NBME 22 Dilution of serum sodium due to ADH (vasopressin) secretion (NBME Answers)

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

+23 upvote downvote
submitted by ∗imgdoc(183)

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I nthik aotl fo lepepo gimth evha rove mshdeazepi who otpimtnra NPA adn BNP ayrell ,rae sye it si tamionptr to wonk etesh dptespei gte ecteedsr yb hte ativautre/rlnlcria aimmrodcuy indurg tarhe l.aurife werevoH ireth voralle veifnsfeectse ni ntaegirt rhtae leurfia is ,iczhl a cteeroprp dtlo em htta if PNA nad BNP ewer os fseulu in iseaiusrrtn nteh ywh od ew vgie ucirs?idte tIs' ebescua RASA wpvsorreeo sthi estmys ecneh ngcaius negveiat fceefts nda the ldseens olpo of ehart .faireul AAK hwy ew iegv CEA .iinsohritb

ninwKgo htat NAP gtes lreduenzait yb hte ARSA s,temsy we anc shfti our usocf kcab to threa efaiurl ni tihs ,etatnip ehrwe raccida putout si a,eseecddr aingedl ot HDA rsceneoit adn yllfnai aidtluonil ehopiyanmtar.

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almondbreeze a cpeonct cunoniosluty zesmhpiaed by ,uw but I etg aylwas gnorw :'( +4

almondbreeze dgoo krow od!ne +1

raffff yhw osde teh ydbo ekma npa at all cinse tis so slsesue +4

makinallkindzofgainz f@arfff - ta salet PNB esvgi su a gdoo aekrmr fro erhta raliuef rsbtacxienoea :) tkahsn odby! +1

mannan aYeh 'sit toiampntr lylciliacn sceaeub ti sah a ghhi tisyetniisv f(i a,niveegt erul t)ou rfo rtaHe al.irufe +1

alimd At hte smae itme PNA iihnstib innre ?leraese +1

freemanpeng If ti si gHih ,ASAR odlA utms be High as AgllnwII(e ducnie lAdo rmoe hnta .ADH) hTne ahtt duowl be SAELT-ARWT eritenton erthar nath REPU EWATR otn.erteni NO ymprthaieona +

plaguedbyspleen hsiT tpietan si htn-pcgasidri nda treheeorf has low ceevfetif agrtncilicu ov.umle I keil ot tkinh taht eingv ihs VC h,itsyor eh is ylobprab no an EAC tiihiobrn or itogsenmh isia.lrm oS tath seeval HDA to od tsi git.nh oAls hihg ntsleaooder sngiva tsla n'tis tomihgens we dnee ot isrdnoec ignev the tsme dan sarnwe hci.ocse +

+12 upvote downvote
submitted by ∗meningitis(644)

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I lsoa totuhhg the ames sa bblsub@,e utb wno yrntgi ot tfyj"si"u sthi ykcirt NMEB inetuq:os I inthk siht serevvol no hte afct thta teh neatipt ash a GIHH odobl rrpsseeu nieagmn ew ldohus fosuc no an ansrwe taht aispnxel btho rideecsan PB and iovpmaHleoy i:(e. isceedarn HDA hiwhc sanccoivtrtoss dan losa rassbob tafe-,ewrer btho fo chhwi rsicenea PB adn seuca mevhapiooly.)

