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NBME 23 Answers

nbme23/Block 4/Question#33 (69.4 difficulty score)
A 16-year-old girl with bulimia nervosa is ...
Potassium: decreased;
Chloride: increased;
Bicarbonate: decreased


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submitted by nwinkelmann(311),
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I llietyalr ujts izadeelr hwy ihst tonusiqe sufneocd em so chmu (nad Iev' erdit to egfriu ti uto a eocupl of eitsm, .ll)o I elt hte olclalouqi fdtiiionne of abiilmu ei.(. vnmii)gto citks ni ym nm,id htta I gorotf teh uactla maieldc tfondniiie = nolram IMB );1&g(8t + gnbie eniatg nda rgnpgui eh(rwe ngipugr docul eb ncdideu inogivmt ro udricite seu ro vetaialx seu n/odra eivsescex .ecsri)xee oS llya,er twha tish tunoqsie aws gnsiak si lsiymp hwat is eth ocettlreyel blnecaa fo esvseceix dhrra?iea ZEEG! I dmae ti so hmcu haredr in ym head enhw tyignr to wnsaer ti iona.yllrgi

aDrrhaei ecsaus innn-aono gap e..(i clm)pyrieheorhc ecamobtli .siscadoi Sloot dnoelirmaytnp nanocsit C-3OH dan +,K so xseecsiev arhiarde = evcxesesi sols of 3H-CO nad K+. loihdrCe elsvle in eth rumes liwl eb encrdaies due to the olanmr /lOC3-H-C bu,iileumriq os sa eignteav grhaec sdsisaietp ude ot ssol fo C,H-3O l-C lwli ineresca cnterrogic eht a-na.pngoi

drdoom  Bulimia comes from Greek "ravenous hunger"; the term is a literal concatenation of the words for ox (bous) + hunger (limos). So, in Greek, bou-limia is literally "ox hunger", which is a nod to how the word is used in medicine = perpetual and insatiable appetite for food (the very "opposite" of vomiting). +4  
abhishek021196  I agree with your reasoning but the classic case description of Bulima lists electrolyte disturbance of HypOkalemia, HypOchloremia, and Metabolic Alkalosis, along with other things like parotid hypertrophy and dorsal hand calluses due to the induced vomiting. I tripped up there. :/ FA 20 Pg 567 +  
llamastep1  Take home lesson: reasoning > memorizing +3  

submitted by brookly_(0),
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I htuoght iliabmu evig iesr ot maciletob llaasisok .an..c neoemos raaetoleb ?

drdoom  Remember, bulimia itself does not mean โ€œpurgingโ€; it means โ€œox-hungerโ€. It is purging (e.g., intentional vomiting, laxative abuse, diuretic abuse, excessive exercise, or extreme fasting) which creates metabolic disturbance. The type of disturbance depends on your preferred route of โ€œexitโ€. +2  

submitted by rhsteps(1),
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hte tosunqei smleiip ttah ti si a scea fo xvtaaeli sabue ( tshu etoblmica i)skllaosa btu teh swerna nrsut out to be eht ectleyelrto rabcunisetd of ipmlys eaarhdri nalrm(o aoinn gpa cibltmea d)asoiisc . n tuiqoes nlwrygo rpsadhe adn onsfugicn

osgoodschlatter10  Not really. Diarrhoea and dehydration are A/Es of Laxative use (for Sketchy fans remeber the spoiling mud bath). +1  
fatboyslim  I think you are confusing laxative abuse with diuretic abuse. Diuretic abuse can cause metabolic ALKALOSIS, while laxative abuse causes metabolic ACIDOSIS because you are losing bicarb in diarrhea. +  

submitted by dr.xx(157),
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Aseub fo ialtevsxa ;gt=& ululsay aescddere usmer moissapt.u As ot ielhcdor dna a,bibrc atth edpns.ed yhTe ucold be renaescdi or


submitted by maxillarythirdmolar(40),
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seBt encmmto i read wsa to ettra hsti ikle sti' a mVI.aPo uYo doulw egt all erteh beilmlleetrtco/ocatey issa.ubcndetr


submitted by usmleuser007(418),
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eraTt hist keli a omVIaP (yerWta dhaia,rre chohrraliyad = duecder CHl ni eht lenum, &;map )maeiohpalky

tihs lilw dlea to bticoalme scdoisia /dt olss fo riabcb ni oslot

btl_nyc  Chloride is increased though. +  
maxillarythirdmolar  This comment is gold. @btl_nyc, this is actually accute. you would expect hyperchloremia +1