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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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Teseh etaosilxanpn neart ar.egt tI tdenso yarlle heav hmcu ot od hwti ARSA .aiocattvin It sha msltao eetrngvhyi to do tiwh a nhmepooenn caelld hte leinalka ted.i nI rchocni m,itgvinto oyu dlwou ceextp C-l ot eb wol and =K to eb lwo alsr(iim to bal retlsus in onesemo hitw mibl.u)eal oT enomaetspc for eht olw -,Cl teh amthcos ash na iorrnatept hihcw eeschngxa l-C orf CO.-H3 h,eoTfrere Cl- ilwl be sdlhreienpe ni teh cs,amtoh heliw 3OHC- iwll scirenea ni eth blo,do nsgauic na ai.lslaoks nI lclikaaot tts,esa teh H+/+K etirtaonpr will igneb to t,evcitaa htnigisf +K IOTN lslec a)yipalk(omhe nda gnriacsein .Hp ARAS bporabyl plysa a reol ni makgni hte kihmaoaeply swreo utb eth naallkei tide is omer onaptrtim he.re

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spaceboy98  Istn lialaekn ited redlaet to an aresenic ni Hp eraft ?lames ruoY gocil si on tinop but m'I tno reus therhew ew anc yplap ttah ecpnotc rehe. +1
kevin  tcepnoc nca eb pialdep hree aueebsc we eedn to terpeel hte l-C ni orerd to trecae HC;l het cosahmt t'nedos race if Cl- is olw ni meur,s nlyo taht -Cl is wlo ni teh letiapar lecsl nda so lwli umpp uto COH3- ni sti peeexns +
usmleaspirer  yhw is +K ?wol +


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 +6  upvote downvote
submitted by โˆ—hayayah(1212)
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hWit hncocir mnvii,gto yuo osle etsecrleyolt dan a olt fo a.cdi It rtigrgse iteaobclm asikollsa cihhw is hwy lla hte uemrs esuval rea wol r(o no hte wrole dne fo het roanlm an)gre cexept fro ba.aobericnt

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ergogenic22  aeerdsced K+ orm(f aresednic RAAS edu ot ulvmoe )lsso dna scdaderee Cl- sosl( of ClH mrfo teh )a,tmhsoc oAkiaslsl orfm ssol of HlC nda tsuh hhgi b bor iF.acr shit aseron hhgi ot mdi rnega K is nwgor +5
sbryant6  ldnut'Wo eedcrsian RSAA aled to rdcsenaie ?N+a The serwna whsos rcdseeaed .+Na +3
sbryant6  oAs,l eebrmerm aBlmiiu aveNosr si etsaoaicds wiht .homaelpkaiy +1
sugaplum  os the ngrae yteh gave ofr K si 3-?6 os 3.2 is NLW ent?h ro aer ew ujts tagrnpioe on it" is no eth olerw dne fo maonrl ni e"dsp +2
dbg  smuoid eselvl ni rlocyip etoisnss va,ry onitgnh ryalle ic,slcas acn be hhig sa ni sthi aesc imypls edu ot y,noarihtd acn wol ni oerht ecssa fi deaonstorel gmaaend ot srreeev ttah to the tehro eexrtem +1
skonys  oeh,Hoi"rymlccp cmapekhloyi otcmilaeb aklosilas si hte saislcc ryetlcleoet dan s-cbadiae ncieblaam of corlypi sitessno" mofr esemcdap nhdeib mt.Viogaylpl iawn = ouvlme olss c(ed skni tug)ro sa wlel sa sslo fo H+, -lC nad at(hNwi+ )H02 &-gt; taliMobce sA.lkaolsi ssoL fo +H aucses rncieesa 3CO-H nrniotete sa lwel sa +K hstfi tnoi eslcl pakilm(yaohe 19FA 57.)8 +

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 maeitbocl salkaosil, utmispsoa mosve onti eth llesc

heT sosl in velumo hutohrg essiem ergsrigt ARSA eugslntir in caisernde onetoesldAr elaerse dan htuerrf pssiutamo etroxicne

ew/w.d.btn11hltp:tepewst/i/6a/ta

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 +3  upvote downvote
submitted by iamapotato(3)
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No neo hree bredthoe ot taaullyc sdsucsi whta's niogg iTsnho. si a omh1tn- lod ro.nbnew

eH omsivt etrfa ifne,gsde a5-yd tyshroi.

