THE USMLE TIMES - #92
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Welcome to issue #92 of The USMLE Times… We’re nearing the century mark and have some great things in the works for you in 2025! Thank you to all of our supporters—new and old!
I’m Paul Ciurysek, MD, and this is The USMLE Times: An independent, subscriber-supported newsletter designed to help you survive medical school, pass your USMLE exams, and match into your dream residency program. If you find value in the daily content, consider supporting our publication while accessing tons of bonus content with an “all-access pass.”
Here’s what’s on tap for issue #92 of the USMLE Times:
Question of the Week (Cardiovascular Physiology)
This week’s video training (50 Tips For Step 1 & Gaining Momentum)
Question deep-dive & breakdown
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Let’s dive in!
A 67-year-old male with a history of congestive heart failure presents to the emergency department with worsening shortness of breath and leg swelling over the past week. His vital signs are as follows: Temperature 98.6°F (37°C), pulse 105/minute, respirations 22/minute, blood pressure 140/85 mmHg, and oxygen saturation 92% on room air. Laboratory studies reveal an elevated B-type natriuretic peptide (BNP) level. The physician administers a diuretic to help improve the patient's cardiac function. Which of the following changes would be expected after successfully treating this patient's condition?
A. Increased preload and decreased afterload
B. Decreased preload and increased afterload
C. Increased preload and increased afterload
D. Decreased preload and decreased afterload
E. Decreased preload and unchanged afterload
The answer & question breakdown is at the bottom of the post.
🔗 LINKS TO RECENT POSTS
USMLE TIMES ISSUE #91 - READ IT HERE
USMLE TIMES ISSUE #90 - READ IT HERE
USMLE Practice Question #53 - TRY IT HERE
USMLE Practice Question #52 - TRY IT HERE
ANSWER + QUESTION BREAKDOWN
The Mental Model for this week’s question (A deep-dive into the nine mental models for USMLE questions can be found in our Test-Taking Skills Training Masterclass).
Step 1. Recognize what’s being asked in the last line: Identify the physiologic change expected after treating the patient with the most appropriate medication.
Step 2. Read the vignette and make a diagnosis.
Step 3. Ask yourself which medication is most appropriate based on the given scenario.
Step 4. Look for the answer choice that accurately reflects your answer.
GENERAL ANALYSIS
This question involves a 67-year-old male with a history of congestive heart failure who presents with symptoms of worsening heart failure, including shortness of breath and leg swelling. The patient is treated with a diuretic to improve cardiac function. The task is to determine the expected changes in preload and afterload following successful treatment with diuretics.
ANSWER CHOICES:
ANSWER CHOICE A: Increased preload and decreased afterload
Explanation: Preload refers to the volume of blood in the ventricles at the end of diastole, while afterload is the resistance the heart must overcome to eject blood.
Why Incorrect: Successful diuretic therapy reduces preload by decreasing fluid volume, not increasing it.
ANSWER CHOICE B: Decreased preload and increased afterload
Explanation: Diuretics primarily reduce preload by decreasing fluid volume.
Why Incorrect: Diuretics do not typically increase afterload.
ANSWER CHOICE C: Increased preload and increased afterload
Explanation: This would imply worsening fluid overload and increased resistance.
Why Incorrect: Diuretics aim to reduce preload and do not increase afterload.
ANSWER CHOICE D: Decreased preload and decreased afterload
Explanation: While diuretics effectively reduce preload, they do not directly decrease afterload.
Why Incorrect: Diuretics primarily affect preload, not afterload.
ANSWER CHOICE E: Decreased preload and unchanged afterload
Explanation: Diuretics reduce preload by eliminating excess fluid, which decreases the volume the heart needs to manage.
Why Correct: Diuretics primarily decrease preload by reducing fluid volume, while afterload remains unchanged.
THE VERDICT…
Diuretics are used in heart failure to manage fluid overload symptoms by promoting excess fluid excretion, thereby reducing preload. Preload is the volume of blood in the ventricles at the end of diastole, and reducing it helps alleviate symptoms like shortness of breath and edema. Diuretics do not directly affect afterload, which is the resistance the heart must overcome to eject blood. Therefore, after successful diuretic therapy, preload decreases due to reduced fluid volume, while afterload remains unchanged. This helps improve cardiac function and relieve symptoms in patients with heart failure.
FINAL ANSWER: E. Decreased preload and unchanged afterload
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Thanks for reading this week’s USMLE Times Newsletter!
See you next time 👋