A 58-year-old female presents to her primary care physician with complaints of chest pain and palpitations. A thorough past medical history reveals a diagnosis of rheumatic fever during childhood. Echocardiography is conducted and shows enlargement of the left atrium and narrowing of the mitral valve opening. Which of the following should the physician expect to hear on cardiac auscultation?
AContinuous, machine-like murmur
BHolosystolic murmur that radiates to the axilla
COpening snap following S2
DHigh-pitched, blowing decrescendo murmur in early diastole
EMid-systolic click
Cardiac muscle serves many necessary functions, leading to a specific structure that serves these functions. The structure highlighted is an important histology component of cardiac muscle. What would be the outcome if this structure diffusely failed to function?
AFailure of potassium channels to appropriately open to repolarize the cell
BFailure of propagation of the action potential from the conduction system
CIneffective excitation-contraction coupling due to insufficient calcium ions
DInappropriate formation of cardiac valve leaflets
EOutflow tract obstruction
A 63-year-old man comes to the physician for evaluation of fever and a nonproductive cough for the past 2 weeks. During this period, he has also had fatigue, myalgia, and difficulty breathing. Five weeks ago, he underwent an aortic prosthetic valve replacement due to high-grade aortic stenosis. The patient has a history of hypertension, asthma, and type 2 diabetes mellitus. A colonoscopy 2 years ago was normal. The patient has smoked one pack of cigarettes daily for the past 40 years. He has never used illicit drugs. Current medications include aspirin, warfarin, lisinopril, metformin, inhaled albuterol, and a multivitamin. The patient appears lethargic. Temperature is 38.6°C (101.5°F), pulse is 105/min, and blood pressure is 140/60 mm Hg. Rales are heard on auscultation of the lungs. A grade 2/6, diastolic blowing murmur is heard over the left sternal border and radiates to the right sternal border. A photograph of his right index finger is shown. Laboratory studies show a leukocyte count of 13,800/mm3 and an erythrocyte sedimentation rate of 48 mm/h. Which of the following is the most likely causal organism?
AStaphylococcus epidermidis
BEnterococcus faecalis
CStreptococcus gallolyticus
DStreptococcus pyogenes
EViridans streptococci
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