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NBME 18 Answers

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submitted by โˆ—azibird(278)

Endothelin (ET)-1, a potent vasoconstrictor peptide from vascular endothelial cells, is also synthesized and secreted by cardiomyocytes and induces hypertrophy of cardiomyocytes through activating phospholipase C, protein kinase C, extracellular signal-regulated kinase (ERK) 1 and ERK2, and upregulation of c-Fos and c-Jun.

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motherhen  is this super out of left field or am I supposed to know this +18
ab721  @motherhen I don't know if this is correct, but I personally tried to reason this one out. If hypertrophy is occurring, more sarcomeres are added which means more beta-myosin. Hypertrophy also means the cell is doing more work, so a transcription factor is likely to be upregulated. From there, the only option with both of those increased had endothelin increased as well, though unclear why that's necessarily increased. +14
motherhen  genius +1
yerpderp  Loud S2 made me think of pulmonary hypertension which would have an incr endothelin +2
geekymle  that loud s2 was from systemic hypertension. +1
utap2001  systemic hypertension -> induce LV hypertrophy -> induce pulmonary hypertension -> endothelin increase, plus loud S2 and S4 gallop +1
jdc_md  wasnt sure about endothelin but i knew fos and jun were tf's and i knew it was HTN--> concentric hypertrophy so you need more tf's to get the heart bigger also if the heart is bigger more myosin heavy chain so that only leaves endothelin as increased as answer A +1

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