welcome redditors!to snoo-finity ... and beyond!

NBME 23 Answers

nbme23/Block 3/Question#46

A 19-year-old woman is severely burned over 35% of ...

Increased metabolic rate

Login to comment/vote.

Skin provides insulation and prevents heat loss. This patient's body will compensate for increased rate of heat loss by increasing metabolic rate.

davidw  This is directly from Goljan I) Hypovolemic shock may occur due to loss of plasma from the burn surface (refer to Chapter 5). • Loss of protein from the plasma loss may result in generalized pitting edema. II) Infection of the wound site and sepsis may occur. (a) Sepsis due to Pseudomonas aeruginosa is the most common cause of infection in burn patients. (b) Other pathogens include methicillin-resistant S. aureus and Candida species. (3) Curling ulcers may occur in the proximal duodenum (refer to Chapter 18). (4) Hypermetabolic syndrome may occur if >40% of the body surface is burned. +4  
yex  Can someone explain why is it not increased ECF? +1  
charcot_bouchard  i picked same. Increased ECF but cant remember why. Can you explain WHY it is increased ECF? what was ur reasoning +2  
isotopes  Burns would lead to a decrease in ECF because the protection from fluid loss is absent; it can lead to shock. :) +  
tinydoc  My reasoning behind picking ↑ ECV was that your losing fluid but not electrolytes with the burn ⇒ the ecv would have increased osmolarity, so the fluid from the ICV would be pushed the the ECV. It made sense to me at the time. I guess technically its wrong because the loss of fluids and the gain of fluids would amount to pretty much the same thing. But the insulation and heat loss thing makes sense I guess. +  
yex  Increased ECF, bc I was thinking about the edema formation.... :-/ +1  
atbangura  I picked increased ECF because burns increase the capillary permeability coefficient, but now that I am going over it I realized that increasing the permeability would only transfer plasma volume to the interstitial volume, which are both a part of the ECF so therefore ECF would not change. SMH +2  


easiest thing to do - try to justify STUPID NBME answers. But i think we missed important part that 35% of body's surface is almost both legs , so next few days body will try to remove all toxins , balance extracellular and intracellular fluids, make new cells for parts its possible, make granulation tissue , try to not lose body's heat , basically do a lot and things that way increasing metabolic rate (through stress hormones and TSH PDGF , EDGF , Colony stimulating growth factor , VEGF etc.)

+/-1 usmlecharserssss(-3),