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NBME 22 Answers

nbme22/Block 1/Question#1 (reveal difficulty score)
A 66-year-old man develops worsening ...
Dilution of serum sodium due to ADH (vasopressin) secretion 🔍 / 📺 / 🌳 / 📖
tags: RAAS

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 +23  upvote downvote
submitted by imgdoc(183)
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I think lato of eplpeo thgmi vhea erov amdezsphei who mirapntto NPA adn PNB lralye era, eys ti is itpromnta ot konw ehets pspdiete etg esrdecte yb hte ncrrtar/lvleiautia aumryidmco inurdg treha .ilaufre rowveeH etrih learovl enescsftefive ni genttari hetar laeufir si clh,iz a repetocpr ltdo me ttha if ANP adn PNB reew os fsuule in suesntaiirr hten hwy do we vegi duscei?itr 'tsI bcesuea RSAA esrvowproe siht ytssem echen icgnsau tneeivga ecfsetf and teh esldnes lpoo fo arhte realf.ui AKA wyh we evig CEA .inostibihr

inowgKn thta PAN setg enladtzruie by hte RSAA ,tsmeys we nca stfih our suofc abkc ot rahet ifleuar ni isth petitn,a where ccaiadr tputou is e,ecesrdda lnaedig ot AHD eneocirts adn fllinay iutaiodlnl mnatayoiprh.e

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almondbreeze  a ocecpnt nicnlsotuoyu smziehdape by ,wu btu I get lsaywa gwron :'( +4
almondbreeze  dgoo rkow !oedn +1
raffff  ywh does hte ybdo akem nap ta lla nisec sit os lseuses +4
makinallkindzofgainz  raff@ff - ta taels BNP eigsv us a good errmak ofr ehrat riuealf eoetnicasrxab :) tanhks obd!y +1
mannan  heYa 'tsi opamtitrn clnaliilyc esuabec ti has a ihgh sivsnieytit i(f egvi,tnea eulr uto) fro reaHt afle.iur +1
alimd  tA het mesa emti APN itihibsn rinne eerelas? +1
freemanpeng  If ti is Hihg RAS,A Adlo smtu eb ghHi sa (gIIneAllw ducnei lAdo oemr than .A)DH enTh atth wuldo eb TRT-AWASLE troeninte terhar ahtn UPER WERAT nteotn.ire NO aonyiatprehm +
plaguedbyspleen  hsiT itnptea is dihip-stgncra dna ehrertoef sha lwo eifvtcfee rtualgcinic lm.uveo I ilek to ihktn ttah geivn ihs VC yrit,ohs eh si ralyopbb on na ECA hiiornbit or giemhsotn a.rsimil So ahtt seveal DHA to od ist ign.th Aslo hhig eolenodrsta nivsag stal tins' otmgnhies ew need to siordcne egivn eth semt nad snwera hi.ecsoc +



 +12  upvote downvote
submitted by meningitis(643)
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I sloa htgthuo teh maes sa ub@b,esbl utb onw tnyrig to "jytif"us isth ycitrk MNEB iosu:nteq I hnkti this evsleorv no het tfca ttha the aptenti ahs a IHHG oobld uprsseer eiamnng ew uhdols csfuo on an wneasr htta lexnaips otbh needcsari PB dna Homoaeiplyv e.i:( sadieecrn HAD cwihh vctnitorsacsos adn osal osarbsb r-ewea,fert btoh fo chhwi ecsinrea BP dna sacue a)ohmevy.poli

aeybM fi tish naietpt erew etondamsdcpee hwit OWL PB, neo ucodl tkhin emor abtuo .NAP

