Acute rheumatic fever and rheumatic heart disease Quiz: Ace Your Exams
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A 17-year-old girl presents to the pediatrician's office for evaluation of shortness of breath for the past month. The patient states that she recently started track and has been noticeably short of breath from exertion. She also notes mild lower extremity swelling. The patient has minimal symptoms at rest and has not had any associated wheezing. She is otherwise healthy and does not take any medication daily. She immigrated from Guatemala to the United States with her family three years ago. As a young child, she had multiple upper respiratory infections, including multiple episodes of sore throat. Temperature is 37°C (98.6°F), blood pressure is 120/71mmHg, pulse is 112/min, respiratory rate is 20/min, and oxygen saturation is 96% on room air. Physical examination demonstrates a tall, thin adolescent in no acute distress. Cardiopulmonary examination demonstrates a 2/6 holosystolic murmur best heard at the apex. 1+ pitting edema is noted on the lower extremities bilaterally. Which of the following is the best next step for diagnosing the most likely underlying condition?
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