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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; Cl−: 90; HCO3−: 37 🔍 / 📺 / 🌳 / 📖
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 +8  upvote downvote
submitted by apop(8)
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sTehe aonnetsxlpai ntear arg.te tI snetod lrleya veah uhcm ot od ithw SRAA tiovtai.acn tI ash oastml eirygvenht ot do tihw a eohmnoepnn eladcl eth alnaleik e.itd In hrioccn onv,igtmit uoy udlow cpxtee -lC to be wlo dna =K to be wlo ir(mlsai ot lab tssuelr in msoeone thwi llem)b.uai To nocspmatee fro hte owl ,C-l eht schtmao has an rtaprnotei ihhwc sehgaexcn -Cl for O-HC.3 Troh,freee C-l liwl eb slndpihreee in eht asotc,mh ehwli -CO3H ilwl aeceinsr ni hte oodb,l cgnuasi an slliao.kas nI liatkaclo ,ssttae the /++HK iraepotrtn llwi gbnei ot i,vcaetta tisgnifh K+ NITO cells oiaylmph(ka)e nad aniirgnsec p.H SAAR aprbyblo laspy a reol ni nikagm hte yiaophlamke soerw but the klaelain tdie si emor mrtatipon ehr.e

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spaceboy98  tnsI nalkeail deti eadtelr ot an iancsree ni Hp eftar m?elsa uorY ilocg is on inotp btu Im' ton seur eehrtwh ew cna papyl atth ctncoep .rehe +1
kevin  eptoncc nca be eiaplpd rhee ecesbau ew eedn ot prteeel the lC- in errod to eceart lC;H the comtahs 'onteds rcae fi l-C si owl in ,uerms only ttha -lC si lwo in hte taeaprli slecl nda so llwi pupm tuo CH3O- in sit npexese +
usmleaspirer  ywh si K+ lwo? +


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 +6  upvote downvote
submitted by ∗hayayah(1212)
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itWh nrcohic ivo,mgnit yuo seol etlslrtoyeec adn a otl fo ic.ad tI itgrersg mliebtcoa laaoikssl ihcwh si why all the eusrm evalus are lwo o(r on het worel den of the normla ag)ern ceexpt rfo bbe.caationr

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ergogenic22  drceaesed K+ rmfo( asrcedeni ARAS ued ot uelvmo s)los nad sdeedacre -Cl ssl(o fo HlC rmfo hte oa,)cstmh islksolAa mrof lsso fo HCl dna tsuh ihgh b. o rriaF c b itsh onaesr ghhi ot mid ragne K si wnrgo +5
sbryant6  n'Wltoud naerescid SRAA adel ot derniscae ?aN+ hTe swnrae wsohs ddeaeercs +N.a +3
sbryant6  o,lsA bemrerem ialBmui srNevoa is doisctesaa thwi oaak.mhiplye +1
sugaplum  os teh rgean htey vega rfo K si 63-? so 2.3 is WNL th?en r o aer ew just rtnapeoig on "ti si on eht orwel den fo lmorna ni ed"ps +2
dbg  miosud veesll in lipyorc ntsisoes ,yavr nhingto aeylrl ssc,alic can be hhig as in shit saec ipymsl due ot oyi,hadtnr cna low in orhet esasc fi olsdreaneot naedamg to veerres tath ot het roeth eterxem +1
skonys  omHryhil"coe,pc imchkaeylpo tblamiceo soasallki is het ssaclic yoeeecrtllt nda edci-basa alcnbmaie fo orclypi st"iosesn mfor decpeams iedhnb Va gtioilymla.pwn = lmueov lsso (dce nksi tg)our as lewl sa sosl fo H,+ C-l dna Nhati+(w )0H2 g&;-t taiolcMeb alAlsikso. ssoL fo +H csaesu eciearns 3HOC- rtoenient as ewll sa +K sfhit onit lecsl hpmakoleaiy( A19F .7)58 +

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 ∗masonkingcobra(408)
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nI cilbatoem il,ssoakal apoutsism ovsem oint eht celsl

heT osls ni vulmoe rhotghu mieses stergrig RASA snltrieug ni sndaicree Alentdeoosr eelreas and furterh moiastpus extciroen

/nplwpsiww/e/h6te/.ae1tt.d1ba:tt

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 +3  upvote downvote
submitted by iamapotato(3)
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oN oen ereh ohebedtr ot uatalcyl cisssdu was'th giogn Toshi. n si a o1n-thm odl rne.onbw

eH vsmiot afret if,ednseg -d5ya ti.rhosy

tA 1 tnmoh dlo, hwit vmnogiti fatre e,sfdenig it si mots lieykl a case fo ILCOYRP ISESNOTS eud to yhpeptohryr of hte criloyp tnipehrcs l(saluuy coscru 6 weeks l)etra.

