A middle-aged gentleman from an ethnically-relevant background comes to see you for follow-up on his likely genetic condition among other problems. He lives happily in a house by the farm where he is exposed to many risk factors for various diseases. His past medical history is not significant for much except for a couple of surgeries that may or may not cause bowel obstruction in the future. He drinks a borderline amount of alcohol in addition to 1-2 various illegal drug occasionally. He is also poor, has no social supports, and may or may not be expressing suicidal ideation. On exam, he appears frail but not underweight. His blood pressure is 170/25, his pulse is 100 and ranges from irregularly irregular to perfectly normal. His JVP has some sort of abnormality that is consistent with a heart or lung problem. On auscultation, he has at least 6 audible murmurs which seem to all be radiating to his forehead. A gentle melodic wheeze is audible to the tune of “Old McDonald Had A Farm” on expiration. His abdomen has no signs of pathology aside from rebound tenderness. Peripheral pulses are all absent despite your medical student’s best claims. Which of the following is NOT his favorite color? A) Option that sounds right, but is actually irrelevant to the question B) Long-winded answer that has 3-4 technical terms that seem relevant to the prompt C) Probably the correct answer, but you’re too scared to pick C because the exam is written by psychiatrists who know all about the “C is most likely” approach D) The answer that will kill the patient E) lupus Source
