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  #1  
Old 10-29-2012
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Arrow Billy Step 1 Questions # 58

A 35-year-old man with no signifi cant medical history presents to his primary care physician with a 2-week history of progressive shortness
of breath that occurs with activity. He previously exercised regularly and has never had symptoms like this before, but now he finds that he can walk only one block before becoming symptomatic. He has also noticed a 7-lb (3.2-kg) weight gain during this time. He does not smoke or use alcohol or illicit drugs and has not traveled recently. In addition, he has
no family history of cardiac disease and does not have any sick contacts, but recalls having an upper respiratory infection about a month
ago that improved on its own. Physical examination reveals crackles in his lungs bilaterally and an S3 gallop. X-ray of the chest reveals cardiomegaly. What is the most likely mechanism causing this patientís heart failure?


(A) Antibodies to a variety of cardiac proteins
that cause immune-mediated damage to
myocytes
(B) Direct cytotoxicity via receptor-mediated
entry of virus into cardiac myocytes
(C) Granulomatous infl ammation of myocytes
(D) Hyperadrenergic state leading to dilated
cardiomyopathy
(E) Ischemic damage to cardiac myocytes
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Old 10-29-2012
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A????
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  #3  
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B i guess its coxasckie virus infection
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Old 10-29-2012
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My answer is B), because I am thinking of a myocarditis due to Coxackie B virus. The S3 indicates a dilatated cardiomyopaty plus the upper resp infection -> Coxackie
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Old 10-29-2012
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B) coxsackie virus--classic case i think

thanks
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Old 10-29-2012
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ouch...i need to stop doing these questions...so far i am 1/3 correct....
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Default my answer :)

(B) Direct cytotoxicity via receptor-mediated
entry of virus into cardiac myocytes
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Default my asnwer B

yepp coxackie virus
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Old 10-30-2012
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Correct Answer B is correct

This patient is most likely experiencing congestive heart failure (CHF) secondary to dilated cardiomyopathy (DCM), which is characterized by dilation and impaired contraction of one or both ventricles. Symptoms of CHF include dyspnea (especially on exertion), orthopnea, paroxysmal nocturnal dyspnea, and peripheral edema with weight gain. DCM may also present with arrhythmias such as atrial fi brillation, or sudden cardiac
death. DCM has a variety of etiologies including idiopathic, myocarditis, ischemic, druginduced, hypertension, infi ltrative disease, HIV infection, connective tissue disease, and the chemotherapeutic agent doxorubicin. In this case the most likely cause of the patientís DCM is viral myocarditis following his upper respiratory infection several weeks ago. Viruses
known to cause myocarditis include coxsackievirus, influenza virus, adenovirus, echovirus, cytomegalovirus, and HIV. These viruses cause myocarditis with subsequent DCM by infl icting direct cytotoxicity via receptor-mediated
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cox scakie virus induced CCF
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