NBME 12 Question

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je355804

Mew Nember
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Ok so maybe this is really easy... but I am totally drawing a blank on this for some reason.

a 22 year old man who is a military recruit is brought to the physicion 15 minutes after fainting while waiting in line to receive a series of inoculations before departing overseas. immediately after he fainted his pulse was 45/min and his palpable systolic bp was 50 mm hg. his pulse is now 88/min and bp is 100/70. physical exam shows no abnormalities. which of the following is the most likely cause of this patient's syncope.

A. Aortic Stenosis
B. Hypertrophic Cardiomyopathy
C. Increased Parasympathetic Tone
D. Third degree AV block
E. V-Tach

I am thinking the most logical choice is C. However, I'm really not sure. I usually don't spend time worrying about answering individual questions I missed.... but this one is bugging me.

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I would go with D. Just a guess.

D was my original answer. It was wrong.

I can't see it being stenosis. There would have been a murmur on physical exam. Same with HCM. Could it have been tachycardia because he's scared of shots haha?
 
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It's C increased parasympathetic tone. He has anxiety.

Wouldn't anxiety increase sympathetic tone?

Anxiety --> Increased catecholamines --> Sympathetic tone.

This was my line of thinking. Could you explain where I'm going wrong here?
 
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