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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; Cl−: 90; HCO3−: 37 🔍 / 📺 / 🌳 / 📖
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 +8  upvote downvote
submitted by apop(8)
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eehTs sltpinxaenoa taern .agter tI nodste lalery have umch to do whti SAAR noviatci.ta tI sha toslma nevgiethyr ot do wiht a enmennopoh delcla het eaallink id.et In onhccri nt,tomgivi yuo loudw xtpece l-C to eb wol and K= to eb low imi(aslr ot lba lesurts ni mooeesn thiw i.ulbl)eam To peesatmcno fro the wlo C-l, eht aocmths sha na tertpaorni ihhwc excasehng -Cl orf 3HO-.C ,ohererTef -Cl iwll be pierdhsneel ni eht cmhao,ts wehil OC3-H lwli neraesic in hte ldboo, uacsgni na la.soslkia In ilaoklcta ,eatsts teh +K+H/ nretrapiot lliw being to ,etaatciv hnfitgsi K+ TNOI lslec elaay)hk(mpio nad eicngirsan H.p SAAR blbparoy ypasl a lore ni knaimg eth halkimpyeao eoswr ubt eth aikealln teid is oemr trpnoaitm h.eer

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spaceboy98  sItn akaielln idet leredta ot an isenecar ni pH efrat me?las Yuro goicl is on iontp ubt 'Im otn reus weehrth we nac pyapl ahtt pontcec eeh.r +1
kevin  ptcoenc acn eb ppidlea ereh ebasuec ew nede ot ltrpeee hte Cl- in rdero ot eatrec l;CH eth otcashm o'sedtn cear if l-C si low ni ,meusr onyl taht C-l si owl in eth plreaiat clsle nad so llwi ppmu otu 3-CHO ni sit esxeenp +
usmleaspirer  why is +K w?lo +



 +6  upvote downvote
submitted by ∗hayayah(1212)
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Wthi nicochr ig,tivnom you oles eyretlcsotle dna a olt of a.icd It rigrgest mcltoieab akalslsoi hichw si hwy all eth esumr vesual aer wol (or no eht lrowe edn fo the mrlaon agnr)e etpcex ofr c.aiantbbroe

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ergogenic22  eededarsc +K or(mf iecredasn RSAA deu to umlvoe )lsos nda eaeddecrs Cl- lo(ss fo HlC orfm the m,asot)hc lklsAsioa rfom ssol fo lCH nad sthu hhig i r c.ro babF hist srnoae hhgi ot idm raeng K si owngr +5
sbryant6  dWtnlo'u sdercneia SAAR aeld to riacednse N?a+ ehT nsarwe sswho eecdreads N.a+ +3
sbryant6  o,sAl eerremmb uBliami vNoreas is citaassdoe with pal.eihykmoa +1
sugaplum  os teh ngera yhte vage for K si -?36 so 3.2 is NWL tneh? or ear we utsj gnaopiert no it" is on eht orlew dne of arnoml ni dsp"e +2
dbg  oimuds vleles in ripcylo nsteisos a,ryv intoghn eylarl ascislc, acn eb hgih as in sith acse lmypis eud to aidhtno,yr anc low in eroht ecssa if otoreanesdl adeanmg ot srrveee tath ot eht etohr temreex +1
skonys  Hyo"mheicopclr, yplkimheoca itaobmecl ssailokla si teh lacciss yoetllecret dan seda-biac aialemnbc of crplyoi nsits"eso mfor decesmpa ihnedb pnolyilgata. mwiV = vumoel ssol dce( inks trou)g sa lewl sa slos of H+, -lC nad ta+h(iNw 2H0) ;g&-t tMalbcieo l.slkaiAso sLso fo H+ eascsu eicraens 3CHO- eitternon as ellw as K+ fhist iont slcle kypm(aoalhie 1AF9 )7.85 +

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)


 +5  upvote downvote
submitted by ∗masonkingcobra(408)
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In litbcaoem s,alsikalo msptasiou meosv tion the escll

The slos ni omuevl turhhog isemse igtegsrr RAAS egusrltin ni neaeisdcr ledresAnoot sreelae dna frruhte amiusopts ecrteniox

wn1elasptphw://t/e6i../tet1atdwb

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 +3  upvote downvote
submitted by iamapotato(3)
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No neo rehe trdobhee to lcaaltyu diusssc whsat' igogn nTsh oi. is a 1om-nht odl wnor.enb

He itsomv rfate neesidgf, y-d5a ih.yrsot

At 1 mntho od,l itwh goitvnim eaftr esfi,ndge ti si tmso lyiekl a aecs of YOIRCPL ISEOSTSN ude ot rhypeprhyot of the ypliorc csrhtinpe slulu(ay rocucs 6 wesek ar).etl

euD to him igtmnvoi socamth cstetn,on he illw OESL ,l-C +K, dna a.N+

He lilw OSLA lose +H. isTh si hwy oyu go niot the cotielmab saosllaik twhi a elnruastt cienrsea ni hte O3.HC-

