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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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eThes tiaxsnlpenao eratn egat.r It dnoste erally evah umch to do hitw SARA .anavctioti It hsa alomst veiehntygr ot od wtih a nepnoenomh cllaed hte ekalilna edi.t In ccroihn nvtgi,moti ouy wdulo tpecex -lC ot eb wol adn K= to eb lwo ria(ilsm ot lab ursstle ni smneooe htwi blu.l)eami To cetepsaonm fro eth wlo lC-, eth mcahtso sah na ttrieaonpr hcihw enshagcxe C-l rfo .3H-OC Toeerhr,fe l-C iwll eb eehrsnlepdi ni teh om,tchsa ehlwi HCO-3 lwli csriaene ni het blood, uigsnca an aolklasi.s In aatloilck tets,sa eth KH/++ rptitneora wlli gnieb to ettvca,ia hgsfitni K+ TOIN lscle (aimy)kalhope dna iraniesgnc H.p ASAR alpbobyr plysa a oler ni gnkmia teh iheakomypla oerws ubt eth llekaina edti is oemr irnatpmot eer.h

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spaceboy98  nstI llniakae tide aetdelr to na caseneri ni pH rftea mslae? oruY gcilo si on opitn btu mI' not sure wtheerh ew cna lypap hatt pectcno reh.e +1
kevin  cetcnop cna be pledipa hree aucsbee ew eden to rltpeee teh Cl- in edorr ot erctea lH;C teh msactho e'otdns crae fi l-C si lwo ni urs,me nylo hatt -Cl si olw in teh iaetrpla lclse and so lliw mupp uto HO3-C ni tis eepsnex +
usmleaspirer  ywh si +K ow?l +


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 +6  upvote downvote
submitted by โˆ—hayayah(1212)
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hitW hoincrc vitnm,goi you lsoe teeylteocsrl dan a lto of .ciad It rrigtgse ilmcatobe kaoilasls chhiw is wyh lal eht resum alesuv ear wlo o(r on het lwore dne of eht nmlora rg)ean epexct rfo obtnriaa.cbe

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ergogenic22  aredcsede K+ m(rfo sedrecnia SRAA ude to ouvmle ss)lo nad eedrcdesa -lC so(sl of CHl rmfo the chs)m,tao lisoAkals fomr olss fo HlC and thsu hhig io bcr. raF b isth onrsae ihgh to idm ngrea K is orgnw +5
sbryant6  und'ltWo isaeercdn RSAA dale to danceesri ?a+N ehT answre owssh asecdeerd .a+N +3
sbryant6  ,Aosl eemmrebr iBmliau ervsaNo is dissotaeca tiwh hpaeimal.yko +1
sugaplum  os the egrna ythe vgea rfo K is ?3-6 so .23 si NWL te?hn or rea we tujs erpgointa no it" si no het ewlor ned of lranmo ni "dspe +2
dbg  udomis leesvl ni ciyrpol ssoentsi vy,ar gonniht ayrlle lssiac,c cna eb high sa in hits aecs ylismp ued ot aihy,dtron nca olw in ehotr casse fi raonoetlsde damenag to eeevrrs hatt to eth eorth exrtmee +1
skonys  ",cyelcpoHoimrh paekolchiym tliocameb olslaiask si teh aslccsi lcrteoeetyl and baiad-sec ambceinla fo polircy no"isests fomr asedmpce iehdbn aiimoly.g npwVlta = ovmeul sols dec( iskn )rutgo as elwl sa olss of ,H+ Cl- nda a+whi(Nt 2)H0 ;t-g& Mlticoabe s.iosllkAa ossL fo H+ usscea eserinac CH3-O otneietnr as lelw as K+ ftshi inot lclse ypmhl(akieao 9AF1 ).587 +

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 miboltcae ai,slaskol umiaptsso veoms iton eht lslce

ehT sols ni loumev gotrhuh essmei rgtigser ARSA etlgnrusi in eeirndsca doestornleA aeeslre and rfehutr stuoismap eenrixcot

t6/w1w1h//bt/:tnaa.psdtel.pewite

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 +3  upvote downvote
submitted by iamapotato(3)
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oN noe here ehbredto to ucatyall sucdsis w'thsa gngoi .osTih n si a 1t-mhno ldo eonwr.bn

He iosvtm eaftr isdefeng, -d5ay hsi.royt

tA 1 mohnt l,od htwi vntigoim arfte id,efegns it is tmos kyleli a scae fo YCLPRIO SETISSON ude ot trhpyeoryhp fo the ylpocir irnstehcp sy(uallu ocrusc 6 swkee aret).l

uDe to mhi ngvoiimt hsoacmt sntoce,nt he llwi EOSL C-l, +K, and +.Na

He illw OASL soel +.H sTih si yhw uoy go oitn eht almbteico alaksiosl thiw a uttneasrl ecrsaien ni eth OH.-3C

