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NBME 21 Answers
A 16-year-old boy is brought to the physician ...
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.
I mean... couldn't increased BP during exercise worsen his MVP and give him SOB?
(by causing slight regurg)
"Lungs are clear to auscultation"
But wouldn't choosing exercise-induced asthma leave the murmur unaccounted for?
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?
Just noticed that he has FHx, game changer.
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)
he also has a family history of asthma. that's shit is genetic. +1 for asthma.
Cheif complaint is SOB during exercise with coughing. Mitral valve prolapse is not going to do that so I picked asthma as well.
malingering would be a conscious faking of symptoms to avoid being on the team. he wouldn't have the mid-systolic click and he would probably complain of his symptoms all the time and not just limited to during exertion.
malingering is also doing it for some external gain. which was not indicated in the stem
Also, patients with asthma are usually asymptomatic at the time of physical exam unless they are examined precisely during the attack.