At 1 hnmot do,l ihwt mivgtoni rftea nefgdi,se ti si smot leklyi a aesc of YRPLCOI SSSOEITN ued to reyrhtyphop fo hte yocplir spehrcnit ullu(say occurs 6 eeskw e.lta)r

uDe to imh nmvtiigo satocmh escnont,t eh lilw OESL -,lC +K, dna N+.a

eH liwl ASOL leso H+. iTsh si why yuo og noti teh ilecomabt ilkloasas wtih a seunrttal iscraene in het OH.C-3

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kamilia20  t:c:eyshk ogiivtnm assuce sols of WERAT aetrerg hnta suโ†’idmo ecdniresa rmsue mโ†’oidus SRAENCDIE rumse sltiamlooy, So NA lwil rdsceeea ot,o btu no ttha far +


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 +1  upvote downvote
submitted by ark110(1)
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utB ahwt is hte efdferiecn nebeetw ootpni A nda toonpi C (1;23 49;. ;90 )35

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sympathetikey  +K ou'nsdhlt .insearce Its' gmionv tion sllce eud to mbeoalitc lkas.lioas +
home_run_ball  In teh aplertai lcel fo eth omsyg atH dn r oech nsio ear doermf omfr hte diosiatisocn of biocrcna .daic erWta is a rvey nrmoi urceos of noegrhdy osin in coipnsmoar to craoibcn adci. abnciCor adic is emfodr mofr orbcna xiieodd dna etawr yb oarcinbc saTd yenreah.h cobeiaanbtr noi C(H)3Oโˆ’ is dhxanecge ofr a hdriceol oni l(โˆ’C) no the abals dsei fo eth clel nda het cbinaerbtoa dsfseufi otin eht ensouv lo,dob dieglan to na naeiklla etid .enmnnopeoh +1
ergogenic22  SARA rnaescise rmof ovmleu sos,l adn usht mroe eanrotodsle saedl ot lwo +K +1
sinforslide  Teehr eraossn orf hmkpa.aileyo istFr, oems +K si stlo in ractigs dulfs.i c oSn,de +H hfssit out fo lcsle dan K+ ithsfs tnoi lclse ni mtiaolbec . iaTraillkhsds,o FEC eluvom itoonanccrt ash udasec recinsead nocetseri fo lseeotndo.ar +3


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 +1  upvote downvote
submitted by โˆ—rainlad(33)
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cepoiychr,mHol ymhlpakceio mcleatobi liskasloa si het ssaclci etlertyolce dan -esciabda iaecnlbam fo opyrlic snsi.soet

tePsrenist ionvmgti ssrulet ni sosl fo lHC. ehT ldrehioc ssol luserts ni a owl oobld cerldoih velle hiwhc aisripm teh ink'ysed tiyibla ot terxece iteobbacanr. hTis si eht catrof atth serpvent icrtcoeron of eth iksloslaa anigedl to ilebatomc iaallsso.k

A cedrnosya asnodsrperiohmlyet elpeovds deu to teh deeacsrde oodbl m.uveol heT high sletnaoedor lleevs escaus the snyiekd to airtne N+a o(t toerccr teh rtaiuvarslnac levoum e,iplo)dnet adn ecxeret cednaesri osnaumt fo +K otin teh rienu (nigeusltr in a lwo olbod vleel of mi.)uspasot

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 +0  upvote downvote
submitted by thefoggymist(12)
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I o'ntd teg t.his uhndlo'St eht dnieksy rtats concteigrr het cabibr lveesl aref 5 asd?y Teh yeddeal pseah of the roinccreot insec yteh tkae i.tem.. dna in eht usnqtieo h'eeytr gaksni e Wwn"o". ehav teailbcmo oailklsas icsne LHC si ol,st os eth ydob wlil rty to rccorte it tfirs by ohtpieeyltirnvna dna lreat by idencrase rctxnieoe of i.cbrba cibrBa lsohud eb o.lw.. su(lsne 'mI msnisgi tieonsmhg ued ot bnieg tedashu)xe

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thefoggymist  vnme,iNrde I hitkn I otg it. eaBt tceartdnaeli lcsle tnncoa tfunocni dna xertcee icrbba eusceba we dno't vahe lce.oidhr eYa praaelypnt I wsa et.uxdahse +


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 -3  upvote downvote
submitted by โˆ—amirmullick3(76)
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ryeV yesa etiounqs. onuoNiilbs o.ivtm 1 nhmot e.ag oMts lyekil oacsnrie is irpcloy sn.issote

eTh movtinig seascu slos of lCH os ew eahv hte rilopyah,cemho nda areln msntoencoapi ofr siht H slos bs iy eersvginpr ooptrsn at teh enesepx of K os ttha vsige pak.yholaeim As hte daseise is nma,de teh rd reraow in teh maieg fo teh mtscaho is sthoom elsmcu prphyhyoert of teh lopyrci amucilrssu aumcso,e ngh eomrtfi oa-ledhvipse asms elft on nppa.atiol hsiT si a biltecoam asolaiksl ebcsuae uthtoiw -C,l the alaO/blt3CreHaCsol nehcrexga iwll ont o,kwr so ouy iatenr C3H.O

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