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Retired NBME 22 Answers

nbme22/Block 1/Question#1 (reveal difficulty score)
A 66-year-old man develops worsening ...
Dilution of serum sodium due to ADH (vasopressin) secretion 🔍 / 📺 / 🌳 / 📖
tags: RAAS

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 +23  upvote downvote
submitted by imgdoc(183)
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I ktnhi alto fo oepepl ghimt aveh rove himeazsedp woh antrmtopi ANP and BPN lrylae ar,e yes it si mprnoatti to wokn hetes itpedesp gte tedcerse by hte tlca/uirarvlnreait omcaymruid rdignu rthea fua.leir orHveew hiret orlavel tnieecsesfefv in ettrgani areht efariul is hzicl, a cporetpre dlot em htat fi APN dan BNP rewe so ueflus ni erarnissiut then wyh do ew vgei u?criidste 'Ist eecusab AARS eosowrevpr htsi tsyesm cnhee sunicag itveeang tcsffee dan teh lsneesd polo fo aetrh .rlfuiae KAA yhw ew ivge AEC hotrbs.iini

nnKwoig tath APN etgs dazueteilnr by the RASA tsmyes, we acn tfhis oru cuosf kbac ot hetar ufeirla ni sith ptetn,ai eehrw cacaird uutotp is r,esdadeec lgadeni to ADH tcreeosin adn lyaflni iitdnualol p.yitonaehram

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almondbreeze  a epnoctc ocotyiunslnu deezmisahp by w,u tub I tge awsaly wgrno ':( +4
almondbreeze  doog wokr n!doe +1
raffff  wyh eods het ydbo kmea apn at lla sneci sit os ulseses +4
makinallkindzofgainz  fffraf@ - at setal PBN igsve us a dogo rkarem ofr taerh lureiaf xcetrbasaoeni :) nshtka bdo!y +1
mannan  Yhea s'it manroptit alcnilliyc scaebeu it sah a ghih viitssyenit f(i ,tnvigeea lreu o)ut rof Hatre uif.laer +1
alimd  tA teh mesa imte PAN tnihisbi nerin rl?aseee +1
freemanpeng  fI ti si iHhg A,RSA lAdo stum be High as eIAlIwg(ln iedncu loAd eorm naht )DH.A Then atth lwodu be LSTAW-TERA teinnrteo rtaher hant REUP AEWRT erotitenn. NO yaenpoitrmah +
plaguedbyspleen  Tish itpneta is gda-hicrntpis and feeoertrh ash wol eetivcfef grucaiitnlc emovul. I klie to ntihk thta vgine ihs VC hirotsy, he is lbboyarp no na ACE oinibriht or sigmehont rsmaiil. So that aeselv HDA ot od sti hn.gti oAls high etralnosedo avisng tlas st'in ohtismneg ew ened ot niodesrc nivge eth mest dan sewrna .hcoices +



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submitted by meningitis(644)
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I sloa utohhtg het emsa sa bubseb@l, ubt now yirgnt ot ys""ufitj sith kyicrt MNBE qiueson:t I tkhin ihst eoevlrvs on teh fcta tath the atetnip sha a HGHI lobdo srsrpeue ainegnm ew hsluod ufsco no na srawne tath einlaxps hbot caierneds PB nad iovlmpeaoHy i(:e. acsrieden HAD hiwhc rasctoiscotnvs nad also ssbbrao wertfree,-a obht fo hichw icnarsee PB nad scuea meyvli.ooahp)

Meaby if tsih tpienta erew patodeecsdnme twhi WOL ,PB neo ocldu iktnh mreo abtou PNA.

I lslit nhkit itsh tioesuqn si TOO irykct.

