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NBME 22 Answers

nbme22/Block 2/Question#41 (55.4 difficulty score)
A 12-year-old boy is swimming in a mountain ...
Central blood volume: increased;
Serum ADH (vasopressin): decreased;
Serum atrial natriuretic peptide: increased


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submitted by keycompany(296),
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srA:wen snaIrcdee etlCnra odlBo Vumoel (BV),C eeaecrdsD DHA, Ianseredc PN.A

ehT hpyglilioacos serseopn ot reythamopih si ttinovcooasirnsc fo ialrphrepe vslssee ie..( the enos ni oury tiesreim)xet in an oftfer ot epek uoyr creo ybod eueatpretmr ,nmlaor nad uhst rouy gsarno tifnugicnno .epropylr ehrpiralPe ostcistnoVnaicor lwli scraeeni CBV. ecIednrsa CBV will easuc na naciseer ni a,dolrpe nda tuhs ueasc an snreiaec in NBP/ANP. PPN/BNA ahs yitionbhri eeftsfc no teh toiisniA-nednnrgeeontRenlsAo- ,sSmeyt urnigeslt ni ddserecae ADH.

gokings2021  RAAS is not directly linked secretion of ADH as claimed above. Increased pressure at baroreceptors and increased central volume sensed by the hypothalamus will decrease secretion of ADH. +3  
miniarnie89  another way to think about it is central vs peripheral blood. peripheral is now being vasoconstricted, so central things (heart, lungs, KIDNEYS...) will be receiving more blood. more blood in kidneys = less ADH +  
jurrutia  The excretion of free water also has an adaptive benefit in hypothermia (less mass for your body to keep warm). +  

submitted by yotsubato(968),
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Wath ahppsen hwen uoy og tion cldo awr?et Yuo epe.

wHo osed ihts nepahp.

ntooaccsiostiVrn of slsvees to vereresp ta,eh lslup tware ntoi usuaetvcral eud to ceeaddsre toytiardhsc esursrpe ni svl.sees oVumle sgoe ,up AHD osge ,nwod NAP geso up due ot sanircdee v.uoeml

submitted by bubbles(66),
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do'lntWu nrcotctiiosn of eaelprrpih eevslss asol rgtrgie lsccianhnp oiatnsntoriv,cocs ihhcw mtaeuisls anlre icamhesi and usaesc esedcainr ASAR tiaictyv?

drdoom  Constriction of peripheral (cutaneous) arterioles/capillaries in response to cold surroundings is an attempt to reduce heat loss & maintain internal body temp; it is not at all coupled with splanchnic vasoconstriction. In fact, the peripheral vasoconstriction is trying to “re-route” blood to more internal/visceral compartments; simultaneous splanchnic vasoconstriction would impede that very process! +46  
bubbles  Ah, okay! I got led off track because I had a bunch of super hard practice questions asking about hepatorenal syndrome and how the constriction of sphlancnic vessels might trigger renal ischemia. Do you know if there would ever be a time when sphlancnic vasoconstriction occur outside of hepatorenal syndrome? +  
drdoom  @bubbles i would think only in cases of catastrophic shock (when the body is doing everything it can to maintain central tension; pressure to vital organs like heart,kidneys); in those cases, i could see the body sacrificing visceral flow as an "option of last resort" +  

submitted by medstudied(1),
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I dsmesi tish sa ellw sucabee I ctlepeomly rthhtougove it iscne yhte adh to add siesrv()ospan aestnid of tusj yinasg HDA hichw aemd em hitnk fo sit reol in cnoistcrinot fo otsohm ulems,c btu the ption si taht herte wlil be oglpino fo het dobol muelov in the icvares and laitv gosnra cihwh lwil ceainser ANP eeersla romf het airat nda seicn NPA si eelsraed wiht hihgre oodbl urlmel/aovait shrte,tc you cna dwra eht cunolncsoi htta ADH illw be lwo ebsueac ANP si ignlnagis to the sdikyen atth theer si an cnabudena fo m.elouv solA, neics eth cesavri is oging to tge mero oodbl fwlo promaced ot hte ixteisemter iesnc eh is nigog to be ormieytchp,h you dsouhl oasl egt rcinseead ofwl ot eth ieynksd ro at estal prnraeiotvse (ot a atrcnei e)xtnte dna tish uoldw ont ropmote eth aelsree fo DAH whchi is onyl dreeslea hwen eht boyd sessen an seairnce in obdol mos.

submitted by osgoodschlatter10(27),
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etarnlC oBold lmuoev srrefe ot the boldo in het anlrect or noridyrmluaacpo eacmn.rtpmot riDugn ldco tuemptareer three si errlepaihp roscootiavitcnns ot etnperv etah sipoisatdni mrfo the ieiestmertx hiwch aensm eehtr si ssle odbol ni hte epripsherei and mreo in het elcnrat tmnptocmrea &tg;– tnraCel odBlo uovlem rGra scsnetaeiere vemoul ni het htare lilw aceus rntscithge fo eth raitla llaw dna sttmielua PNA eerslae  dnsiecare PgNA iHh lnraCet dlobo olmuve  hhgi uelmvo eatts  drtgousnlwaee HDA rsitcneoe  dacmnre/ersoalde HAD

submitted by osgoodschlatter10(27),
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Cltnare odlBo levoum frrsee ot the loodb ni the ntalcer ro ynrauriocdploma .cmamopettrn niDgur olcd mreaeuttepr eetrh is rhieeaprlp itcroooisnsacvtn to vetprne htae dtoinaspisi ofmr hte mettersixie cwhhi names rhete si ssel blodo ni hte hiirrespepe nda meor in eth neratlc otmtnrmepca gt–;& ratleCn loBod lmveuo Gctrs aeeanrieers lvomeu in teh ehart illw ceuas cirehngtts fo the lartia wlla dna eiuamtlts NPA seleare  nercdeias AHNPhgi tClnera bodlo melvou  hhig uvmole eatst  tauodgwrseenl AHD sceeorint  sddmoelarracee/n DAH

submitted by usmleuser007(370),
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ishT snietuoq sha oigtnnh ot od htiw mttrrpaeuee (eth etitegnv 'entods dsaedsr eth preattuemre fo the atrew - so dtn'o a)sumse

Thsi is owh yuo get the easw:nr

1) iBneg ni rpo-tsecaeu ro in a gwinimsm pool up ot het knce illw:

.a eIasersnc eraltnC lodob vleumo (ermo dolbo srneurt ot the tgrhi ides of atrhe = rcaenides peldoar)

.b eIrscnsae PNA = ereicnsad tldniiao fo vnsirceelt ~ yamoercotnsp ciamemnhs to euedcr leomvu aedrvolo

c. cDseeeard HAD &pam; tel-nasye-Rmdosni = odyb is in taest fo elouvm loderova amp&; edsne to ercued sscieytm uelovm

usmleuser007  correction: yea it does address the water temp but the main take away is increased preload +  
d10s  ANP is released from atrial stretch not ventricle. +