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NBME 22 Answers

nbme22/Block 3/Question#6

A 50-year-old man is admitted to the hospital ...

Intracellular [Na+]: increased;
Intracellular [K+]: decreased;
Intracellular [Ca2+]: increased

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submitted by titanesxvi(2),

hope this image help to understand it, the pumps don't work because lack of ATP

 +0  upvote downvote
submitted by oznefu(7),

I get that the answer is correct for a reversible injury where there is cell swelling because of the increased intracellular Na+ and Ca2+ due to impaired Na/K and sarcoplasmic reticulum activity ...

But if there are increased cardiac enzymes in the blood indicating cell death and membrane damage, wouldn’t the intracellular electrolytes be low since they are released into the blood?

lord_voss  troponin = irreversible injury and membrane damage -> high extracellular concentration of Na+ and Ca++ causes both to move into cell through damaged membrane and high intracellular K+ leaves the cell +7  
rogeliogs  Question is asking about the changes in the myocardiocytes and my second interpretation was that they are asking the changes before they "rupture" and liberate their content in the blood producing increase enzymes in the patient. Therefore because is a ischemic process = reduction of O2 = low ATP = impairment of Na/K ATPase = increase Na-decrease K intracellular = block Ca/Na exchanger = increase Ca intracellular. the same effect as digoxin +  
allodynia  What will happen to Na and ca conccentration when there is an irreversible injury? +  

 -2  upvote downvote
submitted by sbryant6(22),

If you know the MOA of digoxin you should be able to get this question right.