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  #1  
Old 01-29-2014
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Default step1 question plz help

previously healthy 54 yo man comes to the clinic because of lightheadedness for 6 hours. His symptoms began after skiing at a resort at an altitude of 9000 ft. he has been taking a carbonic anhydrase inhibitor since 2 days before arriving at the resort. His BP is 110/60 which sitting and 95/50 while standing. PE shows no other abnormalities. Which of the following is the most likely cause of his orthostatic hypotension?
a). High-alt. sickness
b). Hypovolemia
c). Hypoxia
d). Impaired sympathetic nerve activity (wrong)
e). Respiratory alkalosis

the correct is b Could someone please explain how acetazolamide causes hypovolemia? I picked D b/c I thought they wanted to test concept with Baroreceptors. I never know what these NBMEs are looking for =( please help.

Thanks alot in advance
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  #2  
Old 01-29-2014
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Dont post NBME questions!!!!!

Or At least mark the thread! Just think what DIURETICS do...
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  #3  
Old 01-29-2014
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Quote:
Originally Posted by Curacao View Post
Dont post NBME questions!!!!!

Or At least mark the thread! Just think what DIURETICS do...
But how Do u explain the orthostatic hypotension with diuretic use?
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  #4  
Old 01-29-2014
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Default hypovolemia

Most common cause of orthostatic hypotension is hypovolemia then autonomic dysfunction. Diuretics cause volume depletion, orthostatic hypo more common with loops but is also reported with acetazolamide
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  #5  
Old 01-29-2014
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Quote:
Originally Posted by Curacao View Post
Dont post NBME questions!!!!!

Or At least mark the thread! Just think what DIURETICS do...
thanks, but why not? There is no policy on to not post NBME qs, everyone has done it...
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Old 01-29-2014
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No offense meant there. Please mark them.Its just that nbme is used as assessment tool and for people like me who hav not yet done nbme s,when we are already exposed to it,we will get false high results and will think we are well preparrf
Hope u understand. Thanks
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  #7  
Old 01-29-2014
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Quote:
Originally Posted by step11 View Post
No offense meant there. Please mark them.Its just that nbme is used as assessment tool and for people like me who hav not yet done nbme s,when we are already exposed to it,we will get false high results and will think we are well preparrf
Hope u understand. Thanks
ooh okay! I understand My bad! This was nbme 13 for the record
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  #8  
Old 01-29-2014
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Default other qs from nbme 13

hi these were some other qs I had if any of you know plz share your thoughts so I can understand as well . I really appreciate it thank you

A 62-year-old man is brought to the emergency department because of a 3-hour history of progressive difficulty breathing and mild left shoulder pain. His symptoms began after he ran up several flights of stairs. He has poorly controlled hypertension and mild angina pectoris. He has smoked one-half pack of cigarettes daily for 40 years. He appears uncomortable and has labored breathing. Diffuse crackles, ronchi, and scattered wheezing on auscultation of the posterior lung fields. His arterial PO2 is 58 mm Hg. Which of the following is the most likely diagnosis?
A. Cardiac tamponade
B. Pneumonitis
C. Pneumothorax
D. Pulmonary edema
E. Pulmonary embolism

correct ans is D, could someone how to pick up on that please? I found the answer through other blogs but no explanation.
Did he have underlying HF, and the crackles and wheezing gives it away? Thank you

1. 42 yr woman comes to the physician because of 3 weeks history of numbness of the fingers on the left hand. Neuro exam shows loss of touch graphesthesia and loss of two-point discrimination in the left hand. Lesion location is?? Its picture of a brain with letters , I can't post it on here but does anyone remember this question? Or if anyidea on what condition this is, it can help.

Thanks aALOT
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  #9  
Old 01-29-2014
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Quote:
Originally Posted by prep891 View Post
hi these were some other qs I had if any of you know plz share your thoughts so I can understand as well . I really appreciate it thank you

A 62-year-old man is brought to the emergency department because of a 3-hour history of progressive difficulty breathing and mild left shoulder pain. His symptoms began after he ran up several flights of stairs. He has poorly controlled hypertension and mild angina pectoris. He has smoked one-half pack of cigarettes daily for 40 years. He appears uncomortable and has labored breathing. Diffuse crackles, ronchi, and scattered wheezing on auscultation of the posterior lung fields. His arterial PO2 is 58 mm Hg. Which of the following is the most likely diagnosis?
A. Cardiac tamponade
B. Pneumonitis
C. Pneumothorax
D. Pulmonary edema
E. Pulmonary embolism

correct ans is D, could someone how to pick up on that please? I found the answer through other blogs but no explanation.
Did he have underlying HF, and the crackles and wheezing gives it away? Thank you

1. 42 yr woman comes to the physician because of 3 weeks history of numbness of the fingers on the left hand. Neuro exam shows loss of touch graphesthesia and loss of two-point discrimination in the left hand. Lesion location is?? Its picture of a brain with letters , I can't post it on here but does anyone remember this question? Or if anyidea on what condition this is, it can help.

Thanks aALOT
U have not gotten the import of what we are saying.
Don't post nbme questions please.
If u desire an explanation just start a thread the with a heading saying " Nbme 13 or 15 etc question"
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