On a routine physical exam visit, the physician mentions that he ...

[jeatrice]

On a routine physical exam visit, the physician mentions that he hears a new murmur. The patient gets worried and asks, What does this mean? The physician responds,
 
  A)
  It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit.
  B)
  This could be caused by an infection. Have you been feeling well the past few weeks?
  C)
  One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problem.
  D)
  This may make you a little more fatigued than usual. Let me know if you start getting dizzy or light-headed.

Question 2

A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His glands are swollen, and he moves stiffly because his joints hurt.
 
  His parents, who believe in natural remedies, have been treating him with various herbal preparations without success and are now seeking antibiotic treatment. Throat cultures show infection with group A streptococci. This child is at high risk for
  A)
  myocarditis.
  B)
  mitral valve stenosis.
  C)
  infective endocarditis.
  D)
  vasculitis.

[raenoj]

Answer to Question 1

Ans:
C

Feedback:

Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. Blood flow through a normal valve can increase by five to seven times the resting volume. Valvular disease is not caused by stress. The murmur can be caused not only by infection but also by stenosis or regurgitation of a valve leaflet. The valve problem is very severe if it is causing signs of decreased cardiac output.

Answer to Question 2

Ans:
B

Feedback:

Group A streptococcal infection can be adequately treated with antibiotics, but this infection may have been present long enough to trigger an immune responserheumatic feverthat will damage his heart valves, ultimately causing mitral valve stenosis. Group A streptococcal infection is not known to predispose to myocarditis, endocarditis, or vasculitis and aneurysm of coronary arteries.