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NBME 20 Answers

nbme20/Block 1/Question#18 (44.7 difficulty score)
A 36-year-old man comes to the physician ...
Urine output: increased; Urine potassium: increased🔍,📺
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 +11 
submitted by hayayah(1101),
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eTh betus ear ecttseahr ptu in rof uinre to folw oint a gb.a So irneu ottuup is onggi ot irn.secea The tepnait si asol irlhemkyapce. stneoArldoe eopsrnds ot elmiaphekayr by nrgeciinas K+ roi.excetn

eipmlrakyHea liwl satletmui erldeaosont eestrcnoi eenv if renin is sdeepsspur edu ot sih e.nopehrynits glhhoutA aN+ wlil be rrsoeebdab, tshi iwll be sanrinett sdhou(l roevsel ecno eht simpsatou slvele madlezrn)io adn nesic shi eirnu tutupo wlli sotm ilekyl tuerrn ot onmlar, ish bodol seerrpus odluhs olas rz.oemnila

charcot_bouchard  Postobstructive diuresis Postobstructive diuresis is a polyuric state in which copious amounts of salt and water are eliminated after the relief of a urinary tract obstruction. The incidence of POD is unclear but estimates suggest 0.5% to 52% of patients will experience POD after relief of obstruction.10 It generally occurs after relieving BOO, bilateral ureteric obstruction, or unilateral ureteric obstruction in a solitary kidney.11 Diuresis is a normal physiologic response to help eliminate excess volume and solutes accumulated during the prolonged obstruction. In most patients, the diuresis will resolve once the kidneys normalize the volume and solute status and homeostasis is achieved. Some patients will continue to eliminate salt and water even after homeostasis has been reached, referred to as pathologic POD. These patients are at risk of severe dehydration, electrolyte imbalances, hypovolemic shock, and even death if fluid and electrolyte replacement is not initiated.9 +7  



 +3 
submitted by waterloo(89),

I had a different thought process to answer this question that might be worth mentioning.

  • urine output increased: pretty simply they are putting tubes in to increase the urine flow into the bag.
  • If you increase urine flow rate you increase K+ secretion. That's why diuretics like thiazides and loops increase K+ secretion. You can sort of think of it as the gradient stays wide for the K+ in the cell to leave into the lumen because as new fluid reaches the principal cell it wouldn't have much K+ allowing for an increased driving force

The aldo reasoning is def true as well, stimulus for aldo is hyperkalemia. Costanzo teaches this well, you can also reference BRS physiology 166-167

sweaterguy  Sounds like a situation similar to the recovery phase of ATN. +  



 +0 
submitted by step1soon(46),
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In cstteoiturspbvo srdiuesi eht rneiU is uyalsul tyohniopc thiw regal osumatn fo ousdmi eoh,dcril mtias,sopu oaphptseh nda snmmiguea ][Unir 3e uOputt ;gt& 125 - 0rm0/oL2hu eatfr leeifr fo snctrbutioo rof ta laets 3 ccneovuseit 4 ner]hriu[Uos ysmilraOot g&t; o/m25gks0m [5]

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