NBME Orthostatic hypotension (NBME Answers)

NBME Answers

free120/Block 2/Question#31 (reveal difficulty score)
A 23-year-old woman is brought to the medical ...
Orthostatic hypotension 🔍 / 📺 / 🌳
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+7
submitted by thisquestionsucks(9),

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isTh otnsqeiu si ndkai k.hwca hiRtg ,yaaw I udolc eltl tihs swa sxneredicd-eeciu lapecslo, hwihc penspha ettpry fnote ot .nunsrer I epkdci atocomuin nysfucdtoin bsueace I tddni' elreazi htta this si oscrienedd an ochsttt"aoir eyhoitpon.n"s Artef a ongl are,c runsnre aevh a dadeseerc VRS mfro lal fo eth lbdoo lfwo oggin ot eu.lsmcs encO ethy p,tso bodol sopl,o do'nset gte abkc ot eht lo lnodeo dna thye lael.csop tuB fsf I ltsli dtidn' ipkc ttroosissah asuebec I ntkih of ldo l.ppeeo uFkc me

step7777 Not to mention orthostatics in the hospital imply a sudden change based on positioning. This patient didn't go from lying down to standing suddenly (just bitter bc I also chose autonomic dysfunction. +2

jbrito718 Hypokalemia would present with muscle weakness. Autonomic dysfxn is a decreased baroreceptor sensitivity so we would not see appropriate correction with elevated feet (over correction/hypertension would be seen). Isotonic saline would not correct hyponatremia, it would probably make it worse (dilution effect). MI would have different symptoms. +1

faili7777 @jbrito718 I think you misunderstood something. People who do marathon are really susceptible to hyponatremia. And the treatment for hyponatremia is literally '0.9% saline' because it is isotonic. So it's used to treat 'hyponatremia' +1

+4
submitted by ∗lpp06(38),

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+3
submitted by ∗mamast16(4),

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hoTug senitoqu tbu .09% nasile si instooic adn yllrnamo dseu rfo uolmve noerpetil si how I got it

+2
submitted by ∗b1ackcoffee(91),

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nufsdcoe why isht si ton onmutcioa oftcuynsnid ro yiomarehtapn eud ot wtgesian dan hyw is tish ohsttitcaro ?syitpnnehoo

mdmofongo This one is tricky and come downs to choosing the “best” option. I can see why you were confused. However do note that in an autonomic dysfunction you will never present tachycardia as this patient does. I guess the key here is seeing how her BP normalizes once she is laying down? Sorry, this one is a kinda unusual presentation of Orthostatic hypo. +

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 +2

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! +4

+0
submitted by ∗cassdawg(1702),

This is a tricky question. The another big point of confusion here is that sweat actually causes a hyperosmotic volume contraction. This occurs because the content of sweat is composed primarily of water more so than salt. With that said, its unlikely that this patient will be hyponatremic. If anything she will be hypernatremic.

-Billy Rubin