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meningitis  or,yrS *haomryteiapn r?tgih +1
mantarayray  I hknti taht its' not ANP eecbuas NPA will uaces a ossl of Na tbu aewrt wlli wloflo yt(eh ylusaul go thre,toeg) ewahres HAD lwil ucsae sbnoptiaor of nyol ratew adn will eucsa arhiyopemant texpce oynl tghuhto ihst tpso itggten eht suienqto gnwro "): +5
mantarayray  spoO rrsoy eht fttamirogn si o:inscgfun I ihktn atth sit' not APN csbeeua APN iwll scaue a slso of Na btu ewrta iwll wofllo eh(yt uusalyl og erg)heo,tt wsheaer AHD ilwl uasec boospntair of loyn wreat dna iwll cueas eoanpmryati.h +4
pg32  tnyaa@ram eypttr sreu yuo aer hgtri nda htta is hte olny ayw to gte ihst ntsqeiuo .ecortcr rimeemenRgb taht aN ntntnrccoaeoi rlealy is a esreaum of rawte abcalen si y.ke fI het tp is rm,iphyeatnoc ahtt stuj names etyh ahve oot umch awert ni eht b,dool wchhi is daecsu by HDA. fI eth entiatp asw ChMV,pOyoEIL that htgim eanm ehyt are losgin oot mcuh .aN shi T si tileadtruls by tsp hwti DAS.HI heTy rea ohtnapcmei,ry ubt umeloc,iev egnnmai atht tyhe aveh oot umch twera noyearha(ipmt rofm teh HAD) but eihrt aN blaacne si ok edu( ot tceroinex of Na avi A)NPN/BP +1
avocadotoast  eW dnee ot eb nikihtng utboa ohw hrtae uealirf is a inontdcio iwth a olw teveiffce gacuirtnicl .muolev rOu tinapte ahd na IM nda own shi areht tnac kepe up with teh mlveuo wlo( O,)C nelagdi ot nto.eingcos hneW sninoegtoc cro,suc ewtar is uhedsp tnio eht ltntriaitise acspse adn tsni' rucctgliain in eth tralaeri tess.ym For htta no,ares het obyd pamrs pu het SRAA dna AHD dsiptee an utalac siarceen ni boyd awert. Tsih si a -cstinmonoo saereel of HDA. At shti otipn amspla oumisd sveell rae rieentdemd by ivlrteae iktena dna soelss adn toiaparyhnem is oomcnm ni thees aiepnstt uebesac fo tat.h ,olsA PNA adn BPN 'notd lhod a alcden ot hte SAAR. +1



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submitted by nwinkelmann(366)
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moFr pUDtaoTe: OENSSPIHAGET

eiLk omst theor ecussa of aapiorh,teynm heatr uaelfri ripasmi teh itilbya ot ectxeer engstdei rteaw yb rnsiicngea cinaeidittur nomeorh lvlse.e When raccaid tupuot dna etysicms oldob preeusrs rae cuerd,de melivh"pcoy"o ohn,mosre scuh as niner itw(h a sbueeuqtns esnreiac in estinnaoing II faomit)rn,o uiniittdraec ronhmeo D(AH), nad rhnronnip,eepie osdrepn 3-1].[ lgthohAu doeteuasm petastni itwh rateh reualif heav redecanis lsmapa dan ealcurlxlaert ufdil s,mvlueo eht bydo eesepricv umoelv pndiotele cudeder( vicefftee railerta odobl emul)ov iescn hte olw daicacr ttouup derscseae eht rpeeruss usipgernf the obaeretrcspro in eht ractiod isusn adn eth aernl nrftafee ertT lhoei.era deeegr of meoaurunrohl ivaoaictnt is nyalregel terelad to teh tvesiyer of crcaiad tndiofnus,yc sa seasdsse yb felt cntiaurlver oijtcene arnfcito or ifnctuaonl ssacl ]2[. eTh hemralouonru segcanh tilim htob osmdui dna rtwea rotnecxei in na eptmtta to urrnet seunfoirp esusrepr to .nlmrao DHA eeerlsa dcyeilrt heannesc ertwa aserpornbito ni eth gntcolelic l,useutb ewsahre goininasent II dna riipnehpnnereo imtil atdlis awtre yveeidrl nda( tebhyre raetw )recntoeix by ilwregon het gmoulearrl oialfnttri taer (due ot a dmarke otucienrd in aenlr )rinesupfo nad by gnsceinira rpiomlax siodum nda etwra onteapibrors .4][ In it,onddai btoh hte lwo ccdraai ttouup nda ighh itsngionnae II ellves rea eptont miisult to ih,trts igaelnd ot anhndcee ratwe iakent.

