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NBME 23 Answers

nbme23/Block 4/Question#45 (94.5 difficulty score)
A 32-year-old man has a diastolic blood ...
Precapillary resistanceπŸ”,πŸ“Ί

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submitted by ferrero(43),
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A yevr rsmalii esoinutq I hvae eesn in nsQbka lwli ksa ywh a tanptie twhi rgiht taher alirfue sdoe tno pdoevle eedam dna eth nsawre si ierdnacse mciythlap gadaenr.i I ogt thsi ntoesqui nrgwo iiganlrylo csabeeu I eewndsar lanog hits leni fo nsogirane but I itnkh in tshi esca ti all has to od thwi EWHRE the rtaex sesrpreu is iognmc r.fmo In hsit etniusqo the tp sah atiscdlio yepstienronh os uyo nca kthin uotab eth rsrspeue as cminog rrd"oafw" so itrgcositncn erariclpplay cpsnhtirse nca revnept na cnieesar in ruesepsr ni het plylaicra ebd. evwHore rof thrig rheat urlaeif shit artxe ldiuf si cinmog omfr teh TPPEOSOI rditocnie (scarakwbd orfm the rgiht )thrae nda iscrgotcnnit ppiayrelcral csrsipthen can od ghniotn o(n teosipop sedi of yaialrcpl ebd) - hte ylno wya ot etnevpr meaed is to anrecies lthcmyapi aei.rdang

seagull  The question clearly lead us to think about Osmotic pressure by talking about protein and urine. I wonder how many people used that line of reasoning (like myself)? +16  
mousie  Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank) +9  
sympathetikey  My reasoning was much more simplistic (maybe too simple) but in my mind, systolic BP is determined by Cardiac Output and diastolic BP is determined by arterioles. Therefore, what comes before the capillary and regulates resistance? Arterioles. That's why I said that pre-capillary resistance. +35  
cr  the main difference between the 2 cases is that in this case the patient has high BP +1  
link981  So in kindergarten language the question is essentially asking how high pressure in the arterial system is NOT transmitted to the venous system (which is where EDEMA develops). But you know they have to add all this info to try confuse a basic principle and make you second guess yourself. (Got it wrong by the way) because of what @ferrero said of Qbank questions. +6  
hello  @ferrero what are you talking about? lymphatic drainage is the wrong answer... +1  
hello  ok never mind. i got it. hard to understand b/c it was a big block of text. +2  
asteroides  I think they may be talking about the myogenic compensatory mechanism: "Increased arterial or venous pressure also induces myogenic constriction of arterioles and precapillary sphincters, which raises arteriolar resistance (thereby minimizing the increase in capillary pressure) and reduces the microvascular surface area available for fluid exchange. For example, because vascular smooth muscle in arterial and arteriolar walls contracts when exposed to elevated intravascular pressures, this myogenic response increases precapillary resistance and protects capillaries from a concomitant rise in their intravascular pressure." +4  

submitted by staph_aureusxx(5),
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pyeirlpacral esctriensa = irecgsndib het oer.raistle ehs' ogt ilmniam nreiopt ni het i;eunr dan no n.aiblmu het yek was ayngip nttitoaen ot eth obldo .supeesrr ePrusesr si tugardeel by eht sareinscte lvesses sa dbosra sclla it whchi si het aielorrste aka lypcrliparea .esesainrtc

submitted by notadoctor(165),
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'vIe eneb rasnehigc ofr ym rosuce for htsi ubt tac'n emse to idfn .ti v,rHeoew eht wya I gthhtuo otaub ti asw htta daeme ppsnhae aiv hte criseapalli. If rehet is aseerdnci sractsiene avi teh lirayprapcle cnsisrphte sa hcmu odlbo 'owuldtn eb able ot teg toni teh e.liaacslirp eTh olbdo wloud dteians egt euntsdh vai oasmastosne ot teh veins. hsTi iarlect fmro loovyoscpihgmyc. salxpnie ti a etltli r:ebett VC iPyhlsyog:o sTuesi Eadem and erlnGea lpeciinsPr of Tacnyparllrias lFidu echExgna

submitted by chagas14(1),
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yaebM eth suoitenq is danglie whit the etccpno of conegmyi lraeitorar nncssttaooviroci wchih is a neatohr teaa-ndemi csmmin.aeh heT rpe pycrlaila erspncith rctancot ni onrepess ot a esiar ni BP. I otg het Q nogrw sauceeb I pidkec yacpmlhti lof.w eTyh voel to og for teh a"twh sel"e enmelet of ayn icto.p I otnnca difn any naesor hyw eht pamtiylhc ontiop dlcou eb orngw :/

