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NBME 21 Answers

nbme21/Block 1/Question#10 (24.0 difficulty score)
A 34-year-old woman is brought to the ...
Primary metabolic acidosis with increased anion gap🔍

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submitted by ergogenic22(238),
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laCn3=+-nNoC-ia-(H)O gap = 10+)0541-(01 = 25 mL/Eq

naroml genar for nanoi agp is 8 to 61,Ee/rr.q.ofm esiotipv nonia .pga

pH = 275., mrlnao genar 7...5.4.37-5 foerhereT sasiocdi

rmNola broaatcnebi ,228-2 uiosentsq sshow brbaci fo 10. fhrreeToe mocetilba dssiacio

lidiytldAnao OCP2 rlmnoaly 4335- mm H,g nuoqiets hssow 2COP fo 23 wthi lrnmoa 2O,P toerrfehe oirsparyret snoapnoecitm

mambaforstep  why did the stem say she had a drinking problem... is that just a distractor? +  
castlblack  I think alcohol uses up all the NAD+ in its metabolism leading to increased NADH/NAD ratio. After that, TCA cannot progress and the cell is forced to use anaerobic metabolism, which increases lactate. lactate causes anion gap metabolic acidosis (L in MUDPILES from first aid) +1  
nafilnaf  She may also have ingested methanol if she couldn't get her hands on regular ethanol which causes an anion gap metabolic acidosis (M in mudpiles). +  

 -4  upvote downvote
submitted by temmy(112),
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epslae lehp ngardccio ot enwrsit tuonqaei het tnaptei ash a anolmr noian gap

ergogenic22  winter's formula is to look at the compensation to see if it is appropriate. PCO2 = 1.5[HCO3-] + 8 +/- 2 In this case, 1.5* 10 (Pt's bicarb) +8 +/-2 = 21 to 25 Pt's PO2 is 23, so compensation is appropriate. If PCO2 was below 21, it would be concomitant respiratory alkalosis +5  
ergogenic22  in other words, winter's formula is not necessary for this question +2  
the_sacramento_kings  lol unless you want to make sure its not A. +1  
hello  @ergogenic22 Someone might use Winter's formula to rule out choice A. +  
maxillarythirdmolar  respiratory depression of alcohol should rule out "A" +  
baja_blast  Isn't the low pCO2 enough to rule out A? +