oraet-Htee-ymctwttnhpiaea--/snnranhoi-/twuttmiifure.pwa2#shshwpeiatl/odt.p/co:tn

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 +3  upvote downvote
submitted by bubbles(79)
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Tihs uiqteosn foecsdnu em a olt saueebc so yamn tsoisuqne vhae rlddlei me on the nmroatpcei of eht NAP eecsap ceimnahsm in smtei of lfuid eodlovar s(a in F)HC.

I thhutog PNA saw a guhe aelpry ni het lsso of aN in iratssecmcucn of vluoem aoroedvl sa in tshi ttpniae hi(chw si wyh yuo ees uolcvieem aatpnOemihyr in tpnitesa tiwh ISDAH or tiytivcoarev fo hte RAAS as ni FC.H)

yhW is ADH nwo egnib mnead as teh lnerissoepb g?atne

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jooceman739  yM hinkngit si that NAP cauess ntei,rrsiasu so y'euor gosnil stla nad twrea ta hte ames imte smoc(ooisti )dliuf.? ilM,heewan DHA ssbbrao onyl free tear,w os it udowl uietdl the rrme e.otrc C us me fi m'i w.rogn +13
bubbles  hhhO uoy are rihgt. nkhaT you rof eht aio!pnxetnla I tgo so afdietx on thta eno ncmhaesmi hhaa. +4



 +2  upvote downvote
submitted by dr.xx(176)
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FHC tpsetain oetnf daislpy gssin nad tmmspoys fo sreinaedc raseoivnssp ctoenes.ri

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hyperfukus  if lal else lasif i hpeo i tjus lidlr this neo ttnemaest ni my brani nda it coesm tuo ni teh tigrh awy no estt dya hnkta !!!u +1



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submitted by drmohandes(193)
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ereH ew :go

  • eardcseed VL occyrliitattn rltlae(iba ca)scekrl
  • sdedrecae aircdac tptuou
  • tateavic ARSA → HAD
  • aecirsne ceiypmhtast tvitcayi → roem RASA → orme DHA
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 +1  upvote downvote
submitted by moloko270(77)
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8ib0/.lug..tbh/e/i7wmwn2om2tpnp5nc8.d:wsvh/

myosnd"re fo "oudtlilian ho-olmisy"ayptlo ni esreve nsiecevtgo tehra luireaf may eb esacdu yb an irpiportelapayn hhig DHA torsnceei in ihhcw hte eteosmcpoorr essmty si eotdmandi yb rnloonsmoa miults"i

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hayayah  A,prypalent in orcnihc FCH oyu ees antmaohrpy.ei eeBasuc FHC cssaeu a raeedsce in acicrda ptoutu dan ccgiliantru odblo l,umeov wichh in utrn rterigsg a npooymcesrat snersope iedam ta ernrpsvegi loobd .rrspuese hTsi sutasmietl het oybd ot arteni hobt rweat dna .mudsoi +10
seagull  i graee twih .yyhaa.H.a het AARS sesmty si vteiatdac due ot orpo ofeniuprs ot the dnikey ude ot eopcmd aerth ul.fiare +6



 +0  upvote downvote
submitted by nicsar(1)
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pHyernamtoai omrf uerltaiaeHrf tp.

tI dsholu eb ohperdaapc fmro tHaer earfui.

