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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; Cl−: 90; HCO3−: 37 🔍 / 📺 / 🌳 / 📖
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 +8  upvote downvote
submitted by apop(8)
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ehesT eaxisnntoalp rtena a.gter tI dnetos alreyl eavh umhc to do hwti ASAR .ivniacatot tI has slmtoa etgerhnviy to do wthi a hnnpooeemn decall eth nlleaaki et.di nI chncrio ,ovgmitint yuo wluod etpxec Cl- ot eb wlo dan =K to eb wlo msia(lir ot bla lsurtse ni eonomes htwi lma)ubl.ie oT sepnocteam rfo hte wlo C,l- teh ahstcmo has an neitrrotap ihwch xsahecgen l-C orf HO-C.3 fh,rreeeoT Cl- wlil eb ereiedlpnhs in hte c,amhsto ewhil OHC3- liwl eeacnirs in the dobo,l gaicuns na ailas.lsko In oclkaatli sts,eta eth K/+H+ peariotrnt illw nbige ot ,evtatcia sfhgntii +K IONT llsce yiom)phaekl(a nad igsancinre p.H RSAA rlypbboa spayl a roel in giankm het makyaeilpho oswer tub het nlliakae tide is erom piatmtnro ree.h

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spaceboy98  Inst llkiaena idte eltaerd to an rncaeeis ni pH artfe ?lsmae Yruo gloic is on npito but Im' ton reus hhrwete ew acn apply ttah ctcoenp erh.e +1
kevin  coepnct anc be dlaippe rehe aeubsce ew ende ot rtepeel teh -Cl in edrro to cterae CH;l eht smtohca odnt'es aerc if l-C is olw ni umes,r lyno htta -lC is wol ni teh ieaptlar lsecl and os wlil ppum out 3-OHC in ist xnseepe +
usmleaspirer  hwy si K+ wol? +



 +6  upvote downvote
submitted by ∗hayayah(1212)
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iWht ihconrc iinvo,gtm uoy esol yrsloecetlet dna a olt of icd.a tI isgrgrte liatbcmoe klislaoas hwhic si why lal teh umsre vslaeu ear owl ro( on eht orlwe den fo the omlran angre) tpeecx orf rb.ocateainb

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ergogenic22  aeredcdse +K for(m drnesecai SRAA eud ot oeuvlm ossl) nad dedacseer Cl- so(ls of lCH fmro het cmtsh,o)a laoksiAsl ormf slso fo HCl nda htsu gihh . obac bFrr i shti eonrsa hgih to mdi grnae K is grnow +5
sbryant6  loW'dtnu anrcsedie RAAS dlae ot endrsieca ?Na+ Teh sawern sowsh esaedcdre +a.N +3
sbryant6  A,ols eemrebmr umiailB aNservo is cdtiossaae htwi ayka.mpheiol +1
sugaplum  so eht ragen hety avge for K is ?3-6 os .32 is LNW n?teh or rae ew ujts trapoieng no "ti is on hte wrelo ned fo aormnl ni epsd" +2
dbg  umdois lvsele in cplroyi ostsesin r,avy hotingn lerlay cailcss, acn be hhgi sa ni ihts ceas implsy edu ot yhritnoa,d anc wlo in hoetr ssaec if sladteroeno mgeaadn ot svereer htat to the hoetr exmtere +1
skonys  roelmciyhp,"Hoc hlkoaycempi maltcioeb issaklalo si het clssaci letlrteceyo nad asai-ecbd belinmcaa of riyploc inoss"ets fomr deacpmes dheinb .ptamVi nwligaoly = muloev slso de(c nksi gur)ot sa llew as lsos fo ,+H C-l dan aiN(h+wt H20) ;&-gt Micaloetb asAosi.llk sLos of +H cuseas raenisce -3OCH tenoentir as lewl as K+ ithfs niot clesl yoamehik(apl 91FA 5.7)8 +

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 ∗masonkingcobra(408)
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In ielmacotb lkaiso,als tumsopsai emsov onti eht lscel

heT osls in mvlueo huthogr mseise irgrgtes AASR unrteglis in eaerncisd onoeeltAsdr serelea and utrfher osapismut irexotcne

6apaet/e.nt.blw/tst1whp/i/d:1wet

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 +3  upvote downvote
submitted by iamapotato(3)
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No neo reeh berotehd to catyulal csidsus s'htwa ggino ihosnT. is a tm1nh-o lod oennwr.b

He smotvi aertf e,eigndfs y5da- ishrt.yo

tA 1 mhotn dlo, twih mviotgni rfeta denfi,egs ti si mtso kylile a csea of CPYLROI SOTESNSI ude ot poetrrypyhh fo eth oycirpl rtpcnehsi slyualu( urccso 6 wkees l)r.tae

uDe to mih ivointmg hsomcta ecottnn,s eh llwi SLEO l-,C K,+ nad .Na+

He illw OSAL eols +H. ihsT is yhw ouy go into eth baloeicmt aksslloia wiht a uertnastl aeinrecs ni the -.3COH

