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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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hseeT atnxieonlasp tarne t.aerg tI estdno lelary veha mcuh to do ithw AASR avoanitt.ic tI hsa lsomat ynevhegtri ot od iwth a nepnoomnhe cdlela teh kalelain di.et nI rhcinoc toiniv,gtm yuo uldow ecextp Cl- ot be owl dna =K ot eb wol ra(ismli to alb rltesus ni mesonoe with bium).leal To ecmnsoaetp rfo teh olw -,lC hte chtmsoa ahs na eitprntoar cwhih cxegheasn lC- rof H-O3.C eoT,erhref C-l lwil be eehpilersdn ni eth tcmaos,h hleiw O3H-C llwi srenceai in teh dlobo, ugiacns an ssall.aoki In clotakila a,esstt het K/+H+ netitrrpoa iwll ibgne to ei,vttaca htfigsni K+ NOTI leslc m)a(hoialkpey nad sanecignir pH. RAAS rybaobpl lpyas a orle in naimgk hte haeyoamkpli oersw but the kaaeliln deit is orme onmtatirp .eerh

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spaceboy98  Istn laklenia eidt erltdea ot an siereanc ni pH artfe esma?l roYu ocgil is on otnpi tbu I'm otn rues erhwteh ew cna pypal ttah tcnpoec hree. +1
kevin  ncotcep nca eb pdapeli here subceea we eedn ot prleete the lC- ni erdro to eracet CHl; het chatmos n'osted erac if -Cl si wlo in um,ser oyln htat -lC si wol ni hte iltaapre lecls dan os lwil mppu tou 3O-HC in ist exeepsn +
usmleaspirer  why is K+ lo?w +


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 +6  upvote downvote
submitted by hayayah(1212)
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tWih oircchn ov,gtiimn oyu esol lleercseytto nda a olt fo a.icd It egsirgrt cmaetilbo oaiskllsa hhciw is hyw all eth remsu seulva rae low or( no hte wloer den fo teh nalrom rn)eag xepcte rfo benorabia.ct

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ergogenic22  drcaeesde K+ fm(or nsriecdea AARS ued to loumve ols)s nda edrcseaed l-C los(s of ClH form het hmaos)ct, lAaksosli romf sosl fo CHl dna uths gihh rFb.boarc i sith nrsaeo high ot mdi gearn K si wrgon +5
sbryant6  odl'tWnu rndaeisce AASR laed to cdenarsei N+a? eTh wranes sowhs seddeaerc +.aN +3
sbryant6  sl,oA meebmrer umiiBal sreavoN si todeaiscsa ihwt haolykiepam. +1
sugaplum  os the geran yeht agev fro K si 3?-6 so .23 si WLN ?tehn ro are ew utjs agnoptrei on i"t si no eht orewl dne fo nralom ni d"spe +2
dbg  domusi lvesel in cilpoyr oissnset v,yra ginhotn yrlael ,asccsli acn eb hhig as in ihts seac ymislp eud to n,todraiyh nca owl ni heort secsa fi lradotneseo mdaaeng to rerseev ttha to hte horte texeemr +1
skonys  chlporo,mcHi"ey cyiolkeahmp lietamcob ikssolala si teh sclicsa retceyelotl adn esaac-ibd nabaemlic of opylrci ois"stnse fmor dpemcsae edhbin wnto.Vai plglymia = evouml sslo edc( isnk ogrtu) as llwe as sols of ,H+ C-l nad w+(tihaN H02) &tg;- ictbleaoM islAao.skl ossL fo H+ ascsue acesiner -3COH tneitonre sa wlel sa K+ hsitf inot eslcl plkoimhey(aa A9F1 .785) +

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 mtbecalio aslioaslk, tssuipoam vsoem into eht sellc

eTh ossl in ouvmle hourhgt iemses rigrtegs SARA ienrgults in drecesina oAnesdetolr eaeerls and rthreuf posauismt exiternco

/ee1sw1t.atttp/pww.lhant//:6ibed

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 +3  upvote downvote
submitted by iamapotato(3)
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oN neo ereh berdheto ot ualyalct dscssiu sath'w ggoni T hsn.io is a nh-mot1 old .orwnneb

eH tvoims etfar fgenide,s -yda5 r.yohtsi

tA 1 tomnh lod, with ovmniigt freta gsdfnei,e ti is most lelyki a easc of CIROPYL SSETISON ued to ryehotppyhr of the iyolprc csrpihten yluusal( rcsuco 6 swkee t.lra)e

euD to hmi migntiov sotmcha snt,teocn he lwil EOLS -,lC ,+K nda a+.N

eH ilwl OSAL selo +H. hisT is wyh you og toni eht abcietlom klisoalas with a esunlattr eecsnari in the COH-3.

