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NBME 18 Answers

nbme18/Block 2/Question#8 (16.1 difficulty score)
39 yo man, polycystic kidney disease
pH: 7.22; PCO2: 28; HCO2: 11🔍

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 +4  upvote downvote
submitted by sammyj98(16),

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..

myoclonictonicbionic  EXACTLY... 7.2 for 6 months without any drastic symptoms.. that doesn't sound right +2  

 +2  upvote downvote
submitted by elzeinmd(2),

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

 +1  upvote downvote
submitted by banana(8),

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