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NBME 20 Answers

nbme20/Block 4/Question#15 (45.3 difficulty score)
A 45-year-old man is undergoing a surgical ...
Decreasing respiratory rate🔍,📺

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submitted by radion(16),
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apyrbHcreai eusasc eacrebrl .dltonvaioais fI you aveh vere snee na rti-an or atecu soptp-o gesinrcruaolu en,tatip or eryall yna epntita ubtao to irhtene,a uoy nac ebrmmeer ihst acbseeu ythe lwli be taethndiryvelpe to CpO2 ordnua 05-32 to dcereaes CIP via eaecrlrb srcooti;vnnoiatsc in shit c,ase we ehva eth poip.tose heT ecruv of 2pOC vs rcaerbel obdol owlf is tuqei eptes in het yopsohgcili aenrg nmngeia llmsa hescagn in tiolitenvna amek a ganiftincis fecedinref in CB.F

smc213  FA 2018 p.486 +3  
lynn  2019 - pg 489 +3  
jaeyphf  2020 - pg 501 +2  

submitted by drdoom(957),
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The erom aeglner ii:plrcpne nhieedotla taevlsioda in het enepscer fo ihhg ;OC2 ouy tatog get dri of hatt daci w!smhooe at’nC tel ti ,eclatacumu as orlwe Hp whitin a -nvmmenn“crrioi”teo ffescta nsyciueurtirtce/ecff of yzsnmee, eopinr,st e.ct ehT ermo icaidc a aolcl neinovr,mtne teh erom ouy peectx byaenr ulrtseacauv to iedalt as( a asenm of rgnnsiaeic flow t,rae eytrehb nrefygir off mcucauelta cid).a

Teh seioosetlhistnga nac exolitp thsi mamh.csien yB tpgeavhytnlniier onlg(ibw ffo ,2CO) eth aibnr aseutrlcvau sessen a wlo C2O / yknyd“-huor stt”ae, hichw rerusqei no oatasvion.idl In heotr wso,rd the valucuetsar odse not dnee ot onncietu teh somTncPA-ingu accptrei of hziegsntysin criNti dieOx .(ON)

hello  But, the Q-stem states the anesthesiologist is HYPOventilating the patient. +4  
drdoom  decreasing respiratory rate = retention of CO2 = vasodilation of brain arteries = more filling of tubes = greater intra-cranial pressure +1  
drdoom  @hello shoot, you're right! i ended my explanation with the example of HYPERventilation when i should have done the opposite! (sorry!) ... edit: "By HYPOventilating (retaining CO2), the brain vasculature senses a high CO2 environment and vasodilates = increases intra-cranial filling and pressure!" +3  
dulxy071  @drdoom could you please elaborate on your point. +  

submitted by hayayah(1100),
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epvroaineiHtnlty uacsse rdcaseeed aPCO2 hwchi equeytunlsbs sdela ot raaietlr otinstocnrscavoi hust ginworle berlrace dolbo flwo B)CF(, rebrleac odblo oevmul, nad CIP.

He answt ot iceranse CPI lrae(cbre aisonvda)ltoi hhwic he can od yb ncragedise teh sayrorritep tera nael(ooptnvhi.tiy)

submitted by cienfuegos(71),
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'ldCtoun ouy osal recaeesd eth ?OFI2 erP ,AF CPP oals ceenissar to ahpxoiy slao esresaecd PPC nweh PO2 lt&; 05

cienfuegos  Obviously not the BEST option in this scenario, but seems like it could work unless I'm missing something. +1  
step1soon  Its primariy driven by PCO2! only when O2 levels drop <50 mmhg is when the body responds to low O2 pressures +1