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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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hsTee nexsolptaian rneat at.gre It todsne lrayle veah chmu ot od wthi RASA av.oacitnti tI ash omlsat ngtehyirve to do ihwt a ohnmnenope cdalel eht aeklinla .idte In norhcci voi,tntgmi ouy wudlo pcxete -Cl ot eb olw dna K= ot eb lwo lmia(irs to bla rstsule ni mensooe htwi la)bmlie.u To apsecoemnt ofr the owl lC-, the cmoasht hsa na trpeiotran hhicw haxesnegc -lC orf H.3OC- ero,herfTe l-C illw eb epelnesihdr in hte mtaoc,hs ielwh H-OC3 illw ereascni in eth d,bolo cnuagis na asslial.ko In kioclalat sttsae, teh +H+K/ parttrione illw bneig to ac,ittave iinhtfgs +K TNOI lslec eolhypaia(k)m dna nirigcasne .Hp SARA ypbboral spyal a role in mganik het ipeamykhloa erwos utb teh aalkieln ited si omer tapirmont hre.e

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spaceboy98  tnsI elnlkaai ietd lrtaeed ot an raincsee ni pH taerf ?smael Yuro glioc si on piotn tbu 'Im nto rsue tehrhew ew nac yplap ahtt ontpcce hree. +1
kevin  opnecct anc eb ipadlep erhe ecubeas ew eend ot peetelr eht C-l in rrode to eatecr C;lH teh mohstac no'teds erca if C-l si wol ni sremu, ylon thta lC- si wlo ni het rpiatlae lcsel nda so illw pmpu out -H3CO ni ist epnexse +
usmleaspirer  wyh is +K wol? +


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 +6  upvote downvote
submitted by โˆ—hayayah(1212)
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htiW rccnhoi inmogvi,t ouy sleo ytsecrleetlo and a lto of i.acd It rteggris eloitbmca oiakallss wcihh is ywh lal eth urmes valseu era lwo (ro no teh lorwe ned fo the lanmro arn)eg pextce fro atceroiabbn.

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ergogenic22  acsreeedd +K mfro( ircedsaen RAAS ude ot euomlv slo)s nad drceeedas -Cl o(ssl of ClH mofr the c)hm,saot sllaiksAo romf sslo of CHl adn usth hghi b rFor .ai bc this onaers high ot dim eangr K is gonwr +5
sbryant6  uodln'tW sdeaencri SRAA dlae ot dceeanris +a?N hTe newsar oswsh deerseacd +N.a +3
sbryant6  Also, erememrb Buiilam vsoeraN si oetssacdai with yo.kemiplaha +1
sugaplum  so eth aergn they vaeg rfo K is -36? os 3.2 is WLN etnh? or rae ew tujs nroigpate on "it si no eth rewlo den of lamnor in "desp +2
dbg  misodu lsevel in ocilrpy toseisns yrav, thonnig lryeal asciscl, anc eb ghhi sa in ihst esca yimlps eud ot hy,adotirn can wlo in hroet seasc fi noteoderals aadnegm ot erseerv ttah ot eht ehrot emxeter +1
skonys  Hcc,"emyripohlo eiaocympklh cmtblieoa saloslaki is eth cssalic tretleocley and badi-csea animleabc fo piorcly sesn"iots fomr ecsamedp ehdbin .agilmVyiolwt anp = olveum olss e(cd inks )rguot sa ellw as sslo fo ,+H Cl- and wa+Nih(t H02) &-gt; eblatoiMc o.lAsasikl soLs fo +H asuecs nireseac HC3O- tineonetr sa wlle as +K isfht ntoi sclel aih(myalkpoe F19A 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 โˆ—masonkingcobra(408)
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nI lmtiaebco oalkla,iss ouapsitms eomvs iotn hte lelcs

Teh lsso in evmuol htguohr seisme esgritrg ARAS rituegnls ni ndcasreie onereAltsod eeleasr nad rrfethu mspoautis eoxrcntie

p//wespthaetatw/idtbn1:6tle./.1w

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 +3  upvote downvote
submitted by iamapotato(3)
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No noe ehre rbeoehdt to ayuatlcl sicsusd sa'htw going Tonsi.h is a h-nt1mo odl robennw.

eH smoitv aeftr fsn,gedei 5a-yd rh.soyti

tA 1 mhnot odl, hwti ovtmiing retaf dfgesein, it si mots llkyei a asec fo OYRCIPL OSINSTES edu to pyhythoprer of eth prylcoi thsiepnrc luysa(lu usccro 6 keesw talr).e

uDe ot mih timovnig acotmhs net,tcosn eh wlil LSEO lC-, ,K+ nda aN.+

eH lliw SLAO selo H+. Thsi is hyw you og iotn het mloectiba aasklsiol twih a nertaslut earecnsi in the 3CO-.H

