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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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Thees tnxaaleopnsi rante grt.ae It edotns laylre evha hucm to do itwh ASRA tinaivt.aco tI has oatsml nteehivryg to od ithw a neohnneomp adclel teh leliakna .tied nI hocnirc ov,gtimnit uoy odwul tcexpe l-C to eb owl nad K= to eb wlo sl(miiar to bal srslteu in emnoeos hitw .iml)eubal To aseopmecnt for hte olw ,l-C het oacstmh ash an aioenprrtt whhic gcanhxese -Cl rof OH-3C. ,oreTerfhe lC- lwil eb enreipldhse in het mtsoh,ac ielwh C-3HO ilwl arineesc in teh bd,olo acnguis na aiaslls.ok In aoilatclk ats,set het ++/HK ioatntrepr lwil egbni to vaactt,ie istnifgh +K INTO scell ai(lyaomhpe)k nda nesgairicn pH. SARA bprylbao ypals a eolr in agimnk eht ypaoliehmka rwsoe btu het ainkeall tdei si mero ratpomitn eerh.

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spaceboy98  nIts keilalna tdie eatrdle to na ecrsniea ni Hp areft asm?el uoYr icglo si on iontp but mI' ton srue weetrhh ew acn ylppa ttha npcceot ere.h +1
kevin  ectpocn anc be lpiepad ereh eecuasb we eedn to eelpetr the Cl- ni reord ot cterae H;Cl eht omchsta ote'snd arce fi lC- si owl ni u,serm ynlo ttah -lC is low ni teh apialret llecs nda so llwi pump tuo -CHO3 ni its xnspeee +
usmleaspirer  yhw si +K w?ol +



 +6  upvote downvote
submitted by โˆ—hayayah(1212)
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tihW chocrin tgi,iovnm yuo leso coteylrlseet dan a otl of icda. It iggterrs ambteicol aolslskia whhic is why all hte uersm svaule ear wlo ro( on the wlroe dne fo het aonrlm an)rge teecpx ofr eainrbacb.to

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ergogenic22  drdesaece K+ (omrf drensecia RAAS ude to levmou )ssol nda csradeede l-C s(los fo HCl rofm eht ,scmh)ato Akaloslsi rofm olss fo lCH nad uhts ihgh oic. rr b a Fb tish narose gihh to dim egnar K si rwngo +5
sbryant6  Wnu'ldto ariednecs ARAS elad to aeserndic aN+? heT nsaerw hswso sdeeacedr a.N+ +3
sbryant6  ,Asol ebrmeerm mialiBu evNroas si osadeciast wiht ilopaemh.aky +1
sugaplum  so eht aegrn teyh agve for K si 36?- so .23 si NLW th?en r o are ew ujts eigatnpor no it" is on the olrew nde fo lnmora ni ps"ed +2
dbg  doimsu vselle ni olriycp esoissnt ry,av gnntohi lylare cs,lscia can eb hihg as ni sthi asce iyplsm ude ot tinyohadr, nac lwo ni hotre scsea if otnodaleres aadmnge to rseveer htta ot the hroet teexmre +1
skonys  c,hocimHpory"le lmeiokhypca aocmlibet saaiskllo is eht lacssci letelyotrce nad sacb-aide aacnebmil fo opilcry oisstns"e ormf aempcesd hdienb lmVi.a npiltwgayo = mlevou sols d(ce niks r)gtuo sa elwl sa ssol of ,H+ l-C dan (Nhitaw+ )02H g-t;& lcobteaiM .kisallAos Loss fo +H sceuas eincrsea H3O-C totienner as elwl sa +K fhtis oitn lslec (eohlaipmayk 1AF9 )8.75 +

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 โˆ—masonkingcobra(408)
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nI icbomleta aolassi,lk ssopmatiu omves onti teh slelc

eTh slos in ouvmle tguhohr sieems gegstrri RASA egnsrluit ni esedacirn rtsAoeldeon erseela adn fetrhru ustosmiap cxreointe

t1epbe/n/si/aewt1/ttt6wh.adw.:pl

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 +3  upvote downvote
submitted by iamapotato(3)
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oN noe hree dereboth ot laayuclt ssdiscu stawh' oiggn inhso.T si a 1htn-om lod or.wnneb

He oismvt frtea ee,fdgisn y5ad- .ishroty

tA 1 nmhot o,dl iwht giivntom aerft nf,sidege ti is stom ykelil a ceas of LPIROYC ISTNSOSE ude ot pphyyhrerot of teh oliycpr ncpterish a(sluuly ocrsuc 6 ewsek ael).tr

uDe to imh imgvtnio camoths enst,cnot eh illw OELS l,-C +K, nda a+N.

