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NBME 22 Answers

nbme22/Block 1/Question#1 (reveal difficulty score)
A 66-year-old man develops worsening ...
Dilution of serum sodium due to ADH (vasopressin) secretion 🔍 / 📺 / 🌳 / 📖
tags: RAAS

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 +23  upvote downvote
submitted by ∗imgdoc(183)
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I hntki otal fo epeopl might vhae oerv dizsemeaph hwo amrttinpo PNA and PNB lrlyea are, yes it is tpoinmatr ot wnko seteh esepidpt egt cerstede by eht eiianvcrtru/lrlaat imymcaduro gurdin thera lauir.fe evreHow htier elvroal fsensceteifev ni enragitt ahtre fluaeri si hcz,il a erppoertc dlot em hatt if NPA adn BPN erew os uselfu in ainrtueisrs nhte why od we vgei cdrietisu? 'tIs sueeacb AARS wroeeosrvp sith tessmy neech nugacsi nigaetve ffsceet dna eth dlenses pool fo ahret lr.ufeia AAK hwy we veig ACE rtoiibni.sh

nwnKgoi htta NAP estg ltrnziadeeu yb teh SAAR et,ssym ew nca sftih oru ufsco akbc to haret ueflrai ni ihts a,pntiet ehwre iccraad tptuou si ead,dsrcee lnaedgi ot ADH tneiseroc adn yfnlail nuiaidtlol oma.rphtaneiy

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almondbreeze  a eccotnp lunoucntsioy hiaedzepms by wu, ubt I egt aalswy nowgr ':( +4
almondbreeze  oogd work !eond +1
raffff  hyw esdo the ybod ekma pna ta lal esnic tis so seuless +4
makinallkindzofgainz  fffrf@a - at asetl PBN gsive us a dgoo rrkmea ofr arteh ilfuear eitaarcbonxes ): akhtsn d!yob +1
mannan  eaYh 'sit imottarpn lnylilicca uscabee it sha a hhig iiieystvsnt if( gvtiaen,e rule otu) fro Hrtea fai.urel +1
alimd  At eht same meit PNA iniihsbt nrnie sreleae? +1
freemanpeng  If ti is ihgH RASA, oAdl muts be gihH sa wA(elnlIgI ueicnd dolA omer htna .AD)H hTne thta lduow eb SATTELRAW- innortete rahtre nath URPE AWETR rneeo.ttin NO yitmpraahoen +
plaguedbyspleen  Tish naetitp si p-iihdgtascnr nda efhreerot ash low ecvefefit inltrguacci .mvluoe I lkie to intkh atth egvni ihs VC i,hoyrts eh is bablproy on na CEA riitbhnio or steghinmo mi.siral So ttah elsave DHA ot do tsi ht.gni sloA gihh oalstdoeenr vgsnai alst 'stni omthsgein ew edne ot eoisrcdn vegni teh smet nad wrsena o.cchsei +



 +12  upvote downvote
submitted by ∗meningitis(643)
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I oals huhogtt hte amse as beub,@slb tbu nwo tnirgy to "j"uiftys tihs kctriy BMNE isueotn:q I nhikt isht oveveslr on the acft that the paitnte sha a IGHH odolb sepersur eanimgn we sduhol uofcs no an swrnea tath saxpienl hobt ireacesdn BP nda Hvlayipomoe i.(:e rdsaicene AHD wchhi tticcoovsnrass nad aols brssabo wte,afrer-e hbto of hhicw neaecris BP dna auesc aihvpeo).oylm

aebyM if siht attinep erew potedeedancsm with WOL PB, neo dcoul ihnkt emro btuao PNA.

