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NBME 23 Answers

nbme23/Block 1/Question#48 (reveal difficulty score)
A 20-year-old man is brought to the emergency ...
3,4-Methylenedioxymethamphetamine (MDMA) πŸ” / πŸ“Ί / 🌳
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 +20 
submitted by βˆ—hello(386),
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leepSn is egadrl.en mrapoCe ti to TC ncsa hgsiwon zeladmno-irs le:nsep

olsthip4/.tg8tpys1/wc:1gbjr/ouro5doalh/twir/w.lpmd3/toal.aucqs6o


 +11 
submitted by βˆ—azibird(218),
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oWh lees otg hsit sjtu csaueeb ti asdi "til-galhn ndcae r"pyt?a ppidAle ym ekglwdone of rsaev dan iognnht esl.e

chaosawaits  that almost ruined me because I remembered all those fun levodopa parties my boys and I used to have. /s +  



 +3 
submitted by βˆ—mousie(252),
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yhW no ena?wsgti I aemn I etg scaEyst is lyobbrpa hte dgru fo ehccio beorfe na all ghnti edcna patyr )l(ol utb ond't udnndresta yhw eehtr odlwu be clod tremtsxiiee dan on gstiwnae ewnh is FA ti asys pieathrhmery dna hbo???adr?

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  
usmleuser007  Why not LSD? +1  
d_holles  @usmleuser007 LSD doesn't cause HTN and ↑ HR. +2  
sbryant6  @fulminant_life FALSE. KETAMINE CAUSES CARDIOVASCULAR STIMULATION. +11  
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/ +4  
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 +1  



 +2 
submitted by macrohphage95(9),
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ADMM si hte nlyo olegclnuhnia htat has ieahmtctpsy icyttvai as it si edrdevi fomr heihthtpsmmenmaea ( kloo at its a)men ... htat penxasil heevrytgi.n

tyrionwill  Yes, good point to remember. In the category of FA stimulants, 2 agents has sympathetic activity: 1)MDMA; 2)PCP +  
jackie_chan  Basically how I solved it, all the other drugs are downers +  
jackie_chan  Even tho ketamine has sympathomemetic effects, they would be widly tripping, they dont call it falling into a K-hole for nothing. +  



 +2 
submitted by βˆ—bmilt34(1),
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Ok I tkhni ihts is a bda bicitoamnon of )1 a opolyr entritw ntoise,qu )2 a lntitaope ianrudnssmintsged- by eht rtriwe nda3,) a pixctoenate orf the lcelar fo coisreet onafiromnti tpcoiedaclm by hte 8 srhou cwihh veah laeespd ciesn the ngiiosetn

er'Hes what I nkhit: ) 1 eyht doen defgoo yb igynas etehr is no siehoaidsp.r We haev lal snee ahwt MMDA sode ot seeolpp' iencrce gsdanl - moeoverr eeolpp irkdn ...a tol tsu(h aiguncs hte alccsis wlo aN wichh ecussa z sie)su)r2e st'I iderw ttha eh uoldw ehva cihctyaaard tbu oenn fo eth htore sx of MADM ciinaxontoit 3) I suegs we ear ssuepop ot ownk /nda or rneaso thta veen tghouh DAMM ucssea ,perhetahyrmi ti olsa has pymtechtais ceefstf cresn(iade e/dihsiienebeartl treepu fo ie,enndlara ,pehnieroennipr otesi,ornn adn p)omeanid icwhh cuodl easuc the cldo rsteiimexte




 +2 
submitted by medstudent22(10),
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Saigwetn si temedida yb eth sipcahtmtye nureovs mess,ty but si gtohuhr nllcoAteichye mRre(bmee - ciiaArniMt-uscn noipgonsi = Dyr as a enbo esaubce no aewt)n.sig tI lal nitspo to NE oevrdeso e(kdmicmi yb an ihpatanmme)e &-t-g; yachrdaciaT NE( @ ta,1-eb) eHnypvirseet N(E @ ,halp1a)- Pale + dClo = rcvtcinsnisooato (NE @ a-hp)la1

eKy tiopn - ageswnti lwil tno be atulitesmd yb NM.AD

toN tcxlyea suer yhw ateiknem si NOT hte reasnw ba(emy it 'estdon eadl ot rphrielepa etvscostivoriacn psteripe?)ro But ADMN seod tif the ucrpite!




 +0 
submitted by βˆ—brise(74),
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oHw od you reul tou DLS? tI lsao aesucs aahatircdyc!




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