Mbeay fi thsi tinptae rwee pmocntedsdeae twih WOL BP, eno locdu hknit eomr otuab AN.P

I tilsl nkiht hsit tiqsuneo si OTO c.tryik

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meningitis Sy,ror oiyapmntha*er i?hrgt +1

mantarayray I ihnkt ttha 'tsi not PNA acuebes PAN liwl auecs a ossl of aN tub awter llwi llowfo tey(h lyauslu go trt,e)ehgo harwese DHA lliw sacue ibnpoastor of yonl artew and liwl ceuas maaiyrpnteho cpxete olny httohgu isth opts tgegtni teh enoqusit rwngo )": +5

mantarayray spoO yrros teh imatrnfogt is gifocuns:n I thnik htta its' ton ANP cebuase PNA ilwl esuca a ossl fo Na but rwate liwl wlolof h(ety yaululs go gheoet,)tr wraseeh DHA ilwl csaeu oonstiapbr fo only ertwa nda lwil usaec .ahmtneyiropa +4

pg32 rtyma@naa pyetrt sure uoy ear igrth dan hatt is teh only ayw ot get sith uqtnieos .ortrecc mgnebeRremi htta aN etoncnocranti aellry si a mseaure of atwre aanlebc si yk.e If eth pt is ayorhcemnt,pi tath sutj saemn htey ehva oto cmuh rtaew ni hte d,bool iwchh is ucesda by .HDA If het iatnpte was ,VMEoOyLIpCh atth gmthi eanm tyeh are losnig oot uchm aN. iT sh si rlttsledaiu by tps hitw .AHDIS ehTy era moriht,npecya btu o,mecliveu nemniag ttah hyet eahv oot cuhm ewart rhoynpia(taem mrfo het A)DH tbu ethir aN ncaebal si ko ed(u to ectnioexr of aN iva N)/PABNP +1

avocadotoast eW nede to eb ntgkiihn batuo how aetrh ifrueal is a oticnnoid thiw a wlo fetcfevei ciuangirltc mluveo. urO ipantte dah na MI dan nwo ish treah tcan keep pu ihwt the oulvem (wol )CO, iglaned to ngsoin.ctoe hWne osicengont csuc,or wtare si dhesup tino het tsiniltiaret epsacs dan s'tni itnuccailrg in eht erratali symes.t For htat oesar,n teh dbyo arspm pu eth ARAS dna HDA eesdtip an acualt eaercsin ni odyb taer.w sThi si a -cootnoimns esalree fo A.HD At tihs otinp pmaasl osidum eslvel are mdnredeite by valieret tiakne adn seslos nad nhtripaymaoe is mocnom ni seeht ntaispte eaeusbc of .that ,sAlo APN nad PBN ndto' ldho a cdnale to teh R.AAS +1

+5 upvote downvote
submitted by ∗nwinkelmann(366)

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omFr opUe:atDT NEPGOTEAHSIS

kLie tmso hetor ssueca fo iyehptamorna, tahre lairuef iramspi teh biytali ot eeecxrt enitsged rwate by nrgenciisa ticdiuneitra noehrom vle.lse neWh dciraca tpuout nad mtyeicss lobod ressuerp rae uer,cedd o"veocpmhly"i oehrn,mos hcsu sa einnr htw(i a teesqsbnuu rceneisa in igennnsaito II )om,rofnati indtteriuaci omnohre A(,DH) adn eeeppr,noiirhnn dpenors -[].13 hlAuothg oesdaeumt itptasne hwit ahret fliaeur hvae sedcraeni pmasal nad lxureaetlrlca lufdi l,musvoe eth ydbo pcieresve olmuve enedolpit cd(reued ivfeetecf iarelrta ldobo mu)vloe ncise hte owl iraacdc uuoptt seersceda het suesperr rpufgnsei the ectrrropbseao in eht adcoirt usins nad eth anlre rfafenet ieTaletr.r eho edrege fo mhoeauunrrlo ivaatcnoit is enlareygl rtaeled ot teh yvrestei fo cracdia douintsyc,fn sa esassdse yb flet irnreclavut onctjiee nifroatc ro auoctfinln scsal ][.2 The rurahueoomnl acehgns timil tbho imsoud dan etwra toeirxcen in an amttept to reurnt rpoienfus ersrpues ot o.marnl ADH leersae yercdtli echseann artew rptiaobrones ni eth teiclngocl su,btleu wsharee giienansnto II dna nrnihpeeropnei iilmt adilts ewtra dleiyrve (nad tebyrhe aterw cxonrete)i yb eolriwng the rlaorugelm talnoftiir raet deu( ot a maerdk citunodre in ernla osnpruf)ei nda yb scenrginai iaorplmx dsimou dan rewat rooinprabtse ].[4 In a,nddtiio btoh het wol riaadcc pttouu adn hhgi nentnsigiao II eesvll rae tnetop liuimts ot ,thitsr dgienla ot nehadecn etawr ki.neta

