Mastery series Medicine Form 2 Question

[water11]

1. 15 y/o F comes to the physician because of a 2-week history of intermittent, fleeting pain under her left breast. She has had no cough, SOB or nausea. Her uncle had MI at age 40 and father had MI at age 36. Afebrile, HR 96/min, resp. 25/min and BP is 120/74 mm Hg. Lungs are CTA. Cardiac exam shows a normal S1 and S2 and a mid systolic click, there is no chest wall tenderness. Pulse oximetry is 98%. ECG is normal. What is the next step in management?
1. Beta Blocker
2. CT chest
3. outpatient exercise stress test
4. Reassurance only

(there were other ans choices that did not make any sense)

Mid systolic click is MVP. I was in between Beta blocker vs reassurance only.

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[mbMD]

4

 

[water11]

Why not Beta blocker? Beta blockers can be used for chest pain in MVP.

 

[water11]

@Phloston any thoughts?

 

[Phloston]

Diagnosis is mitral valve prolapse syndrome. From UpToDate:

"
SUMMARY AND RECOMMENDATIONS

●Atypical or non-anginal chest pain is the most common symptom attributed to mitral valve prolapse (MVP). Other manifestations may include palpitations, dyspnea, exercise intolerance, dizziness or syncope, and panic and anxiety disorders. Any combination of these symptoms and signs plus the typical auscultatory features of MVP have been defined as the mitral valve prolapse syndrome.



●The large number of symptoms directly attributed to MVP may be coincidental. It is possible, however, that autonomic and neuroendocrine dysfunction found in some patients with MVP may underlie some of the symptoms associated with this disorder.



●Reassurance about the benign nature of MVP syndrome is often adequate to reduce the severity of symptoms in many patients. Many patients also appear to benefit from a change in lifestyle, including aerobic exercise training; the avoidance of stimulants (caffeine), alcohol, and undue fatigue; and a reduction in stress."

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Therefore the answer is 4.