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NBME 19 Answers

nbme19/Block 0/Question#0 (reveal difficulty score)
76-year-old-man...severe substernal chest ...
Coronary vasospasm due to alpha1-adrenergic stimulation πŸ” / πŸ“Ί / 🌳

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submitted by βˆ—sugaplum(427),
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FA 0192 Pg 337
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submitted by βˆ—peteandplop(38),
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prolific_pygophilic  ^Comment of they year +1  
chaosawaits  Who else got a little distracted by the tragic story of watching your brother have a heart attack because of an argument you were having with him and then had to refocus to get this question? +  
an1  wouldn't coronary vasospasm refer to prinzmetal angina? can someone go over the other options? +  
neurotic999  The way I approached it was, since they specifically asked about the role that the argument played in developing the symptoms, it seemed as though they were pointing in the direction of vasospasm rather than an occlusive cause like atheroemboli, ruptured plaque, etc. So I looked at the options with that in mind. Some of the options were blatantly wrong: -vasospasm d/t beta (beta is vasodilatory) -increased afterload d/t beta (beta 2 would cause vasodilation, decreasing afterload. beta 1 would increase hr but I don't think it alone is enough to increase afterload) -negative chronotropy d/t alpha (that would be a beta blocker) -positive inotropy d/t b2 (that would be beta 1, not 2) The one I wasn't sure about was decreased perload d/t alpha1 stimulation. I was thinking decreased preload, hence decreased blood in the coronary circulation. But it didn't seem convincing enough to cause an MI. Plus not sure if alpha stimulation decreases preload to begin with. +  
neurotic999  If the ST elevation part of it throws you off, FA2019 301 says prinzmetal angina has transient ST elevation. +1  

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