n-/emwnpis-ot-wncw/ht/wuiaeH/hiho2layreectsa-trinft.poopta#atp-tuamne:i.strtdeth

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+3 upvote downvote
submitted by ∗bubbles(79)

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sihT noueqsit escduonf em a olt uesaceb os aynm sonetqsiu hvea idellrd me no the tmpcoeiarn of het APN scpeae scemnhima in smtei of fidul oledoavr (sa in )CF.H

I tghohtu NPA wsa a gehu leprya in teh lsso of aN in cmtcsresunaic of ulevom olvedroa as ni iths tetanip (iwhch si ywh oyu ese omveuciel irayhtnaOmpe ni asnettip twhi AHDIS or taicrvevoyti of eth ASRA sa in .)CFH

yWh is HAD wno geinb edamn as hte onpsieelbrs get?na

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jooceman739 My nitignhk si thta PNA aucses ressi,ruiatn so oy'eru ionslg slta nad watre ta eht eams emit soitcsoomi( d.uil?)f hwneea,Mli DAH bsrbsoa lyno refe ra,ewt os ti wlodu deluit eht se.et r rCurmoc em fi m'i gowr.n +13

bubbles hhhO ouy aer t.higr hkaTn uoy rfo eht ponl!exnitaa I got so tdiafex on tath one anceimmhs hah.a +4

+2 upvote downvote
submitted by ∗dr.xx(176)

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FHC iepatnts feont ayldpsi gsnsi dan ptmysmos of drseneaic rpiesvasosn .rcisoeent

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hyperfukus if lla eesl slafi i ohpe i just rildl isht neo tnetmatse in my narbi and it mseoc tou ni teh tgirh wya on stet yad tanhk !!!u +1

+2 upvote downvote
submitted by ∗drmohandes(193)

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eerH ew og:

rescdaede VL crittcnoiylta tlrb(aliae caskr)elc
deearesdc aciadcr utotup
icvataet AARS → HAD
ieanscer hmtiayctpes avitciyt → mroe SAAR → mreo HAD

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+1 upvote downvote
submitted by ∗moloko270(77)

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bps:.ne/l/mb82pvuti0w7m/2wh5oc/.nhd8n.witg.

nmosdyr"e fo iuaidot"lnl mahosloot-ylip"y in sevree cvsteengio ethar rufaeil yma be ucased by an aplyiptrnpiroea ighh HDA cnrteosei ni whhic eht eomtorceprso ssytem is dndaiemto by msanloonro u"limtsi

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hayayah rptlpn,aAey in hrnccio FHC oyu see haniy.motprea cBsauee HFC eucass a craeedse in iadcrca ututop nda cirnctgalui oodlb umvle,o iwhch in trun rstgrgie a scermaptonoy onsseper deima ta iresgpnrve oodlb ps.uersre Tshi tlatssmuie het doyb to arnite obth twera nda .dsuiom +10

seagull i ageer iwht H.h.ya.yaa eth ASRA stmsye si atdtcvaie eud ot proo eonprsiuf to eth nkidey edu ot edmopc rteha r.fuiale +6

+0 upvote downvote
submitted by nicsar(1)

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Haaetrpnoiym omrf tufielreaHra .tp

tI ohusld eb dhcopaarep rmof trHae rfai.ue

t;-HFg& AARs ;-&tg secievexs seto,loAdren H;AD APN pecase ,eirufa like adnseycro htl;eoaemorrnsypdis ramaiyntopHe

i/wn7/gvch1h19W-948t/-//tC3t2p/g9ts6:w00fl-wm.u4e.j5wl/15omJ-.

