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Retired NBME 24 Answers

nbme24/Block 2/Question#43 (reveal difficulty score)
A 35-year-old woman has difficulty urinating ...
Parasympathomimetic stimulation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +6  upvote downvote
submitted by โˆ—coolcatac(19)
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They are asking, in a complicated way, the mode of action of Bethanechol. All the other options are not muscarinic receptors except parasympathetic stimulation.

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 +5  upvote downvote
submitted by โˆ—beeip(141)
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Can anyone explain what they're getting at here? How can bethanechol be indicated and contraindicated?

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sniperx3  I think it's because Bethanechol acts on M3 receptors which can treat her urinary problems but it might exacerbate her asthma symptoms since there are M3 receptors on the lungs. +42
suckitnbme  I definitely had to read this question multiple times to understand it. +2
brotherimodu  I read it like 6 times and gave up +2
motherhen  I definitely had to read this question multiple times to still not understand it +2



 +1  upvote downvote
submitted by โˆ—jbrito718(48)
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This is the stupid way I've ever seen anyone ask a question

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submitted by โˆ—sexymexican888(46)
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I kind of just thought about the muscarinic antagonist treatments for COPD exacerbation and asthma

  • Tiotropium is a M3 antagonist used to treat COPD and asthma -> inhibits M3 -> airway dilation

  • There fore if an M3 antagonist dilates airways than an agonist such as bethanecol should do the opposite -> airway constriction (AKA parasympathomimetic stimulation) it would sorta be like doing a methacoline challenge pretty much

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 +0  upvote downvote
submitted by matchalatte(1)
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FA 2019 p. 240

It says that in Cholinomimetic agents you should watch for exacerbation of COPD, asthma, and peptic ulcers in susceptible patients. I think this is what makes Bethanechol a contraindication. Bethanechol activates the bladder smooth muscle which would help urinary retention. I think this is what makes Bethanechol an indication.

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