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Retired NBME 18 Answers

nbme18/Block 2/Question#44 (reveal difficulty score)
35 yo woman, passed out while washing dishes
K+: decreased; HCO3: increased; Anion gap: normal; pH: increased ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +11  upvote downvote
submitted by โˆ—aneurysmclip(209)
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She's vomiting - Metabolic Alkalosis > loss of HCL > ie; acid, there would be increased HCO3 Anion gaps are usually with metabolic acidosis because in alkalosis there is high HCO3 which keeps gap normal. For the K+ > vomiting > loose water along with the vomit > decreased blood volume > RAAS activation > aldosterone secretes H+ and K+ > hypokalemia

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schep  Dirtyusmle has a good video on this topic if you're like me and struggle with renal https://www.youtube.com/watch?v=8codyTuFccI&list=PL5rTEahBdxV71pfkyqb3lpUMvVVFxuU-R&index=11 +3



 +3  upvote downvote
submitted by โˆ—sugaplum(487)
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FA 2019 pg 555
cause of metabolic alkalosis vomiting in someone whos a bulemic, hypokalemia and hypochloremia are common.
anion gap formula Na-(Cl+bicarb) Since we have excessive bicarb there shouldn't be a large gap. Normal is 8-12.

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