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kamilia20  k:ecshyt: ngmiovit suceas slso fo TEARW eetgarr ntha ousdi→m scineerad eusrm iusdm→o DESECRAIN smeur oomltla,siy So NA lilw eercesad t,oo tbu on htat afr +



 +1  upvote downvote
submitted by ark110(1)
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uBt wtha is eth cenifdrefe nbeewte oponit A and ontpoi C (3;12 4.9; 9;0 35)

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sympathetikey  K+ lot'snuhd eniar.ces stI' mignvo otin lsecl edu to mclabtoie lisaslk.oa +
home_run_ball  In teh earltaip lcel of teh o m yrtcdsoeaHgn h soni rae fdermo mrfo eht oniosacsditi fo oarcbinc a.cid trWae si a vyer roinm ercsuo of rhedonyg isno ni apmsnrcooi to ioabnrcc .ciad nbaCrcoi icda si mfeodr romf arbcon eidodxi adn wetar yb conbicar h ehye.rna sTda actaobniber oni (OCH−)3 is hadenexcg ofr a ilrdcheo nio l)(C− no het sbala sdie fo eht lelc nda eth enbiabacort fdiufses tnoi the nuveos b,dool niaelgd ot an aelalkni etdi hpemonnn.oe +1
ergogenic22  ASAR nsrisaece rfmo evolum s,osl and huts reom odsntaoeerl elasd ot lwo K+ +1
sinforslide  hTere rasoens rof olakimpe.yah r,si Ft some +K is sotl in sacgrit fsul.di noeSc, d H+ hssitf out of lcesl nad +K istshf noit secll in bimcotale ho,d. is slraTlaki EFC oeulvm orntcocntai sha dsecua adircesen teoienrcs fo lonro.saetde +3



 +1  upvote downvote
submitted by ∗rainlad(33)
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chmpeHyc,ooirl ylhipomecak ctmboieal loklsiasa si the lisascc ytrtelecloe nda dabcs-aie cbnelmaai of cryopli seo.sinst

eneiPstsrt mitovgin elsturs ni slos fo H.Cl ehT rhoeclid loss sleusrt ni a olw ooldb ilchrdeo level ciwhh pamrsii hte ysdei'kn tyiabil ot trcxeee at.obcnibrea isTh si teh ftoarc ttha vterspne etrrcioonc of teh oislasalk dgeailn ot lacbetiom a.ilklsoas

A ynaoedsrc syoodprmnarisheelt oepeslvd eud to het adseecdre bldoo mleuvo. eTh gihh ensortodlea eeslvl aucses the ydkensi ot irntae Na+ t(o oectrcr eht rlvriaactnsau oevlmu i,oledtenp) dan xeecrte eiracndse santomu fo K+ tion eht ineur sui(glnetr in a owl oblod levle fo osmuip).ats

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 +0  upvote downvote
submitted by thefoggymist(12)
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I o'dtn etg shti. ludo'Sthn hte iendyks asrtt igetrrncoc het iacbbr svelel aerf 5 yad?s The yeaeldd heaps fo het cciotrneor nseci they etak im.e..t nda ni teh uqeistno etrh'ey ngaksi " Wn.oew" avhe acmitlbeo lialkaoss escni HCL si lso,t so the odyb liwl ryt ot rrectco ti srtfi by ehaeyonnipttrliv adn elart yb iacesdren oerxcnite of .acirbb braciB dulsho be ol.w.. nslse(u m'I smsingi mseohgtni ude to bnegi )eaxshuetd

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thefoggymist  Neredvnmi, I ihnkt I tgo .ti eaBt neartaideclt esllc anocnt ciunfotn nda tecxere iacrbb ubcseae ew d'tno veha edcrh.ilo aeY yelpapntar I was .sdhueaext +



 -3  upvote downvote
submitted by ∗amirmullick3(76)
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reyV asey nqieos.ut osibnoliuN i.mvot 1 othmn e.ga osMt ikllye oriasecn si cyolpri snstoi.se

eTh nvitgomi eussac sosl of HCl os ew evha hte hiymhrloocae,p nda aenlr ectsoianmpon rfo ihts H ssol yisb rierpsgnev otpnros at eth eensepx of K so ttah vsegi yoalpaihk.em As the eaesids si ae,ndm het adewrr or in the maeig fo het mhctsoa si mohsto slmceu thypyprhero of eth cpoirly sursalmcui esu,maoc hn mroeigft savidel-ehpo smas lfet on lpoanta.pi Tish si a mleotbaci llaksosai asecube iwouhtt C,-l hte ler/Cl aH3ltCsbaoaO eexcganrh lilw not o,krw os yuo rantei O3C.H

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