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 +5  (nbme21#16)

I choose MVP too, but this patient’s main symptom is cough only during exercise. This is more indicative of exercised associated asthma. You could see shortness of breath in MVP during exercise, but choosing MVP leaves the cough unaccounted for.

.ooo.   I agree! Also, At the end of the stem, the question is which of the following best explain the patients symptoms? Not physical exam findings. Since this patient is coming in with a chief complaint of SOB while playing sports exercise induced asthma is the best choice. Hopefully that helps.
uslme123  I mean... couldn't increased BP during exercise worsen his MVP and give him SOB?
uslme123  (by causing slight regurg)
yotsubato  "Lungs are clear to auscultation"
sahusema  But wouldn't choosing exercise-induced asthma leave the murmur unaccounted for?
cienfuegos  I incorrectly chose malingering and am wondering if the fact that he presented (although it doesn't state who brought him in/confirmed his symptoms while exercising) makes this less likely despite the fact that he clearly states "I don't want to play anymore" which could be interpreted as a secondary gain? Also, regarding the MVP, I'm wondering if the fact that these are usually benign should have factored into our decision to rule it out? Thoughts?
cienfuegos  Just noticed that he has FHx, game changer.
kimcharito  clear lungs, they try to say no cardiogenic Pulm. edema, means is not due to MVP shortness of breath while doing sports and no shortness at rest makes me to think more asthma induced by exercise)

 +3  (nbme21#2)

It is syphilis. Syphilis is an endarteritis! :)

“The pathologic changes associated with syphilis are characterized by obliterative endarteritis that is found in all stages of the disease.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811633/





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