A 20-year-old man comes to the physician for evaluation of a murmur that was discovered on a routine physical examination. The patient has no discomfort and has not had chest pain, palpitations, dyspnea, exercise intolerance, or syncope. He has no history of chronic illness. He is a college basketball player and exercises regularly. He takes no medications. He says he sometimes smokes marijuana and drinks alcoholic beverages socially on the weekends. His uncle died while playing soccer at age 26 years. Pulse is 65/min, respirations are 12/min, and blood pressure is 117/77 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Physical examination shows clear breath sounds, no jugular venous distention, and no lower extremity edema. Cardiac auscultation discloses a faint systolic murmur heard along the lower left sternal border with the patient in the supine position. Upon standing, a grade 3/6 systolic, crescendo-decrescendo murmur is heard in the same location. Which of the following is most likely contributing to the presence of this patient's cardiac murmur?A. Abnormal opening between the left and right ventriclesB. Calcification of the aortic valveC. Dilation of the tricuspid valve annulusD. Prolapse of the mitral valve leafletE. Systolic anterior motion of the mitral valve

A 24-year-old woman comes to the office due to pressure-like, substernal chest pain that occurs when she exercises.  The patient began noticing the pain approximately 6 months ago when she started to exercise to lose weight.  Prior to that, her lifestyle was largely sedentary.  She has no associated nausea, vomiting, diaphoresis, dyspnea, palpitations, or syncope.  The patient has no significant past medical history but was told as a child that she has a "murmur."  She has no significant family history of heart disease.  Blood pressure is 130/70 mm Hg on the right and 105/55 mm Hg on the left, and pulse is 72/min and regular.  BMI is 29 kg/m2.  A palpable thrill is present in the suprasternal notch.  There is a loud midsystolic murmur best heard at the first right intercostal space.  The lungs are clear to auscultation.  What is the most likely cause of this patient's chest pain?

A 48-year-old man presents to the hospital after passing out during a basketball game with his friends. He was running toward the basket when he “blacked out.” He does not remember how long he was out, but he does remember waking up. On examination, his vitals are normal. Cardiac examination reveals a 3/6 midsystolic crescendo–decrescendo murmur heard best over the right upper sternal border, which radiates to the carotid arteries. The rest of the examination, including a neurologic examination, is normal. An ECG suggests left ventricular hypertrophy. Which of the following symptoms carries the worst prognosis in this condition?Ask StudybuddyGroup of answer choicesPalpitationsDyspnea from pulmonary edemaSyncopeAngina

A 48-year-old man presents to the hospital with swelling of the abdomen and legs. He first noticed shortness of breath with exertion several months ago, and has had a few episodes where he momentarily became lightheaded and lost consciousness. Now the symptoms have been progressing with increased dyspnea and edema. He reports that he has always lived a healthy lifestyle and has no past medical history. There is no family history of any cardiac or pulmonary disease, or any cancer. He was born in Brazil and moved to the United States at the age of 43. He does not smoke or drink alcohol. On cardiac examination, the apex is displaced laterally with an S3 on auscultation. Estimated central venous pressure is 15 mmHg, and there are faint crackles at the base of his lungs. He has hepatomegaly with shifting dullness and bilateral pitting edema of the lower extremities. An ECG is normal, with no visible Q waves. Which infectious etiology is most likely responsible for this patient's disease?

A 32-year-old man comes to the physician complaining of fever, shortness of breath, and a productive cough that has developed slowly over the past week. He has no other medical history and does not take any medications. His temperature is 38.5°C, blood pressure is 122/78 mmHg, heart rate is 68 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 98% on room air. There are decreased breath sounds and dullness to percussion over the right lung base. The rest of the physical examination, including cardiac auscultation, is normal. A chest x-ray confirms consolidation of the right lower lobe. What is the most appropriate course of action for this patient?

A 38-year-old immigrant woman comes to the Emergency Department with right-sided weakness and slurring of her speech. Initial imaging and studies are obtained, and she is found to have suffered an ischemic stroke and is treated appropriately. When you go to examine her, she has an irregularly irregular pulse, and on cardiac examination she has an early diastolic high-pitched opening snap at the apex followed by a low-pitched diastolic rumbling murmur. Upon further discussion with the family, they indicate that she does not have any chronic medical problems and has not been to the doctor since she was a baby. She had frequent throat infections as a child, but these always resolved without treatment. She takes no medications and does not smoke or drink alcohol. The mechanism by which this condition developed is most similar to which of the following other conditions?Ask StudybuddyGroup of answer choicesGraves diseaseCystic fibrosisGuillain–Barré syndromeSarcoidosisInfective endocarditis