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Comments ...

 +4  (nbme22#27)

Question said "Nonhemolytic, Catalase -ve, Gram +ve cocci"

Enterococcus fits description

Listeria: ROD

Staph. aureus: Cat +ve

Staph. epidermidis: Cat +ve

Strep. pneumo: alpha/partial hemolysis

 +0  (nbme22#45)

Dec. NaCl - general volume loss Dec. K+ - Diuretic (most diuretics, except K+ sparing ones, cause hypoK+) Inc. HCO3-& pH - Volume loss -> RAAS -> aldosterone causes K+ & H+ wasting -> metabolic alkalosis; She may be vomiting as well, which is another possible cause of met. alk. Inc PaCO2 - respiratory compensation for met. alk.

hello  Patient has normal Na.
hello  Lab data indicates serum bicab not ABG bicarb.
hello  oops! just realized bicarb is never given as an ABG haha

Subcomments ...

submitted by bobson150(4),

Is this saying there is vesicoureteral reflux? I could have sworm this same image was on form 20 or 21 and the answer was Wilms tumor

hello  Yes, it was. I think in both vignettes, the picture was basically irrelevant. Or another possible clue -- but definitely not needed to answer the Q. +2  
presidentdrmonstermd  My school uses old "retired" NBME questions for exams and I've also seen this exact same picture multiple times...w/ different scenarios I think. I tried remembering what the questions were but I guess it's mostly irrelevant. +2  
hyperfukus  SAME +  
hyperfukus  I also put wilm's tumor bc it felt really familiar wtf +