Author Question: A 23-year-old patient presents the emergency department with high fever, chills, extreme fatigue, ... (Read 179 times)

xclash · **on:** Jun 25, 2018

A 23-year-old patient presents the emergency department with high fever, chills, extreme fatigue, and arthralgias. Your physical examination reveals grade II heart murmur heard loudest over the fourth intercostal space left sternal border.

The arms of the patient reveal past intravenous drug abuse. The clinician should recognize these are signs and symptoms of:
A. Pulmonary embolism
B. Right ventricular failure
C. Functional heart murmur
D. Bacterial endocarditis

Question 2

Dyspnea, cough, and pulmonary crackles are symptoms that can occur in left ventricular failure and respiratory disorders, such as pneumonia. Which of the blood tests below can be used to differentiate cardiovascular from pulmonary disease?

A. B type natriuretic peptide (BNP)
B. Pulse oximetry
C. Arterial blood gases
D. High sensitivity C reactive protein (hs-CRP)

brittiany.barnes · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: D
Bacterial endocarditis is a microbial infection of the endocardium. The most common causative organisms are Staphylococcus aureus, group A streptococcus, pneumococcus, and gonococcus. Risk factors include valvular disease, intravenous drug use, dental disease, and invasive diagnostic procedures. Initially, the signs and symptoms are similar to those of other systemic illnesses, including fever, chills, arthralgias, malaise, and fatigue. Petechiae, anemia, weight loss, new or worsening heart murmur, and emboli alert the examiner to a more serious disease process.

Answer to Question 2

ANS: A
Brain natriuretic peptide (BNP)For patients with cardiovascular disease and comorbid respiratory disease, BNP can help differentiate a cardiac from a respiratory etiology of dyspnea. High levels of BNP in the blood, greater than 400 mg/dL, occur if heart failure is present.