Autonomic Pharmacology USMLE Step 1 Practice Question
A 28-year-old woman with generalized anxiety disorder started on phenelzine 45 mg daily three weeks ago presents with severe occipital headache, neck stiffness, and diaphoresis. Vital signs reveal BP 220/140 mmHg, HR 128/min, RR 22/min, temperature 38.2°C. She reports consuming aged cheddar cheese and red wine approximately 30 minutes prior. Fundoscopic examination reveals bilateral flame hemorrhages. Serum creatinine is normal; urinalysis shows no proteinuria. Plasma metanephrines are markedly elevated. She denies recent SSRI use or sympathomimetic ingestion. What mechanism explains this hypertensive crisis?
Answer choices
- AEnhanced metabolism of dietary monoamines
- BActivation of peripheral nicotinic receptors
- CTyramine-induced massive catecholamine release from sympathetic terminalsCorrect answer
- DCompetitive inhibition of dopamine reuptake
- EDirect serotonin agonism at vascular smooth muscle
- FDirect tyramine agonism at alpha-1 adrenergic receptors in vascular smooth muscle
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