I tlils inkht htsi ontseiuq si TOO .yctikr

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meningitis  ,Soyrr *meatpyrnhioa rhgti? +1
mantarayray  I hiktn ttah ti's otn PAN ebaecus APN iwll uacse a lsos of aN but trwea lwli lfoolw e(yth ullusya og tghree)to, aehwers HAD lwli eacus osbtnproia of lnoy rtwae dna liwl cause haetrnmaoiyp cp etex nloy hothgtu itsh pots ttgegin eth iqneotus ongrw ):" +5
mantarayray  Opso rrosy het rfntmaogti si ocsunfnig: I inhkt tath ti's not ANP beusaec PAN lilw cuase a slos of Na tub etwra iwll oolflw h(tye lsluauy go ),eorhgtet aeerswh HDA illw caseu btsaorpino fo yonl tewra nad lliw escau y.mhtnaepoair +4
pg32  nayarmta@ ytrpte esru uoy rea hrtgi dna that is hte noyl ywa ot gte stih ietusonq c.ecotrr Rbergmeimen taht Na coeonanctintr lrleya si a ueaersm fo twear albncea si y.ek If het pt is pramh,iyecnto atht sutj naems tyeh aevh oot uchm erwta ni eht olodb, cihhw si dseuac yb DAH. fI teh epntiat asw p,oVyLIOChME ttah mgthi nmae yeth aer gnslio oot chmu N.a sTih is dusaittelrl yb spt thwi .AHDSI They aer pinyroa,emthc btu iec,vemluo engniam htat hyte avhe oto uchm artwe eraapnohm(tiy mfor het A)DH tub tiher aN ebalcan si ko (due to ieocetrnx of Na iva )NAPNPB/ +1
avocadotoast  We dnee ot be nhintgik tuoab how htera uafiler si a niootidnc wiht a wol tcifeveef ailrtingucc lmuov.e ruO nitatpe had an IM nda nwo sih eraht anct epke up htwi het umoevl wlo( C),O eiadngl ot c.ensngotoi eWhn tgsnioocne rc,souc etraw is suehpd noit teh lirttnsietai ecapss and nits' icurlcaitng ni het erlraiat ytms.se orF hatt eso,arn het body armps pu teh SRAA dna DHA tepdsie na alcatu earicsen in obyd .rewat hsTi si a oosm-oninct esaelre fo .DHA At tihs iotpn lamasp smiodu leelsv era eedidetrnm by rtaievel eikatn and slesos nda aompetirhyna is mconom in esteh eipasntt euecbas of th.ta os,Al PNA dna BPN 'tndo hdol a ncaled to eth RS.AA +1



 +5  upvote downvote
submitted by nwinkelmann(366)
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Fomr a:otTDUpe PENGOHTSISAE

keLi tmos orhet sceusa fo ipty,omaeahnr rtaeh lfreuia rspamii eht ibytila to rxetcee gsniedte etarw by nceinrgasi ectiidnritua mroneoh evlle.s eWnh ardacic outupt and esytmcis olbdo rrpsusee era ucr,deed h"pocy"eomlvi sromh,oen ushc sa irenn t(iwh a snsteuequb rcaiesen ni enostnigian II oomfi,)anrt ceditanitrui noerohm (D)A,H nda pnenn,ieihrepro ersdpno []13.- lhoAghtu esteumdoa sptatien ithw retah eirlfau eahv cianrdsee mlpaas nda cetlrlaleurax udfil mulv,eos eth oybd ceresievp evlumo leinpetod cdurde(e feieecvtf taaerril olobd l)vmeuo censi hte low accdiar ttupou sraesceed teh sspeuerr snfrpegiu het orerbposaretc in eht rotaidc inuss dan eth enalr atfeenfr h orral.eTiete geered fo uohauelrormn tctoanivia si ngelarlye tdareel to hte servyite fo darcica fsydotciu,nn sa sssesaed by ftel renrlaiutcv ctoejeni cirfaont ro ulnfnaocti cslsa [2]. hTe lraorunouemh acensgh litim htob siudom nad ertaw iecxeontr in na tetpmta ot uernrt nfropsiue sreeuprs to ol.armn AHD raeesel ictryedl hsenncea erwat srbpriaotnoe in hte citeclognl btue,lsu reshewa sgientinona II adn reeneniorpnpih iimtl tdaisl awret vireyedl dn(a yberthe rewat toce)enrxi yb iwrnelog eth emuarlglro ratoinfitl ater d(eu ot a kraemd ectirduon in lnrea )rfusoipen and by sraiigcnen xmoliapr umiosd dan aerwt oobirrtepasn .[4] nI io,tnaidd ohbt eth owl rcaacid puttuo dna hihg otanninsgie II svelle era noeptt uistmil to shirt,t angleid ot ecdhnane tarew eintak.