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kamilia20  :sky:hect imvngoit scasue slos fo TEARW grtraee nhta โ†’imosud seindcrae meusr muโ†’iosd SERCANEID eursm llo,motasiy So NA lilw ardeseec oo,t tbu no taht fra +


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 +1  upvote downvote
submitted by ark110(1)
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utB htaw is eht dffrceeein bneeetw tipoon A adn ootpni C ;2(31 94.; 90; )53

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sympathetikey  K+ o'dsthlnu eaiec.rns 'Its mvingo niot llces ude ot lbetimcoa sl.ksiaalo +
home_run_ball  In eht arleiapt lcel of the oHnstda h rgoy mce nosi ear mfdore omrf het tsiiaodiscon of rcoicnab adci. Wreat si a reyv inmor esurco of yoredhgn ions in cosoiprmna ot norccaib .acid obincarC dcai si rdmoef frmo nrboac ddeoiix and atwre by ncacobri esr eah.adhyTn inbtoaaecbr oin C)3(โˆ’HO is gnedahcxe rfo a heodlcir noi โˆ’)(Cl on hte albas edis of eth clle and the boabnercait disffesu tino eth uvoesn ,olbdo iagndel to na lliaanek edti eon.ohemnnp +1
ergogenic22  SAAR caeisesrn orfm evulmo sls,o dan suht roem etnseolrdao dlase to olw +K +1
sinforslide  Teher ssaerno ofr oaahmkepiy.l t rFi, s mose K+ is tslo in ctsiagr fild.su S,eon cd H+ shtsif out of eslcl adn +K hfssit ntoi slcle in cbaelmoti .lriios ,ahksT dla CEF mevulo cnrtntiaoco hsa eausdc rsenadeic eceitsron fo lr.denooesat +3


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 +1  upvote downvote
submitted by โˆ—rainlad(33)
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pe,ylicohrcmoH aickmyehplo ltieobamc iaksaolsl is teh saccils tltylceeore nda a-dseacbi amlanbcei of pycolri ins.sotes

siesrePttn tinoigvm ustlesr in loss of C.Hl The coihdelr sosl trulses ni a wlo dolbo rihoceld levle whchi ipmrisa eht 'ysikden yaitlib ot rtxeeec neat.abrbcio hsTi is eht aoftrc hatt pternevs ncrrocetoi of hte ilakssaol ilndaeg to ctlbiaome k.soillsaa

A yedsoarnc hsasoeoyrmnprdtlei leoesvpd due ot eth drdesaeec bolod mlvoue. Teh ghih aeoestrldno slleve ssauec the kyisned to etiran +Na o(t trcecor hte avaairrslctun melvuo e)i,ltepond dan xeretec draesncie omsnatu fo +K itno het nreiu suniegtr(l ni a lwo lobdo lleev of sptuo.ai)ms

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 +0  upvote downvote
submitted by thefoggymist(12)
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I not'd etg th.is Sunotlh'd teh skyndie rstat ncorgectri eth abrbci evslel aref 5 ayds? Teh addeyle ehpas of teh eocrrtcion iscen ethy kate .imet.. dan ni eht tneiuqos 'tyreeh aksngi w"."Woen aveh boileatmc soklisala sinec CHL is tol,s os eth oydb lwli ryt ot rcreoct ti ftrsi yb leiionyvearpthnt and artel by eidcnaers xontcerie of .abibrc bciarB hdluos be ..ow.l usl(nse m'I nmisgis steognhim due ot ebgin xeseaud)th

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thefoggymist  rvmi,eeNdn I ktihn I got .it atBe tneeaarlcdit clles conatn ocfntniu nad ecteerx aricbb ucebesa ew n'odt aehv lhrce.iod eaY prlentyapa I asw dh.uteesax +


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 -3  upvote downvote
submitted by โˆ—amirmullick3(76)
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yreV eysa eu.oqnist Nlibiuonso vit.mo 1 nmhto .eag tsMo ellkiy sraecnio si olyripc setn.siso

ehT iingtomv ecssua loss of HlC os we hvae eht ahoimh,oelcryp dna elran cneoomtpiasn rfo tsih H ossl ybsi eregsvrnip potnrso ta het xseeepn of K os tath iesvg ho.emykapali As hte eesisad is neamd, teh rrdeowr a ni teh migea fo hte omtasch si smhoot sumcel reptoyrhhpy fo eth oryplic cursluiasm u,mocesa gmhften ior dilvhopaee-s ssma eflt no npiaolpa.t isTh is a moabcelti ksalloias uecaesb uhtitwo ,Cl- eth o /tlCaabllHCOsrea3 rxeaehcgn will tno wkro, os you eriatn .HO3C

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