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USLME Step 2 Review
Question #33 A 35 year old male with no past medical
history presents
with increasing shortness of breath and dyspnea on exertion and lower
extremity
edema increasing over the past month. His temperature is 37.0, blood
pressure
90/60, heart rate 100, respirations 20, and oxygen saturation 95% on
room air.
Physical examination reveals decreased breath sounds at the left base
without
wheezing, elevated jugular venous pressure markedly worse with
inspiration, a
regular rhythm with an S4 heart sound and 2+ lower extremity pitting
edema.
Laboratory studies are normal. Cardiac biopsy revealed green
birefringence with
Congo red staining. Genetic testing reveals a mutation in the
transthyretin
gene. Which of the
following is the correct diagnosis? 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9
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