NBME Answers : radshopeful's page

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+6 visit this page (nbme24#43)

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The classic side effect of anthracyclines is dilated cardiomyopathy. This question could have gotten tricky if you thought the pulmonary symptoms were due to the drug which could have led you to bleomycin (causes pulmonary fibrosis) but these pulmonary symptoms were most likely a result of dilated cardiomyopathy leading to HF and pulmonary edema.

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nwinkelmann What is the clue that this is not pulmonary fibrosis? How do I decide between Doxorubicin and Bleomycin? +

ilikecheese Also both bleomycin and methotrexate cause pulmonary fibrosis, so that helped me rule both those out and focus on the HF instead of the pulmonary symptoms +6

adisdiadochokinetic The S3 gallop and enlarged heart together are very strong evidence for heart failure. It's much more likely for heart failure to cause interstitial edema than for pulmonary fibrosis to directly cause heart failure. +12

jurrutia Also pulmonary fibrosis would more likely cause right-sided HF. This patient has left-sided HF (orthopnea, crackles, pulm edema.) +

+4 visit this page (nbme24#48)

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This patient has decompensated left heart failure. Decompensation occurs because of the hearts inability to keep up with demand any longer. This leads to a decrease in SV mainly because of a contractile issue which leads to a decrease in CO (CO = SV x HR). Lastly, the LVEDV will be decreased because the SV is decreased leaving more blood in the left ventricle after systole since it cannot be pumped forward. Hope this helps!!

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xxabi Great explanation - I think you have a minor typo, LVEDV will be increased* bc SV is decreased +15

smoothie More blood left in the ventricle after systole is LVESV. I thought LVEDV increases because more blood remains after systole and on top of that blood from left atria from diastole is now also added. +5

+9 visit this page (nbme24#26)

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chronic kidney disease --> decreased EPO --> decreased hematocrit chronic kidney disease --> decreased PO4- excretion --> increased PTH chronic kidney disease --> decreased 1,25 dihydrovitD (calcitriol) --> increased PTH

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jotajota94 she is also volume overloaded. more fluid leads to a decrease in Hematocrit. +6

h0odtime I thought PTH increases 1-alpha-hydroxylase which increases levels of 1 ,25? +1

batmane it's supposed to in the setting of proper kidney fxn +2

h0odtime Whoops +1

avocadotoast The decrease in GFR leads to decreased delivery of 25 dihydro vit D to the PCT and the decrease in functional renal mass limits production of 1a-hydroxylase. The increase in PO4 also stimulates FGF-23 from bone, which inhibits PO4 reabsorption and 1a-hydroxylase. +1