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NBME p2ck_form8 Answers

step2ck_form8/Block 4/Question#18 (reveal difficulty score)
A 62-year-old woman with hypertension comes ...
Decreasing circulating angiotensin II concentration ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ
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 +1 
submitted by โˆ—step_prep3(24),
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 +0 
submitted by โˆ—azibird(256),

"Carotid pulses are decreased. A systolic bruit is heard over the abdomen at midline. The left femoral pulse is absent and the right femoral pulse is decreased. A left femoral bruit is heard." ^What in the hell is going on here? I'm freaking out about her absent femoral pulse meanwhile they just want to ask about ACE inhibitors...

And on that subject, how do ACE inhibitors not decrease intravascular volume? "This class of agents effectively inhibits the conversion of angiotensin I to the active vasoconstrictor angiotensin II, a hormone that also promotes, via aldosterone stimulation, increased sodium and water retention. The ACE inhibitors, therefore, are capable of lowering blood pressure primarily by promoting vasodilatation and reducing intravascular fluid volume." https://pubmed.ncbi.nlm.nih.gov/2188439/

"They work by causing relaxation of blood vessels as well as a decrease in blood volume" https://en.wikipedia.org/wiki/ACE_inhibitor

Obviously angiotensin is the safest answer but I am beyond baffled about how "decreased intravascular volume" is incorrect. Anyone?




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