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NBME 21 Answers

nbme21/Block 3/Question#33 (63.2 difficulty score)
Left radial arterial and venous blood samples ...
HCO3 transported in the plasma🔍,📺

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submitted by hayayah(1101),
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eht iyomjart of obranc eodidix locumlese rae dacerri as rpat of eht ioaeratbncb ubeffr m.sstey nI shti e,symst brocan iieddxo fsdsuief tnoi teh BCsR. rcoCiabn nsyardhea A(C) tihiwn RsBC ykiqcul sctrnvoe eth ocrnba ddoexii tion inrobcca dcia (2C)OH3. rcCnaibo iadc is an auentslb eridetemiant ceuemlol ahtt itmedilmyae ssatisdocei nito nboicbeatar sino -)O3CH( dan dregyhon H)(+ .inso

hTe lnwey nzeetsidhys taibcneoarb noi is rapondettrs uot of teh RBC tnoi the spamla in egxacnhe rfo a rcoidehl oin C;−l)( ihts si ealcld eth eirhdlco thisf. Wehn hte oldob rchease hte g,lsnu hte etcbnaorbia nio is rtopntdaers cabk niot hte RBC ni gcnxaeeh fro hte ldirchoe io.n eTh +H ino isoatcedsis rfmo het gmlooebihn dna bsdni to teh btacanoireb hsTi edusrpoc eth ociacbnr dcai mteeai,denrti hwhci is dtneocver kacb onit rbacon xddoeii tuhhorg eht etcmyanzi notica of AC. heT orncab xiiedod eopudrcd si edpllexe htuorhg the gslun drignu leotnaa.xih

hungrybox  Amazing explanation. Thank you!! +2  
namira  in case anyone wants to visualize things... +5  
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +3  
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +3  
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. +3  
teepot123  fa 19 pg 656 +1  
surfergirl  "majority of blood CO2 is carried as HCO3- in the plasma." I guess that is all they're testing us on, just in a very convoluted way. +  

submitted by mcdumbass(25),
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I thgouht uhogtht mseiguanr a gsa ni het lodbo yonl eaemsrsu patilar ressreup of ivelsdsdo sga ni the oobld

schistosite  Yeah, me too...the fact that they expect us to assume that HCO3- is counted in their measurement for CO2 concentration is absolutely absurd. +3  
happyhib_  they tell you measured is around 24 and 22 or some bs but give "mM"; if you look at the lab sheet HCO3 has a units in mM and normal is 22-28 = they are not just looking at partial pressure's. +2  
an_improved_me  Yea,.. Suprisingly in clinic, when you are measuring important parameters in the blood (think fish-bone diagram), you actually use HCO3- as an approximation for CO2 in the blood (so you use the value in CO2 when calculating like the anion gap or something) +1  

submitted by mafoo_xtreme(10),
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For R'sBS:

tA hte :glun l-C o,ut 3-COH in

tA the uts:ssei -Cl n,i 3-OCH uot