p/.oKssbonk4eog4Nlrr./?55tB3ms.bnwioih=//w.sacp/tvic:thlcnwk Cehc hte efuirg 1.4 heT rngaMi of fSaety ntigAsa Eemad onroatFmi – mEeda fayeSt toarsFc

submitted by adong(102),
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nI onidtadi to whta has aadrley enbe isda I hnikt na tainomtrp inotp in the qeuostin asw rgelyoautr etnutdsasmj icwhh nitops meor droastw aretrolira nouitralg.e

submitted by ninja3232(8),
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nWeh" atiraler epreussr s,llfa niyocmge etno is erucded ni ree,itsolra icgseneard hetir iescentsra ot olfw dna iganntiiamn yaplcrlai esesu.rrp sheeT vsieaorobsnt gsgsteu atth piacyalrl srruepse may be autreedgl evro het aesm grean of puerrses hacnges rove whchi fwlo si teaeagdlruuto ni a geinv ,edIend omfr hte "aie:nlrto


submitted by hello(350),
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why is lamaps tinoocc rseespru rngw?o

rainlad  I think it's because we would expect to see some more proteinuria/albuminuria if the plasma oncotic pressure had increased to compensate +1  

submitted by ferrero(43),
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A ryev iamlirs qsouetin I evah eens ni nbQksa lliw aks hyw a ptnteia twhi ihtrg hater fieural dsoe ont vpeodle eemda nad eth swrena is saeinrecd pilmatych edngaira. I otg ihts sieotqnu gorwn ngiioarlyl bceaeus I daerwens nlago tshi inle of onaneigsr tbu I hntik ni shti aecs ti all has ot do hitw EREWH hte retxa usrsepre si nigcom frm.o nI ihst otnqieus teh tp has doisactli irheoesnyntp os ouy acn iktnh buoat het eprssreu as nmgcoi rdwafr"o" so rignstnicoct alpiyacrlepr hpecsnsirt anc nevpret na icresena ni rspeerus ni eth rclaialpy .bed vwoHeer orf tihrg ertha ruifela shit ertxa dfiul si gicnmo mfro het IEPPOTSO reitcnoid k(scdabawr from het trihg htare) dan tgosccinirtn alicrarppyel tcpisesnhr nac od itgnhno o(n tpoispeo dies fo alrpyliac db)e - eht olny wya ot pernvet daeem si ot ereaicsn lymihacpt igadn.rea

submitted by usmleuser007(418),
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cAoirt licaDstoi reuesrsP

  • Hhig TRP = hgih DP
  • hgiH RH = ighh DP
  • ihHg SV = ghhi PD

oictrA coystilS ues rPsre

  • hgiH otiCaritynctl = hhig PS
  • ihHg SV = gihh SP
  • owL monilaCpec = hhig PS

submitted by spow(41),
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I oasl khnti taht eht tinop igbne aemd ereh is about enma ielrraat urrsepse M,AP)( wchhi is what agtyeraruoutol ysesstm ytaalucl angehc adebs .no uceBesa he sha rsaeiecdn AMP du(e to aienesdrc DB,P) eht saaipceillr illw ntscrocti to taamnini totnncas we/fssrleprou ouhthgr het plciaryal

submitted by divya(63),
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i od'nt kihtn you eden to hnkti all htta hcm.u look at all eht iotsnpo adn ithkn fo atwh aphsnpe newh htey ne a,Ai.escr B, C, D dna F all cna acesu nsteiitrlita e.mauted B isncgrnaei cailalprrpye sertacenis iltfnyeide t.s'nedo

drzed  Increased lymphatic flow would not cause interstitial edema. +1  
123ojm  but it doesn't say "increase in," it just says "regulatory adjustments in." +1  

submitted by usmleuser007(418),
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1. trcoAi licsiDtoa ersePsur .1 Hgih TPR = hgih PD 2. higH HR = ihhg PD .3 Hihg SV = hghi DP .2 Aortci otlySsci esesurPr .1 iHhg Crtaclittyoin = gihh SP 2. hgHi VS = ihhg PS .3 owL pnCciaelmo = hihg PS
yex This helps somehow, the first part about capillary pressure. +  
usmlelol  that's the exp part:: The average capillary hydrostatic pressure is determined by arterial and venous pressures (PA and PV), and by the ratio of post-to-precapillary resistances (RV/RA). An increase in either arterial or venous pressure will increase capillary pressure; however, a given change in PA is only about one-fifth as effective in changing PC as the same absolute change in PV. Because venous resistance is relatively low, changes in PV are readily transmitted back to the capillary, and conversely, because arterial resistance is relatively high, changes in PA are poorly transmitted downstream to the capillary. +