I iltls hktni stih stiqoune is OTO tric.ky

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meningitis  r,rSyo eta*nroapyhmi rhi?gt +1
mantarayray  I knith ttha si't ont PNA ubcease APN wlli saceu a slso of Na utb taerw iwll oflowl (yhet lluuasy go )o,ehgtret ewehsar HDA lliw esuca ntsbpiorao fo noly reatw adn lwli esacu aotraynmpieh xe pcte oyln tthhoug stih tsop ggentit hte iustoeqn ognrw "): +5
mantarayray  psoO ryros hte gnamirotft is inuofcn:gs I tkhin that 'tsi ton PAN uebecas PNA lilw aesuc a sslo of aN but rteaw lliw lwfolo yeth( luyasul og tehrg),oet aeswher HAD illw uacse bpaisnoort fo olny retwa dna iwll scuea nahmaptioe.ry +4
pg32  tyraamn@a rytpte seru yuo era higtr dan hatt is het olyn yaw ot teg tshi nseoiqut ec.rcrot eeinrmegbRm tath aN tceinrcnaoont lleray si a ruesmea of retwa nacleab si ke.y If teh tp is mporetacy,ihn thta sjtu smena etyh vaeh oot chmu atrwe ni eht oolbd, wihch is esucad yb .ADH fI het tipntae saw LIOypMho,CEV ttah imtgh name they ear linsog oto hcmu Na. iThs is luridaettls yb spt hiwt ISD.AH yhTe rea nyhtoeirpa,cm tbu colevemui, gnneami tath hety veah oot hcum teraw h(aeotmyraipn ofrm het AH)D tbu ethir aN bneaalc is ko de(u ot tcexoeirn of aN via P/BAN)NP +1
avocadotoast  We eden ot be gnithnik otabu owh reath aeuilrf si a ioinoctdn hwti a wlo tieefvfce nurcgcaitil movul.e ruO tenitap adh na MI dan nwo sih raeht atnc eekp up twih teh leumov l(wo O,C) ignedal to ots.nocigen Wehn ieoogcntsn rccsu,o ewtra si pshude itno het taltistrneii pcasse dna 'inst rcgciitlnau in het rraeialt y.ssetm rFo ttha n,soaer eth obyd rsamp pu hte AASR nad HDA tseepid na clutaa screnaei in byod aewr.t Tihs si a ooinmscnt-o eaelser fo .HDA tA shit ioptn mpaals ismduo lvseel era trmdiednee yb leeiatvr tekian adn sseosl nda paramtyoeinh si ocmonm in ethse iaetntps ubseeca fo t.hat l,oAs ANP dan PBN nd'to lohd a lncaed ot eht SRA.A +1



 +5  upvote downvote
submitted by ∗nwinkelmann(366)
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rmFo Tat:epDoU ANPSHIEETSOG

Lkie stom hoter uessca of r,mteyhaainpo terha lfiruae simarpi the libiaty to rcexeet gesintde trawe by cangniiers uaiciitetdrn meorhno lee.vls enhW daracci pttuou dan csiyesmt ooldb srsrueep rae uredd,ec "yvcelompoh"i ernhomos, hcsu sa ernin twi(h a uqeesbstnu iaesncre in teiogniasnn II oran,tmfio) diirceitautn hoomnre )(HDA, adn npiheee,rionpnr onresdp -1]3[. ohhAgtul eodmatesu titnsaep whit ethar raeulif hvea dncrseeai alpasm adn eulrxcealtrla fludi e,msulov eth oybd eripescve oeumvl poenetldi d(edrecu ecitfevfe riaearlt obldo mevluo) nesci het wlo ciacadr toutpu scaesdere hte ressuper nigpeusrf het prrroeescotba in het tdcairo nusis dan hte anrle nfertefa iae .terolrheT grdeee fo onormueahulr ainovitact is gleaenyrl ldeaert to hte itseeyrv fo acdaicr tycifns,dnou as sadeesss by tefl aelitrcunvr ecotneij citrfoan ro nlnotifuac csals .2][ The eohmuuarlnro gnhaecs tmlii hbto odsmiu dan wtrae rexnotiec ni an ttaeptm to rrnteu oipnrsfue rreespsu to m.nroal HDA elreeas liryetcd ansecneh wtrae nprrosibaoet in the tgnoclilec uetl,bus aeewrsh inaeoingsnt II and iipnpenroerenh imlit ldiats rewta deyervil nd(a bethrey eatwr reeto)ixnc by irwlgeno hte rrgaelouml trlnoifait aert (ued to a derakm eocunrtdi ni anlre siep)ruofn nad by ingcnaisre amrpolix dmiuso dna awert oteisopbranr .[]4 In iantdoi,d ohtb eht low acircad utptuo dan hhgi gintsonenia II slleve are eoptnt mtluiis to tsthri, elgndai ot eahencdn traew aeti.nk

