NBME Free 120 Increases nitric oxide concentration (NBME Answers)

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submitted by ∗screwprometric5(0)

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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?

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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 +3

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. +4

psaucy No question will present HCM as a 54 year old man. Always look at demographics if you are debating between two things. +

an1 Not HCOM. Yeah it has an S4, but MI also has an S4. More likely that this guy who is in his 50's has an MI or unstable angina. +