A 38-Year-Old Man Is Brought to the Emergency Department Due

question 322

Multiple Choice

A 38-year-old man is brought to the emergency department due to sudden-onset shortness of breath and diaphoresis.  He has no fever, chills, cough, or abdominal pain.  The patient has no other medical problems and takes no medications.  He had surgery for bilateral inguinal hernias at age 16.  The patient does not use tobacco, alcohol, or illicit drugs.  Blood pressure is 95/60 mm Hg, pulse is 116/min and regular, and respirations are 28/min.  He is in marked respiratory distress.  Pallor and diaphoresis are noted.  His skin is velvety and has many atrophic scars.  The apical impulse is hyperdynamic.  Cardiac auscultation reveals a soft, early-systolic decrescendo murmur at the cardiac apex.  S1 is barely audible; S2 is normal.  Lung examination reveals bibasilar crackles.  Jugular venous distension is present.  The abdomen is soft, nontender, and nondistended.  Neurologic examination shows no abnormalities.  ECG shows sinus tachycardia with occasional premature ventricular complexes.  Chest x-ray reveals no cardiomegaly, but bilateral alveolar infiltrates and hilar prominence are present. The patient feels better after receiving appropriate therapy.  A more detailed physical examination shows the presence of thoracolumbar scoliosis.  Serial cardiac enzymes are negative.  Arterial blood gas analysis shows respiratory alkalosis.  Complete blood cell count and serum chemistry results are unremarkable.  Which of the following is the most likely diagnosis?

• A)Coronary artery disease
• B)Ehlers-Danlos syndrome
• C)Marfan syndrome
• D)Rheumatic fever
• E)Thyrotoxicosis

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