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Opioid use disorder — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)Opioid use disorderUSMLE Step 3

A 46-year-old with episodic headache, diaphoresis, and hypertension has markedly elevated plasma metanephrines and a 4-cm adrenal mass. Resection is planned in 2 weeks. Which preoperative strategy is most appropriate?

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Correct answer: E — Begin alpha blockade and volume expansion; add beta blockade afterward

The best answer is “Begin alpha blockade and volume expansion; add beta blockade afterward”. Alpha blockade and volume expansion reduce perioperative catecholamine crisis. Beta blockade before alpha blockade can cause unopposed vasoconstriction. Same-day preparation, direct surgery, and mineralocorticoid blockade do not provide safe adrenergic control. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: Endocrine Society, Pheochromocytoma and Paraganglioma Guideline: https://www.endocrine.org/clinical-practice-guidelines/pheochromocytoma-and-paraganglioma