A 7-month-old male infant is brought to the emergency room by his mother, who notes that he appears to be having trouble breathing. Upon speaking with the mother, you discover that she suffered from a serious infection during her pregnancy and that the this baby was born with fever, stuffy nose, pink eyes, swollen glands around the head and neck and a red-pink skin rash made up of small spots which the delivering doctor called ‘blueberry muffin rash’. On physical examination of the baby, a continuous “machinelike” murmur is heard and you note signs of pulmonary congestion. Which of the following, which congenital infection is most commonly associated with this disorder of the baby?

You’re overseeing the discharge of a 26-year-old woman from the hospital after she had stayed in the hospital for 3 days for pulmonary embolism. As you prepared her discharge instructions, the floor nurse came and informed you that the patient developed a severe headache, sudden trouble seeing in one eye, dizziness, loss of balance and right sided weakness. Patient reports that her symptoms started suddenly while she was straining at the stool during a bowel movement. You suspected a stroke in this patient and wondered how such a young woman all of a sudden could get a stroke. You glanced over her medical record. She has no history of hypertension, diabetes or prior stroke or transient ischemic attacks. She does not smoke but drinks occasionally. She is sexually active. She works as a bank executive and four days ago, she returned home taking a 17-hour long transcontinental flight after attending a financial conference in Singapore. She developed chest pains 3 days ago, came to the emergency department, eventually diagnosed with pulmonary embolism, admitted and treated for it. Her current medications include a combination pill for contraception, colace for constipation, and a low-molecular weight heparin for the treatment of pulmonary embolism. On physical examination, you notice right sided weakness and normal heart examination. Which of the following is a risk factor for paradoxical emboli-associated cryptogenic stroke in this patient?

You’re overseeing the discharge of a 26-year-old woman from the hospital after she had stayed in the hospital for 3 days for pulmonary embolism. As you prepared her discharge instructions, the floor nurse came and informed you that the patient developed a severe headache, sudden trouble seeing in one eye, dizziness, loss of balance and right sided weakness. Patient reports that her symptoms started suddenly while she was straining at the stool during a bowel movement. You suspected a stroke in this patient and wondered how such a young woman all of a sudden could get a stroke. You glanced over her medical record. She has no history of hypertension, diabetes or prior stroke or transient ischemic attacks. She does not smoke but drinks occasionally. She is sexually active. She works as a bank executive and four days ago, she returned home taking a 17-hour long transcontinental flight after attending a financial conference in Singapore. She developed chest pains 3 days ago, came to the emergency department, eventually diagnosed with pulmonary embolism, admitted and treated for it. Her current medications include a combination pill for contraception, colace for constipation, and a low-molecular weight heparin for the treatment of pulmonary embolism. On physical examination, you notice right sided weakness and normal heart examination. Which of the following is the most likely cause of her stroke?

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?