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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

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submitted by โˆ—welpdedelp(269),
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This was .LSE oyt9eu/-ty:l/mm2kp3ml/0ut-o.etesslsrhsdu1m1i.p/sshsscute/tcmepetsb1a

Tnhik: 3=,,12 LES--

nUisg :DCAI Tpey III si rof muneIm xolmeeCps

submitted by apop(9),
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heTse itenposaxaln naetr .geart tI dontes yalrel evha umhc ot do hiwt SAAR otnvcaaiti. It sah lmaost ingheeytrv ot do with a ophennemon lldcae eth aelnkial .diet In hcronci tgiio,mnvt you ouwdl pxetec lC- ot be wol nad =K ot eb low asl(irim ot lab suslrte ni eseoonm htwi iaull.bem) To etnmopscea rof eht lwo C-l, eht hacsomt ash na orintrtaep chihw ceehngxsa Cl- ofr C-.OH3 orereehTf, lC- liwl be edsreinleph ni eht cos,tamh ehliw O3C-H lwil aeiesrcn ni teh odblo, cnsguai an asaisol.kl In ciktllaoa ,ssttae the /HK++ otatnreipr wlli egibn to ,iavtaetc snhfiitg K+ ONIT eslcl a)e(kaymihplo dan airinsngce .Hp SAAR bbrpaloy slyap a loer in ngmika hte pekiolaahym erows tbu eht alkenial edti si emor imtnrotpa e.rhe

spaceboy98  Isnt kailnlae tide elatder ot an ecrsanei in Hp ftera ?lsmae Yruo gcoli si on ntipo btu mI' ton esru erwheht ew anc lyppa taht nccetpo +1  
kevin  tpocecn can be piapeld eerh ceaesbu ew ened ot etelper eth Cl- ni odrre to trecea l;CH eth amthosc os'entd earc if l-C is owl ni s,meur oynl thta -Cl si wlo in the ieaprlta slecl adn so wlli pupm uto H-CO3 ni tis xesnpee +  
usmleaspirer  ywh si +K l?wo +  

submitted by โˆ—hayayah(1200),
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With rniohcc gno,tmivi uyo osle lerscttoeyel and a lot fo dca.i It igtergrs bamoicetl iaallosks ciwhh is yhw all teh umres evausl aer wol (ro no teh rolew nde fo eth mnalor g)rnae epxect orf rbboe.nctaai

ergogenic22  seereddca +K (morf ndaeesirc RSAA due ot eolumv los)s nad eecersdad lC- os(ls fo lCH fmor eth sh,o)mcta sokilaAsl fmro osls of ClH dan thsu hgih rabF. ciro b siht anoser ghih ot imd ngear K si nrwog +4  
sbryant6  Wt'noldu aeridcsne SARA adle to ecrnesadi +?aN ehT snrwae hossw derdescea .Na+ +3  
sbryant6  lsA,o mrremeeb aluBmii rseaoNv si adticssaoe hiwt eoahalimkyp. +1  
sugaplum  so teh nreag eyht gvae ofr K is 63-? so .32 si WNL th?en or era we sutj toarinepg no t"i si on teh lweor end fo lanrom in pdse" +2  
dbg  sodumi eellsv in cyilopr sitoness r,ayv ngintoh leraly sia,cscl cna eb ihgh sa ni shti aces slimpy due to ontyrhd,ia acn low in hrtoe csaes if rentlodosea gemaadn to esvrree ttha to teh hrtoe rexeemt +1  
skonys  lohcmpoe,"yiHrc lmphoiekcya ltmaocibe alkssliao si hte saclsic elctoelyter adn cies-baad aelbnimca fo roilycp esios"nst fomr dpseamce hdnibe .lp aotnVmaliwygi = veuoml sslo (dec iksn u)gtro sa lwel sa ossl of H,+ -lC dna N(ht+iwa )02H t&g-; oletcbMai Aals.isolk Loss of +H ceasus snrciaee COH-3 oetinetrn as lwle sa K+ thisf otin lelsc l(aapmekohyi F19A 758). +  

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),

submitted by โˆ—masonkingcobra(405),
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In leomtciba sk,saiolla aupstmois smveo niot het sllce

eTh slso in vmuelo gurtohh ssimee grsitegr RSAA tuinlesrg ni einsredca tedsenoolAr reeeals and rufehrt miasuopts riecenxto


submitted by iamapotato(3),
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No oen reeh eerdbhot to aylacult cssuids ws'tah gniog sh.Toni si a omht-n1 ldo nwbnreo.

eH imvsto faret sie,nefgd 5yad- hsyi.ort

tA 1 tohnm lod, twih ingivmot after gdfsiene, ti is stmo klleiy a ceas fo OYPLRIC IETSOSNS eud to hyrrotyhepp fo teh oyrpcli tehsncrpi (alulyus rsuocc 6 eksew aler)t.

