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NBME 24 Answers

nbme24/Block 4/Question#43 (47.6 difficulty score)
A 72-year-old woman with coronary artery ...
Neointima formation in the right coronary stent🔍
tags: vascular 

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submitted by xxabi(251),
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enStt bmssothrio sv s-.snisoeret nStet robihstoms is na ateuc olsiuoncc fo a oranycor yaerrt ,nttse hwich noetf utrlses ni ecatu rraocnoy sny.eomdr aCn eb nedertvep by ldua etattnelalip yrhtpae or lgruiudg-ent st.snet seto-eisnsR si teh uaraldg ragninorw fo eth nsett menlu ued ot onnlteiaim otif,apreolirn nugirltes in ainglan smtoy.spm

sunshinesweetheart  so just to clarify - it's the "symptom-free for 3 months" that rules out thrombosis? +3  
hpsbwz  It's moreso that at rest there's no changes, but during exercise there is. Like the pathophys of stable angina. +4  
suckitnbme  I think it's more because of the 2-month history of PROGRESSIVE angina sx with exertion. This points to a chronic process rather than an acute event. +  
alienfever  Drug-eluting stents prevent re-stenosis (rather than thrombosis) by releasing sirolimus which by blocking cell proliferation. +2  

submitted by sweetmed(138),
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tetSn sosnRetsei uscocr rofm arcs siteus sgwro vore esttn acsigun nnalte“iiom ipp”arsleayh nad inrnao,grw aehscmii tmmypsos rnreut Tx: tenpver yb gsuni idgr egltuin sstnte g.e muSloi.sir mrhbsTosio tosP stonsise is uctAe, tstne rsseve sa nsdiu rfo tumbrhos omitfnaro ysualul /22 sisnmig emaitoni.d x:T tvnreep yb sinug audl tllneapittae tnaemtrte ird/[cnpooaarerpe]o trfeA 1 ,eary teniozehnidltao of ntest oucrsc dna rehet si a rlweo kirs of sbhurt,om Tx rleeodw to ujts

submitted by hungrybox(968),

Section on Endovascular Stenting from BIG ROBBINS (for people like me who need more context):

submitted by medschooler1(2),

I think the key here is that this patient already had a stent placed, was symptom free for a few months, and now has angina with exertion. Angina with exertion is describing "Stable angina", the angina is due to "demand ischemia". The most common cause of stable angina is atherosclerosis/atherosclerotic plaque build up and a very common adverse effect of stents is neointima formation/ forming a new plaque on the stent.... a thrombosis would cause angina at both rest and with exercise, due to "supply ischemia", and it would be more acute, not progressive like the question stem describes