A previously healthy 25-year-old-woman comes to the emergency department because of a 3-day history of fever, chest pain, and rapidly progressive shortness of breath. Use of an over-the-counter cold medication has not relieved her symptoms. She has no history of serious illness and takes no other medications. Her temperature is 40oC (104o F), pulse is 128/min and regular, respirations are 28/min and blood pressure is 80/54 mm Hg. Physical examination shows jugular venous distention and weak pulses in all extremities. Auscultation of the chest shows diffuse crackles bilaterally, muffled heart sounds, and a soft S2 gallop. After 30 minutes she goes into ventricular fibrillation and cannot be resuscitated. At autopsy, the heart is diffusely pale and floppy with focal petechiae, all chambers
1. A previously healthy 25-year-old-woman comes to the emergency department because of a 3-day history of fever, chest pain, and rapidly progressive shortness of breath. Use of an over-the-counter cold medication has not relieved her symptoms. She has no history of serious illness and takes no other medications. Her temperature is 40oC (104o F), pulse is 128/min and regular, respirations are 28/min and blood pressure is 80/54 mm Hg. Physical examination shows jugular venous distention and weak pulses in all extremities. Auscultation of the chest shows diffuse crackles bilaterally, muffled heart sounds, and a soft S2 gallop. After 30 minutes she goes into ventricular fibrillation and cannot be resuscitated. At autopsy, the heart is diffusely pale and floppy with focal petechiae, all chambers are markedly dilated.Histologic examination of cardiac tissue shows a lymphocytic infiltrate and myocardial necrosis. Which of the following infectious agents is the most likely cause these findings?
a. Coxsackie A
b. EPV
c. H influenzae
d. respiratory syncytial virus
e. staph aureus
f. strep viridians
2. A 40-year-old man has a 3-month history of progressively worsening cough, paranasal sinus pain, a persistent purulent nasal discharge, arthralgias, and knee and ankle pain. An x-ray of the chest shows nodular infiltrates. Laboratory evaluation shows an increased serum creatinine concentration, and a positive rheumatoid factor assay (1:32) A photomicrograph of a pulmonary vessel obtained on open lung biopsy is shown. This disease is characteristically associated with the presence in serum of which of the following antibodies?
A. Antiglomerular basement membrane antibody B. Antimicrosomal antibody X
C. Antimitochondrial antibody
D. Antineutrophil cytoplasmic antibody
E. Antismooth muscle antibody
DX: Small Vessel Vasculitis
3. A 63-year-old man with mild emphysema has the sudden onset of headache, myalgia, and fever followed by a dry cough, chills, and chest pain. He has smoked one pack of cigarettes daily for 45 years. Examination of
A. Inhalation of aerosols from an environmental source -pseudomonas aeruginosa
B. Inhalation of dust from bird droppings
C. Inhalation of respiratory secretions from an infected animal – Coxiella burnetii
D. Inhalation of respiratory secretions from another infected person
E. The patient’s normal flora – Klebsiella pneumoniae
4. An 18-year-old man has had the insidious onset of shortness of breath over the past 2 years. Examination shows jugular venous distention and lateral displacement of the apical impulse. Echocardiography shows biventricular dilation; wall thickness is normal. Histologic examination of tissue obtained on an endomyocardial biopsy shows nonspecific changes. Two months later he has a stroke and dies. Which of the following cardiovascular findings at an autopsy is most likely to determine the cause of the stroke?
A. Carotid atherosclerosis
B. Deep venous thrombosis
C. Infectiveendocarditis
D. Nonbacterial thrombotic endocarditis
E. Ventricular mural thrombus
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