Sunday Morning 1, rewritten to resolve error - sammy08

[ArchivalUser]

A 32 year old man presents to the emergency department, with a three days history of fever, cough and weakness.His BP is 120/80 mm and his pulse is 110/min. Physical examination reveals multiple needle tracks on his arms. ECG shows sinus tachycardia but is otherwise normal. CXR shows scattered round lesions in the peripheral lung fields bilaterally. Urinalysis shows 2+ proteins. Which one of the following is the most likely accompanying finding in this patient?

A. S4 when the patient is in left lateral decutibus position
B. Systolic murmur that increases on inspiration
C. Diastolic murmur heard best with the patient sitting up
D. Systolic murmur that increases when the patient stands up
E. Paradoxical splitting of S2



The correct answer is B now..

[ArchivalUser]

This patient has bacterial endocarditis affecting the tricuspid valve, based on the following evidence. He has fever, weakness, and cough, there is physical evidence of intravenous drug abuse, and his chest x ray is concerning for septic emboli from the tricuspid valve. Septic pulmonary emboli typically cause cough, chest pain, and hemoptysis and produce numerous round alveolar infiltrates on chest xray. This patient's proteinuria is likely the result of septic emboli to the kidneys or immune complex mediated. IV drug users are at increased risk for bacterial endocarditis involving the right side of the heart. Triscupid regurg is common in individuals with endocarditis of the tricuspid valve and cause systolic murmur that increases on inspiration