NBME 18
*spoiler\*
I can't tell if I'm just overthinking/underthinking but why is this pulmonary artervneous shunting? I saw the petechiae on the tongue and thought it was some sort of hypertensive issue. There was no clubbing of the fingers so I ruled out anything lung related. See link (https://drive.google.com/file/d/15ZVWs4SprNZ2_HWiyqQXfYMFBqJ5HLOF/view?usp=sharing)--any help is greatly appreciated!
Also, I'm 5 points (as per form 18) away from my goal and I have step in a week. I took 19 the same day right after 18 and scored 10 points lower... should I postpone?