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I have a problem with this question... Nitro is contraindicated in hypertrophic cardiomyopathy (FA 2020 pg: 318) and this patient has a S4 (which can be seen in hypertrophic cardiomyopathy FA 2020 pg: 308). So my thought process would you would want to give Digoxin to prevent the decreases cardiac output but then both C and D would be right. I think it's just a shitty question by NBME. Anyone's else thoughts on this?

katielit  I think you have to just go with what is most common, seems like it would be more likely for him to have HTN and atherosclerotic disease than a genetically inherited HOCM (also hes in his 50s which would be a late presentation for HOCM), normal routine treatment for STEMI/NSTEMI is MONA BASH, and NO was the only option that was part of that +1  
acidfastboi  I don't think this dude has HOCM - seems more likely that he concentric hypertrophy from the physical exam finding of an S4 (cause undisclosed in question). I agree with the above that he probably wouldn't present this late with HOCM. +3  


submitted by hungrybox(1026),

Other answers:

sebaceous gland → acne, Cutibacterium acnes (formerly Propionibacterium acnes)

apocrine gland (aka sweat gland) → The substance secreted is thicker than eccrine sweat and provides nutrients for bacteria on the skin: the bacteria's decomposition of sweat is what creates the acrid odor.

eccrine gland → used to secrete stuff inside the body (ie salivary glands, pancreatic glands)

dermis → middle layer of skin.

melchior  To tweak the above a little, eccrine glands are more commonly known as "sweat glands," although sweat glands that are apocrine do exist in the armpits and perineal area, though they do not contribute to cooling. +2  
acidfastboi  Per what @melchior said: "Eccrine glands are the major sweat glands of the human body, found in virtually all skin, with the highest density in palm and soles, then on the head, but much less on the trunk and the extremities" - Wiki +1  


submitted by alexb(47),
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It esems liek a lot of the sitcmsey iaemuunotm iseessda aer mlfoiurt.claiat sI ehter a enregla relu orf isth?

ls3076  Really good observation +2  
acidfastboi  Never forget what our lord and savior Dr. Sattar says - environmental trigger in a genetically predisposed individual (aka multifactorial)! +3