He illw SAOL olse H+. hiTs is ywh ouy go tnoi teh bemtclioa saklsalio itwh a rtetualns iaernsce ni teh O3C.-H

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kamilia20  kse::ctyh inomivgt uasesc ssol of ARWTE trgraee ahnt sudoimโ†’ sdranceie esumr โ†’osudim REICSNEAD eumsr oimlta,yslo So AN lliw dreacese ot,o btu on ttah arf +



 +1  upvote downvote
submitted by ark110(1)
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utB whta is the edncfeefri tebneew ptinoo A nda pontio C 3;21( 4.;9 ;90 53)

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sympathetikey  K+ dotnlus'h ceiae.srn s'tI voimgn nito eslcl due to tlimaecbo s.alioklas +
home_run_ball  nI the tieprala llec fo teh etm oyaro nhdscH g osni are mdfero morf teh cdaooissitin fo robnaicc dic.a Waret is a vyre irmon ouecrs fo grhndeoy nosi in niosmparoc ot cbanicor .acdi cbairnCo icda is feodrm omrf ranbco doiexdi dan wraet by acrioncb ysnar .hTeh ade reabncotabi nio โˆ’)3CHO( is axghdecen for a hdiecrol oin l(Cโˆ’) on teh lbaas dsei fo teh lecl dna het boaeanibtcr sudiffse toni eht unseov l,dobo ldnaige ot na ainlkeal tdei pohemn.oenn +1
ergogenic22  RASA rsicenase rfmo mveulo ls,os adn shtu erom deeoorsanlt dasel to owl +K +1
sinforslide  herTe ossrnea rfo liyekoa.hamp r st,Fi emso +K is otsl in agtrisc idulf.s e,n o cSd H+ fihsst tuo fo elslc dna +K htifss oint scell in mioltcbae lrsl kd .i,shaoTia CEF mueolv anntcioocrt sah ucesad sdnciaree iceernost fo .tarensoledo +3



 +1  upvote downvote
submitted by โˆ—rainlad(33)
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c,yphicoorelHm hkilcemyoap cltibmoea kolalssai si eht lssicac lerteytlceo adn a-debsaci ialcbname fo lcpiory ni.sostse

sPtterinse itmoivgn letusrs in ssol of Hl.C hTe deoihrlc lsso ltusrse ni a lwo olbod hrleicod elvel hihwc amiipsr eth skdin'ey lbtiyai to xteeerc .rbaeboiatcn hisT is het oaftcr ttah tnvesper rterocnioc fo the aoilaskls elndaig ot ieomctlba .llskiaosa

A sdrayeonc mrnseslthoaydrpeio pseodevl due ot het eedrcesda lbodo el.movu eTh ghih eoarnstdleo eevlls scsuae eth sekidyn to ntarie N+a o(t occrert eth aialvacnsrtru voeuml l),etoedinp dna rectxee disacnere ontsaum fo K+ iotn the uneri t(esugnril in a wlo doobl elevl of psustamoi).

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 +0  upvote downvote
submitted by thefoggymist(12)
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I dn'ot gte ist.h ln'utoShd hte ikydnse ttsar ctiegrrcno eht ibacbr slelev frea 5 ys?da eTh aydeedl shape of eth ericntrooc sncei teyh etak .im.e.t adn in het tqonesui rh'eety ksgani oWnw"e" . aevh lmeabotic soaiklsla cisen LHC is l,tos so eth doby liwl rty to rcrocte ti srtif yb ryvinielhptoeatn and eltar yb siacrende ereitnxco of acrbib. rciBba sdohlu eb ..l.ow elsuns( I'm ssgiinm hmntisoeg ued ot neibg uts)xadeeh

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thefoggymist  ndvei,rmeN I nthki I tgo it. teaB atnirtadecle lecsl nacton icunfnot dan xeerect rcaibb aebceus we d'not aehv ohrlce.di Yae aplarpyten I wsa eteas.dxhu +



 -3  upvote downvote
submitted by โˆ—amirmullick3(76)
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ryVe ayse tneoi.qsu lnboisNiuo o.vitm 1 tmohn ga.e tMso ilyelk creosina si ciplyor snts.osei

eTh tgniomiv caeuss loss of CHl os ew vahe het ilacmyh,proheo nad rnlae opmoastnneic fro tihs H osls bis y ervrsegpin oronpst at teh nepesxe fo K so ttah giesv lmoehykpia.a As the iaessed si d,mean teh drw aorre ni het igeam of het aohtsmc si omtsoh ceuslm hehrryppyot fo teh rlcipyo lumaiuscrs souac,em enf irtgomh ed-epvalosih asms lfet on pal.poaitn shiT is a ecbtloami olsasilak cebesau totuhiw C,-l teh bsl/atl aoaClre3OHC heaxecngr liwl nto k,rwo so yuo iatner H.3OC

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