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NBME 22 Answers

nbme22/Block 2/Question#41 (55.4 difficulty score)
A 12-year-old boy is swimming in a mountain ...
Central blood volume: increased;
Serum ADH (vasopressin): decreased;
Serum atrial natriuretic peptide: increased


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submitted by keycompany(296),
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nAwer:s cIedserna Cnlarte dlBoo moleVu ()CB,V rsceaeDde A,DH Ircedasen N.AP

heT coailsglioyph sropesen ot rpoyamehith si ctsoitovnoiasnrc of rpheeiarpl leevsss ei..( teh nsoe in ouyr xe)irteimste ni an etfofr to eekp yuor ecor doyb etmprearuet nla,mor dan usht yuor sanogr nnctniufogi pr.oryepl hrraeePilp rncotcsoiVosinta will rcaseein BCV. dsaIenecr VCB iwll asecu an rsieenac in rlpaoed, and tuhs ueacs na enicesra in /NBNAPP. A/PPBNN ahs otiirnbyih cestffe on eht oino-AedtglRAnisennnne-teisro Sts,yme nitlgseru in edardeesc HDA.

gokings2021  RAAS is not directly linked secretion of ADH as claimed above. Increased pressure at baroreceptors and increased central volume sensed by the hypothalamus will decrease secretion of ADH. +3  
miniarnie89  another way to think about it is central vs peripheral blood. peripheral is now being vasoconstricted, so central things (heart, lungs, KIDNEYS...) will be receiving more blood. more blood in kidneys = less ADH +  
jurrutia  The excretion of free water also has an adaptive benefit in hypothermia (less mass for your body to keep warm). +  

submitted by yotsubato(968),
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htaW hpnpaes ehwn you og nito dloc wte?ra ouY pee.

woH does shti ae.pnph

cntcsiotirsanoVo of evssesl ot rerspvee eaht, pllsu atewr ntio eastclavuur ued ot rsceddeae aithstocrdy pessuerr ni se.evssl mlVuoe sgoe pu, AHD egos ,ownd NPA soeg up due ot adrecines oem.vul

submitted by bubbles(66),
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u'Wlotnd scnrtiiocotn fo iraeppehlr esevsls loas gtgrrei ninshclpac tooctavr,isnioncs wihch siesultam rnael ecmahsii adn aeucss adneceisr ASRA yt?ivciat

drdoom  Constriction of peripheral (cutaneous) arterioles/capillaries in response to cold surroundings is an attempt to reduce heat loss & maintain internal body temp; it is not at all coupled with splanchnic vasoconstriction. In fact, the peripheral vasoconstriction is trying to “re-route” blood to more internal/visceral compartments; simultaneous splanchnic vasoconstriction would impede that very process! +46  
bubbles  Ah, okay! I got led off track because I had a bunch of super hard practice questions asking about hepatorenal syndrome and how the constriction of sphlancnic vessels might trigger renal ischemia. Do you know if there would ever be a time when sphlancnic vasoconstriction occur outside of hepatorenal syndrome? +  
drdoom  @bubbles i would think only in cases of catastrophic shock (when the body is doing everything it can to maintain central tension; pressure to vital organs like heart,kidneys); in those cases, i could see the body sacrificing visceral flow as an "option of last resort" +  

submitted by medstudied(1),
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I deissm ihts sa wlle uescaeb I lmlpyecoet ohtrhvtgoeu it nices yteh ahd to dda ivessson)pr(a sitneda of jtus ynsiga ADH ihhcw edma em kinth of its orle in tosincoctirn fo toshmo suc,lme but het onitp is ahtt etehr lilw be liogpno of eht odobl mevlou ni hte cresiav dna vtlia sgoran whhic wlli airncsee NPA saeerle omfr hte aatir and esinc PAN si sdereeal tihw erhigh dolob amoieul/raltv ,hcesttr yuo acn adwr hte nosculinco ttah HAD wlli eb olw eaubesc NAP is gnasniilg ot eht isekydn ttah heter si an duancbnea of mvleu.o olsA, ncesi hte ecvarsi is iggon to teg meor dolob wofl modrcaep to the xtetieimser ecisn he is inogg to be hrmycieh,pto oyu osdlhu osla gte iendascre oflw to teh kyidens ro ta alest aotnpveiresr o(t a rietnca tteenx) and ihst odwul ont rtpoome the lreseae fo DAH iwhch si olyn sdaeerle wneh the ybdo ssenes an enicaesr in lodob .mos

submitted by osgoodschlatter10(27),
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tlanrCe Bolod lovemu srefre ot eth obold ni eth eltarnc or urmyoilrodcnpaa ctpmntm.orae rniugD dlco trtereuapme erhet is lpeiarrhep rsasooiovtncicnt to nevrtpe etha itsasnoipdi fmro eht imrteitxsee hhwci mesna hrtee si less lbodo ni the irpesphreie adn emor ni eth trecnal maprtmotenc –g;&t eranCtl Blood moeuvl cerrea enstsearGi oeulmv ni eth aterh iwll caeus trgsinchet fo hte iraatl llwa adn litusemta APN arseele  esdricane HgNiAPh alerCnt dolbo vuleom  hhig eulvom tatse  eeowugtadnlsr HAD nieesrtco  rcalmsaeddeo/nre AHD

submitted by osgoodschlatter10(27),
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etanlCr oBdlo oumlev srefer to the bdool in hte taenlrc ro aurocpyndialrmo atper.omtncm Dunirg odlc tarutemeper htree is helipeprar oncrvsntsocoiati ot erevptn eath sdniaisiopt fomr eht reteitmiesx iwhhc mesna heret is essl odobl ni teh rhiseeripep adn roem in eht tnlecra opmmatnrect &tg;– lCnetra doloB luomve retrrG aenacseesi mlueov ni het ehtra illw aeucs hirnscegtt of het ratlia lalw dna iesamultt NPA serelae  ndaeicser gPNAh iH tneCral bolod eovuml  ighh vmluoe seatt  tdragowelenus AHD oscetiern  nlroaddcra/eseme DHA

submitted by usmleuser007(370),
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iTsh etiqunos hsa hgtonin to od hwti eauteprmtre the( tentvgie nost'ed ssddaer eht rtetrmpeuea fo the etarw - os not'd as)msue

hisT si ohw uoy egt het ewn:ars

)1 Beign in op-caesrute or in a wniimsgm oopl pu to eth kecn w:lil

a. ernseIsac lenrtaC boold vluome rem(o oldob srteurn ot hte trhgi dsei of arhet = rdcensiae or)lpeda

.b cIrsensae PAN = arndeisce daoinlit fo vlsnecerti ~ etnapocmorys cmianhmse to ecrude eumlvo eaolvdro

c. ardecDees AHD ;mpa& dissRnn-mlyeta-eo = dyob si ni taste fo levmuo overaodl pm&a; needs ot uecerd csetymis luvoem

usmleuser007  correction: yea it does address the water temp but the main take away is increased preload +  
d10s  ANP is released from atrial stretch not ventricle. +