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NBME 21 Answers

nbme21/Block 3/Question#33 (61.1 difficulty score)
Left radial arterial and venous blood samples ...
HCO3βˆ’ transported in the plasmaπŸ”,πŸ“Ί

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submitted by hayayah(1080),
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teh atoirymj of acnrbo didoeix csmleeuol era aedrcir sa arpt of teh bibaecaontr ubfrfe nI stih e,tsysm bcnrao eioddxi duefisfs oint the BRsC. nbcioaCr eadsahryn A)(C twniih CBRs kyuqcli ontescrv the onrcba iieodxd ntio onccriba ciad 2C.O)H(3 Cboirnca aidc is an ublseant imeeardnitte eoullcem taht eaimdlymite tssicoiadse ntio brebctaaion snoi -O)H3(C adn oghrnyed )(H+ .nios

eTh wleny inhezdeysst ecirbbnaaot oin is sdetartpnro uot of hte CBR oitn hte pmlsaa in aengchex rof a eoirdclh nio l)(;Cβˆ’ hits is lalecd eth icerdhol fthis. hWen the odblo ahcseer the uns,gl eht ciaatnobbre oni is spordaretnt kcab tion teh BCR ni ngchxaee rfo het doeclrih no.i Teh H+ oin ssaicitesdo mrfo the ogelmbhnoi and bsdin ot the ratiecoabbn .oin sThi roepcdus teh bccriaon dcai remtd,eeiitan which si evcneotrd cabk niot abronc oixdeid htuhgro het incamtzye iaonct of AC. hTe bconra idiedox crpuoedd is deellepx tgouhrh hte gulsn durgin hioel.atanx

hungrybox  Amazing explanation. Thank you!! +1  
namira  in case anyone wants to visualize things... +5  
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +3  
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +3  
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. +3  
teepot123  fa 19 pg 656 +1  
surfergirl  "majority of blood CO2 is carried as HCO3- in the plasma." I guess that is all they're testing us on, just in a very convoluted way. +  

submitted by mcdumbass(22),
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I gotuthh tuthohg gasienumr a asg in het oldob lyon emsasure itarapl suesrrpe of edldvsosi ags ni het lobdo

schistosite  Yeah, me too...the fact that they expect us to assume that HCO3- is counted in their measurement for CO2 concentration is absolutely absurd. +2  
happyhib_  they tell you measured is around 24 and 22 or some bs but give "mM"; if you look at the lab sheet HCO3 has a units in mM and normal is 22-28 = they are not just looking at partial pressure's. +1  
an_improved_me  Yea,.. Suprisingly in clinic, when you are measuring important parameters in the blood (think fish-bone diagram), you actually use HCO3- as an approximation for CO2 in the blood (so you use the value in CO2 when calculating like the anion gap or something) +  

submitted by mafoo_xtreme(10),

For RBS's:

At the lung: Cl- out, HCO3- in

At the tissues: Cl- in, HCO3- out