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She has heard media reports of infected cattle in other countries and of the possible risk of a similar disease spreading to people generic 10 mg vardenafil. She wants to know if it is safe for her and her children to consume beef and dairy products in the United States. Which of the following statements about new-variant Creutzfeldt-Jakob disease (nvCJD) is false? Compared to CJD, nvCJD typically develops in younger adults B. The agent of disease is thought to be a protein, or prion, which is spread by the consumption of animal protein products C. There have been documented cases in the United States D. There is currently minimal risk of acquiring the disease from con- sumption of milk or beef in the United States Key Concept/Objective: To understand the epidemiology of BSE and its association with nvCJD BSE is a spongiform encephalopathy that has occurred primarily in the United Kingdom and is associated with the consumption (by cows) of protein supplements derived from ruminant tissue. There have been substantial efforts to reduce the incidence of BSE by ban- ning the feeding of such ruminant-derived tissue to cattle and by the disposal of poten- tially infected herds. There is evidence that nvCJD may represent bovine-to-human spread of BSE in the United Kingdom. Unlike the sporadic or familial forms of CJD, patients with nvCJD have shown prominent senso- ry disturbances and psychiatric symptoms. Current epidemiologic evidence suggests that the United Kingdom epidemic will be less widespread than initially thought. There have been no documented cases of BSE or nvCJD in the United States. Thus, the patient can be reassured that dairy products and beef are in general safe to consume.
A and C Key Concept/Objective: To be able to recognize constrictive pericarditis Given this patient’s symptoms and his history of dialysis cheap vardenafil 20 mg, he most likely has constrictive pericarditis. Definitive diagnosis requires demonstration of a thickened pericardium and equalization of right and left heart pressures. Findings of elevated central pressures in the absence of other signs of congestive heart failure are very helpful. In contrast to cardiac tamponade, paradoxical pulse is present, and the Kussmaul sign can occasionally be seen. A 26-year-old woman is being evaluated for dyspnea, which she experiences when she engages in phys- ical activity. She has been having these symptoms for the past 4 months. She denies having chest pain, orthopnea, or paroxysmal nocturnal dyspnea. The patient’s medical history is significant for her having one episode of atrial fibrillation 1 month ago. Her physical examination shows fixed splitting of S2 and a 2/6 systolic murmur in the pulmonic area. An electrocardiogram shows mild right axis deviation and an rSR’ pattern in V1. A chest x-ray reveals an enlarged right atrium and main pulmonary artery. Which of the following is the most likely diagnosis for this patient? Dextrotransposition of the great arteries Key Concept/Objective: To be able to recognize an ASD ASDs occur in three main locations: the region of the fossa ovalis (such defects are termed ostium secundum ASDs); the superior portion of the atrial septum (sinus venosus ASDs); and the inferior portion of the atrial septum near the tricuspid valve annulus (ostium pri- mum ASDs). The last two are considered to be part of the spectrum of AVSDs.
In all likelihood 10mg vardenafil with mastercard, his hyper- tension has been long-standing, as suggested by his S4 gallop and LVH. Thus, he is best managed by a long-acting antihypertensive and very close follow-up to ensure that the hypertension has not worsened. He should also be educated about the symptoms of target- organ damage and told to seek emergency care should they occur. Sublingual short-acting nifedipine has been associated with stroke, myocardial infarction, and death, and its use is very strongly discouraged. Because the patient does not have evidence of acute target- organ damage, hospital admission is not necessary. A previously healthy 47-year-old woman presents with a complaint of palpitations of sudden onset. Her evaluation includes an electrocardiogram, which reveals atrial fibrillation (AF) with a ventricular response of 135 beats/min. Her cardiac examination is unre- markable except for an irregularly irregular pulse. She has no other medical problems and takes no med- ications. Lone Key Concept/Objective: To understand the appropriate classification of AF The ACC/AHA/ESC guidelines include the following categories: recurrent—more than one episode of AF has occurred; lone—AF occurring in a patient younger than 60 years who has no clinical or echocardiographic evidence of cardiopulmonary disease; valvular—AF 1 CARDIOVASCULAR MEDICINE 13 occurring in a patient with evidence or history of rheumatic mitral valve disease or pros- thetic heart valves is defined as valvular; paroxysmal—AF that typically lasts 7 days or less, with spontaneous conversion to sinus rhythm; persistent—AF that typically lasts longer than 7 days or requires pharmacologic or direct current (DC) cardioversion; permanent— AF that is refractory to cardioversion or that has persisted for longer than 1 year. Paroxysmal, persistent, and permanent AF categories do not apply to episodes of AF last- ing 30 seconds or less or to episodes precipitated by a reversible medical condition. Reversible conditions include acute myocardial infarction, cardiac surgery, pericarditis, myocarditis, hyperthyroidism, pulmonary embolism, and acute pulmonary disease. A 75-year-old woman with a history of symptomatic, recurrent, persistent nonvalvular AF comes to your office. She has been told that there are several options for the treatment of her AF. Which of the following is true regarding establishment and maintenance of normal sinus rhythm, as compared with pharmacologic rate control?
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