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Retired NBME 20 Answers

nbme20/Block 1/Question#37 (reveal difficulty score)
A 1-month-old male newborn is brought to the ...
Na+: 132; K+: 3.2; Clโˆ’: 90; HCO3โˆ’: 37 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +8  upvote downvote
submitted by apop(8)
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eeTsh nsaoapnxilte tnare raeg.t It onedst yrleal aevh muhc to od ihwt AASR oavt.citina It hsa asotml rgteihveny ot od whit a omennpnheo aecdll eht nalilkae etdi. In nhcroic tgvtoi,min uyo ldouw teepcx C-l to eb owl nad K= to be wol ialir(ms to bla lsstuer in oesomne hiwt .e)albluim To pemcnatoes for eht olw l-,C teh ohctmsa sha na nraetirtop hiwch casxeenhg l-C for C3.-OH eefeTr,roh C-l will eb sphnieeedlr in eht ahctm,so ehwli 3H-CO lwil aiercens in het ,obold aigsunc an saak.illos In iclolakat atsts,e eht +/K+H teaprtirno wlil gneib to tv,caaite tsgihnif K+ NTOI leslc eal)(yimkhpao nda riaecnsgin Hp. ASRA boabyrpl saply a olre in igakmn teh ylkaipoeham woers btu eht elnaklai teid si mreo mtntairpo ee.rh

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spaceboy98  nsIt inlakael teid reteadl to an riaecnse ni pH taerf esl?am uYor gilco is on itnop ubt Im' not seru twhereh we acn appyl taht ctenpoc eehr. +1
kevin  ptocnce anc eb epaidpl reeh escuabe ew dene to elreept teh -Cl ni rreod to tcerae ;HlC eht hoctsma odsnet' crea fi C-l si lwo ni mu,esr ynlo ttah -Cl is wol ni the rptealia cslle dna os lilw pmup uot 3-OHC in tsi pseenxe +
usmleaspirer  ywh si K+ w?lo +


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 +6  upvote downvote
submitted by โˆ—hayayah(1212)
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tihW chciorn ,ogimnivt you elso tcsreoeltyel nda a lto fo acd.i It rgetsirg lamoicbte ksialolas chhwi is hwy lal hte erums asuvel aer low or( on the owelr end of teh anlrom gnae)r etcxpe fro ran.baocetib

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ergogenic22  cdasedeer +K omrf( sceenardi AARS deu ot luvemo loss) adn dedcserae Cl- s(slo of CHl fomr het t,chmas)o iskllAsoa ofmr slos of HlC dan hust hgih brcb a .oir F hist roasen ihgh ot dmi anegr K si rwnog +5
sbryant6  uWltond' erdasnice SAAR dlea ot arceenids ?N+a ehT wenasr hwsso eesradcde Na+. +3
sbryant6  os,Al meerrebm lBmauii vaorsNe si otaicseads whti leaahm.iokyp +1
sugaplum  os teh enrga htye agev for K is 36?- os 2.3 si NWL e?nht r o ear ew utsj tgiroanep no i"t si no het erwlo edn fo omnlar ni ps"de +2
dbg  oudsim svelle in opcyrli sstsoein ravy, ontihng allery ,scilcsa nca eb hihg as in ihst aces piymls eud ot yrihaton,d nca low in ethor acses fi aoeodelstnr mengaad to everrse that to hte otehr mexeret +1
skonys  co"lhcHmypeoi,r ceaphoyklim mtleibaoc soaskllai is teh clsiacs lrlcteetoye dan scebaaid- aeclnbmia of lyoipcr n"siosets rfom semaedpc hiedbn ypimaVtwao .lnilg = lmvuoe ossl e(dc ksin r)outg sa llwe sa sslo fo +H, C-l dan awN+hi(t )0H2 -&;gt atoiblcMe .ssoalAkli Lsos fo H+ seausc eircsaen 3O-CH tneorneit as wlel as +K sfhit niot llces (apoklmiyeha F19A 875.) +

From amboss: The loss of gastric hydrochloric acid from emesis results in increased bicarbonate concentration in the blood and decreased chloride. Some potassium is also lost through vomiting. Hypovolemia leads to an activation of RAAS, which exacerbates metabolic alkalosis via increased bicarbonate reabsorption (as a result of angiotensin II). Aldosterone also causes renal secretion of potassium and hydrogen ions, further exacerbating both hypochloremia and metabolic alkalosis.

+10/- smpate(20)

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 +5  upvote downvote
submitted by โˆ—masonkingcobra(408)
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nI clietobam ako,alsils pitusomas smeov tino hte lecls

heT loss in luvemo uroghth iemses gitrgesr RSAA guisnlrte ni edrcsaeni teleroondsA erselae and hutrfre msupaitso exnroteic

t6pwatbe/./lpw1dht1atse/w/nie:t.

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 +3  upvote downvote
submitted by iamapotato(3)
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No neo rehe rteeohdb ot acltyaul dsicuss wtha's onigg h.Tsoni is a m-hont1 dlo roebwnn.

He stomiv aetrf f,esdiegn -yd5a sotrhiy.

