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NBME 24 Answers

nbme24/Block 1/Question#32 (reveal difficulty score)
A 24-year-old man receives an injection of ...
Increased lymph flow ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +7  upvote downvote
submitted by โˆ—nor16(70)
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Histamine increases microvascular permeability, i.e. Fluid + Proteins, this increases pressure in the interstitium > lymph flow increases

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(In case you need visuals)

This picture shows the interstitial fluid. Basically just the area outside the blood vessel -

https://textimgs.s3.amazonaws.com/osanp/m46411/2702_Fluid_Compartments_ICF_ECF.jpg

This picture shows the relationship between blood vessels and lymph -

https://i.imgur.com/4dO0qfq.png

+/- hungrybox(1277)


 +5  upvote downvote
submitted by โˆ—mariame(16)
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Histamine causes endothelial contraction, this increases vascular permeability and leakage of protein-rich fluid from the postcapillary venules into the interstitial space -> increases interstitial oncotic pressure. (choice C).

Due to this it also increases capillary filtration rate, because the endothelial contracts. (choice A)

Because there is more fluid in the interstitial space, there is more lymph flow. (choice E).

FA19, pg 213

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 +4  upvote downvote
submitted by โˆ—fahmed14(31)
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Histamine plays a major role in the cardinal signs of inflammation. It helps mediate vasodilation and vascular permeability (via endothelial cell contraction). These two functions are already contrary to A, B, C, and D. By increasing fluid in the interstitial space, you can reason that there will be increased lymph flow.

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youssefa  If more transudates are leaking into the interstitium wont this dilute the interstitial proteins and cause a decrease in oncotic pressure and increase in interstitial hydrostatic pressure? +15
titanesxvi  @youssefa I think because it is an exudate from increased permeability of venules, the oncotic pressure in the interstitium is not going to decrease +6
thotcandy  @youssefa transudate is like pulmonary edema due to CHF, no proteins, just fluid congestion and leaking out. That would decrease interstitial oncotic pressure because it has very little protein. Exudate due to inflammation/histamine has a high amount of protein (due to inc permeability) so the IOP doesn't change. +6



 +2  upvote downvote
submitted by โˆ—famylife(110)
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There is "a direct action of histamine on the lymphatic smooth muscle via stimulation of H1 (and in some vessels H2) receptors. H1 receptors enhance and H2 receptors slow down lymphatic pumping, the dominant effect being an increased contractile activity."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1573448/

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unknown001  i wish i could downvote this a hundred times. its simple, histamine causes localized third spacing and lymphatics there have extra work . simple +1
madamestep  Keep it simple, stupid! It's usually the most obvious, simplest explanation that makes all of the information make sense together! +



 +2  upvote downvote
submitted by โˆ—dji(2)
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"Lymphatic vessels adapt their pumping activity to changes in fluid load. This function is particularly important during inflammatory reactions where the increase in vascular permeability and resultant elevation in interstitial fluid and protein concentration give rise to oedema that must be offset by an appropriate rise in lymph flow."

The article is saying that in an inflammatory response, histamine increases the vascular permeability, and blood will move from the capillaries into the interstitial space. To maintain fluid balance and prevent edema, the lymphatic system will respond with increased lymphatic flow back into blood vessels to offset the increased fluid flow into the interstitial space. That is why there is increased lymph flow.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1573448/#:~:text=These%20studies%20consistentl%20reported%20that,vary%20according%20to%20the%20preparation.

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