THE USMLE TIMES - #99
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Welcome to issue #99 of The USMLE Times! We’re just 1 issue away from our 100th, within which we’ll be making a major announcement about the new direction of The USMLE Guys heading into 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. All content is FREE! Please share the newsletter with a friend if you’d like to support our efforts.
Here’s what’s on tap for issue #99 of the USMLE Times:
Question of the Week (Foundations of Pharmacology)
This week’s video training (50 Tips To Pass Step 1)
Question deep-dive & breakdown
Let’s dive in!
A 29-year-old man with a known history of severe allergies is at a party where he accidentally consumes a dessert containing peanuts. Within minutes, he begins to experience shortness of breath, wheezing, and noticeable facial swelling. His friends observe that he is struggling to breathe and appears anxious. They recall his history of severe allergic reactions and administer a medication that he carries with him wherever he goes. Which of the following best describes the mechanism through which the administered drug works?
A) Agonism of alpha-1 adrenergic receptors only
B) Agonism of beta-1 adrenergic receptors only
C) Agonism of beta-2 adrenergic receptors only
D) Agonism of alpha-1, beta-1, and beta-2 adrenergic receptors
E) Agonism of alpha-2 adrenergic receptors only
The answer & question breakdown is at the bottom of the post 👇🏼
🔗 LINKS TO RECENT POSTS
USMLE Times Issue #98 - READ HERE
USMLE Practice Question #81 - TRY IT HERE
USMLE Practice Question #80 - 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 best describes the mechanism through which the administered drug works?”
Step 2. Determine if this is a first-, second-, or third-order question. It is 3rd order. 1st: Identify what’s happening; 2nd: Identify the drug that was administered; 3rd: Identify the correct mechanism of action.
Step 3. Read and understand the vignette, then ask yourself: “How does the drug administered work?”
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 has ingested peanuts, leading to an anaphylactic reaction. the most appropriate (and most likely administered) medication is epinephrine.
ANSWER CHOICES:
ANSWER CHOICE A: Agonism of alpha-1 adrenergic receptors only
Explanation: This would not address the bronchodilation needed for respiratory symptoms.
ANSWER CHOICE B: Agonism of beta-1 adrenergic receptors only
Explanation: This would primarily affect heart rate, not addressing vasoconstriction or bronchodilation.
ANSWER CHOICE C: Agonism of beta-2 adrenergic receptors only
Explanation: This would only provide bronchodilation without addressing vasoconstriction or cardiac support.
ANSWER CHOICE D: Agonism of alpha-1, beta-1, and beta-2 adrenergic receptors
Explanation: This would increase blood pressure and reduce swelling (alpha-1), increase heart rate and contractility (beta-1), and cause bronchodilation (beta-2).
ANSWER CHOICE E: Agonism of alpha-2 adrenergic receptors only
Explanation: Alpha-2 agonism is not the primary mechanism in treating anaphylaxis.
THE VERDICT…
Epinephrine's broad action on multiple adrenergic receptors makes it effective for rapidly reversing the symptoms of anaphylaxis.
FINAL ANSWER: D. Agonism of alpha-1, beta-1, and beta-2 adrenergic receptors
That’s it for issue #99 of The USMLE Times!
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See ya next week 👋