H&-g;Ft RsAA -;gt& viecsxsee Asdeoorentl, HDA; NPA peeacs eifur,a klei deoncrasy oips;nraedemrlsytho otaaprHymein

/t9w/-9/.10/1.gwCcs-/-vJ8hw9l-/p/63.umW7e4m0g5j2i41t5olfn:tthw

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submitted by dubywow(23)
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oeDdcsnmpaete HF. cLak fo lbdoo owlf eud ot ilfigan ertah ;>- orlwe BP ;-> ricedsean AHD to ceenrsai obdlo ursseerp cabk to aelbst l.elev nI D,HF HAD toupaecs sshitameoso fo cotcgnrnauite APN a&m;p NB.P Ths,u eth term dneop""d.eamcest aitsecAods hitw nressthso of ret,ahb damee fo(ent fo .lgnsu)

Tihs oiusvci lcyec necniusot sa oydb ipiesirrtoz udaqetea PB for lvasv,riu btu it omcse at hte snexpee of rvoeoderkw taerh hatt smtu korw erarhd nad rrhd,ea lyamiueltt xeabagtercni the rheat rifeula ont.niciod

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submitted by asharm10(37)
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salwAy know sthi Hopy ro manarpieerthy si aeucesb fo gnchea in the loemu,v thsi tteinpa si ngigo ghtohru hreat faierlu, lnear fsniupore has ngeo down htat ldsae ot eerslea fo DHA osc fo cmooesrtepsor itlti.aonmus woN hgih DHA wlli bsbroera eorm feer atwer thta lliw alde to ort.aehynamip oS rptamoyahnie is almtos salywa adlreet to ghhi .HAD I nowk wfe of you iwll nikht utb ASRA emtsys is aedtcvtai too utb ttha brsboa aN nogal thiw aerwt tub DHA juts free .atwre

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submitted by hello(429)
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erhTe sah to be a eetrtb pntlxainoae orf hyw APN si nrg?ow

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waterloo  fI hsit stp' A/NBPNP wree nasiucg hmi to ebocme ecomipyat,nhr hwy osed eh aevh liduf oedvolra pomstysm lleat(rabi ,cklecrsa JV,D ghih P?)B Terhe ahs ot be isnmthgoe lese ceoovgmrin eht ANP stm.eys +1



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submitted by happysingh(57)
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i inakd of lefe "odd" gainks sthi qienstou : but teh tteniap adh an MI 6 stnmho a,og so ywh dluow ti eb eulklyin taht eh was dtlo to icte"trsr s,lat rctrstie lifusd e)tw(ra " ??

ueGss hwat mi' gskani si : thaw mseka ciheco E shcu an nkyuleli cehico (JDV, a-bsrbalii ,cerskacl erihaplepr deme)a ?

a;m&p gns@ieitmni : his pb is 35/812 Hmgm ... why si htat GHHI"" ??

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submitted by freemanpeng(7)
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,ytFirsl I oechs .DHA nWhe I ughhtot tcwei in rve,eiw I edkpci soredsc HDA dna eipdck .yA MPN olgic ot csosr AD1. :H The naim cdeunir fo DHA are mOs dan P.l/oemvBu THsi tp, msO vloyibous tno h,igh Bp iouyvlbos not l.ow So, enenossn ni idneserac ou HA.YD2. yam see nIgAI loas usidenc HAD. utB ti meess to eb a oirnm e.druicn lnwiMeha,e fi ti is axeclty hhig g→AIIn hgih .HAD ,nheT doAl muts eb ghhi sa lwe,l dan hHig dloA ta→Sl vpsrni→rege OWH CNA eursm miSdou be ?LOWw L"o acidrCa tu→ptuo hgiH SSRA AngII( odAl )DHA" yptahaw si IRMSA-WETOUD i.otnteern ONT peru WEATR es teneotrelniaP erroctc em

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