NBME Orthostatic hypotension (NBME Answers)

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free120/Block 2/Question#31 (12.7 difficulty score)
A 23-year-old woman is brought to the medical ...
Orthostatic hypotension🔍
tags:

+4
submitted by thisquestionsucks(7),

This question is kinda whack. Right away, I could tell this was exercise-induced collapse, which happens pretty often to runners. I picked autonomic dysfunction because I didn't realize that this is considered an "orthostatic hypotension." After a long race, runners have a decreased SVR from all of the blood flow going to muscles. Once they stop, blood pools, doesn't get back to the ol noodle and they collapse. But ffs I still didn't pick orhtostasis because I think of old people. Fuck me

+2
submitted by b1ackcoffee(34),

confused why this is not autonomic dysfunction or hyponatremia due to sweating and why is this orthostatic hypotension?

mamed Not sure if this is correct thinking but how I got this right was: 1. She is hypovolemic 2. Likely retaining salt so water follows (ADH or just renal dynamics in general). This is how I ruled our hypokalemia and hyponatremia 3. If she is hyponatremic b/c sweating then why wouldn't she also be hypokalemic? so both have to wrong because both can't be right 4. Volume depletion ==> orthostatic hypotension +1

blah I thought that orthostatic hypotension was more of a chronic condition, but I fooled myself into believing that. +

cbreland I completely read over the initial BP measurement and picked the wrong answer (mostly b/c of that). Test in 4 days lets get it! +3

+1
submitted by mamast16(1),

Tough question but 0.9% saline is isotonic and normally used for volume repletion is how I got it

+0
submitted by lpp06(26),

I fudged and went with autonomic dysfunction - BUT you can eliminate this option because the body's response to her hypovolemic state is exactly as it should be (increased HR due to decreased baroreceptor stretch). There is no dysfunction