#march2020mccqe1
A 48-year-old high school teacher with no prior medical history presents to his primary care physician after feeling extremely fatigued for >1 month. Previously an avid runner, he has recently experienced dyspnea on moderate exertion. Although he denies vomiting, he admits to intermittent episodes of diarrhea. His blood pressure is 73/37 mm Hg and he is afebrile. On physical examination his skin is warm and erythematous, and his jugular venous pressure is elevated. Cardiac examination reveals a systolic murmur near the right border of the sternum that is accentuated with inspiration. Which of the following is most consistent with these findings?
(A) Elevated urinary excretion of 5-hydroxyindoleacetic acid
(B) Elevated urinary excretion of vanillylmandelic acid
(C) Peaked T waves on ECG
(D) Pseudomonas species grown from blood cultures
(E) Severe pulmonary congestion on x-ray of the chest
A 48-year-old high school teacher with no prior medical history presents to his primary care physician after feeling extremely fatigued for >1 month. Previously an avid runner, he has recently experienced dyspnea on moderate exertion. Although he denies vomiting, he admits to intermittent episodes of diarrhea. His blood pressure is 73/37 mm Hg and he is afebrile. On physical examination his skin is warm and erythematous, and his jugular venous pressure is elevated. Cardiac examination reveals a systolic murmur near the right border of the sternum that is accentuated with inspiration. Which of the following is most consistent with these findings?
(A) Elevated urinary excretion of 5-hydroxyindoleacetic acid
(B) Elevated urinary excretion of vanillylmandelic acid
(C) Peaked T waves on ECG
(D) Pseudomonas species grown from blood cultures
(E) Severe pulmonary congestion on x-ray of the chest
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