atherosclerosis due to the chronic debilitation that occurs with the underlying disease.Rhabdomyoma is a rare cardiac tumor which occurs in children or patients with tuberous sclerosis. 12.A 68 year old diabetic man has become increasingly lethargic and weak for the past 7 months.On physical examination his temperature is3.9C.pulse 70/min,respirations 15/min,and blood pressure 150/90mm Hg. His blood urea nitrogen is elevated.On auscultation.the physician notes a friction rub.There are no other remarkable findings.A representative gross appearance of the heart is shown above.Which of the following is the most likely diagnosis? A.Bacterial pericarditis B.Metastatic carcinoma C.Myocardial infarct D.Uremic pericarditis E.Systemic lupus erythematosus Ans:D This patien has fbrinousor remic pericarditis which frequently and elevated blood levels Bacterial pericardins causes stabbing chest pin whch breathing and may radiate to the neck shoulder or back.There is usually a fever.Metastasis to the heart is very uncommon.When it does occur,it is usually intraparenchymal.Widely metastatic carcinoma presents clinically with cachexia, malaise and weight loss.Myocardial infarct presents acutely with chest pain.Acute MI may be associated with fibrinous pericarditis overlying the area of infarction.It is not diffuse as seen with this patient.Systemic lupus erythematosus may be associated with pericarditis but this is unusual.ANA titer is elevated and the pericarditis with SLE is serous,not fibrinous. atherosclerosis due to the chronic debilitation that occurs with the underlying disease.Rhabdomyoma is a rare cardiac tumor which occurs in children or patients with tuberous sclerosis. 12. A 68 year old diabetic man has become increasingly lethargic and weak for the past 7 months. On physical examination his temperature is 36.9ºC, pulse 70/min, respirations 15/min, and blood pressure 150/90 mm Hg. His blood urea nitrogen is elevated. On auscultation, the physician notes a friction rub. There are no other remarkable findings. A representative gross appearance of the heart is shown above. Which of the following is the most likely diagnosis? A. Bacterial pericarditis B. Metastatic carcinoma C. Myocardial infarct D. Uremic pericarditis E. Systemic lupus erythematosus Ans: D This patient has fibrinous or uremic pericarditis which frequently occurs with renal failure and elevated blood urea nitrogen levels. Bacterial pericarditis causes stabbing chest pain which increases with breathing and may radiate to the neck shoulder or back. There is usually a fever. Metastasis to the heart is very uncommon. When it does occur, it is usually intraparenchymal. Widely metastatic carcinoma presents clinically with cachexia, malaise and weight loss. Myocardial infarct presents acutely with chest pain. Acute MI may be associated with fibrinous pericarditis overlying the area of infarction. It is not diffuse as seen with this patient. Systemic lupus erythematosus may be associated with pericarditis but this is unusual. ANA titer is elevated and the pericarditis with SLE is serous, not fibrinous