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NBME 21 Answers

nbme21/Block 3/Question#33 (61.0 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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eht ajimtyro fo rabcno ixieddo eollucmes ear aecdrri sa rtpa of eth aonbirtabce ubreff emts.ys In tihs y,smset raobcn xdiedio ifeusdsf tnoi eth Cs.BR biroCcan drynhsaea )A(C ihwint CRsB ilckquy cvtensro het rcaobn eddioxi niot caorbcni acdi C2O3).H( Cibaronc aidc is an aslbeutn naemtietdrie ocmeuell htat ymilaemdeti stdiiacsose otni ibrotenbcaa nsio 3HO()C- adn rnhgeody +)(H o.nsi

heT nywel szstendyhei cabaeirbotn nio si tarosprtdne otu fo teh BRC ntoi het pmalas in eecaghxn rof a dilreoch noi βˆ’l;C() htis is adlcle the iehlordc ifts.h Wnhe eht loodb srhecea het snugl, hte bcbaoneiatr oni is ernatrdopst akbc onti the BRC in hgncxeea for eht ihleocrd i.on heT H+ oni aisdesitosc ofrm eth nbogohleim nad dinbs ot het tbceabniaro ion. sThi serodupc eht obcircna ciad eedtnmre,iita whcih is evoecndrt cbak tnoi bcanro idoxied tuhhogr eth eznmyitca iacnto of .CA eTh rnbaco dioidxe ddeupcro si eexdllep ughotrh eht slngu urding txaioe.hlna

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 tgutohh uthgtoh iaurmegsn a sga in the doobl lyno msseareu iartpla reesrspu of edovsldis gsa in hte lobod

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