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NBME 22 Answers
A 73-year-old man comes to the physician with his ...
sorry about the formatting, they were supposed to be bullets not italic.
looks good to me! ;) instead of asterisks try using the plus sign for unordered lists; the system gets confused sometimes because the asterisk is also for italics 😊
Yeah, I noticed :s
Oh, I didnt know the + sign did that! Very much appreciated, I will try that next time.
CPAP increases intrapleural pressure as the elevated airway pressure is transmitted to other things in the cavity (lung pushes on pleural space/cavity which can then push on other structures). This can lead to compression of veins, including the vena cava -> decreased venous return -> decreased bp (from decreased preload). This is similar to what happens during valsalva (exertion phases) though the positive pressure is provided by a machine pump instead of abdominal muscles/diaphragm. I think heart rate likely increases instead of decrease as a compensatory response.
Here’s one site that explains it well (the “free” content is enough and probably already exceeds the depth one might need to know) https://thoracickey.com/extrapulmonary-effects-of-mechanical-ventilation/
I guess since changes in HR are such a transient phenomenon and you only have sustained increase in HR when exercising or like acutely experiencing some medical emergency vs BP that can be elevated for long periods of times with no effects. Therefore an improvement in BP is more important. That’s my take.
The hypertension in obstructive sleep apnea is due to increased sympathetic tone not increased intracranial pressure lmao
@lispectedwumbologist : Be mature enough to correct him/her and move on, not laugh at him/her.