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Old 03-28-2012
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Arrow NBME 12 Block 3

can any one explain to me Q8 of nbme 12 block 3
why to choose increase parasympathetic tone , not 3rd degree heart block??
as when increase sympathetic , it increases in response to increase blood pressure by decreasing heart rate , but here we have decreased blood pressure so the reflux shoul be sympathetic response which increse heart rate????
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Old 03-29-2012
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Default ans. C. increase parasympathetic tone

ans. C. increase parasympathetic tone

I can answer this question by doing a “process of elimination”.

Always start out with what you know first and which of these don’t fit to the scenario.

Choice E (wrong)—should have high heart rate, not 80 bpm because this is normal.

Choice A (wrong)—should see history of heart problem, plus this patient is too young to have aortic stenosis.

Choice D (wrong)—should see heart rate is being much lower as there is no signals from SA node and no signals from AV nodes.

We have Choice B/C left.

A patient is probably nervous to take a shot hence this will cause increase in Parasympathetic tones (Choice C Answer) which you see fluctuation of pulse and heart rates.

Choice B (wrong)—even though you see in young pt, however, you should see increase in heart rate as a heart is trying to pump the blood out through narrowed or hypertrophied chamber
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