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NBME Answers

free120/Block 2/Question#31
A 23-year-old woman is brought to the medical ...
Orthostatic hypotensionπŸ”

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

mdmofongo  This one is tricky and come downs to choosing the β€œbest” 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 +  



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