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NBME 18 Answers

nbme18/Block 2/Question#8 (reveal difficulty score)
39 yo man, polycystic kidney disease
pH: 7.22; PCO2: 28; HCO2: 11 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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 +11  upvote downvote
submitted by โˆ—sammyj98(39)

did anybody else second guess the heck out this answer just because he's got a pH of 7.2 and he's hanging out in an outpatient clinic? I haven't done my clinicals yet but it seems like this guy would be struggling..

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myoclonictonicbionic  EXACTLY... 7.2 for 6 months without any drastic symptoms.. that doesn't sound right +5

 +7  upvote downvote
submitted by elzeinmd(7)

No need for MUDPILES here. Bad kidneys = Can't reabsorb HCO3 "base" > Metabolic Acidosis. Compensation is Resp Alkalosis. Based on that: PH less than 7.4 HCO3 Less than 24 Pco2 less than 40 Only answer is A

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 +5  upvote downvote
submitted by letsdothis(12)

Uremia: part of MUDPILE

hence you develop metabolic acidosis --> LOW bicarb with DEC. pH and you develop respiratory alkalosis in response

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 +2  upvote downvote
submitted by โˆ—banana(18)

Or, if you can never remember MUDPILES: + he is way in renal failure: metabolic acidosis. + respiration 24/min: resp compensation, low CO2 + HCO3 is low (^^renal failure)

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 +0  upvote downvote
submitted by โˆ—donttrustmyanswers(73)

Uremia = Metabolic acidosis = Bicarb is low. High respiration = Low Co2; for respiratory compensation.

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