Every case of Munchausen syndrome is different but usually starts with everything being almost too good—the patient helps too much with the diagnosis, armed with a bewildering amount of supporting facts, carrying sheaves of paperwork (to include results from previous diagnostic studies such as in this case), and appearing most helpful and gracious. However, things usually begin to soon fall apart. The patient’s knowledge base, no matter the ruse, soon belies itself, as the facts that the patient has are out of step with that which they have presented so far. Additionally, the personality disorder—most commonly borderline personality—reveals itself in the patient’s inability to maintain useful working relationships with anyone around them. In the case reported by Highland and Flume, the physical examination did not support chronic lung disease, failing to corroborate the supposed disease. They also discovered that the “diagnostic” laboratory report that she carried with her (and promptly presented), namely a sweat chloride test, was fabricated.