- Joined
- Jan 20, 2009
- Messages
- 1,168
- Reaction score
- 86
Question # 693 for those who'd like to follow along.
I have a serious issue with the logic of this question and I would like for someone to explain how on earth this question only has one answer.
For those who can't see the question, it basically asks about a certain phenomenon that can occur with the first dose of an ACE-I (hypotension), and which concurrent medications you should ask your patient about taking beforehand, to prevent a compounded issue of this.
The correct answer to this was a Thiazide diuretic, their logic being that someone on this medication could already be volume depleted/hypotensive and you could drop their BP even more with the first dose of an ACE-I. Completely understandable and I guess I agree.
However, another answer choice, the one I ended up picking, was a Beta-1 selective antagonist. If you were to experience a first done hypotension from the ACE-I, presumably in someone with an intact SNS, your heart would be able to compensate by increasing HR and thus CO -- the classic compensatory tachycardia that occurs with almost all vasodilators. Now logically I believe that if you were to become hypotensive, and your Beta-1 system was blocked due to medication, you could not get this compensatory tachycardia to maintain your CO and could become profoundly hypotensive.
Where is the fault in this reasoning? This wasn't even a "most likely" question, where it's correct but not most correct -- UWorld just flat out says it's incorrect.
I have a serious issue with the logic of this question and I would like for someone to explain how on earth this question only has one answer.
For those who can't see the question, it basically asks about a certain phenomenon that can occur with the first dose of an ACE-I (hypotension), and which concurrent medications you should ask your patient about taking beforehand, to prevent a compounded issue of this.
The correct answer to this was a Thiazide diuretic, their logic being that someone on this medication could already be volume depleted/hypotensive and you could drop their BP even more with the first dose of an ACE-I. Completely understandable and I guess I agree.
However, another answer choice, the one I ended up picking, was a Beta-1 selective antagonist. If you were to experience a first done hypotension from the ACE-I, presumably in someone with an intact SNS, your heart would be able to compensate by increasing HR and thus CO -- the classic compensatory tachycardia that occurs with almost all vasodilators. Now logically I believe that if you were to become hypotensive, and your Beta-1 system was blocked due to medication, you could not get this compensatory tachycardia to maintain your CO and could become profoundly hypotensive.
Where is the fault in this reasoning? This wasn't even a "most likely" question, where it's correct but not most correct -- UWorld just flat out says it's incorrect.