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+0 upvote downvote
submitted by ∗dubywow(23)

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ncetDsdpeoema .FH Lcka fo oodlb owlf due to nigifla rheat &tg-; ewolr BP -&g;t dascnieer DAH to eaeincrs ooldb sersruep akcb to tbseal e.ellv nI DH,F DAH aoceptus haeotssosim fo utngatcoenrci NPA a;&mp .PNB hTsu, hte remt mt"cesnpedd"oe.a iAoeadstsc ithw hornestss fo rt,aheb meaed f(note of .)uslng

isTh oiivusc ceycl nouenistc sa bdyo zeiitirrsop aeqtdaue PB fro r,visuval but it cmsoe ta het expeesn fo vewderkroo tarhe that mtsu wkro hrdaer and rdar,eh tuitamlely eanbitgcerax eht rateh lrfeiua .ncotiidon

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submitted by ∗asharm10(37)

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awAysl wkno tihs poyH or aeeirmyarnpth is bseeuca of ghcane in hte mve,ulo hits netpait si onigg gthrouh haert riaeful, laern uiosefrpn ahs egon wdno tath sedla ot erlsaee fo ADH ocs fo opsrocsoemret na.ittmsluoi oNw high DHA illw bosberar eomr refe tware taht lliw leda to rme.ynoaipath So ayoehprintam is mtosal sawaly tdeearl to ghhi DHA. I wkon fwe of uoy liwl inhkt ubt SAAR ssmeyt is itteaavcd too ubt htta sabobr Na golna iwht traew ubt DHA just eerf ewtra.

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submitted by ∗hello(429)

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eTehr sha ot eb a etretb xlpnteiaona ofr wyh NPA is o?grwn

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waterloo fI tsih 'tsp NNPBA/P reew ncaugsi him to cmeoeb ynrhmptoeaci, wyh deos eh evha lidfu rodelvoa tysmsmpo eilbaatr(l raceks,lc VDJ, gihh )B?P ehe Tr has to be tonegshmi else crgnvomoie the NPA ytsesm. +1

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submitted by ∗happysingh(57)

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i dnaik of elfe od""d ansigk tsih tuqsneoi : but eht tepntai dha an IM 6 nhotsm o,ga os hyw oduwl ti eb yneilklu ttah eh was ldto ot secrtr"it ats,l ttrcseri fisudl )wae(tr " ??

esGus hawt mi' nikgsa is : wtah easmk ciheco E csuh an linkyuel hcoiec ,VJ(D i-sbbaliar akr,elcsc ahilerppre ademe) ?

amp&; iiismn@negt : sih pb is 8/1352 gmmH ... wyh si ttha G"IH"H ??

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submitted by ∗freemanpeng(7)

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rt,sFiyl I eoshc A.DH hneW I htutgoh wciet in v,reeiw I idcpek cosesrd DAH dan eckpdi My PNA. lciog ot corss .1HA: D Teh main nirduce of HDA rae Oms and /PoB.mluve iTsH pt, mOs yblisuovo ont ihh,g Bp bsuvoyoli nto .owl ,oS ennensos in adenecsri .2AD HuoY. may ees AngII slao iudcnse HAD. uBt it emsse to be a iornm reduni.c iwaehl,eMn fi ti si yaetclx hghi nIAgI→ ihhg A.DH nehT, odlA umts eb ghhi sa ll,we adn gihH dolA tSal→ vrn→iesrgep OHW ANC muesr mioduS be OL"W o?wL daaricC tupu→to giHh RSAS A(ngII ldAo DH")A awyathp si WIEMDSOAR-UT onieretn.t OTN uper EAWTR eonnaitetelPrse tcoerrc me

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