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kamilia20  thces:ky: mvnioigt ueascs loss fo EWTRA tegarre atnh d→sioum csenrdiea mesru o→msdui ISDREANCE sumer ial,oosmytl oS NA liwl ecseedra oto, btu no ttah rfa +


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 +1  upvote downvote
submitted by ark110(1)
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tBu htaw is eht ednefeifcr newteeb poonti A nad tnioop C (;213 ;4.9 09; 35)

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sympathetikey  +K s'tlnhdou cisera.ne t'sI ingvom ntio lslec ude to emcotlabi sla.iasokl +
home_run_ball  In the ilrtpeaa llec fo hte H mynd gstreoa hoc ison are doferm fmro eth idaciitnsoos of aicbnocr c.aid Wtrea is a ryve minro ruceos fo hnygdreo sion in rosocaimnp to cbainrco di.ca baricCon dcai si mdeorf frmo ornacb xidoeid nda tawer by rcobicna hyern haTe ad.s inbaeobtrca ion O)H3−C( is negexdahc for a ohidlcre ino (−lC) no the ablsa deis fo eht cell adn hte eonbcarbita fusfeisd iton hte ouevsn odo,lb inlgdea ot an laleinka edti p.noenhmnoe +1
ergogenic22  ARSA eesinsrac morf eovmlu s,osl adn tuhs ermo rnosteeload dsela to lwo +K +1
sinforslide  eThre srnesao rfo aieok.hpylam F isr, t osem K+ is lsto in garctsi uifl.sd ,de nS oc H+ fshtsi tou fo llesc nda K+ hssfti iton elcsl ni ibatmeloc , kdTahrss. oaiill CEF mlvoeu ooacrnicttn ahs eacsud erecainds nerisetco fo tnsdlraoee.o +3


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 +1  upvote downvote
submitted by rainlad(33)
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,olcecriyHphmo yilameohkcp tealocbmi lkilsasoa is hte clssaic ltrlteyoeec nad baai-sdce ebnicaaml of pilcryo so.instse

iPersettns ovgtnmii stleusr ni lsos of Cl.H The icholedr slso usslret ni a low blood rdcolhie eelvl hichw miairps eth seni'ydk itblyia ot extrece bcerna.tabio hTsi is eht ctoraf htta nsepvert noocrrtcie of eth ilsslakao liagend ot letbaciom .alsloiksa

A saondecry aoilrtydohesnerpsm oedlsevp eud ot hte edreeasdc dlobo .lovume eTh hgih tooeelsarnd leevls eussca teh snekyid ot neirat Na+ to( ctoercr teh srurcianvtlaa oluemv ,edptoe)inl nad etcerex caineesrd sumotan fo K+ tion eht nirue isrulget(n in a olw obdlo evlel fo utimpos.)as

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 +0  upvote downvote
submitted by thefoggymist(12)
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I dot'n get i.ths uhS'donlt eth dniyeks rtast ietngoccrr het acibrb lesvle eafr 5 y?asd Teh dydleea paehs fo teh tcncoroeir icsen eyth eatk mi..e.t dna in eht iteqnous yhe'ter gsanki w"noe."W ehva cmaelboit aolslaisk icsen LHC is sto,l so teh yodb wlil rty ot rcetcor ti ftsir by talhvtpienneioyr adn atelr yb dnsriceae xctreoeni fo ai.bcrb rBaicb udhsol eb l..ow. en(ussl I'm msniigs gtsnhoemi ude ot bgeni xuahest)de

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thefoggymist  dN,einremv I nhikt I otg i.t Beta cairaetndelt ecsll ctnoan niouctfn dna txceeer aicrbb ceaeubs ew ntdo' aveh hlrocied. eYa yapletparn I was h.dtsxeaue +


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submitted by amirmullick3(76)
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yerV asey qsti.ouen nNbusoioil oi.mtv 1 onmht .gae tsMo yllike eoincsra is ycpirol .sseniots

ehT vngotiim auscse olss fo CHl so we hvea eht hromci,ayoleph dna lerna emiaononstpc ofr hsti H sosl biy s giepvsernr rtonsop ta teh epsenxe of K os ttah vgies ylaap.eomhik sA eth sisdaee is medna, eth raer rwdo in eht mgaei of teh tsacohm si hsmtoo mluesc hrohryepypt of teh yilrpco srlcmausui ueoa,scm orhtfemgin eshep-oilavd mass lfet no otpp.iaaln hisT is a eatbolmci ailaolkss abesecu houitwt lC-, the lHlaC3O/rbalaoC tes reahnegxc wlil ton ok,wr os you rneita CHO.3

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