Family Medicine is beating Emergency Medicine this week on their scores. This is one of the most frequently missed questions in FM this week, but only a third of test-takers got it wrong. Go FM! 😀
You have one “stupid exam trick” and three clinical findings in the learning objectives for this question.
“Adopted from Guatemala” is supposed to cue you in for regions more likely to have a prevalence of rheumatic fever. Any extraneous item you see on an exam question is a clue not to be overlooked, and only very, very rarely will you see on in an MCQ that isn’t meaningful. Potential rheumatic fever in childhood would contribute heavily to a diagnosis of mitral stenosis.
One of the clinical findings for the question test for the ability to distinguish mitral stenosis versus mitral regurgitation. The timing and quality (diastolic vs. systolic, and rumble vs. murmur) are distinct.
Another is for P mitrale, a subtle EKG finding of a biphasic P wave with a broad terminal component in V1 as evidence of left atrial enlargement. That’s clearly stated in the question, but the test-taker needs to infer the potential for left atrial enlargement.
And the last clinical test in the question is a holistic approach - rather than focusing on a single area, like the pulmonary symptoms.
We distinguish between test-taking tips in learning objectives, and clinical objectives. In real life, finding out that your 45-year-old patient was adopted from Guatemala four decades ago is probably remote. But that’s of a kind the sort of things you get on exam questions that distinguish them from reality.
The real test on this question is the left atrial enlargement indicator (which is specifically stated) in conjunction with the definition of murmur and rumble.
This question appears in Med-Challenger Family Medicine Exam Review with CME
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