wu-claemnstttspwedhafohyrtt:ai-n//re.nc/wwte2pphie.nnar-hto-titoai-#/aiseuttoHmp

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 +3  upvote downvote
submitted by bubbles(79)
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ishT tnqisoue edsufonc me a lot eacbsue so nyam otusneqsi ehva idlredl em on hte ieparcotmn fo eth ANP apeecs nemmhcais in ietms fo dfliu aoedvolr as( ni C.)HF

I ohugtth ANP aws a gehu erpyal in eht osls of Na ni etnsucrsiaccm of vlueom ovelodar sa in siht teanpti ichh(w si yhw ouy ese celuveoim atmehipyarOn in epatstni thwi AHSID or eytvoraivcit fo hte RASA as in .H)FC

yhW si AHD onw nbige aemdn as hte rslpeoibens e?ntga

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jooceman739  My nnhgikti is that PNA sacsue ait,usinrres os 'euyro ilosgn stal and atrew at hte msea tmie oioi(omcsts .f)uldi? eielhw,nMa AHD asosbrb nloy rfee r,waet os ti ouwdl tuedli eth r.ecC m reuost r me fi m'i wrn.go +13
bubbles  hhhO uoy are h.tigr Tkhan oyu rof eth tna!loepnixa I got os aftedxi on atth oen manecmhsi .haha +4



 +2  upvote downvote
submitted by dr.xx(176)
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FCH ptitasen efotn dysipal nssgi dan psytosmm of eericsnad issvperason neic.sorte

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hyperfukus  fi lal eles lsaif i pohe i ustj irdll shti oen tsnmeteat in ym inrba and ti smcoe otu ni eth ihrtg way on etst yad hkatn !!u! +1



 +2  upvote downvote
submitted by drmohandes(193)
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eerH ew go:

  • ddaecseer VL cyottltiianrc rableil(ta lscc)rkae
  • seceardde diacrac otptuu
  • atvcteai RSAA → AHD
  • isecrane mhtseyictpa yiacvitt → emor ASAR → orem ADH
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 +1  upvote downvote
submitted by moloko270(77)
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cnowtbg.h2me0u8l/i.p/w8:2dhbwpmnn/7.sit5/.v

n"odsyrme of lu"dnloitia ll"yoypa-tmosioh ni versee itvsecgnoe hetra ufrlaie may eb decsau yb an pneyliripptaora ihgh ADH ieecosrnt in ihchw the opeoorrtscme yssemt si indmdeoat yb nsloaonmor imi"ulst

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hayayah  ny,tpalpreA ni rinochc FCH ouy see irehoym.pnaat eeuBacs FHC asuces a deercesa ni aicdacr uouttp and iirctlgcnua obodl eovm,lu chiwh ni runt resggtri a rtpnomeycaso perosnes adiem ta vnesgrirpe olbdo .rspesrue Tihs lusesamitt eth ybod ot earnti thbo tewar and siu.mdo +10
seagull  i eareg ithw aayy.a.hH. the SARA ytssem is eactavtdi deu to poro seoiufrpn to hte yndkie due to podcem reaht fr.ieula +6



 +0  upvote downvote
submitted by nicsar(1)
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noyiparHmeta romf iHetfeaurlar tp.

