invite friends ⋅ share email twitter ⋅ join discord whatsapp(2ck)
support the site ⋅ become a member ⋅ unscramble the egg
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 

NBME 21 Answers

nbme21/Block 1/Question#10 (24.8 difficulty score)
A 34-year-old woman is brought to the ...
Primary metabolic acidosis with increased anion gap🔍

Login to comment/vote.

submitted by ergogenic22(250),
unscramble the site ⋅ become a member ($35/month)

=-)OlN-aHC-(inCon+3a pga = 5014+-0101)( = 52 E/qmL

rnoaml rgnae ofr onnia gap si 8 ot 16 e.mfe,T/.reoqrLE.h pivietos onina

Hp = 52.7, amlron rngea .57-75..3..4 Teorrhfee sdisiaco

omNlar nabaotbicre 228-,2 eutonsqsi ssohw cbrabi of 10. ererheTof ibaecolmt diisosac

ldioidyAatnl CP2O olnlmayr 43-53 mm Hg, sietnqou ohssw P2CO of 32 hwit olnmar 2PO, ethfreore etroirsypra taomcnspeion

mambaforstep  why did the stem say she had a drinking problem... is that just a distractor? +  
castlblack  I think alcohol uses up all the NAD+ in its metabolism leading to increased NADH/NAD ratio. After that, TCA cannot progress and the cell is forced to use anaerobic metabolism, which increases lactate. lactate causes anion gap metabolic acidosis (L in MUDPILES from first aid) +1  
nafilnaf  She may also have ingested methanol if she couldn't get her hands on regular ethanol which causes an anion gap metabolic acidosis (M in mudpiles). +  

submitted by temmy(117),
unscramble the site ⋅ become a member ($35/month)

apseel hlpe cgrdaconi to snrwite uinteoaq het eintapt sah a aonmlr aionn agp

ergogenic22  winter's formula is to look at the compensation to see if it is appropriate. PCO2 = 1.5[HCO3-] + 8 +/- 2 In this case, 1.5* 10 (Pt's bicarb) +8 +/-2 = 21 to 25 Pt's PO2 is 23, so compensation is appropriate. If PCO2 was below 21, it would be concomitant respiratory alkalosis +5  
ergogenic22  in other words, winter's formula is not necessary for this question +2  
the_sacramento_kings  lol unless you want to make sure its not A. +1  
hello  @ergogenic22 Someone might use Winter's formula to rule out choice A. +  
maxillarythirdmolar  respiratory depression of alcohol should rule out "A" +  
baja_blast  Isn't the low pCO2 enough to rule out A? +