Due to ihm goitimnv taomchs ns,eonttc he llwi LESO lC-, K,+ adn .aN+

eH llwi AOLS osel H+. shTi is hwy uyo og iont hte tcbmleiao olsaskial wthi a aelnsttru ricneaes in hte 3.-CHO

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kamilia20  :ech:ystk ovtginmi scuesa slos fo TRAEW etrrega hnat du→oims dcraienes ermus udsim→o ENAREDISC muser ,mllayitoso So NA ilwl deesrace ,too utb on thta raf +


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 +1  upvote downvote
submitted by ark110(1)
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utB twha is eth fieerdfecn weneetb ntopio A and iptono C 3(;12 .94; ;90 )53

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sympathetikey  +K uhntsd'lo seernaci. st'I gvimno tnio eclls eud ot tcbioalme skalaso.il +
home_run_ball  nI teh arltpiae ellc fo teh g scmyo d arnte hoH ions ear rodmef form eth aitidoncssio fo ncobcair i.adc aWtre is a yrev mnoir cuesro fo erdhygno snoi ni omiporacns to icbnorac i.cda obacCinr aicd si eofdmr ofrm boncar dxodeii nda werta yb cibrnoca haydr aeTe.hns tenirocbaab oni ()O3−CH is xghdeneca ofr a oechdlri oni C)l−( no hte slaab ides fo the lelc nad eht aienotbcabr fdesisfu onit teh vneuso ,doblo ldnegai ot an laelkian eidt phmnonoeen. +1
ergogenic22  SRAA nersecias ofrm emvulo lss,o and hust mero ndtralesoeo deasl to olw +K +1
sinforslide  Terhe eassnro for ipklmao.ehya rs ,tiF emos +K si stol ni itcsagr .sildfu od,nSe c +H htfiss uto of llsec dan +K stfhis toni lsecl in bitemoacl is.d,alTlh o aksri EFC vemolu iacnnotrotc ahs edasuc adresenic ieetrsocn fo ornels.eodat +3


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 +1  upvote downvote
submitted by ∗rainlad(33)
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oyhrc,pcmolieH cimphyaeklo atomeiclb oiasaskll si het sailscc ecloltyrtee adn cidasa-eb beanmclia of oirclpy isse.ostn

snrPtieest iovmingt ustrsle ni sosl fo H.Cl Teh dicholer osls tslreus in a owl odlob doirlehc eellv hhicw pisiram the skynde'i iabytli ot ecreetx ibtcoena.rab siTh is het rocfta htat vtenrspe ciecrrnoto fo eth ikaslaols eandlig ot bmaeiltco oslak.lasi

A esnyrdaco esretydnooshmaprli lespedvo edu to teh aeerdsdec loodb emuo.vl heT hihg soetadolrne lvlsee ssceua eth nseikdy to iatner a+N to( trcocer the raturiavslcan molevu e,le)itodpn nda cxeeert rsdenieac ntmaous of K+ itno teh eurni e(slgnrtui in a wlo dobol evell fo moss)u.pait

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 +0  upvote downvote
submitted by thefoggymist(12)
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I n'tod tge shit. thSoudl'n eth dksieny trsta gireoctnrc the raibcb svleel rafe 5 ydsa? ehT eadedyl speah fo eht encorticor esnci yhet keat .m.i.te adn ni hte utosiqen rt'hyee ianskg .w"Wno" e vahe biaelctom laikasosl ecnis CHL is ,tsol so hte yobd iwll ytr to crtcore it ritsf by thetnnavyripolie nda tlear yb rinsdeeca cxronetei fo ai.bcrb rBaibc dolush be .low.. sneus(l 'mI msising mgsehitno ued to bigen txasd)eehu

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thefoggymist  ee,idmNvnr I think I gto t.i eatB aactrenitedl slcel antcon cofutnni and cxeeret ibarcb ebcsaeu we 'notd vahe hldiocer. Yae aeynlaprtp I was ehtuxse.da +


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 -3  upvote downvote
submitted by ∗amirmullick3(76)
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eVry yaes eutqsoni. boNliniuos votmi. 1 thomn gae. otMs eiyllk eaconsri si ircyplo essst.nio

eTh onimgvit sceaus olss of CHl os we veah eth mahiolcyrhep,o and nealr nmasioconept orf siht H slos si by gvrpirnese opnsotr at teh pxeseen of K so atht geisv yhpamk.lieao As teh edseisa si dem,na eht rerrdwao in eth gaemi of het osmathc is ohostm emuscl ehotrpyphyr of het liocrpy icssrlmuua o,mseacu orfei mgthn ves-apeolhdi smas tfel on aapotnil.p ishT si a omceiabtl llksaaois bceusae ttihuwo -,lC hte alaosell/ CaCH3tbOr axgeenrch ilwl otn k,row os uoy enrati 3CHO.

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