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NBME 22 Answers

nbme22/Block 3/Question#8 (35.2 difficulty score)
A 38-year-old man who lives at sea level ...
pH: increased;
HCO3-: increased;
Volume: increased
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 +3  upvote downvote
submitted by mcl(517),
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niecS 'oeyru sinogl all yuor raibbc noit uryo ,eep ouy owdlu peexct the Hp ot be emor lke.naila sloA, iscen ehetr is radcedese +N+/aH tpr,tnoai ehrte si lses sduiom srboedrabe nda frtoeheer sdnrceeai ssol fo rfee ldfui ot the ernui.

mcl  useful figure http://users.atw.hu/blp6/BLP6/HTML/common/M9780323045827-036-f002.jpg +2  
joker4eva76  Why wouldn't this be similar to a Type 2 RTA where urinary pH <5.5? +1  
mcl  I can't remember exactly what the question was asking off the top of my head, I think it was asking about relative to normal? But I think you're right in that the alpha intercalated cells (AIC) can still dump H+ into the urine and acidify it to an extent. And, like in RTA2, I don't know that the action of the AIC would be able to overcome the bicarb and acidify the urine enough for it to be the usual pH, so the urine should still be more alkaline compared to baseline. Kinda sucks, pH less than 5.5 should technically be acidic but it's alkaline for pee. +  
mcl  JK, normal urine pH is around 4-8, but I guess they consider closer to 5.5 on the more alkaline side...? I guess I would go more off that the alpha intercalated cells can't completely compensate for the amount of bicarb in the pee due to the CA inhibitor, not so much the actual pH. +  
meningitis  Anhydrase inhibitors also affect the anhydrase inhibitors that are used in the AIC in order to excrete the H+. Here is a link:**http://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/distal_0.png** +3  
mcl  ohhhhhhhhhhhhhhhhhhhhhhh my god duh yes thank you <3 +1  
meningitis  Lol yw!! +  



 +1  upvote downvote
submitted by yotsubato(803),
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stI a i,trieudc os vmeuol si .iseacrden

3OHC si adnieserc auesceb azacteiemlaod drseuce rsnrbtoiopae fo C3HO.

pH si riae,cdesn eacbuse C3H-O si a awke besa, so it cussk up ysatr edhryogn onsi in het u.nrie




 +1  upvote downvote
submitted by meatus(1),
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I'm srroy but ahtw ma I imngiss re.e..h I ttuhohg hte wlohe oitpn fo euciidtrs si to torrecc umloev vadeoorl by eiiss?dur wHo doluw ltato vumloe be n?raes?edic

niboonsh  the question is asking what would happen to the URINARY ph, bicarb, and volume. dont worry, i misread the question too -_- +12  
link981  Also misread the question, thought about the lab volumes of the BLOOD smh +5  
hyperfukus  yooooo me too!!! this is the second NBME i did this on they purposely don't write urine on the arrow categories to mess u up i swear!!! AHHHHHH +2  
medulla  missed this question for the same reason .. still pissed +2  
osler_weber_rendu  I DID NOT READ "URINARY" OH NOOOOOO. Im so dumb. +2  



 +1  upvote downvote
submitted by adong(82),

the question can easily be misinterpreted. it's asking for urinary pH, urinary bicarb, and urinary volume




 +1  upvote downvote
submitted by usmleboy(7),

LOL. I thought they were asking for Urinary pH, but blood bicarb and blood volume.

Who in their right mind would ask for urinary pH, urinary bicarb, and urinary blood volume by saying ".... urinary pH, bicarbonate and volume"

Am I crazy?