NBME 24 Respiratory acidosis (NBME Answers)

NBME 24 Answers

nbme24/Block 3/Question#16 (reveal difficulty score)
An 18-year-old woman is brought to the ...
Respiratory acidosis 🔍 / 📺 / 🌳
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+20
submitted by ∗seagull(1794),

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out of t,yrcsiuoi owh yma epolpe kewn is?ht odn(t be hsy to say uoy did ro d?dint)

yM rtyoevp decotiaun didt'n griainn hits in m.e

+11
submitted by ∗keycompany(344),

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sThi nattpie ash a hmntopxoue.ar tvniotHelrpaynlie is ont neuogh to stmaponcee rof het rlaoevl eeedrasc ni lgun rascfue r.aea

_yeetmasterflex Could the pneumothorax also cause less ventilation due to decreased lung surface, retaining more CO2 causing respiratory acidosis? That's how I got to the answer at least. +8

duat98 I think pneumothorax would increase RR because you're probably hypoxic. Also I'm sure when you have a lung collapse on you you'd be scared and that would trigger your sympathetic so your RR will go up either way. +4

kateinwonderland Arterial blood gas studies may show respiratory alkalosis caused by a decrease in CO2 as a result of tachypnea but later hypoxemia, hypercapnia, and acidosis. The patient's SaO2 levels may decrease at first, but typically return to normal within 24 hours. (https://journals.lww.com/nursing/Fulltext/2002/11000/Understanding_pneumothorax.52.aspx) +2

linwanrun1357 How about choice C, --ARDS? +3

bullshitusmle there is no bilateral lung opacities as you would see in ARDS +5

jesusisking Was thinking some sort of infection b/c of the atelectasis so picked empyema but this makes sense! +1

djeffs1 does it need to be ARDS to cause "diffuse alveolar damage"? +1

makingstrides Not only that, does having a collapsed lung affect the alveoli? +1

+6
submitted by jucapami(14),

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rayx- esoncopsdrr ot a iseontn hreooxmtpnua = nimnteim eiaortrsryp elfiaru if t.aentderu tRihg ugln si lulfy osda,lcepl icrngaeins i-ratnoachritc pereu,ssr nramgipi 2O heenxcga u(de ot sasm fetcef tdawro etfl l,ngu nda oadlplces grtih ,e)on cehne ngucaliumcta O2C ni( l,od)ob nnigiudc torisprarye ds.isaico

j44n how is it a tension if there is not tracheal deviation? +2

djeffs1 I can see that its resp. Acidosis, but wouldn't the most risky potential complication be diffuse alveolar damage (If you arent able to reinflate sometime? +

sexymexican888 @j44n honestly you cant even see the damn trachea on this! lol +

+4
submitted by solgabrielamoreno(8),

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lp99o-awoxtocgoui./stohr/nnae/sc:8tiwcutginicrgiweeessmps-md4aksmanh-8.t/m//

xacet rpieutc mrof het emax pxiedlena. ):

+2
submitted by ∗pingra(4),

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I oguthht fo stih sa a ngait gohiipslocy hnust ,e(i ued to eth ruotpomhanex ehtre is on titaoneivnl to na ntriee ,lgun sa a cuceqneones uoy aietrn 2CO) - not esur if siht si het uaclta mmncsheai ubt ti hpdlee me gte hist ouetinqs grtih

yfolplheu siht seph!l

drdoom this definitely makes sense to me, especially if it happens “acutely”/suddenly. if someone gets a lung or lobe removed, e.g., cancer, my guess is that the reminaing lung would “remodel” over time and recoup at least some of that lost surface area — in the same way new anastomoses form in the weeks or months after near-complete artery blockage (as guided by VEGF elaboration) +

drdoom but in the case where it happens “all of sudden”, i totally agree you’re going to get CO2 retention +

+1
submitted by ∗faus305(32),

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ocpyaKmyne geva the ,iqcuk lipsme ioln.enapxat

tub ormf a i-slslaclecin ct:rIpfsveeep i nnyaeo sha reve nbee "u"pLt-i on hte talflboo elf,id or tsju nlalyrege vree dha eht -enki"dnodkwc u"to fo t,mhe ouy wnok ahtt oruy eahbgrint rfo the xtne 5 imnstue si eyvr loaslhw beceaus ti stuj ruhst ot hreabt oto pd.ee

Tihs irlg krboe a bir so ylekli na'tc tabrhe yvre e,dep so neev guohth hes si riantgehb playdir eth 2CO si ieylkl gaiemrnni in erh slngu adn icngusa a ysapeotrirr sdaic.iso

,losA hree si hyw hte oethr ssewran 'odtn mkea sn:see

Asylsdiioom ;map& cianricdo - nlgo rmte pomelsbr not eatrled ot a onkrbe rbi dna eauct ipen nrmetmesEy-paato oletclon"ic fo spu" ntlwud'o rfmo isht noos and fi it ddi hte nespuicsor duwol not ervlea sicdenare mlrtaynmPyyuna. po ed-ame sscieuronp uwold not eeavrl idencsaer ay-p.P ynmEt olCud aucse armisli msymospt utb rssoipuecn olwdu tno rvlaee ecsreandi ,mpnytay nad eht xr-ya nad ihyotrs of mturaa ltsle oyu that htis is detifineyl a .exrnmaphutoo