THE USMLE TIMES - #98
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Welcome to issue #98 of The USMLE Times! This is the 99th straight week we’ve posted our USMLE Times Newsletter! Thank you to all of our supporters—new and old!
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Here’s what’s on tap for issue #98 of the USMLE Times:
Question of the Week (Cardiac Physiology)
This week’s video training (Speed up your USMLE question-answering process)
Question deep-dive & breakdown
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. Increased preload and unchanged afterload
F. Decreased preload and unchanged afterload
G. Unchanged preload and increased afterload
The answer & question breakdown is at the bottom of the post 👇🏼
🔗 LINKS TO RECENT POSTS
USMLE Times Issue #97 - READ HERE
USMLE Practice Question #77 - TRY IT HERE
USMLE Practice Question #76 - TRY IT HERE
This week’s recommended video 👇🏼
ANSWER + QUESTION BREAKDOWN
The mental model used to answer this question comes from our detailed test-taking skills masterclass (check it out if you want to elevate your USMLE test-taking skills) Here’s how to think through this question:
Step 1. Read the last line to determine the question: “Which of the following changes would be expected after successfully treating this patient's condition?”
Step 2. Determine if this is a first-, second-, or third-order question. It is 2nd order. 1st: Understand/identify the patient’s state (as explained in the vignette); 2nd: Identify the physiological change that would be expected based on the given treatment (diuretic).
Step 3. Read and understand the vignette, then ask yourself: “What change would I expect as a result of treating this patient’s CHF with a diuretic?”
Step 4. Look at the answer choices and select the option most closely resembling your thoughts from “Step 3” above.
GENERAL ANALYSIS
In this scenario, the patient with congestive heart failure is treated with a diuretic to relieve symptoms of fluid overload. Diuretics reduce intravascular volume, which decreases preload on the heart.
ANSWER CHOICES:
ANSWER CHOICE A: Increased preload and decreased afterload
Explanation: Preload would not increase with diuretic use. Diuretics decrease preload by reducing fluid volume.
ANSWER CHOICE B: Decreased preload and increased afterload
Explanation: Diuretics decrease preload, but they do not increase afterload.
ANSWER CHOICE C: Increased preload and increased afterload
Explanation: Both preload and afterload increasing is not expected with diuretic treatment.
ANSWER CHOICE D: Decreased preload and decreased afterload
Explanation: Diuretics primarily decrease preload by reducing fluid volume. They may have a minor effect on afterload indirectly through improved cardiac output.
ANSWER CHOICE E: Increased preload and unchanged afterload
Explanation: Preload does not increase with diuretic use, it decreases.
ANSWER CHOICE F: Decreased preload and unchanged afterload
Explanation: Diuretics reduce intravascular volume, leading to decreased preload. Afterload remains largely unchanged directly. This is the most accurate description of the changes expected with diuretic therapy in heart failure.
ANSWER CHOICE G: Unchanged preload and increased afterload
Explanation: An unchanged preload is not expected when using diuretics; afterload does not typically increase.
THE VERDICT…
Diuretics are used in heart failure to reduce fluid overload, which decreases the volume of blood returning to the heart (preload). This helps alleviate symptoms such as shortness of breath and edema. Afterload is not directly affected by diuretics.
FINAL ANSWER: F. Decreased preload and unchanged afterload
That’s it for issue #98 of The USMLE Times!
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