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NBME 21 Answers

nbme21/Block 3/Question#29 (29.4 difficulty score)
A 34-year-old man is evaluated after becoming ...
Number of impulses from carotid baroreceptor: decreased;
Sympathetic efferent activity: increased;
Parasympathetic efferent activity: decreased


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submitted by haldol(12),
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pparalpha  Hyotension will lead to decreased arterial pressure and DECREASED stretch. This leads to decreased afferent barcreceptor firing (carotid sinus and aortic arch). This leads to an increase in efferent sympathetic firing and decreased efferent PNS stimulation. This leads to vasoconstriction, increased HR and increased BP. +1  
sahusema  The way I remember this, carotid massage slows the heart. So baroreceptor stimulation (more impulses) increases parasympathetic output. +4  
cienfuegos  FA 2018 pg 291 has helpful image/description +  

submitted by an_improved_me(18),

This question is pretty dumb... I feel like if he was running 12 miles obviously his SymNS will be thru the roof already. My thinking was that the lightheadedness may be the result of sympathetic fatgue, and hence, could fall.

Obviously, ParaNS activity and Carotid impulse will decrease... But those who run know the bear of running long distances on a hot day.

an_improved_me  I always harken back to "don't overcomplicate these questions", but sometimes, NBME requires making some leaps of logic. The trick is knowing when the question requires such a leap... I haven;t gotten very good at that. +