Question 22

24 year old man comes to the emergency room with history of fever, malaise, and shortness of breath. He has been having fever for last 7 days for which he tried over the counter acetaminophen for symptomatic relief. He appears in moderate distress. He is disheveled, and has smell of alcohol on his clothes. There are some scars on his both forearms. He confesses to be an alcoholic and drug abuser. He has a past history of pulmonary TB treated at the community center about 3 years ago. He has no past histroy of any neurological or psychiatric illnesses. He usually does not visit a doctor, and does not remember about his vaccination status. The veins on his right forearm are thick and cord like but are non tender. He has history of sulfa and penicillin allergy. On examination his Temp is 101.2 degrees, BP is 98/46 mm Hg, and Pulse is 112/min. His chest examination reveals few rhonchis. On cardiac examination the physician hears an abnormal sound in his left lower border of sternum (see media). He does not remember of any childhood cardiac illness. He has no neck stiffness. What is the most likely diagnosis?

a) Rheumatic Heart Disease

b) Ventricular Septal Defect

c) Tuberculous pericarditis

d) Cardiac Tamponade

e) Infective Endocarditis

This vignetter applies to Question 22 to 24

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