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sympathetikey
FA says, "euphoria, disinhibition, hyperactivity, distorted sensory and time perception, bruxism.
Lifethreatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome."
So I think they wanted you to see Sinus Tachy and jump for MDMA. Idk why Ketamine couldn't also potentially be correct though.
+13
amorah
I picked ketamine because it said no diaphoresis. But if you need to find a reason, I guess the half life of ketamine might rule it out. Remember from sketchy, ketamine is used for anaesthesia induction, so probably won't keep the HR and BP high for 8 hrs. In fact, its action is ~10-15 mins-ish iv.
+13
yotsubato
Because the NBME is full of fuckers. The guy is probably dehydrated so he cant sweat anymore?
+22
fulminant_life
you wouldnt see tachycardia with ketamine. It causes cardiovascular depression but honestly i saw " all-night dance party" picked the mdma answer and moved on lol
+10
monkd
Ketamine acts as a sympathomimetic but oh well. NBME hasn't caught on to ketamine as a drug of recreation :)
+6
d_holles
@usmleuser007 LSD doesn't cause HTN and โ HR.
+2
sbryant6
@fulminant_life FALSE. KETAMINE CAUSES CARDIOVASCULAR STIMULATION.
+12
dashou19
Take a look at why the patient has pale and cold extremities.
"Mechanistic clinical studies indicate that the MDMA-induced elevations in body temperature in humans partially depend on the MDMA-induced release of norepinephrine and involve enhanced metabolic heat generation and cutaneous vasoconstriction, resulting in impaired heat dissipation."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/
+5
drzed
@sbryant6 you're both saying the same thing. Ketamine has a direct negative inotropic effect on the heart, but it is also a sympathomimetic. You are both correct.
+1
paperbackwriter
@drzed Can you please site that? As far as I understand ketamine has a sympathomimetic effect on the CV system --> increased chronotropy and BP. I also don't see how they're saying the same thing. One person said "stimulation" and the other said "depression"
+1
nutmeg_liver
People tend to drink a lot of water on MDMA. I just guessed the confusion was a result of hyponatremia (too much free water) but no idea if there's any data saying that people tend to become hyponatremic due to water over-consumption on MDMA lol.
+2
cassdawg
"Despite possessing a direct negative cardiac inotropic effect, ketamine causes dose dependent direct stimulation of the CNS that leads to increased sympathetic nervous system outflow. Consequently, ketamine produces cardiovascular effects that resemble sympathetic nervous system stimulation. Ketamine is associated with increases in systemic and pulmonary blood pressures, heart rate, cardiac output, cardiac work, and myocardial oxygen requirements."(https://www.openanesthesia.org/systemic_effects_of_ketamine/)
+1
brise
LSD does cause HTN and tachycardia according to uworld! @d_holles
+2
hpkrazydesi
Excess carotene in what way? sorry if thats a stupid question
+
davidw
this is directly from Goljan
"Dietary ฮฒ-carotenes and retinol esters are sources of retinol. ฮฒ-carotenes are converted into retinol. (a) Increased ฮฒ-carotenes in the diet cause the skin to turn yellow (hypercarotenemia). Sclera remains white, whereas in jaundice the sclera is yellow, which can be used to distinguish the two conditions. (c) Vitamin toxicity does not occur with an increase in serum carotene"
+8
davidw
ฮฒ-Carotenes are present in dark-green and yellow vegetables.
+1
dashou19
When I was a little kid, I like to eat oranges, like I could eat 10 oranges at once, and after a few days, I could tell that I turned yellow...
+8
cbreland
I'm okay with missing this one
+4
veryhungrycaterpillar
That was fucking stupid. I've known this excess carotene fact since 8th grade due to a friend getting it, but I still wouldn't have thought of it. I went with anemia, figured it had to be folic acid since B6 would have shown up sooner than four years. UGH.
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an1
Vitamin C def would not occur in vegans and would cause scurvy symptoms. Folic Acid is HIGH in green leafy vegetables, We can assume vegans eat a lot of veggies. As this causes a megaloblastic anemia, the sclera would be expected to be pale. IFN a + ribavirin is used for hep, which is ruled out because of the normal urine and stool, and lack of scleral icterus. B1 def presents with wernickes/ Korsakoff often with excess alcohol intake and hypoglycemia uncorrected after dextrose. B6 presents with sideroblastic anemia + peripheral neuropathy (remember that INH caused B6 to be excreted resulting in neuropathy).
I got this wrong. Because who has time to go through every option and think it through, and who thought carrots would make the cut for this test.
+1
dashou19
On FA page 250, it is said that Isoniazid can also cause optic neuritis and color vision change. Sometimes it hurts if you know too much lol
+2
thepacksurvives
Yeah, this was my issue. I got it wrong because of this-- still don't understand the logic bc you can get chlamydia multiple times
+8
hungrybox
FUCK you're right. Damn I didn't even think about that. That's fucking dumb. I guess this is why nobody gets perfect scores on this exam lol. Once you get smart enough, the errors in the questions start tripping you up. Lucky for me I'm lightyears behind that stage lmao
+11
usmile1
to make it even more poorly written, it says they are doing a screening program for FIRST YEAR women college students. So one year later, are they following this same group of students, or would they be screening the incoming first years?
+6
dashou19
I think the same at first, but after a second read, the question stem said "additional" 200 students, which means the first 500 students don't count.
+
santal
@hungrybox You are me.
+2
neovanilla
@usmile1 I was thinking the exact same thing...
+1
happyhib_
I agree this is a trash question; I was like well if this is done yearly for new freshman the following year would be of the new class (but the word additional made me go against this). Also you could assume that they were treated and no longer have the disease... I dont like it honestly but know for incidence they want you to not include those with disease so i just went with dogma questions on incidence to get to 10%
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notadoctor
Wouldn't UV light also be contraindicated in Vitiligo?
+5
sweetmed
Phototherapy with photochemotherapy (PUVA) is a well-known and well-studied modality for the treatment of psoriasis, which involves systemic or topical administration of chemicals known as psoralens and administration of ultraviolet light in increasing dosages after requisite time gap. PUVA is also used in the treatment of widespread vitiligo with moderately good results, though it is being surpassed by ultraviolet B (UVB), which is equally or slightly more efficacious with fewer side effects.
+8
dashou19
Honestly, I didn't even know what Methoxsalen is, just chose the right answer because I know you can not give UV light to people with PCT...
+14
sarahs
what about tcell lymphoma which also has cutaneous lesions?
+
shieldmaiden
@notadoctor UVB from the sun is contraindicated. PUVA is actually used for vitiligo therapy
+
Why no sweating? I mean I get Ecstasy is probably the drug of choice before an all night dance party (lol) but don't understand why there would be cold extremities and no sweating when is FA it says hyperthermia and rhabdo????