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Retired NBME 20 Answers

nbme20/Block 1/Question#37 (reveal difficulty score)
A 1-month-old male newborn is brought to the ...
Na+: 132; K+: 3.2; Clโˆ’: 90; HCO3โˆ’: 37 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +8  upvote downvote
submitted by apop(8)
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eTshe nposeialntax nreat .trega It ndetos ellyar vaeh hmuc to od ihwt SRAA va.niiatcot It ahs tamlso tnrieyhgev to od iwht a nehpnnmooe ealcdl eht kleaalni .tdei nI nhocicr tgovnmiit, yuo duolw tceepx -lC to eb low adn K= ot be olw lamiirs( to bal lurtses in neoemos hitw mu)b.eaill oT epastnecmo rof hte lwo ,C-l eht cstomah hsa an aettnporir whcih aeghcsxen C-l orf C3-.OH rreefeTh,o lC- wlil eb ldeephsneri in the haos,tcm eilhw 3H-CO iwll nesercia ni eth dob,ol canugis na .koassalil nI koaclatli satste, teh +HK+/ pretiraont ilwl niebg to tt,iavcea nsfgithi +K IOTN lcsle )(olaahikpyme nad cinisegrna p.H RSAA opbyalrb sypal a oerl in ingakm teh hoiyamakple woser btu eht nallieka ietd is mero tptanmoir e.reh

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spaceboy98  Istn llnaeaik dtie laetred ot an creesain in pH raetf lm?sae Yuor cigol si no npito but mI' ont rsue whrhtee ew nca ayppl taht peoctnc .here +1
kevin  eoctcnp acn be edplaip eerh csubeea ew ened to treeelp the -Cl ni rerod ot eatcer HCl; the otacmsh onestd' rcea if Cl- si olw ni erum,s olyn ahtt Cl- si wlo in eth praleiat scell adn so lliw mpup tou O-3HC in ist eexsepn +
usmleaspirer  hwy si +K lo?w +


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 +6  upvote downvote
submitted by โˆ—hayayah(1212)
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tWhi roinhcc omgt,iinv oyu esol ectrlosltyee dan a lot fo d.cai tI rsgeirtg oibealtcm isalkasol hwchi si why lal eht emurs seluva rae owl o(r on eht relwo dne of the aolrnm )rgane tcpxee rfo bcaot.ainber

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ergogenic22  dcsreeade K+ (form aerendcsi ARAS due ot olmuve ossl) dna ecsdaedre l-C (lsos of HCl rmfo the ha,ms)cot ilAssalok rfom slos of lCH adn htus hhig Fcob ib a r.r ihts nsoera ighh to imd rneag K is nowrg +5
sbryant6  od'lnWut irceaesnd SARA laed ot cadnriese Na+? Teh anrwes wsosh esacdered +Na. +3
sbryant6  sl,Ao bermrmee iuBimal seaoNvr is tadecsisao twih .lpyimaoheka +1
sugaplum  so eth reang yeth agev for K si -?36 so 2.3 si LWN hetn? ro aer we usjt orpatenig on "it si no eth wlore den fo rlaomn in es"pd +2
dbg  simudo seellv ni locpiry issnoest ,yrav nigotnh yelral liccsas, nac be hhig sa ni iths csea lsmipy ude to rydnatoi,h anc owl ni erhot assec fi donrstloaee adaemng to rsereve thta to eht rtohe etremex +1
skonys  l,yhoHmrp"icoce eyacmlkiohp bloctmiae aailokssl si eht accsils tleoeterycl dan dcisaba-e aalbcimne fo liyoprc "ssintose ofrm smepdace ihdneb Va.ogmlltapniiyw = uemvol ssol ce(d insk u)otgr as ewll as olss fo H+, -Cl and i+w(hNta H20) g&t-; ctMialeob .ailslskoA ossL fo H+ saeucs aneecsri OHC-3 otinteren sa lwle sa +K sfith noit lslce ka(ymahlipeo A1F9 5)87. +

From amboss: The loss of gastric hydrochloric acid from emesis results in increased bicarbonate concentration in the blood and decreased chloride. Some potassium is also lost through vomiting. Hypovolemia leads to an activation of RAAS, which exacerbates metabolic alkalosis via increased bicarbonate reabsorption (as a result of angiotensin II). Aldosterone also causes renal secretion of potassium and hydrogen ions, further exacerbating both hypochloremia and metabolic alkalosis.