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kamilia20  hy:ksct:e mintvigo ssueac ssol of RWTAE etearrg htan iomsโ†’ud aniescerd esmur uโ†’soimd SIAEDNECR emurs mtsoloa,yil oS AN ilwl acsdeeer o,ot utb on thta far +


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 +1  upvote downvote
submitted by ark110(1)
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uBt tawh is teh efifrenecd teeebnw opnoti A adn otinpo C (13;2 4.;9 ;09 )35

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sympathetikey  K+ lodstuhn' e.incsrea sI't vmngoi tino lcles eud to etomlaicb sas.ilkloa +
home_run_ball  nI hte aairtlep lcel of teh trnoe ad hocsm gHy snoi era omedfr ormf eth osnicodisati fo icarbnco daci. trWea is a vyre mnior roscue of rgondyeh inos ni iaocmonprs to ocaribnc da.ic rinCboca iadc si edrmfo frmo acbrno ddioxei and eartw yb biccraon a esrnhh.eTyad ctbeiboaran ion )Cโˆ’(O3H is deagchexn rfo a ecdlirho oin โˆ’l(C) no teh bsala esdi of eth llec nda the oebnabcarit susiffde onit hte evnuso bood,l ldiegan ot na anlliake ietd hnnneoeo.pm +1
ergogenic22  SAAR eneairssc fmor molevu slos, nad thus ermo donasortlee aslde ot wol +K +1
sinforslide  eheTr nsseoar rfo phie.yaalmok rts i F, oems K+ is otsl in itacgrs f.lsidu ocn edS , H+ tihfss otu of escll nda K+ ithfss toni lscle in baoecmlti s rli,hkils a.dTao FCE uemolv rtcoictnaon ahs scadue creadesin esiecnort fo eotdnserola. +3


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 +1  upvote downvote
submitted by โˆ—rainlad(33)
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omcHhicyplro,e kemhopcaily eibalctmo asoalikls is hte ilsacsc reletycetol and ibaeda-sc aclianbme fo piyolcr nste.ossi

eirstnsteP ngmtivio lstsuer ni sosl fo H.lC ehT colrihde slso ulestsr ni a owl oblod lcioehrd evlel hhwci pimrsia the dsikn'ye lbitaiy ot xecerte nabtib.racoe shTi si eht coatfr taht srtvenpe nrotecoric of eth alsalkiso glindae to eamlobtic aosliaslk.

A cayosnedr mdosysaltprhneieor lpevsdeo edu to eht saeeedrdc olbod muv.leo The high oordnelesat seevll eussca teh kdsniye ot traine a+N o(t oetcrrc hte iavlsanarrctu eumvol pl,d)inotee dna tecxeer dancereis tmnosua fo +K toni teh iruen en(lusrtgi ni a owl blodo eevll fo mtsoaui).ps

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 +0  upvote downvote
submitted by thefoggymist(12)
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I nt'do tge htis. donhu'Slt eht deiyksn rttas rrccgenito hte ibbcar sellev eafr 5 ?dysa Teh dydleae espha fo teh cooicnrrte nisce eyht atek tiem... dan ni teh oientusq eryeht' ginska Ww ""eon. veah mclieotab kslaisalo escni LCH si o,tsl os eht body llwi rty ot ctocerr ti rfsti by narveinioltthype nad letra by cineardes iocerentx fo .aicbrb ircbaB odlsuh eb ..wl.o lssen(u I'm msiisng ginhmeost edu to engib shatxed)ue

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thefoggymist  mrdNevi,en I nkthi I got it. taBe iatadetecrln elslc ocnatn ucinntfo nda eecexrt iracbb seauecb ew nd'to vhae d.rclheoi eYa ptaarnplye I saw .xeuastedh +


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submitted by โˆ—amirmullick3(76)
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yVer esay untesiqo. iouinblsoN vmoi.t 1 tnomh ge.a tMos kelyil ncrosaie si oyplrci snsi.otes

The ivtimong csuase slos of lCH so ew evha hte ihaphmoler,coy dna nrael ncepnsiomtao for htis H slos bsiy inrrevpesg protsno at teh esxenpe of K so tath eisvg liaphmyeak.o sA het asedsei si danme, teh dar rroew ni hte maeig of eth hostmac is ohotsm lmeucs ryprhoethyp of teh cpyroil cssarumilu ,ucamoes m theogifnr dlsoiaehp-ve asms flte no lnppaaito. hTsi si a mctibeoal salkslaio csaeube ouwitht l,C- eht OCl3Cbl o/rtlaaaHse heeancrgx illw otn w,rko so ouy nerati HC.O3

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