A 2-year-old girl is brought to the physician by her mother for a well-child examination. Cardiac auscultation is shown. When she clenches her fist forcefully for a sustained time, the intensity of the murmur increases. Which of the following is the most likely cause of this patient's auscultation findings?
AFailure of the ductus arteriosus to close
BDefect in the atrial septum
CFusion of the right and left coronary leaflets
DProlapse of the mitral valve
EDefect in the ventricular septum
A 59-year-old male presents to the emergency room with shortness of breath. Ten days ago, he was in the cardiac critical care unit after receiving a balloon angioplasty and a bare metal stent for an ST-elevation myocardial infarction (STEMI). On physical examination, a holosystolic murmur is heard at the cardiac apex radiating to the axilla. You also detect an S3 and bilateral crackles in the lung bases. What is the most likely etiology of this patient's acute decompensated heart failure?
ARupture of the septal papillary muscle on the right ventricle
BRupture of the posteromedial papillary muscle of the left ventricle
CRupture of the posterior papillary muscle on the right ventricle
DRupture of the anterolateral papillary muscle of the left ventricle
ERupture of the anterior papillary muscle of the right ventricle
A 35-year-old man is brought to the emergency department 20 minutes after being involved in a motor vehicle collision in which he was a restrained passenger. The patient is confused. His pulse is 140/min and blood pressure is 85/60 mm Hg. Examination shows a hand-sized hematoma on the anterior chest wall. An ECG shows sinus tachycardia. Which of the following structures is most likely injured in this patient?
APapillary muscle
BLeft main coronary artery
CInferior vena cava
DAortic isthmus
EAortic valve
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