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USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


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  #1  
Old 03-08-2014
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Default Stuck in other one

1. A 45 years old man come to the physician for a follow up examination 2 weeks after beginning treatment with hydrochlorothiazide for hypertension. He says that he feel faint, light-headed, and dizzy when he gets out of bed and when he rises from seated position to quickly. His pulse is 75/min, respirations are 12/min, and blood pressure is 130/85 mmHg while supine. Physical examination shows no abnormalities. Which of the following sets changes best characterizes changes in the cardiovascular system as this man goes from the supine to the standing position?
Venous return, carotid sinus Baroreceptor activity, cerebral blood flow
a. ↑ ↑ ↑
b. ↑ ↑ ↓
c. ↑ ↓ ↑
d. ↑ ↓ ↓
e. ↓ ↑ ↑
f. ↓ ↑ ↓
g. ↓ ↓ ↑
h. ↓ ↓ ↓
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  #2  
Old 03-08-2014
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Default I think is B, but he have hypertension

Quote:
Originally Posted by Jannette View Post
1. A 45 years old man come to the physician for a follow up examination 2 weeks after beginning treatment with hydrochlorothiazide for hypertension. He says that he feel faint, light-headed, and dizzy when he gets out of bed and when he rises from seated position to quickly. His pulse is 75/min, respirations are 12/min, and blood pressure is 130/85 mmHg while supine. Physical examination shows no abnormalities. Which of the following sets changes best characterizes changes in the cardiovascular system as this man goes from the supine to the standing position?
Venous return, carotid sinus Baroreceptor activity, cerebral blood flow
a. ↑ ↑ ↑
b. ↑ ↑ ↓
c. ↑ ↓ ↑
d. ↑ ↓ ↓
e. ↓ ↑ ↑
f. ↓ ↑ ↓
g. ↓ ↓ ↑
h. ↓ ↓ ↓
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  #3  
Old 03-08-2014
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Default Help, please!!!!!!!!

HELP, some one!!! I know is a difficult one that's why I'm asking
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  #4  
Old 03-08-2014
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Default

h)
When the patient stands up the venous return will decrease due to gravity.
As the venous return decreases, your arterial blood pressure will also decrease and you will fire less action potentials on your carotid sinus and your cerebral blood flow will also decrease.

This is a high yield question, because in my step 1 I had lots of similar questions.
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  #5  
Old 03-08-2014
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Venous return will be decrease for sure
Carotid baroreceptors afferent firing will decrease ( because hypotension )
Cerebral blood flow?????
Any one who know the answer share his knowledge with us
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  #6  
Old 03-08-2014
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Sorry, I made a mistake.
the carotid sinus activity (I think he is talking about efferent nerves) will be increased.
So the answer is actually f.
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  #7  
Old 03-08-2014
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https://highered.mcgraw-hill.com/sit..._pressure.html

This video might help you understand the baroreceptor reflex control of the blood pressure.
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  #8  
Old 03-08-2014
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Default My doubt was in venous return

THanks, thanks thanks
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  #9  
Old 03-08-2014
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Hi, that's me again.
So, I though about this question and I think the carotid sinus baroreceptors activity will be decreased. So the right answer is H.
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  #10  
Old 03-08-2014
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Hey I can bet my last dollar on this.
The answer is H.
All others are wrong.
Venous return decreases due to gravity
Well anytime u hear Baroreceptors activity think parasympathetic. So when u are standing up and ur venous return is decreased whom do u think would be working more to keep u going, obviously sympathetic becos parasympathetic would not help U to decrease ur pressure down again wen it's already down from lying down to standing position. So Baroreceptors activity too is decreased.
Cerebral blood flow is a give away answer becos even the question has narrated it to us. When ur VR decreases it also decreases.

Well where did u get this question?
__________________
In USMLE, “Any fool can know. The point is to understand.”
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  #11  
Old 03-08-2014
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H?

Watch the Kaplan 2010 videos. I think Dr. Kudrath does an excellent job explaining this.
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  #12  
Old 03-09-2014
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I think the answer is H !
when you stand up .. VR deacrases because blood will be pooled to veins of legs which have high compliance so blood will be contained in the veins of legs !
This is the reason why blood flow in brain will decrease
also when blood is damped in veins arterial pressure will increase causing the baroreceptor ( which normally fires Parasympathetic NS ) to decrase its activity so that SNS can predominante and compensate for the decrease in arterial pressure !
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  #13  
Old 03-09-2014
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Hey, the answer should be H. We know going from supine to standing the venous return will decrease with pooling of the blood, and since the blood is pooled there's a decrease in cerebral blood flow. As we know the baroreceptors are for parasympathetic activity, and we want to increase our hr so the baroreceptor function has to decrease. Hope this helps!
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  #14  
Old 03-09-2014
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Default I can't stop either thinking about this

The thing with this question is that I have two friend that answer f and H and got it wrong. When they said that to me, I got crazy because now I don't know the answer
I found this in venous return, increase. http://www.cvphysiology.com/Cardiac%...tion/CF017.htm
I think is B

Last edited by Jannette; 03-09-2014 at 01:28 PM.
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