need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (โ€œpredict me!โ€)

You must be logged in to vote!
Retired NBME 23 Answers

nbme23/Block 4/Question#34 (reveal difficulty score)
A 44-year-old man who is a farmer and has ...
Area labeled โ€˜Dโ€™ ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags:

 Login (or register) to see more


 +10  upvote downvote
submitted by โˆ—mcl(671)
get full access to all contentpick a username

To expand on this, organophosphates are commonly used as insecticides, and function by binding acetylcholinesterase and "deactivating" it, so to speak. This results in an excess of ACh within the synapse, which causes sludge syndrome (vomiting, sweating, diarrhea -- basically lots of fluids). The treatment for this is typically atropine (antimuscarininic), and pralidoxime (if given early enough, can "reactivate" the ACh-ases). The diagram given does not show ACh-ase, only the ACh-R, therefore D is the best answer.

get full access to all contentpick a username
lowyield  Also according to uworld you give atropine before pralidoxime because pralidoxime can cause an initial exacerbation (even though you might think you should give pralidoxime first because it is time sensitive) +5
handsome  FA 2020 Pg 248 "Atropine>pralidoxime" +1
fhegedus  FA 2020 page 241 says atropine is given for muscarinic symptoms (DUMBBELLS) while pralidoxime is primarily used for the nicotinic symptoms of acetylcholinesterase poisoning. The q stem has muscarinic symptoms (vomiting, diarrhea, salivation), so the best option to give atropine, which acts at muscarinic receptors +1

To expand further, atropine is used to reverse MUSCARINIC symptoms (i.e. "DUMBBELSS": Diarrhea, Urination, Miosis, Bradycardia, Bronchospasm, Emesis, Lacrimation, Salivation, Sweating) and it can also cross the BBB to relieve the CNS symptoms (i.e. respiratory depression, lethargy, seizures, coma). However, pralidoxime is used to reverse NICOTINIC symptoms (i.e. the neuromuscular blockade). Pralidoxime CANNOT cross the BBB and therefore cannot relieve CNS symptoms. And always give atropine before pralidoxime because pralidoxime can cause transient acetylcholinesterase inhibition, which will worsen the symptoms.

+1/- fatboyslim(118)

You must be logged in to vote!

 +3  upvote downvote
submitted by โˆ—mousie(272)
get full access to all contentpick a username

Organophosphate poisoning = Antidote = Atropine (Airway M receptor blocker) = dilation of bronchioles

get full access to all contentpick a username


You must be logged in to vote!

Must-See Comments from nbme23

ferrero on Precapillary resistance
yotsubato on 99%
sne on Triglyceride
sajaqua1 on Area labeled โ€˜Dโ€™ (Spinothalamic tract, right)
stinkysulfaeggs on Hypoglycemia
hayayah on Iris
soph on Peak inspiratory pressure (alveolar): ...
seagull on Area labeled โ€˜Cโ€™ (Cranial nerve 8: ...
water on Dietary change
wired-in on 28.8
beeip on Binding of permeable ligand to nuclear ...
thomasalterman on Hypoglycemia
yotsubato on Inhibition of the cytochrome P450-dependent ...
seagull on Decreased sodium bicarbonate reabsorption in ...

search for anything NEW!