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NBME 20 Answers

nbme20/Block 3/Question#43 (25.9 difficulty score)
A 71-year-old man comes to the physician ...

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submitted by neonem(549),
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kernicterusthefrog  Just to add: cAMP activates protein kinase A (PKA), which is the more direct mediator of platelet aggregation inhibition, and of myosin light-chain kinase inhibition (which causes inhibition of smooth muscle contraction and thus vasodilation). Just in case there's a question that gets more specific than this one! +13  
brbwhat  wasn’t dypirdamole an option? +  
fataldose  I believe they also cause vasodilation by decreasing the cellular reuptake of adenosine by endothelial cells and the adenosine causes vasodilation. +  

submitted by isaacmed2020(3),

-Page 429- First Aid 2019 Edition. Antiplatelet phosphodiesterase inhibitors

submitted by fatboyslim(38),

I chose Aspirin. So aspirin is a non-reversible inhibitor of COX-1 and 2 which should decrease TXA2 levels, and according to FA 2020 page 485, TXA2 causes platelet aggregation and increases vascular tone...I'm guessing the overall combined effect of COX 1 & 2 inhibition will cause a net effect of either vasoconstriction or no change to vascular tone?

spaceboy98  Me too. i thought aspirin blocking off the TXA2 production would allow for vasodialation. +1  
kevin  This was a UWorld question. I originally thought the same, it's just cilostazol does the vasodilation and inhibition of platelet activation most directly +