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Retired NBME 23 Answers

nbme23/Block 4/Question#33 (reveal difficulty score)
A 16-year-old girl with bulimia nervosa is ...
Potassium: decreased;
Chloride: increased;
Bicarbonate: decreased
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 +13  upvote downvote
submitted by nwinkelmann(366)
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I ailryllte ustj eeairzld wyh htis enitqosu sudcefon me os hmuc dn(a Iev' idetr to uregif it tou a ulcpoe of ei,tsm )llo. I let eht lacilluoqo iinofetidn of alimiub .(.ei iimgt)nov citsk in ym ,nidm atht I rtofog het acutal dmeicla tdfoinniei = romnla BMI 8)t(&1;g + egbin gainte dna puigngr ew(reh pgigrnu olduc eb duiendc tivnigmo or ciudirte esu ro eaivtlax sue or/nda seiexsvec cer)eixse. So ley,lra hwat stih seointqu asw giskan si lyimps what si the lyorcleette nableac of cveeexssi rerad?hia EE!ZG I mead ti so mhuc rehrad ni ym ehad when iyrntg ot senwra ti or.ngiyllia

eiDararh csusea iaonn-nno apg ei..( hhycoerprlci)me mbctiloea aidsioc.s oSlot omadeynlprtni oinasntc C3OH- and ,K+ so esvxescei riadareh = cxesviese olss fo 3OCH- dan .+K Chlrdeio lveles in the srmeu will be aesriedcn eud ot het nlmaro CHOC-3/l- uir,leiibqmu os sa iteeanvg cgraeh etsdiaspsi due ot lsso fo O-,3HC l-C illw acriesen gcrcintero eth pni-ongaa.

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drdoom  iliaumB mosce rfmo reekG "vaoruens n;"heurg eht trme si a lelatri ointaaonncect of the srodw rof xo buo)s( + hrguen .slio()m S,o ni rG,eke a-louiimb is ellartlyi "xo heru",gn iwhch si a ndo to how eth rowd si esud in cmeniied = lreueappt and laasebiint ttpepiea rof oodf (eth yevr sp"tip"eoo fo io.nvit)mg +5
abhishek021196  I rgeae iwht oruy annrgseoi tub eth lssaicc cesa prnisedoitc of Bilmua ltiss etcrlltyoee dncaebtuirs of m,lkOayiapHe ,ylaepmoicOHhr dna Meobatlic sAailslo,k ngoal itwh rteoh tihgns iekl tiproda pphehrroyyt dna ldosar hand eslcusal edu to eht cuenidd vmitngo.i I eidprtp pu reteh. A: F/ 02 gP 567 +
llamastep1  eakT eohm sse:nlo gnairoens t;g& geozmminir +3
lulumomovicky  I guhtoht orem of it by the iowflognl: the ntiepta ssleo 3OHC in teh oslsto nda ihst adihaerr esacsu teh lteaociMb soidiac.s uceasBe nlarmo /ClHOC3 rluqeiimiub usldho be taime,idann dheriocl leselv ni meurs go up to cpnoteaesm hte ossl fo cb.Bria sA teh iptntea is oals IHEOCVYMLPO due ot PB fo /,8196 enth ARSA vcsati.eat eortelAodsn illw eescanir aN nad aetwr itroopsberan to keep maoelvi nad K lilw eb eeerdcxt ylaeh)o.a(pkim lsAo sPeAH-aT in the acaelinedtrt lecsl fo eth ontcgcllie ctdu lilw eb edvtaacti by dertloneso,a rtferuh naigrtpapog eth btcleoiam a.isciods +1

bulimia ≠ purging  Bulimia comes from Greek “ravenous hunger”; literally “ox hunger” = ox (bous) + hunger (limos).

+5/- drdoom(1206)

N.B., there are many ways to “purge”; the method of purge determines the observed electrolyte disturbance. A nice description of bulimia nervosa from MeSH:

BULIMIA NERVOSA. An eating disorder that is characterized by a cycle of binge eating (BULIMIA or bingeing) followed by inappropriate acts (purging) to avert weight gain. Purging methods often include self-induced VOMITING, use of LAXATIVES or DIURETICS, excessive exercise, and FASTING.

+1/- drdoom(1206)


 +1  upvote downvote
submitted by brookly_(1)
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I ttouhhg lmiuabi gevi eris ot boeicmlat aikasllso ca..n. omsneeo otearleab ?

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drdoom  remRe,bme iumlaib tselif osed tno name ugin“rp;”g ti emsna “h-uerxogn”. It is ungpirg (eg.,. tineonalnit tinmogvi, eivlxtaa ,asbue iduteric b,uase xcveeesis ceerxsi,e ro xeterem t)asfnig wcihh cesreta tmolebaci untsrb.cdaei ehT ytpe fo rcntebusida ndeedps on uyro rferpeder retou of .ie”xt“ +2



 -3  upvote downvote
submitted by dr.xx(176)
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uebAs of aesltvixa t=g;& suyuall edaecesdr usrem psit.somua As ot lordiehc nad arcb,bi tath sn.dpede hTye lcodu eb ncsaieerd ro edersdac.e

tpf//pmh11a//003/pf5400.wwpsr3/awt.2t:galoh5.

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 -4  upvote downvote
submitted by usmleuser007(463)
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Teatr ihst eikl a PaVmIo taW(rey ra,dhraie chldrharoyai = eudderc ClH in eth l,enum pa;m& opileak)yahm

hits liwl aeld ot ocmbtalei iisdasco d/t sols fo barbic in ltsoo

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btl_nyc  Cridoleh is inscdreea gh.htou +
maxillarythirdmolar  iTsh mmeontc si gl.od @,lncyt_b tish is ualatycl au.ctce uyo dluow cpteex iyrpe molhehcra/9kb.w607go/t.osom:.ilpKwB//8hv.ncib5stnhn/Nw +1



 -4  upvote downvote
submitted by maxillarythirdmolar(45)
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tseB mtnemco i erda aws ot eattr htis ilke 'tsi a PVo.amI uoY dlowu tge all teehr ltleocecyeml/ebotrtai sint.csbauder

vn.ihwholKm.wpi8sbNn.7t0Bc/ot9ogk56/b//n.s:/w

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