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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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eshTe xielnpaonsta nreta teagr. It snetdo rlalye veah umhc ot od ihwt RSAA itni.voatca tI ahs sltmoa yevnterihg ot do htwi a onephnmone llacde teh kaeallin idet. In ichocnr tgtn,vmoii yuo lowud petxce lC- to be lwo nda K= to be wlo slimair( to lab utlrses in oesnoem tiwh .m)liublae oT ecpamtsnoe orf het wlo ,-lC eth cshatom hsa na natrpeorti ihhwc acngeshex -Cl rfo O.C-3H eehrr,eofT C-l ilwl eb piedlhseren ni eth acs,homt hiwle -CO3H llwi enasrcei in het o,bold cgnuias na slolka.asi nI aallcotki tsstea, teh +/H+K teornraitp lilw ngbie ot vettci,aa htsgniif +K NOTI clles pmk)aeolihay( nad isnegancir pH. AASR bparblyo psyal a roel in mkagni teh amlpahkioey rowes but eht lnkielaa iedt is erom amrnittpo .rhee

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spaceboy98  Ints liakenla tied reldaet ot na reeacins in pH reaft sm?eal orYu colgi si no ioptn tub mI' ton uers reethhw we nca yaplp thta topcnce .hree +1
kevin  pecntoc nac be peildap ehre ubeecas ew ndee to ltepere the lC- ni rdeor ot eacret ;lHC eht chatsmo tde'osn cera if -Cl is low in ,umres lony taht -Cl si lwo in the rliaatpe lscle and os ilwl pupm uto H-CO3 in tis sxenpee +
usmleaspirer  wyh is +K ?low +


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 +6  upvote downvote
submitted by โˆ—hayayah(1212)
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htWi nochrci imnivot,g you loes lyoteeletcsr nad a lto of icda. It tsrgegir lacitemob saloslkia iwhhc si yhw lal the serum elsuav rea olw (or no the erwlo nde of hte oamnrl enarg) xpctee for aibo.cnbatre

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ergogenic22  seredaced +K rom(f iadrneces RAAS deu to vmlueo ssl)o adn cseearedd lC- (ssol fo HCl fmro hte s)cotmh,a asilolksA form olss of HCl nda thus high rFb.c b oa ir htsi anoers ghih ot imd anrge K si gnorw +5
sbryant6  u'tdnlWo adinceers AARS adle ot sdeenacri ?Na+ hTe rnewas hosws eedsdcare a+N. +3
sbryant6  ,solA bremmree uiBmlai roevasN si soteaadics tiwh plima.ykaoeh +1
sugaplum  so hte genra tyeh gvea orf K si 3-6? so 2.3 si WNL n?the or rae ew ujts toeniprag no "it si on eth elwor ned of lnoamr ni "epds +2
dbg  dmouis evsell in cplyrio esitsnso v,ray htngion elyral ,csicals nca eb ghih sa ni hits ceas limyps eud ot dhtoiyn,ar anc owl ni oerht ecsas if rdoneoaselt meagadn ot erevsre atht ot teh otehr remxtee +1
skonys  ocoyHheicr,pml" alcyhkepimo mtalcieob iaoaklssl si the lacscsi tleorectyel dan c-isabead bnmcaaeil of rolycip "sstseoni form adesecmp bhneid iayVlpwanmo ltg.i = olmuev osls ed(c nsik rgto)u as lwle as osls of ,+H C-l and +ihwtaN( H)02 &tg-; Moltacieb .islAoslka oLss fo +H ssauec cirsenae HOC3- trineeont sa lwel sa K+ htsif oitn llsec piakemlhayo( 1A9F 7).58 +

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 abliemtco i,lasklosa aiospmust omesv ntio the esllc

hTe sosl in lvomue gohuhtr eisesm rgsgreit ASRA tniluersg ni scerdenia elosdtenAro eeelars nad thurerf tsisumoap noitecexr

6h/w/d1s/b.tat.e:aitwnl/p1wttpee

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 +3  upvote downvote
submitted by iamapotato(3)
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oN neo erhe hrotdeeb ot laluctay uissdsc hswta' giong Thnoi s. si a 1hn-mot dlo nwr.eobn

eH mivtso teraf fne,dsgei d5a-y ryh.soti

tA 1 mhton dl,o hiwt nvmgtiio ftaer d,engsefi ti is tsmo llyeik a aecs of YIPRCOL SSNOEIST deu to porytyhprhe fo the olrcyip pncthsrie lyula(us ocrucs 6 kewes taler).

eDu ot ihm iintmvog sohatcm ntecnos,t eh illw ESOL Cl,- K+, and .a+N

He wlil SLAO sleo .H+ sihT si hwy oyu go iotn eht biotcalme ailsksaol thwi a lnstatreu erncasie in het CO-H3.

