NBME Answers : 194orbust's page

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submitted by visualninjacontender(18), visit this page

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Irrerugularly Irregular rhythm = Afib Afib --> stasis of blood in the Heart ---> Thrombus formation Thrombus will embolize to the (likely) the popliteal artery leading to acute limb ischemia

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194orbust why would an embolectomy be favored over clopidogrel? +3

194orbust oh nvm......it's bc clopidogrel won't bust a clot, just prevents them from forming. +20

chandlerbas also the way i see it is the hommie has so much pain as indicated by "sudden onset of severe pain" so you want something fast and effective. surgery time! grab my scalpel! drugs could be indicated but arent an option even then heparin takes 20 to 60 minutes to work so +4

leemax lol +

submitted by visualninjacontender(18), visit this page

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Irrerugularly Irregular rhythm = Afib Afib --> stasis of blood in the Heart ---> Thrombus formation Thrombus will embolize to the (likely) the popliteal artery leading to acute limb ischemia

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194orbust why would an embolectomy be favored over clopidogrel? +3

194orbust oh nvm......it's bc clopidogrel won't bust a clot, just prevents them from forming. +20

leemax lol +

submitted by wasabilateral(47), visit this page

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This is what I thought but not sure if it’s correct. There is a UWorld q where it describes co-administration of cortisol and epinephrine. Cortisol significantly enhances the effect of epi because cortisol has a permissive effect on maintaining the adrenergic receptors.

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194orbust per UWorld, "cortisol exerts a permissive effect on many hormones to help improve the response to a variety of stressors. For example, cortisol increases vascular and bronchial smooth muscle reactivity to catecholamines". FA also uses the effect of cortisol on catecholamine responsiveness as the lone example for a permissive drug interaction (FA2018 pg 229). The difference here is that we're talking about exogenous glucocorticoid and adrenergic agonist. I guess it was expected for us to assume that the mechanism is analogous for the analogous drugs +16

maxillarythirdmolar I'm sure it's related to the activating effect of Cortisol on phenylethanolamine-N-methyltransferase, converting NE to Epi. Sounds like a synergistic thing to me. (FA.83) +4

feeeeeever My logic is probably flawed, but I also thought that if cortisol has the ability inhibit COX, LOX, and NFKB you can reduce inflammation and bronchoconstrictive mediators. Therefore, the B2 agonists would have a greater effect since things like LTB4 will be reduced. +2

feeeeeever *LTC4, LTD4, LTE4 for bronchoconstriction, my bad +1