NBME Answers : jrod77's page

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+3 visit this page (nbme23#48)

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Azoles inhibit cytochrome P450 enzyme that converts lanosterol to ergosterol.

this is the best treatment indicated for candida.

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+8 visit this page (nbme23#1)

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I think they might be describing angina...not sure. TXA2 is responsible for platelet aggregation,so it may be contributing to thrombosis, thus ischemia to the cardiac tissue.

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sympathetikey Agreed. I'm pissed though because PGE2 mediates pain, which is why I picked it. +46

he.sanchez14 If im not mistaken, the question describes unstable angina. Unstable angina is due to thrombosis with incomplete occlusion. So, yes TXA2 is responsible for the thrombus that is causing the symptoms in this patient. I'm also pissed because I also went straight for the PGE2 +5

vik hahah, seems like all in same boat like me +

yb_26 thromboxane A2 is also vasoconstrictor, so my thoughts were about vasospastic angina +8

youssefa Went for PGE2 ... shit +

need_answers I went for leukotriene B4, what the hell was I doing....SHIT +15

hopsalong I picked Leukotrine B4 thinking that the neutrophil infiltration was the source of the pain, seems wrong lol. +

bballhandler11 Sometimes it helps me to think of it in a general, non med school textbook kind of way. When answering, I narrowed it down to PGE2 and TXA2 as well. Then I asked myself, if someone is experiencing chest pain, would I recommend Aspirin or Advil? That's helped on a few over the counter pharm questions. +12

ususmle same here I M PISSED PGE2 +3

krewfoo99 Maybe PGE2 isint the answer because it mediates pain and fever during episodes of acute inflammation? Thus making TXA2 more likely. +3

djtallahassee ditto on the looked at it for 2 seconds and went PGE2 +1

veryhungrycaterpillar My knee jerk reaction was to go with PGE2 for pain was well, but we must not forget that PGE2 is also a direct vasodilator. It also inhibits platelet aggregation. +

kungfupanda I'm on a whole new level. i thought this might be an asthma attack and i choose LTB4 +2

an1 Intermittent chest pain does seem like angina. E2 does cause pain, but it also causes fEvEr. TXA2 inhibits platelets (unstable) AND increases vascular tone (prinzmetal) which makes it a better option. E2 increases uterine tone (check sketchy), not vascular so it can be chosen if they were to mention labor. +

+17 visit this page (nbme23#17)

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The systolic pressure difference between the left ventricle and the aorta in this pt. is pretty significant, Whereas in a normal heart those systolic pressures should be just about equal. This hints at the fact that the left ventricle has to put in alot of work to push through the aortic valve. That extra pressure goes into opening the valve and does not appear in the aorta.

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divya why is left atrial pressure normal while pulm arterial and right ventricular pressures are high? +6

leaf_house @divya It looks like the left atria can dilate in response to severe aortic stenosis, which I think would bring up the minimum diastolic pressure of LA (and I guess lower max systolic pressure?) like dilated cardiomyopathy. Link: https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.116.005156 +

cbreland @divya I was on the same page, I saw that the left atrium was normal so I went to look at the right side of the heart and saw pressure elevations. Went with pulmonic stenosis.. Jumped the gun😔 +

jbrito718 @divya I think it has to do with the fact that the left ventricle is pumping so hard that some RV hypertrophy may occur since they contract simultaneously. Chronic aortic stenosis will eventually reflect backwards, causing increased pulmonary vessel resistance. +