/int#st/-opn-hehrie/mw2hHnapdpaoe-stuepyt.tnwlc.ot:iwaneiwrruoitfa-attechm/-tast

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 +3  upvote downvote
submitted by ∗bubbles(79)
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shTi uiotnesq udsfeonc me a lto besaeuc so mayn uqtsisone vahe dilerdl me no het prcinmoaet fo the PAN caesep chmeisman ni seimt fo lduif eroovlad a(s ni F).CH

I gthhtuo NPA asw a uhge aelpyr ni teh sslo of Na in scremccuastin of vumelo rvdaeolo as ni itsh etitnpa iw(hhc si hwy you ese ielcmeuov tnaaripmhOye in ainetspt itwh IDASH ro rtyaivitvcoe fo eht ASRA sa in )C.HF

yWh si DHA own negbi maedn as eth psnsirboeel et?agn

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jooceman739  My ntngkihi si htta NPA uessca tssiani,erur so uye'or ioglsn tsla dna trwea at teh msae itme iissctmooo( l.diuf?) nwl,eahieM DHA asbrbos nylo reef awret, so ti ldwuo dilteu the rue r.C mecsrt o em if mi' .gorwn +13
bubbles  hhOh ouy ear irhtg. kanTh uoy fro eht taoin!xnlaep I tgo os iatdefx no ttah neo cnemhiams .hhaa +4



 +2  upvote downvote
submitted by ∗dr.xx(176)
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CHF pniatset enfto liaspdy sigsn dan tsmpmsoy of eenisacrd sonsaesvpri n.cosreiet

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hyperfukus  fi lal eesl ilfas i ehop i sjut llird tsih noe ntmteteas ni my barin nad it mosec tou ni eht tghir ywa no stte yad taknh u!!! +1



 +2  upvote downvote
submitted by ∗drmohandes(193)
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Here we g:o

  • seedderac LV ycitonaicrttl taib(lrale escakrc)l
  • recdasdee cdairac ptuotu
  • avtcteia SRAA → HDA
  • eaescnir ymhteisatpc vicyitta → emro SRAA → moer DHA
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 +1  upvote downvote
submitted by ∗moloko270(77)
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./lnh5ub8wm2/w0h:vw.t.e8.gon/ptin/bsp7dicm2

yenrsodm" of i"dtlnaoliu lal-o"yisoopmyth in eeevrs gntecoveis atehr ueafirl may eb eaudcs yb na aaoypnileprrtip hhgi DHA tiesrcone ni hchiw teh emctprrsoooe ssetym is eidtmdnoa by orloaonsmn ltumis"i

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hayayah  tppla,eAnry ni oihccrn FCH ouy ese aptehaniyr.mo eceBusa CFH ecusas a erecdeas in irdccaa uttopu nad lgtruiinacc odblo ove,mul icwhh in nrtu gtsgrrei a tymcrnoapeos rpseeosn aidem at rsergpevni dbolo pss.ureer isTh ttsuleasmi teh boyd ot anirte hbto wtrea nda .udsimo +10
seagull  i eareg wthi ayy..hHa.a eht ARSA esysmt is tiedaavtc deu ot oopr fupeosrin to het dekniy deu to domepc ahrte af.ulrie +6



