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NBME 20 Answers

 +15  upvote downvote
submitted by hayayah(1212)
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In erdor for a dugr ot eb edrlcea by eht e,kdyin it tmsu rtsfi eb lfrteide ni teh irulgelm.o Drugs whit a hihg DV eahv moer of het drgu ni teh usetis ttah rea ton vailbalae to elerdfti yb eht d.kniey ugDrs iwth ighh epiotnr ibnndgi wt'no be deerflti ti.rhee oS uoy twan a durg hwit low Vd and wol inibngd fi uoy wtna it eclrdea avi the dnkeiys nda ri.eun

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zevvyt  tuB a owl VD csoerpondsr ot ghih laPasm nniidBg Att(oinnoFnCcear 32,3 .09)21 satT'h my nami ciusnofon whit tish eqisunt.o +3
kevin  fI s'ti hhgi msalpa nn,diigb tenh i'ts lwo d.V tB,u olw VD not'des nssalierecy eeiqurr ghih mlapas g.idninb wLo Vd acn mlspyi eb eud ot ti gebni a lerga rpalo lemlecuo +3
topgunber  So uoy the ifcouosnn is atth VD of 1 nmesa it sstya ni het tonaul/iricc tainausrlcrva nmtro.cmapte hTsi uowdl mkea uoy khnti hatt it lduow nibd ylihhg to nrietpo in escubea of eth olw VD. utB mi smiagnus fi ti bduno trespnio it oudlw ont eb drcaele yb het kenyd,si so if thsi dha a olw DV can( be lcerdea ta )usglolmeru dna if ti nbduo aslpma rensitop ewakyl (olwlsa eth iyenkd to iterfl teh ebuss)antc thne ti nac be eetrfdil noti the larbutu lumne. oNw eth .pak sBesa ehwn apnotrtode hp( ernud trehi apk) cmebeo dec,aghr elhwi icdsa at hp uerdn reiht pak get taneoptord era GHRDNUECA, animnge ni acciid eniru dcsai bemeoc rome phpollciiil dna anc suifedf otu of het ltaburu nel.um fI we mdea the iernu mreo cisab, hnet ew nwat ot dooneatetrp het ciad ph( iegrhh ntah pka) os ti iwll aenrmi utskc in teh urbalut emunl as an n.oi +



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submitted by charcot_bouchard(574)
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Kpa is pH ta cwihh any urgd si ta sti 05% dizioen t.teas

wNo ew rea alk eniur i.e inc p.H hwne &atKpgp;H ti ilwl eahv otw ifdf atph rof caidic drug &;mpa asbci gr.du

ccAdii dgru ilwl icn sti nanltieimoi (inc nezdoii mor,)f cbisa rdug wlil eb rome dbosrsa o.be we dnee ot nwko hte dgru si absci caci.i/d

owN fi u kal rinue tis itnimeoanli cin. os it eavh to be ci.diac or u acn wkon ist a dsio astl fo dugr hitw SNC proetrpy i.e osmt eikl aoPrbbihantel aWek( dca)i

so if Kap fo gurd is 6--a-t Hp 7 ew lwli srtta inmiglinaet

but if apK is 0 we ende ot eaisr Hp fo neiur ta 11 to atsrt tnalmeiatiign. tath tonip pvre grud a(6=)Kp owdlu be tatylol uot of .syetms

thtas why A si the trghi asn Kpa( = )6

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charcot_bouchard  Ctciorerno : tNo .0 i snaem fi Kpa si 01 +3
charcot_bouchard  dn2 tuaped : tocn ot anrle lcsoho greda emhc. fi apK ;tg& 7 it si s.eba adn if apK si lt;& 7 ti si .iacd inSec we etasbilsehd hte rudg have ot eb a waek diac paK ntca be mroe nath .7 +
dbg  snht,ka tub Pak dan PH aer ont at lla het maes ghtin +2



 +3  upvote downvote
submitted by monoloco(155)
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fI uyo tanw ot lerca a u,dgr ti si bolraypb stbe taht it tno be buond to penotsir s(o that it tgse )rfietled dan it ash a low meolvu fo biitonudtsri so( it tin's ni eth eped, ahdr ot caehr suse)is.t

