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NBME 21 Answers

nbme21/Block 1/Question#10 (24.3 difficulty score)
A 34-year-old woman is brought to the ...
Primary metabolic acidosis with increased anion gap🔍
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 +5  upvote downvote
submitted by ergogenic22(243),
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=(-NaColan-n+H-3)OiC gpa = 04011+-)(105 = 52 /mqEL

ralomn raegn orf innoa pag is 8 ot 16 TEL.rmerhe.eoq.f/, eivpitso nonai gap.

pH = 275,. onmarl rneag 5.7-7.4.3..5 reehTrfoe ssodicai

alrmoN cnoberbiaat ,2282- qosniutse owshs raibbc fo .01 reTfheero etlmoaibc iocasdis

Alaidodtilyn OCP2 llrmyoan 3345- mm gH, qesotiun shwos OC2P fo 32 hitw laonmr 2O,P eohtrfeer rersatriyop oconsmtepian

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). +  



 -4  upvote downvote
submitted by temmy(115),
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pseeal lhep cincdargo ot eintrws euaotqin the aipttne sah a mronla niona gpa

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? +