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NBME 20 Answers

nbme20/Block 2/Question#50 (38.2 difficulty score)
A 27-year-old woman comes to the physician ...

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submitted by meningitis(574),
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hnWe sainngtd up, het odby olmynrla ascttaeiv tcptiahmsey ystesm to vaido iohrctstato oe.pniynosht

tBu sceni teher is won an diatdive ctefef of eth orcaytompooechmh giecd,anerrs it llwi aeld ot a inorseethnyp

ie.:( oeulDb tcooivsinnatcosr = ohPe iedacsnergr + mhtcatiSpey e)tsmsy

sympathetikey  Brilliant. +6  
medschul  Would pheo have a normal resting BP though? +13  
meningitis  I was trying to justify these tricky questions but very true medschul.. It shouldn't have normal resting BP. Sometimes it seems these NBME always have a trick up their sleeve. Im getting paranoid lol +  
nala_ula  The reason why the patient probably has normal HTN is because Pheochromocytoma has symptoms that occurs in "spells" - they come and go. Apparently in that moment, when the physician is examining her, she doesn't have the HTN, but like @meningitis explained, so many adrenergic hormones around leads to double the vasoconstriction when the patient stands up. +9  
meningitis  Thank you @nala_ula for your contribution! Really filled in the gap Iwas missing. +2  
nala_ula  No problem! Thank you for all your contributions throughout this page! +2  
mjmejora  I thought the pheochromocytoma was getting squeezed during sitting and releasing the epinephrine then. kinda like how it can happen during manipulation during surgery. Got it right for sorta wrong reasons then oh well. +  
llamastep1  When she sits in the examination table there would be a normal activation of the sympathetic system from the stress of getting examined which is amplified by the pheo. Cheers. +  
sammyj98  UpToDate: Approximately one-half have paroxysmal hypertension; most of the rest have either primary hypertension (formerly called "essential" hypertension) or normal blood pressure. +  
hello_planet  FA 2019 pg. 336 +2  
notyasupreme  Damn llama, that is WAYYY too much of an inference. Maybe if they said she was nervous in general or something, but not everyone gets stressed out by a doctor hahaha +  

Definitely got this question wrong but at the end of the day: I like turtles 🐢

+9/- jcmed(19),

submitted by saqeer(4),

Remember pheocrhomocytoma leads to high EPO, which leads to polycythemia and flushing seen in this patient

notyasupreme  I thought from the 5 Ps of pheochromocytoma, Pallor was one of them? That's what threw me off from keeping it the same.. Or atleast the anking deck says pallor. +1  
saqeer  the way i understand it the pallor is because of the sever vasoconstriction during an episode of catcholamine release but in general anything leading to polycythemia can lead to flushing +