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kingtime9119  utB taht odsnte' amke eens.s aPge 233 of ritFs diA 2091 oiinetd eryclal ettssa htat eibng mplasa eoptnri ondub ceasret eht slwote uelvmo of trtbdiiiu,son sacbeeu otn igenb nbuod ot etosnirp issraecen the necahc ti lwil rheac eedp inot hte esissut bfeeor it hsreaec eht yd.isekn speDanyircc tihw trsiF dAi? +
haliburton  my eisnarong aws grinacmpo otw u,rgds bhot hwit dV of 1, eth urdg thiw hte lowre inblmua nbidngi owdlu be celaedr atsfre .tginkmei@ I 'ndot kthni 'yueor ciesnriongd that A dan B ehva qleau .dV +8
whyisthis42dollars  eBnig lapmsa onubd aym rectae hte lteows dV, but it e'otsdn amen s'it ignog ot eb eielrftd yb eth idk.eyn aeSm asonre wyh irendpb-otnuo uamiclc is'tn eeriftdl by het idyekn. ru'Yoe iggtnte oto gunh pu no d,V tub thts'a loyn neo rtpa of eth ueiqnoat r.eeh +



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submitted by lispectedwumbologist(122)
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Can msydbeoo alesep ailenxp why the pKa ash to eb 6 sndteia of 0?1

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masonkingcobra  ieScn an ziiendo mofr is hadcegr y(b t)ioein,fdni ti illw otn yelias csosr a prnaoonl ilpdi n.bemaemr T,hsu ti si nitoramtp to eiecrnogz the entotpial fo the rudg to izonei in edorr ot irtdcpe its yiilltoubs dna eht rdeege ot ihchw it nca be s.raborbdee eTh rdeege fo aoziniiotn si ddireenmet by teh ’usgrd pKa nad eth Hp of tis rvmnne.iento Wkea dsiac dna sbaes rae %05 diizeno adn 05% niuidzeno hewn hte douuirnrnsg Hp qseaul hte rd’gsu pKa. At 2 Hp stniu obvea or bolwe eht aKp fo eht ,grud yarnel %010 of eht rudg is ioeiznd or iinz.uoedn +4
masonkingcobra  Baialscyl aewk aidsc ear tesb xcdeeetr ni eailklan unier, btu wake asseb rae xedeectr eorm aelrdiy in iacd n.euri +
masonkingcobra  nI uasm,rym uceaebs tshi si a wake cdai at pKa 6, nikgam eth nueir klalnaei lilw erlsut it ist iotaiinonz and .neietorxc Iinodez tcna oemv tohuhgr ldiip rnmeasebm os 'tacn egt resardbbeo adn si edisps o.ut +20
yex  noowFillg no rcsgonoaminkba anlAta:enxi op apK 9-4 can eb hrteei eakw cdia ro eaWa s.ekb acdi apK 7-4; ngtros dcai paK - kW1ea3 bsae paK 79-; rotgns bsea pKa bevao e 9ferntsDif psH: acos:htm 21- muuodde:n -35 rlyae :jumnjue 75- tea l j:umuejn 7-9 iumel: gt9;& ruen:i a.5W- 8e4k csiad p)(aK egst baobsdre ni iaccid (Hp) vtnnesinorme dna larecde ni iscba. Weka sseab gste dabseobr ni baisc eornisnmevtn dna laecder ni dciic.a ISTH SODE TON ALPPY OT TROSGN EASBS OR !AID!SC!Te! h tsbe noxitpaanel ofr htis si a hcmeiBo uctleer mfor sPas grPoram and it is lileaavba no euY,oTub sti gnlo ubt ti is fro urse thowr !i!t Lkoo rfo 91 Bihrisecytmo 1 rmfo assP roargPm no eTbu.oYu +3



 +2  upvote downvote
submitted by chandlerbas(118)
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ghrltia etls do tsih. meos of the ecmmtnos ewer earyll lwle ,dxeilneap owvereh mi onigg ot rty rhnoeat .eotur tles dlea twhi paK sicne teh treoh mtoesnmc aenideaxpl dV ewll one.hug ukosd ofl.la/slslefe

firts inhgt is yuo avhe ot eetdemrin if tis an diac ro bea.s 9%0 fo hte iemt its ingog to be a wkea c,aid ew sempli tond tuormalfe cmhu osdinmatiec sa asbes ni r.leenag aols ist musoid astl nda NCS os yuo wnok ti sah to be narolbpi.ehatb epts 1() wol paK asmen cida 7.4(-) ouy stum onkw tshi. 2)( uyo stum wonk htta lla diacs asttr off uarlnet dna hetn osle na oni t--;&g mgobince edrc.gah nda lal sabse astrt ffo crdghae dan neht selo na noi ot omeceb lauernt h(ist is yhw ew ondt ues sabci dgsru acesbue tish arulent aghecr ash a hghi vd dna pstsdioe ni stiesus = bad in eer)ydl.l yuo tnaw dcarheg bc tthsa htaw is lodyprcihih aak pee it to.u )3( exnt sue wtha i jtusj aisd and pypal ti to isht :hactr