At 1 otmhn ,dlo with intigmvo refat seefdngi, it is tosm elkyil a csea fo ORIYCPL ENISOTSS eud ot yhryptperoh of eht cployir rinchteps uslua(yl crucos 6 wkese lr.t)ea

ueD ot ihm ovitnigm thcoams cnson,tet he ilwl ELOS -lC, K+, adn .+Na

eH iwll ASLO elso +.H shiT is wyh yuo og tion the lmoetbiac sskoialla ihtw a tsrnuatel ernascie ni teh .-H3OC

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kamilia20  yche:tsk: gvotinim cusase olss of RETWA agtreer thna โ†’imsodu easredicn mrseu umdsโ†’io ERDENSICA uerms oilslt,amoy oS NA ilwl eesrcaed oot, btu on tath raf +


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 +1  upvote downvote
submitted by ark110(1)
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tuB hwta si the cnrfiefede wteeebn pitono A nad toionp C (1;23 9.;4 ;09 35)

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sympathetikey  K+ dh'onslut eienarcs. stI' inmovg noit llecs deu ot omclatieb aklsosila. +
home_run_ball  nI teh lterapia elcl of het ooa ymsertdhnc gH snoi ear mefrdo fmor eht tiinooisasdc fo crbcaoin dia.c eaWtr si a reyv rmion eocurs fo ordenhgy inos in coopmniasr ot iaocbrnc cd.ia boarCinc diac is odfmre orfm caobrn ioddixe dna trewa by inoccrba Tae.heranys hd eaoircnabtb ion O(HC3โˆ’) is eecxgahnd orf a ordehcli noi โˆ’)l(C on eth sblaa sedi fo eth lcel adn the taicenorbab dfsefisu niot hte vsouen o,ldob gdealin to na aeilnkla itde epnne.homon +1
ergogenic22  RASA eisseanrc ofrm ulevmo l,sos dna hust moer olsenadoret edsal to low K+ +1
sinforslide  erehT essraon for hp.aylmeoaik tFr ,is moes K+ si ltos ni acisgtr u.sdfil Sc ,d oen H+ thsfis out fo slelc and +K tsifhs onit eslcl in mioclateb hlkraoiTias l,. ds FEC ouvmle notacotinrc has cuased carieedns eceisntor fo .noarledoest +3


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 +1  upvote downvote
submitted by โˆ—rainlad(33)
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yipHrcholcem,o iolkapecyhm eoctbmail isloslaka is teh csilacs yleocetlrte nda ecasba-di lmieaabnc of orlpiyc s.iotenss

Psesttnier nigmtovi ruselts in sslo fo H.lC The erihcdol sslo tueslsr ni a owl lodob derihloc evlel chwih rsipima hte 'syneidk ityblai to cretexe bcno.ibreata iThs is eht fcrato tath strenpev eotonrccir of the soskllaia edlniga to tmiloceba sklaiaslo.

A ryoecnasd rodsasierhlepmynto dlspoeev due ot hte cesededar blood ou.mlev eTh hhig tdoeesralno lelsve cauess het edikysn to tanrie +aN (to tecrroc the ialrsrcuavant vlomeu idel,pn)oet nda exrtece rdeacesin ntmaosu of K+ itno hte iunre enlutirg(s in a owl odblo velle of is.ustompa)

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 +0  upvote downvote
submitted by thefoggymist(12)
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I ot'dn tge .ihst tnuShl'od eth diyskne tstra cernocitrg the brcbai seellv rfea 5 asyd? ehT addyeel ahpse of het rroioenctc cisen ythe teak i.mt.e. dan in eht ntuoisqe rt'hyee sgakni "nw ".Woe haev itocbmela alokisasl nsice HLC is t,ols os hte dboy llwi ytr to rortcce ti fstri by ninlpyhtaireevto adn ertla by ieercsand rteneixoc fo .bcrbia abcBir hulosd eb w..l.o nesls(u Im' miinssg ogehsnimt due ot bieng xtude)eahs

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thefoggymist  nevNd,rmie I nithk I tgo .ti eBat dlaractnteie ellcs onacnt ucntfoin dna ectexre icbarb ecbsuae ew t'odn ehva loeir.dhc Yae tpleaapyrn I was dxh.euaets +


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 -3  upvote downvote
submitted by โˆ—amirmullick3(76)
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ryVe yesa oeqtinu.s bNsunloioi om.vti 1 nomht age. Msto likely oiaescrn is cploryi nsiteos.s

Teh oingtimv uessac ssol of CHl os ew vahe het ayr,lihoemohpc nda anerl nmiponetcsoa rof shit H sols s iyb epenrivsgr storopn at eht seexepn fo K so atth sivge aieymphal.ok sA het edsasie si eam,nd eht eraw rrod in the imgea of het tsamcho is ohmtso uslmce hrphrotpeyy fo the oypilrc uisaumrcls coae,msu fitmrgo enh -eevpiohlsda sams telf no atnippol.a This is a ebtiolacm slioaaslk acbeseu ttouihw -lC, het lrOa 3HetoaaCllC/sb hrngcxeea liwl not ,kwro so uyo enrati 3HOC.

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