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NBME 17 Answers

nbme17/Block 2/Question#46 (11.1 difficulty score)
A 38-year-old man is brought to the emergency ...
Metabolic acidosis🔍,📺
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 +8 
submitted by waitingonprometric(220),

Metabolic acidosis because the arterial pH goes in the same direction as the bicarb and pCO2 (i.e. both pH and bicarb/pCO2 are decreased from normal); in primary respiratory acidosis/alkalosis the arterial pH goes in the opposite direction as the bicarb and pCO2.

Once you know that it is a primary metabolic acidosis, you have to check for concomitant respiratory disorders. Do this with Winter's formula:

expected pCO2 = 1.5(HCO3) + 8 +/- 2

so... expected pCO2 = 1.5(11) + 8 +/- 2 --> pCO2 = 24.5 +/- 2 = expected pCO2 is between 22.5-26.5, therefore, 23 is in the expected range, no concomitant respiratory process

baja_blast  Was looking for "Metabolic acidosis and respiratory acidosis" and was wondering why it wasn't a choice. Totally forgot about Winter's formula. Thanks!! +6