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kamilia20  c:teyskh: omivtign suscea osls of TRWAE eegrtra htna omdsi→u iseneardc uemrs oidm→us DEEAINRCS sumre oollaty,ism So AN lliw aceredes o,ot ubt on htat fra +



 +1  upvote downvote
submitted by ark110(1)
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tuB htaw si teh nricffedee wenteeb pnooti A and iootnp C ;3(12 9;.4 90; 5)3

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sympathetikey  +K uod'shtnl in.aresec s'tI gionmv iton csell deu to iotalmecb ssokla.ali +
home_run_ball  In teh lpreaita lecl of the e shgony m tadcHor osni rea modefr rofm eth istadnsiocio fo ariconcb ic.da taWre si a yver monir usroec of oerhdygn osni in iopsmcaron ot cnbcrioa dai.c cnbCiora caid si dorfem fmor aornbc idxedoi dan rtwae yb crionbac raeedsT .ahhy n baanrcbioet ino ()3C−HO is nedgxecha rof a rliodech noi C−l() no eth balas desi of teh cell nad the abnbioctrae dsiefusf noti the uosven ol,bod dlgenai to na kaienlla ietd mepenononh. +1
ergogenic22  ARAS ieacsrens mofr levuom slso, nda huts orem otdeeasnlor aesdl to wlo K+ +1
sinforslide  reTeh asneros orf oa.pyhmelaik st ,iF r osme +K is slot in crgaist ui.dlsf dceS,no H+ sstfih uto fo elscl nda +K fshsit toni sllec in clmbaoeti di k,l.laoThrissa FEC eulovm ocrniontcta ash easudc eeasrndic osrteicen of tdoel.ronase +3



 +1  upvote downvote
submitted by ∗rainlad(33)
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olp,rhcicmoHey iapkhmeylco ecilmtbao asloiaskl si eth icascls trtyeeeclol and basdiea-c nlbaeiacm fo yiplorc siones.st

etenisrPts mvgitnio rselstu ni loss of .ClH eTh drohclie sols selsurt ni a olw oodlb dhecorli elvel hwich siaprmi hte dikyne's atiyibl to eretxec bcoernbatia. Tsih si het oatcfr atth rtsnvepe ooctceirnr of the slisaolka andlieg to acbtmoile lsl.aakios

A endoyrasc hprernotimssydaeol sedolvpe ude to eth ddeasecer oldob e.olmvu ehT ihgh neadstleoor lelevs ucesas teh dnkyies to rnatie aN+ (ot otrrecc eth rautalraincsv loumev te)nope,idl adn xeeetcr ircsaeedn utanmso of +K tion eht uiner (trislgnue ni a lwo ldobo lvele of spt).msaoiu

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 +0  upvote downvote
submitted by thefoggymist(12)
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I dnot' tge ts.hi S'lntuhdo the skndyei rttsa ignrctoerc het cbrbia sellev aefr 5 ?dsya hTe eeadydl saehp of hte rocretcoin isnce yhet aket .i.mt.e nad ni teh qisonetu yhrete' kiangs o .We""wn hvae licaotbem aiaslolsk secni HLC si slto, so eth ybod will tyr to croerct ti irfst by pintirhlnyetaove dna teral by sacdeiren exocrinet of aicbbr. iBrcba odhlus be ...owl (sunesl I'm nsmsiig oesimhgtn due ot enbig extd)seuha

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thefoggymist  reeNdvi,mn I nhitk I otg t.i etBa idrtlaacneet sllce nncato ocnnitfu and cxteree brabic ecasbeu we tdon' veah lchrdoie. eaY yaelprptna I swa edthex.aus +



 -3  upvote downvote
submitted by ∗amirmullick3(76)
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eVry ysae touiq.nes iuisoNnlob iov.tm 1 ntmoh e.ag tMos klleiy nsraiceo is ciloyrp ssniesto.

The tivgiomn ucsaes sosl of lCH os ew ahev teh hepmraioc,yolh dan laren maeconsnpito ofr tish H olss si by rirsnegepv ntsoorp ta teh eexepns of K os ttah isegv aylkapmh.oei As eth eadsesi is dan,me hte wr rodrea ni teh ameig fo the comhsta si mhsoot uscelm yprhrtyohpe fo the oclpyri rialscumus mo,ecuas nrig emhfot hdvioel-epas mass tlef no anptp.oail hiTs is a tabiemclo likalosas cesubae twotiuh ,lC- eht COaar3He/sltC olbla nhaegrexc llwi ton krwo, so you anirte O3C.H

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