Deu to ihm vnitimog octahms onnectts, he lliw OSLE Cl-, ,K+ nad .+Na

He lliw ASLO sleo H+. sihT si yhw uyo og iotn the lcioetabm oslliasak ithw a testrauln nrseeica ni het -3HOC.

kamilia20  tcy:sk:eh gnvmitoi uecass sslo fo ATRWE erteagr tnha muidโ†’os desaricne emrsu sudomโ†’i ISCERANDE smrue om,olsatyli So NA lwil arsedcee oo,t utb no tath raf +  

submitted by ark110(1),
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But waht si eht fncferedie ebtnwee toopni A dan opntio C (2;13 .;94 ;90 3)5

sympathetikey  +K 'nsloduht ceea.sirn 'tsI ovimgn onit lcsle edu ot tlebocmia ilkssolaa. +  
home_run_ball  In eth tleiapar lelc fo the tgd aryo eh nH msoc nsio are rmfdoe rofm the iidoiatnossc of corcaibn acdi. aetWr is a very nmior rusoec of yogdenhr nosi in inaocrpmso to riboaccn i.acd nbrcaioC idca is dorfme from robanc exddiio dan arewt by icabcron a hde Tehan.rys crbinbaetao ion 3Cโˆ’O)(H is gexecdhan rfo a holeicrd ion โˆ’)lC( on eth sblaa esdi of hte clel nda the aaticbnobre sfusdfei tion het uosnve o,oldb dinleag ot na aelnlkai tedi ehenonnmo.p +1  
ergogenic22  RAAS racnieess morf volume so,ls nad utsh mreo onlersetdoa desal to lwo K+ +1  
sinforslide  erehT nessaro orf mhliaay.okpe tsF ri, emos +K si tlos in itracgs .dluifs cen oS ,d +H sftsih tuo of sllce dna K+ hsifst otni elcls in tceaolbim i haarTis d,.lklos CEF levomu cntntiocaro ash ucesad nieardsec eorcntesi fo .esaldtnoroe +3  

submitted by โˆ—rainlad(32),
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o,Hrcichlmyeop ecoyhalmpki lbometaic sailksola si eth siclcas lleeetcryot nad ca-abseid cebminaal of rcipylo ns.stsoie

Pstnseeitr iigmontv ultsers in slso fo HCl. hTe hidlceor sosl seutslr in a low ldboo iorceldh veell ciwhh imiarps hte dek'ysni biiyalt ot rcxetee a.nboreitabc sThi is het otafrc tath erpvesnt tnceocorri fo eth ialksaosl gneldia ot aboeclimt kla.ilssao

A caodeyrns odialtohrnsmreespy spvdeeol ued ot the eeacsdrde bdool .olvmue ehT ihhg sdnelooreat evlsel seacus hte sykiedn to enitra N+a t(o crrecot het tnaiuraavsrlc eumvol etondiepl), dna eeextcr ecisander utsanmo of +K nito eht niuer eig(uslnrt in a olw lbdoo elevl fo

submitted by thefoggymist(12),
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I o'tdn teg s.hti d'oSuhtln hte ydnsike strta ctonrrigce eht aricbb esellv arfe 5 days? Teh eladyed heaps of het oeirtcronc sncie ythe aetk t.mie.. adn in eth quiteons h'treye gisakn e"n."wWo aehv ibemtaloc oiaslsalk cines HLC si os,tl so eht odyb liwl try to ccrteor it itsfr by aeitlvriepntnhyo adn aletr by nrcaesied teienrocx fo rbai.bc barBic hdlosu be .w.lo. ssul(ne Im' sgisnmi emhnsgoti deu to giebn e)eadhtxus

thefoggymist  nevirem,dN I htink I ogt it. taeB adctteraeiln cllse ctaonn nfcniuto dna terecxe rcbiab ecebaus ew dtn'o vhea l.rhoiced eaY nlypaaretp I aws xdehs.eaut +  

submitted by โˆ—amirmullick3(75),
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Vrye eyas eotq.nsui nuiiNoblso oivm.t 1 hmtno ae.g sotM ykliel naisreoc is lorcpiy t.inseoss

The montiivg seacsu lsso fo lHC so we vaeh the oyhao,imrplhec adn relna esonatmoncpi rof sthi H slso yi sb rivpsgrene nprosto at eth npeesex fo K os ttha vsieg ehikpalo.yam As eth diasees si made,n eth drrrao ew in hte emagi fo eth ctsmaho si homsot sulmec rehhoyprtyp fo the lrpiocy uirscusaml oceamsu, mheogn tfir osld-vieaeph mass left on ploaapit.n shiT si a laceoitbm aiallksos esaeucb uwittho -C,l eth aeOClCaalrt /3sbHlo grehecanx lilw not ,owrk os uyo iertan OH3C.

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