestion in the upper extremity 
Explanation: In mediastinal tamponade, hypotension, dyspnea, cyanosis, and a decrease in pulse pressure will be evident. During inspiration, the pulse pressure is further impeded to cause obstruction to transmitted ACV waves in the neck; in congestive cardiac failure, the ACV waves recorded in the neck are more prominent. Paresis of the arm is unlikely to occur because the lower part of the brachial plexus (T1) passes along the inner border of the first rib to reach the neck.