It udshlo eb rpceopaadh fmro rteaH .uearfi

;Ht-F&g AARs ;&t-g isxceeevs l,eAotdoerns H;DA PAN epcsae urf,aie klie reydncsao dptessra;rminholyeo aytmpiaroHne

g.-9//lv-7g.:fh05w2l9Wc4///mwo8/5s9tmp-t0i1/1-3Jtn1jwuhCet.w64

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 +0  upvote downvote
submitted by dubywow(23)
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cetopemDaesdn .FH cLka of obdol flow due to glafini treha tg&-; ewolr BP &t;-g dsrnceaie DHA to raceensi oobld suesrrep cabk to satbel ee.vll nI FD,H HAD staepcou ishssmaotoe fo iaoucncerttng APN m&;ap NP.B s,uhT teh rmet se"ad.c"tmdnoepe asAdeoistc htwi hneorssts fo areb,th meaed tof(en of sun)gl.

shiT cuivsio yccle ctisuneno sa yobd iirzopitsre adeuateq BP for alivr,suv ubt ti smceo at eht speexen of kovedeorwr eahrt that ustm orkw hrerda nda hredr,a yemuatltli cebeiatrgnxa hte aerht eailurf tic.idnnoo

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 +0  upvote downvote
submitted by asharm10(37)
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Alwasy kwon tshi yHop or eayaepnritmhr si acebseu of ngchae ni teh vuol,em hist tpaetin is ggino gorthuh htrae leaifr,u neral uorensfip hsa enog down ttah dslae to lreaees fo HAD cos fo pssorrtcoeoem ioi.utstnaml owN ihhg DAH liwl roabrseb roem eefr artew atth llwi lead ot .minpraotahey oS paotnihrmyea si stmoal alwyas ldrteea to ihhg AH.D I kwon wef of yuo llwi hkitn ubt ARSA stsmey is teaactvid oot btu ttha bosbra Na ngoal hitw rewat btu DHA sutj reef w.trea

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 +0  upvote downvote
submitted by hello(429)
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eThre sah to be a erettb nlxtanopaei rfo ywh PNA is wgnro?

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waterloo  fI iths pt's /PNANPB erew ucnisga him ot become ca,terynmpoih yhw sdoe he aveh uidfl adeorvol ysopmstm aelai(lbrt cselar,ck J,DV hihg ?)PB rheT e sah to eb soghnimte seel rgoicnovem hte APN .ysmset +1



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submitted by happysingh(57)
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i iankd fo eefl "dd"o ingkas iths suqnoite : ubt the ptntiea hda na IM 6 otnhms gao, os yhw wlodu it be lkeunliy htta eh saw tlod ot crsertti" ,ltsa rtcierst ufslid (tewr)a " ??

Geuss whta mi' kgsnia is : thaw esakm iheocc E ushc na llkeunyi cochei DJ,V( birsilbaa- lskeacr,c rihpaperel dmeae) ?

&;pam sgni@netiim : hsi pb si 52381/ mgHm ... ywh si tath GI"H"H ??

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submitted by freemanpeng(7)
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Frtlisy, I ohcse DHA. ehnW I totghuh icewt ni veier,w I ekdicp dscsreo HDA nad pdkeci AP y.MN oilgc ot socsr : 1.AHD hTe mnia rindecu fo HAD rae mOs and P/evlB.mou TsHi ,tp smO yovislbou ont ig,hh pB byoovusil nto wo.l ,oS nsnsnoee ni edscirane . HuD2Y.Ao mya see AngII sola dcuensi D.HA But it messe ot be a morni .cndiuer lManh,eiwe fi it si xtclyae hhgi n→IgIA hgih DHA. Te,nh oldA mtus eb ihhg sa ,lwle nda iHgh dAlo taSl→ igrrsneev→p OHW CAN msure idSoum be wL?WL O"o daaicCr →tpoutu Hhgi SSAR (gInIA lAdo )D"HA yptawah si IAUSRDOTMEW- rtn.neoeti NTO puer RAEWT oeitetnnePs lrae eortcrc em

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