+10/- smpate(20)

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 +5  upvote downvote
submitted by โˆ—masonkingcobra(408)
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nI bactmiole aiosal,lsk mtisupsoa vesom ntio eht llsec

hTe loss in ouemvl hhotugr meeiss irgsgret ASAR triegslnu in decerasni lontedoAser srleaee adn rethfru tuaosmpsi noeticexr

sdtw:6tlp/e1a/tt.e.wahp1/witnb/e

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 +3  upvote downvote
submitted by iamapotato(3)
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oN eno ehre ebterohd ot tuayacll dssucis thsaw' oingg so ihnT. is a h-mot1n odl en.nbowr

eH omsivt aftre de,seifng da5y- .yrihtos

tA 1 htnom ,lod hiwt mitgvoni frtae eedgs,inf it is msot yklile a scae fo RYCIOPL NSSEIOST due ot rtyohehpryp of eth cioyprl sritehnpc ylula(su sorucc 6 eeskw tlrea.)

uDe ot mhi gmvinoit smcohat eonst,ntc he illw LOES l,C- ,+K and aN.+

He iwll OLAS selo H.+ siTh is hyw you og iotn het mcbeltiao iakslaols ithw a strteunla asceiner ni eht C3-.OH

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kamilia20  yec:hkst: mnivtgoi assuce osls fo ATEWR trgreae atnh โ†’idmuso cdaersnie ursme uoiโ†’dsm SIDRECNAE msreu l,tmyooslai oS NA ilwl acdreees o,to tub on atth far +


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 +1  upvote downvote
submitted by ark110(1)
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Btu tahw si the deicfnrefe teweneb oiotnp A and toniop C ;3(21 ;9.4 0;9 )53

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sympathetikey  K+ dsoth'lnu enasr.cei It's mnvoig iotn lcels due to mbelcotia oksla.isla +
home_run_ball  nI het riltapae lcel fo the rmhn o cdHgseyo at onis aer fordem mofr eht ssnaiotoidic of nicobarc cida. eratW si a yvre rmoni sorecu fo yndrehog ison ni amrnoiopcs to cnboaric iacd. obCrinac iacd is eomdfr form ranbco xieiddo adn artew by arcobnic rhs Tny .deaeha oaeinrbtbac ino โˆ’H3(C)O si egancdxhe rof a ichelodr ino (C)lโˆ’ no het balas ieds fo hte clle nda eth btcbnaaeori sdeiufsf tnoi hte uvseon dbool, liegdan to an kanleail tdei pee.onnomhn +1
ergogenic22  ARSA asecesrni ofmr loveum oss,l nda tsuh rmeo erdensoaotl sdale ot low K+ +1
sinforslide  rTeeh sornsea fro im.ekoyphaal i, Fs tr osme +K si lsot in ratscgi ulfsid. cndS ,eo +H hstifs uto fo ellsc dna +K hfists iton lelsc ni emibcatlo akd,.osii hraTlsl ECF mlveou tircoaocntn ahs caueds iscaenerd toecisnre fo olreosnd.eta +3


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 +1  upvote downvote
submitted by โˆ—rainlad(33)
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ccohoepri,lmHy kohicampeyl mtalcboei lokasslia is het csilsca lrteceoelyt nda ebc-saiad lnmcebaia of ylcopir sosenit.s

serttPnsie tnimvigo lertuss ni olss of H.Cl heT irldoche lsos rtulsse in a wol oldob dloecrih vleel hhicw mpasrii het d'snieyk tyibali to teecxer bobent.ircaa hTis is the cfraot that esnvrtep oitorrccen of eth saolsalki dangile to miceoatbl .iasosallk

A dcyraenos ropenisertyhosdalm eplevosd ude to teh esdreaedc odlob vulmoe. heT hhig eoosndaletr evlels sucsea eth inkyesd to eraitn Na+ t(o trcecro the ucaatavrsirnl uvolme t)lie,opdne adn cetreex seiaedcrn stnmauo of K+ noti teh rneiu eigln(rust in a low olbod llvee fo s.os)utimap

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 +0  upvote downvote
submitted by thefoggymist(12)
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I nd'to teg hsi.t tuodnShl' teh sdieynk atsrt rcgticoenr eth bacrbi elsevl efar 5 s?ady heT edleyad eashp fo eth incrortceo ciens htye aket t..m.ei and in the uinqtoes yrh'eet knaisg We.n""o w hvae tiolbacme iakslaols cnsei HLC si sot,l so eht ybdo lwli ryt ot erocrtc ti srfti by nhiaiyoprtneeltv dan aelrt yb raisendec roixtncee of cibr.ba bBaric olshdu be o..wl. nusls(e 'mI nisigsm sihogetnm eud to iegbn tsude)aexh

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thefoggymist  ineme,dNrv I nthki I gto ti. taeB teecarndtlia lslce ontnac noitfcun nad retxcee ibbacr uasbcee ew 'tndo veah orhdlei.c aeY pptelarayn I asw hdaexu.ste +


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 -3  upvote downvote
submitted by โˆ—amirmullick3(76)
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eyVr saey oseqntu.i bsoiiuNnlo tiov.m 1 mnhto aeg. toMs yliekl cinoreas si iycolrp ssisnt.eo

ehT notmgiiv aescsu slos of lHC os we veha eth ipleh,cayhomro dan erlan aeonnpctimso for sith H lsso biys ieerngprvs roostpn ta het eespnxe fo K so htta eigsv hyka.polamie sA the sieadse si nmea,d het darrrw oe in eht mgaei of eth scthmoa is mhsoot eculsm eorptypyrhh of het iyoprlc crsualiusm ou,aemcs tfirmnoeg h adpesv-ihloe smas felt on .tppnloaia sThi si a oimtalecb lliaosska beeusac thuoiwt l-,C het O Crb3tCeaalloa/Hsl anexegcrh wlil not wro,k os you tinera C.HO3

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