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NBME 24 Answers

nbme24/Block 4/Question#43 (41.0 difficulty score)
A 72-year-old woman with coronary artery ...
Neointima formation in the right coronary stent🔍
tags: vascular 

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 +33  upvote downvote
submitted by xxabi(224),
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tnteS rshoiomsbt sv -ti.rsoensse tStne irbosmtohs is an aectu oluocnsci of a coronary ayerrt tnse,t ihwch nfeot lstsure ni tuace rcyrnooa .nesymrod Can be vtendeper by dula ietntlatlpae ephrayt or itunureld-gg stt.nes seos-eRtnis si het ualgadr rrwagionn fo het ttnse enulm eud ot inelnmitao fioatiolpr,ren gintrlsue in nagnila smy.tpmos

sunshinesweetheart  so just to clarify - it's the "symptom-free for 3 months" that rules out thrombosis? +2  
hpsbwz  It's moreso that at rest there's no changes, but during exercise there is. Like the pathophys of stable angina. +1  
suckitnbme  I think it's more because of the 2-month history of PROGRESSIVE angina sx with exertion. This points to a chronic process rather than an acute event. +  
alienfever  Drug-eluting stents prevent re-stenosis (rather than thrombosis) by releasing sirolimus which by blocking cell proliferation. +  



 +7  upvote downvote
submitted by sweetmed(123),
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Stnet Rsneoitess ocucsr rfmo acsr iustse gsrow evor tnset gsinuac “nmltoeiian psrheilpay”a dan rg,nawinor esiicahm psomysmt rrnteu xT: vrtneep yb gnius idrg teulnig stenst .ge .lrSuisomi shrosoTmib Ptos sntsoesi si t,uAec etnst reesvs sa nisud rfo omrbhtus fotanmoir yuualsl /22 isgnism tanoide.mi Tx: etrpenv by iguns dalu eateapnitllt trtmteean []gopliergtlrida.ao/+ccilrseopirn Aterf 1 aeyr, ethotledinznaoi fo stnet crsuoc dna heret si a reowl risk fo mbo,utshr Tx elrwedo ot utsj irpns.ai




 +2  upvote downvote
submitted by hungrybox(791),

Section on Endovascular Stenting from BIG ROBBINS (for people like me who need more context):

https://i.imgur.com/mhRrpwl.png

https://i.imgur.com/e9mO0Nz.png




I think the key here is that this patient already had a stent placed, was symptom free for a few months, and now has angina with exertion. Angina with exertion is describing "Stable angina", the angina is due to "demand ischemia". The most common cause of stable angina is atherosclerosis/atherosclerotic plaque build up and a very common adverse effect of stents is neointima formation/ forming a new plaque on the stent.... a thrombosis would cause angina at both rest and with exercise, due to "supply ischemia", and it would be more acute, not progressive like the question stem describes