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Retired NBME Free 120 Answers

free120/Block 1/Question#37 (reveal difficulty score)
A 50-year-old woman comes to the physician ...
baroreceptor output ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—icedcoffeeislyfe(56)
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Is the decrease in baroreceptor output due to the body adapting to the hypertension?

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azibird  Apparently. "Baroreceptor activity is reset during sustained increases in blood pressure so that in patients with essential hypertension, baroreceptor responsiveness is maintained." "It is a universally accepted phenomenon that vascular baroreceptors reset to operate at higher pressure levels in hypertension." Okay, so they can reset to normal levels, but wouldn't this patient already have undergone their reset? Why would the receptors further decrease? I thought that eventually their LV would hypertrophy and fail, leading to decreased stroke work. https://www.ahajournals.org/doi/full/10.1161/01.HYP.0000160355.93303.72 https://pubmed.ncbi.nlm.nih.gov/3042363/ +4
azibird  From Costanzo Physiology: "The sensitivity of the baroreceptors can be altered by disease. For example, in chronic hypertension (elevated blood pressure), the baroreceptors do not โ€œseeโ€ the elevated blood pressure as abnormal. In such cases, the hypertension will be maintained, rather than corrected, by the baroreceptor reflex. The mechanism of this defect is either decreased sensitivity of the baroreceptors to increases in arterial pressure or an increase in the blood pressure set point of the brain stem centers." +19
mangomango  Hypertensive heart disease causes concentric LVH - impaired diastolic function, preserved ejection fraction +2



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submitted by โˆ—brise(86)
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Does anyone know why decreased left ventricular stroke volume work is wrong? Would'n stroke volume decrease with increased afterload?

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brise  WOW, OMG IT SAYS STROKE WORK -_- NEVERMIND UGH +3
helppls  I put down stroke work because I was thinking about decompensated heart failure, could this not be a potential answer? +
madamestep  @helppls that was my thought too. But maybe the baroreceptor adaptation comes first... +



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