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kamilia20  tseh:cyk: iomntgvi suseac lsso of WEATR gereart tahn โ†’idomsu sarndieec uerms sdiโ†’umo RSIEDACEN suerm tlmialso,yo oS NA wlli sacreede ,oot tub on ttah rfa +


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 +1  upvote downvote
submitted by ark110(1)
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But athw is het fdenceierf ntbewee optoin A dna ipnoto C ;32(1 4;9. 9;0 )35

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sympathetikey  K+ hdo'ntslu sei.eracn t'Is vgimno nito scell due to celomiatb .aikslaslo +
home_run_ball  In eth erlaatip ellc of het rseo taHgoh dmnyc onis are omdref ofmr het isinsctaidoo fo oacrbicn ia.dc tarWe is a yerv rinmo ouserc fo ngrdhoye oisn ni cosmnoriap to nroiaccb cid.a iobrcaCn dcia is mfdroe orfm bnraoc oidxeid and rwtae by iracconb e.h saTean rhdy iatrbonaecb oni )3โˆ’(COH si gdneheacx ofr a hceilrod ion โˆ’(C)l no teh ablsa eisd of hte lecl dna eht itornbeabac dssiffue inot het ueosvn l,odob naedgil ot na eaiaklln idte npnmeeohno. +1
ergogenic22  RAAS rcnaesies fmro mveoul s,los nad tshu moer dotleseaonr saedl ot wol +K +1
sinforslide  hreTe soreans rfo i.hkopeaaylm stF,ri esmo K+ is stol in ractsgi u.lfsdi eS,nodc H+ istsfh tuo of elslc dna +K htissf onti slcle ni mitcoblea l dh.raoas,Tkli si FCE evmlou iraocntotnc sah desuca rnsicdeae eeicrsont fo nloero.dates +3


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 +1  upvote downvote
submitted by โˆ—rainlad(33)
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Hho,peyocmlrci chyoamlkepi tbcieomla ilasklaso is eht cislacs lrteeyteocl nad d-isaebac cmilaneab fo loriycp ints.esso

srtnetsPei mgiotvin esrtuls in slos fo Hl.C heT reodclhi lsso elutrss in a wol odblo rldoecih eellv wchhi mriipsa hte sdnkie'y yiibtal to teeecrx iobnacerab.t hTsi is teh crtofa that presvent econiorctr fo teh sllkoasai ndiegal to laotcibem iks.lasoal

A eyosdranc hmlsistodrrpaeonye sevepdol edu ot het ecddrseae oodbl vuo.elm hTe ighh eltooansder seevll ecasus hte kyidens to aretin Na+ o(t ocrecrt eth ltuarcaanvsir omvule pt,ei)leodn dna ertexec edreanisc umstano of K+ noit teh unire lutenrs(ig ni a lwo dbloo leelv fo .mt)suaiops

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 +0  upvote downvote
submitted by thefoggymist(12)
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I 'tond egt ish.t 'Shndtluo eht dkseiyn tarts itrecnorcg eth biabrc llseve fear 5 da?ys The laddyee paesh fo eht ernoicrtco ecnsi yhet aetk m.et..i nda ni hte tnoieusq y'heter ksgina owe" .nW" have ltimbacoe lksolaias cnsie HCL is lso,t so the bydo lwil yrt ot rcortec it ifrst by yptlenoinevtarhi nad ratel by cenrsadie etxcineor of irb.abc ciabrB dshlou be w..o.l sl(nseu 'Im nissmgi osethginm eud to niegb txeuadsh)e

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thefoggymist  ,menNdirve I tkihn I gto .ti taBe relneaaitcdt csell noacnt noinutcf adn tcrxeee abbicr eeaubcs ew 'notd vhea d.hiercol aeY pyraptnlae I wsa xaetu.hdse +


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 -3  upvote downvote
submitted by โˆ—amirmullick3(76)
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yerV eyas iutnso.eq lNuonbiios tm.ivo 1 tnomh e.ag ostM lkyeil irnasoce si plcoriy .seotisns

hTe tniivgmo seasuc lsso fo ClH so we vahe teh r,eimyphalhooc nad nrlae stiepncmooan rof ihst H ssol biys reigspvern ptsoonr at eth xsneepe of K os tath gvise lpmk.yehaaoi As eth esadies si m,ande the wdearro r ni eth emagi of het ocshamt is soomht smuecl hrhterpyyop fo hte copriyl iaulrsscum eusa,cmo tmigfeonh r vi-aleespdoh assm tlfe no tppa.iloan Tihs si a baetmloci sillkoasa euebsac uhttwio C-l, eht lbaCtar3HoaCl/e lsO ahxengrce wlil ont ,wokr so uoy taeinr C3O.H

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