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 45-year-old man comes to the emergency department due to a 1-day history of constant upper abdominal pain, nausea, and several episodes of vomiting.  The pain is partially relieved by sitting up or bending forward.  He has also had mild shortness of breath.  The patient's other medical history includes hyperlipidemia and hypertension.  He uses tobacco and alcohol.  There is a family history of coronary artery disease and hypertension.  Temperature is 38.1 C (100.6 F), blood pressure is 110/70 mm Hg, pulse is 114/min, and respirations are 22/min.  There is dullness to percussion and decreased breath sounds at the left lung base.  Abdominal examination shows epigastric tenderness.  Laboratory results are as follows:Hematocrit 44%Leukocytes 16,000/mm3Calcium 7.8 mg/dLGlucose 250 mg/dLWhich of the following plays a principal role in initial management of this patient's current condition? A.Antiplatelet agents B.Broad-spectrum antibiotics C.Calcium gluconate D.Exploratory laparotomy E.Insulin infusion F.Isotonic crystalloids G.Proton pump inhibitors

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 57-year-old woman is brought into the emergency department because of the sudden onset of severe left-sided chest pain and shortness of breath. She had flown back to the United States yesterday following a tour of Southeast Asia. Other than feeling tired after her long trip, she was in her usual state of good health, but this afternoon she had the sudden onset of stabbing left chest pain and noted severe shortness of breath. She denies any previous history of peripheral vascular, cardiac, or respiratory disease. Past medical history is unremarkable, and she is not currently taking any medications. On examination, the patient is in severe discomfort. Temperature is 100.5°F (38°C) orally, pulse 130, respirations 26, and BP 130/90. Pulse oximetry reveals an O2 saturation of 88% while the patient is breathing room air. Physical examination is otherwise unremarkable. Stat labs show normal kidney function. A chest radiograph and ECG are obtained.  What is the most appropriate action at this time?

A 26-year-old man presents to his primary care physician with fatigue, headache, and a sore throat for the past week. There is also nausea and diarrhea, but no weight loss, productive cough, or difficulty breathing. He has no known past medical history, does not take any medications, and has no recent sick contacts. He is sexually active and uses condoms inconsistently; he drinks alcohol heavily on the weekends and has had previous IV drug use. On examination, his temperature is 39°C and the rest of his vital signs are normal. He has nontender cervical and axillary lymphadenopathy, tonsillar exudates, and mild splenomegaly. There are also several painful, well-demarcated ulcers within his mouth and a mild maculopapular rash over his chest and arms. A rapid Strep test and a monospot (heterophile antibody) test are negative; further screening for chlamydia, gonorrhea, syphilis, and HIV antibody is negative. What is the likely diagnosis?Ask StudybuddyGroup of answer choicesUpper respiratory infectionSecondary syphilisHodgkin lymphomaAcute retroviral syndromeInfectious mononucleosis

A 68-year-old male with a history of lung cancer undergoes follow-up labs after recent cycle of chemotherapy. He has mild difficulty with concentration over the past week but is otherwise able to complete all of his daily tasks. He reports no nausea, vomiting, or positional lightheadedness. He has no other significant past medical history. He takes no medications. Vital signs are as follows: Temperature 99.8°F, RR 18, BP 135/88 mm Hg, pulse 76. On examination, he is alert and oriented. Cardiac examination reveals regular rate and rhythm, no murmurs, JVP not elevated. Lung and abdominal examinations are normal. There is no lower extremity edema. Skin turgor is normal. Neurologic examination reveals 5/5 strength in all extremities, no focal deficits, and normal gait. Laboratory tests reveal the following: serum Na+ 121 mEq/L, K+ 4.3 mEq/L, BUN 7.0 mg/dL, Cr 0.4 mg/dL, glucose 106 mg/dL. TSH 2.0 mU/L. Serum osmolality 250 mOsm/kg, urine Na 45 mEq/L, urine osmolality 450 mOsm/kg. What is the most appropriate management of this patient?