 +0  upvote downvote
submitted by nicsar(1)
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payramHnteoi mfro rutairHeaelf .tp

tI lshdou be podpaecrha ofrm taeHr .iruefa

;g-&FHt ARAs t;&g- ecssvxeie eeAosltnro,d HA;D ANP pseeca ,uaefir ikel ecdysrano soiymeldan;rpsehrot nepHraoiymat

uh1/oCn12it7w./c-9p/0.-mg5-w/lt8g1s0tf.lwmw4h946t//:9ej5-JvW/3

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 +0  upvote downvote
submitted by ∗dubywow(23)
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pcoasDdemntee H.F kLca of olbod flow deu to lfinaig hreta &g;t- ewrol PB g&;-t irnesdcea ADH ot esiencra dbolo rreeussp kbca ot slteba e.levl In HF,D DHA ecpsoaut ohtemsssaio fo trectogncauni ANP pm&a; BN.P ,uThs the mtre dd"cmepee".sotna Adastocies ihwt nseshorts fo tareh,b meead f(tnoe of l.guns)

Tsih uocivis cycle ncouietns as doyb trsiieiproz eeqaatdu BP orf vr,auilvs tub it cmoes at eth xsepnee fo dreeorkwvo etahr thta tmsu wkor rdhera dan reahr,d limteyatlu baeeaixgtnrc eth herat fieaulr ndtio.inco

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 +0  upvote downvote
submitted by ∗asharm10(37)
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alswyA nwko iths poyH or aimeenthrapry si uebaecs fo cgehna in hte e,vmolu isth aiepttn is ggnio rughoth arhet rul,iaef leran irpfunseo hsa oneg odnw that ldase to areseel fo HAD soc fo eocootsprrems ntlitusiam.o oNw ighh HAD iwll arrsebbo moer rfee aterw ahtt lwli dale to payeo.tahminr So yanmeitrahop si tmloas salawy arledet to ghhi .HAD I owkn few fo yuo iwll nktih tub ARSA myetss si aettvadic oot ubt atht sbabor aN nalgo whit wtrae tbu DHA stuj feer wet.ar

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 +0  upvote downvote
submitted by ∗hello(429)
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eehrT sah to eb a ebtert oenxlinpata rfo hyw NPA is no?rgw

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waterloo  If itsh 'tps N/NBAPP reew cgsuian imh to oemecb n,moierchyapt hyw dseo eh hvae dlfui oeordvla ssyommpt rla(tiealb ,esklcarc DJV, high ?BP) ereh T hsa to eb osmtneigh else gmrneoicov eht NAP tmssey. +1



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submitted by ∗happysingh(57)
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i ndaki fo lefe o"d"d asngki isth sqeintuo : but het neitatp hda na MI 6 tsnhom o,ga so hwy luwdo it eb lieynluk thta he aws ldot to icsttr"er ts,la irrsctte sduilf a)tewr( " ??

sesuG whta m'i sgikna is : hawt ksema hiccoe E uhsc na yulielkn ociehc DV(J, raaliibb-s cla,kecsr aprephleri meead) ?

&;pma m@ieitingns : hsi bp si 31/285 mgHm ... why is htat G""HIH ??

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 +0  upvote downvote
submitted by ∗freemanpeng(7)
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,sFytlri I ohecs .DHA ehWn I tohhtgu tcwie in erwe,vi I idekcp secsdro HAD nad pkeidc y MANP. clgio to sscor AHD. 1: ehT ainm nuicerd fo ADH rea smO dan uevPoBm/l. isHT ,pt sOm olbouisvy nto gh,hi Bp iylvsuobo tno .low S,o sesenonn ni cnaeresdi 2o. AuHYD. yam see AInIg aslo cdseuin HAD. But ti emess to be a omirn crn.duie eehw,lMain fi it si xatceyl hhig nAI→gI hghi HD.A enh,T Alod smut eb ihgh as ,ewll dna higH Adlo a→tSl sp→viergrne WOH ACN rusme uoSidm be O?LLw oW" adciarC uuto→tp gHhi RSAS A(IgnI dolA "HDA) tpwahay si RIWSDUEMAOT- nne.toeirt TNO peur ARWTE nnoePt leeaietsr ocecrtr me

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