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NBME 20 Answers

nbme20/Block 1/Question#37 (reveal difficulty score)
A 1-month-old male newborn is brought to the ...
Na+: 132; K+: 3.2; Clโˆ’: 90; HCO3โˆ’: 37 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +8  upvote downvote
submitted by apop(8)
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sThee nxtslaioaepn neatr .etgra It ndtseo eylrla ehav uhmc to do wtih ARSA iiant.tavoc It sha maltos ygrieevnth to do wthi a nneeomhpno eldcla teh kilnalae t.ide In inhocrc nimito,vgt yuo lduwo xepcet lC- ot be low adn =K to be owl islmira( ot abl suelstr ni eesomon wthi )ul.aeilbm oT mtonspaece rof het owl ,-Cl eth ctmasho sha an otrnrepiat ihhcw ehcaxnsge l-C rfo -HOC3. oeTfre,ehr l-C wlli eb idlneheespr ni eth mtshoc,a ilhwe O3H-C iwll esiearcn ni teh dbl,oo gucnias na aa.iolsskl nI otclailak taste,s hte /++HK toranpetri illw gnieb ot itvaeatc, hsiintgf K+ NITO clels ao(hiy)pemkla adn rceiginsan Hp. SARA yalobrbp pysal a oelr in akinmg teh aapykelihom osrew ubt teh aliklena idet si erom mtitanopr eeh.r

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spaceboy98  nIts likenaal diet tedlrea ot na enscaier ni pH taref esa?ml roYu lgico si no iotpn ubt mI' nto uesr wrhheet we acn ppyla thta pcnceot .reeh +1
kevin  cptneoc acn be ieappld heer ucaesbe ew ende ot lteepre het Cl- ni rdore ot tecare l;HC teh maosthc ston'de earc fi l-C si owl ni r,emsu loyn hatt -Cl is olw ni hte ltraeipa lcsle nda os wlli pmup out 3-CHO ni tis epeexsn +
usmleaspirer  hwy si K+ o?wl +



 +6  upvote downvote
submitted by โˆ—hayayah(1212)
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ihtW rinhocc to,nmvigi oyu seol seocttyeellr nda a lot of di.ca It rigtserg ltebicaom alolikass ihchw is yhw lla hte semur slveua are olw r(o no eht erlwo edn fo eht ormanl rgena) petecx rof naia.bertobc

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ergogenic22  desadecer K+ m(rof airnedsec RAAS ued to uevoml )lsos dna cedsdeaer C-l ls(so fo lCH rfom het m)sathco, oisaksAll orfm loss of lCH and utsh ghih crFi .b b aor stih senaor high to mdi nraeg K is rngow +5
sbryant6  u'ndoWlt ceadeinrs ASAR eald to redeisnac N+?a eTh nrsaew hwsos eardsceed N+a. +3
sbryant6  Ao,ls eremebmr miuBail srNvaoe is aasoticsed thwi eaah.yopmikl +1
sugaplum  so the narge heyt gaev orf K si -?36 so .32 si NLW enh?t ro rea ew just gpinertao no t"i si on teh rolew edn fo rnloma ni "epds +2
dbg  ousdmi llesev ni liyopcr tesssnoi yvra, hgtnnoi arelly l,cssica cna be hihg as in sith asec liypsm eud to toiyr,hadn anc wol ni ehtro acsse fi oenreadostl aagemnd ot eevresr taht ot eht ohtre rxmteee +1
skonys  ihepHcryo",mloc ieaypmkolch timbolace laiakosls si the asiclcs erclltyetoe dna ads-ciabe cmliebana of plyoric sset"ions omrf spmecdae hebdin pyatlmoiwalinV.g = vmuloe loss ec(d snik rtu)og sa lewl sa sols of ,H+ l-C dna iw+hNta( H02) t&;g- bcMtileoa .loalksiAs oLss of +H sucesa eacensir HC-O3 nriotente as elwl as K+ thifs tion sellc oapaiheklm(y FA91 5)78. +

From amboss: The loss of gastric hydrochloric acid from emesis results in increased bicarbonate concentration in the blood and decreased chloride. Some potassium is also lost through vomiting. Hypovolemia leads to an activation of RAAS, which exacerbates metabolic alkalosis via increased bicarbonate reabsorption (as a result of angiotensin II). Aldosterone also causes renal secretion of potassium and hydrogen ions, further exacerbating both hypochloremia and metabolic alkalosis.

+10/- smpate(20)


 +5  upvote downvote
submitted by โˆ—masonkingcobra(408)
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In iceolatbm ssail,okal spoitsmua emvos toni eht sllce

Teh lsso in lomevu hgtouhr emeiss tgirsreg RSAA uintlsgre ni daeicrnse endrootsAle aleeres nad rreufth usstmoaip oxetcienr

bttn/i.ee:/ptal6tww/.tew/1hasp1d

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 +3  upvote downvote
submitted by iamapotato(3)
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No oen erhe bertdhoe ot yualtacl icssdus a'swth ggnoi h.iTo sn is a mho1nt- ldo bwnerno.

He mtosiv ftera g,nefdesi d5-ay rsotyhi.

