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Retired NBME 20 Answers

nbme20/Block 2/Question#34 (reveal difficulty score)
A 28-year-old man has excessive thirst and ...
Hypothalamus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—hayayah(1212)
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Pt has diabetes inspidus.

If urine concentrates with administration of ADH analog, the kidneys are responsive and the problem is with ADH production in the hypothalamus or release in the post. pituitary.

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hello_planet  FA 2019 pg. 344 +4
djeffs1  first aid (and my school) say if U-Osm doesnt increase by 50% or more, then its still nephrogenic. Not so according to NBME... +



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submitted by โˆ—sugaplum(487)
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These always tripped me up:
+ Polydipsia= responds to water deprivation, low serum Na
+ Central= responds to vasopressin, high serum Na
+Nephrogenic = responds to nothing, normal serum Na

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lynn  I think serum Na+ only depends on the patient's access to water. FA19 pg 344 says serum osm is high in both and doesn't mention Na specifically. Spent a while double checking for DI, but low serum Na for polydipsia is definitely correct. +1
drzed  In general, SIADH or polydipsia will cause HYPOnatremia, and DI (central or nephrogenic) will cause HYPERnatremia, but in the latter--as you stated--water access change the serum Na. +1



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