2+ = 9%9

1+ = 90%

-1 = %01

-2 = 1%

eht frtsi enbmru esnprtesre teh nrdfcieeef eeentbw pH adn Kpa (Kpa si vnige by het tioqsuen a)ly,wsa Hp is waht uoy gdnheca wnhe uyo eilanzldak eth ui.ner os rof shti senuitoq ti dwuol eb: -ppaKH = ghih ibasc aluev &7g(t;) unsim pak ( aekw caid -.)47

won eth desonc eartegpenc srtsepreen eht gaeenrtcpe of ddiastesico ortpn.o so fro na ida,c etyh liwl oebmce gdhcare, hits eanms ahtt if the nefefirdce beeewtn hte ph and Kpa is vore 1+ then 9%0 fo het cida wlli og frmo alnrute ot eghrd.ca fi teh ph si 2+ aertgre ntha AKp hetn 99% fo the adic lwli hvae stlo ist rptnoo nda omebec credgha

tles ueszaimmr st:ih eewr tlod sit a keaw dcai = aka Kap entwbee 7.-4 ew natw to gte ot aket the awek aidc mrfo its ruletna from itno a hgacred rfom ot teg rdi of .ti so we alzilaanek the ,ineru eeuabsc sbeas ear ghierh Hp oyu iwll teg a rmeo + nbrmeu tsuh hte ekwa cdia lwil go rofm untarel ot agchder adn eb dcteree.x

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submitted by strugglebus(189)
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I saw orwgniend fi it wsa to lowla fro aprtlai CNS rteintpenao inces hte urgd si plsyoedpus usdsepop to avhe CNS teffec

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submitted by sha2507(0)
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orf aekw psaHp=idcak + glo A()H-/(A) aka erdnsonhe habacseshl qo tefinaui yuo olsev sit,h yl'ulo get ttha pH - kap = ()o(/AHdan-Ag)l tehn aiagn uoy wlli egt 10 to oewpr ph - pka = .A-HA/ rReef[ ot klni in en] tocmmswon isgdocrnine atht eth hp of uor oydb si 7.3 t,engehiswmo can evslo for apk 10 adn akp 6 gnsiu ihst f u.hTrtamaol si rfo pka 6 nad doby ph ,73. ti wlil eb 10 to het poewr fo 13., ulwdo mnae ahtt AHA/ iroat is a tseovpii unbe,rm piingyml atht A- tg;& HA. ahr wese orf newh kap is 01, het HAA/- nrotia si 10 to erwpo of -.7,2 ngeiamn atht g-A.;tH&A

Adn sa rdleyaa otinmeedn ni hte avobe nm,ecosmt we nede an iiconc mof,r to niemaleit the gru,d it uwdol be eefprrdre fi hte kpa si 6 sa in atth ec,sa i-)cnA(oi lwodu eb in mreo necattnn.coroi

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sha2507  aih/tecawmp-//-foenha-ihnrfa-t/epsdofbth.dteenswi-gnoyscoipa:kblu/asmfeufhvs-rkie-rroccsbsuruiaiiyerutdlwq/p/r/-sabimeln.cf erre ot hist ,ovdie ot utdesadnrn it a etltil ,tebert and orf eht rfaolum hwti eht latb,e sikp ot 62:7 +



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submitted by kingtime9119(0)
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tncomme[ odvme to ntboumm]sec

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submitted by sway(0)
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so hwat if sith asw erisvnde reehw hte udgr ni qintsueo was a bsae nad ahtt urine wsa iiceidaid.f nkow het Kpa would eedn to eb &;gt7 utb ahwt abuto eht pH

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submitted by haliburton(225)
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cemnomt[ edmov to ]ntesbucmmo

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