At 1 omnht old, whti vmtngioi after e,ifdsegn it si somt illkye a aecs fo PIROLCY ISNEOSST edu ot prheroytyhp fo teh opcilyr prnehscit (salulyu uosccr 6 weesk .tear)l

Deu ot him iigomtvn shocatm nn,otctse eh illw OELS l,-C ,K+ adn Na+.

He lliw OSLA esol +.H hsiT si why you og otin het cimaeobtl aoillassk htiw a ttnsrueal csierane in eht .HOC-3

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kamilia20  s:ct:heky imotginv saseuc osls of ATWER errteag hnta douimsโ†’ ncasidree esrmu odโ†’ismu SDAEINREC rumes solo,lmyiat So AN will deaeesrc t,oo utb no ttah raf +



 +1  upvote downvote
submitted by ark110(1)
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But hatw si teh cefdnfieer tbeenew intoop A nda oopitn C 31(;2 ;49. ;90 35)

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sympathetikey  +K ldnhots'u cas.inree t'Is mviong toin lclse ued to bmlaeotci lsikl.aaso +
home_run_ball  In het leaaptri elcl of eth hde sr oycnmoHga t sino era demrfo mfor het siiadoosictn of icnrabco cia.d artWe si a yevr irnom ruesco fo yrengdho nois in nariscopmo to bicrnoac i.adc bnirocCa iacd si rmodef ofmr bnaroc iiddxeo dna awret by biarcnco sdraee.ayh h Tn iboraaebcnt noi 3)โˆ’(HCO si denagchxe rfo a odhcelri noi l(Cโˆ’) on hte aasbl dise of the lecl nad het abobtaerinc eifufsds inot het vsuneo olb,do dgniela ot na akailnel dtie nmhnpeoeon. +1
ergogenic22  RASA ncaeseris fomr oulevm sls,o dna htsu orme ldrenesaoot lseda to low K+ +1
sinforslide  Teehr arsenos orf hyoieaa.kpml ri tFs, emso +K is lost ni stagric .ludfsi S n oced, +H sifhst otu of sclel adn +K sihstf noit sellc ni ilmceotab rii lo,dask ahsTl. CEF levoum trocnonitac hsa uaedcs aensdrcie trceieons of dontrea.eslo +3



 +1  upvote downvote
submitted by โˆ—rainlad(33)
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cmlrip,ehooycH ocmypikhael olcimeatb oalakssli is het cailcss ttloeecylre and ebda-aics elbnimaca fo yoirclp ssnseoit.

ietPresnst imgtnoiv tueslsr in slso of lHC. The iehcdlor slso tsreslu in a olw ldobo icdhelor vleel ihhwc sipiarm hte yeinksd' tlibyai ot erextec icro.nbbtaea hsTi si the rtcafo tath nevesrpt toerccnroi fo het sallaksio ailndge ot imcolbeat .saikaosll

A drseacoyn hrdesymsrailpenoto dlesovpe ued to eth reddeseac ldboo mouvel. ehT hghi anselrtdoeo elvlse aceuss the ndkisey ot erniat N+a ot( rctoerc eht iatrscnavaurl lmovue tdiel)n,ope nad extecer endecrais onaustm of +K nito eht nriue u(lgrnesti in a owl olbdo lvele fo pota)uiss.m

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 +0  upvote downvote
submitted by thefoggymist(12)
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I nod't tge hit.s onlutd'hS eth keyndsi attsr ncrrtciego het rbbaic llseve rfea 5 ?adsy eTh ddyelea eapsh fo eth ccrroeinot ceisn tyeh aket e..mit. nad in eth eotsunqi h'erety agnksi we"oWn ". avhe iemctloab alsilsako nscie CLH is o,lts so the obyd lilw try to roretcc ti stfri yb nvirtoyatehniepl nad relta by cseadneri nerotixec of i.abrcb rcbBai usolhd eb o.wl.. uess(ln m'I nisgism getonismh ued to bgnie xsuehe)atd

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thefoggymist  re,vdNeinm I knith I got i.t atBe nrtltceedaai clsel natcno oninftcu adn rxeecte bricba ucbseae we o'tdn heva heordc.il Yea rapetnpaly I was sehex.udta +



 -3  upvote downvote
submitted by โˆ—amirmullick3(76)
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Very aeys u.iotesnq nliubosiNo miotv. 1 nhmot .aeg tMos likeyl ncseirao si yroclpi .iseotsns

hTe nitgvmoi eacsus ssol fo lCH os ew eavh eth oh,rmailpheyoc dan aelnr snaocmonpiet orf htsi H loss b ysi errsipngev optnros at the eespexn fo K os taht visge mikyal.apeoh As teh esdsaei si ena,dm teh warrrd eo ni eht eimag of eht aohsctm si hsomot emlcsu peyrhrotyhp fo teh rcloypi isuurscmal es,mucoa tfroehmg ni pde-elasihov asms ltef on linpotpaa. iThs is a ocialembt ilssakloa escbeau totwuih Cl-, eth a3lo alHOs/trabCCle hxagencer will ton ,work so yuo ratine .3OCH

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