An 18-year-old female presents to your clinic complaining of progressive dyspnea. She denies chest pain and recent history of infectious disorders. Her blood pressure is 160/110 mm Hg in both arms and 110/70 in both thighs. Physical examination reveals that she has a short stature, a webbed neck, a shield chest with wide-set nipples, and significantly weak femoral pulses bilaterally. Auscultation reveals continuous murmur loudest at the left infrascapular region. Chest x-ray reveals notching of the ribs. Echocardiogram revealed a bicuspid aortic valve. Which of the following is the most likely diagnosis in this patient?

A 27-year-old man presents to the emergency department with complaints of chest pain and hemoptysis. He has a history of chronic sinusitis and recurrent pneumonias, requiring multiple hospitalizations. He also reports infertility, stating that he and his wife have been unable to conceive despite years of trying. On physical examination, heart sounds are auscultated on the right side, and the patient confirms that he has situs inversus. Pulmonary function tests reveal a decreased FEV1/FVC ratio, consistent with obstructive lung disease, and a CT scan of the chest demonstrates dilated bronchioles with a signet-ring appearance and situs inversus. What is the underlying microscopic defect in this patient’s disorder?

A 27-year-old man presents to the emergency department with complaints of chest pain and hemoptysis. He reports a history of chronic sinusitis and recurrent pneumonias, which have required multiple hospitalizations. He also notes a history of infertility, mentioning that he and his wife have been unable to conceive despite trying for several years. During the physical examination, heart sounds are auscultated on the right side of the chest, and the patient confirms that he has situs inversus. Pulmonary function tests (PFTs) reveal a decreased FEV1/FVC ratio, consistent with obstructive lung disease. A CT scan shows dilated bronchioles with a signet-ring appearance and situs inversus. What is the most likely cause of this patient’s infertility?

A 27-year-old man presents to the emergency department with complaints of chest pain and hemoptysis. He reports a history of chronic sinusitis and recurrent pneumonias requiring multiple hospitalizations. He also mentions infertility in his family history, noting that he and his wife have been unable to conceive. During the physical examination, you notice heart sounds on the right side of the chest, and he confirms that he has situs inversus. Pulmonary function tests (PFTs) reveal a decreased FEV1/FVC ratio, consistent with obstructive lung disease. A CT scan of the chest shows dilated bronchioles with a signet-ring appearance and situs inversus. Which of the following embryonic processes is most likely defective in this patient?

A 27-year-old man presents to the emergency department with chest pain and hemoptysis. His past medical history is significant for chronic sinusitis and several bouts of pneumonia that have required hospitalizations. In family history, you discover that he and his wife have not been able to have kids because of his infertility. In the physical examination, you were surprised to hear heart sounds on the right side of the chest. Later he informs you that his heart is on the right side. Pulmonary function tests (PFTs) reveal a decreased FEV1/FVC ratio. CT scan reveals dilated bronchioles with signet-ring appearance and situs inversus. Of the following, which is the most likely diagnosis in this patient?

A 74-year-old Caucasian male presents to the emergency room with complaints of shortness of breath during exertion and while lying flat. He underwent mitral, aortic, and tricuspid valve replacement one month ago. Vital Signs: Temperature: 99 °F (37.2 °C) Heart rate: 89 beats/min Blood pressure: 148/105 mm Hg Respirations: 19 breaths/min Oxygen saturation: 89% on room air Physical Examination: Anxious elderly male with scleral icterus (jaundice). Cardiac auscultation: Normal S1, S2 with a holosystolic murmur heard best at the apex in the left lateral decubitus position. Laboratory Findings: Low hemoglobin Elevated LDH Elevated indirect bilirubin Decreased haptoglobin Which of the following is the most important diagnostic modality in the management of this patient?

A 74-year-old Caucasian male presents to the emergency room with complaints of shortness of breath during exertion and while lying flat. He underwent mitral, aortic, and tricuspid valve replacement one month ago. Vital Signs: Temperature: 99 °F (37.2 °C) Heart rate: 89 beats/min Blood pressure: 148/105 mm Hg Respirations: 19 breaths/min Oxygen saturation: 89% on room air Physical Examination: Anxious elderly male with scleral icterus (jaundice). Cardiac auscultation: Normal S1, S2 with a holosystolic murmur heard best at the apex in the left lateral decubitus position. Laboratory Findings: Low hemoglobin Elevated LDH Elevated indirect bilirubin Decreased haptoglobin What is the most likely diagnosis in this patient?

A 24-year-old man presents to the emergency department after being the victim of a gunshot wound during a fight. On arrival, the paramedics report that the patient is breathing spontaneously and saturating well on a non-rebreather mask. During the primary survey, the patient is found to have equal bilateral breath sounds and stable vital signs. On secondary survey, a single gunshot wound is identified in the left fourth intercostal space, 1 cm to the left of the left sternal border. Which of the following cardiac structures is most likely injured in this patient?