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Retired NBME 25 Answers

nbme25/Block 2/Question#9 (reveal difficulty score)
An 18-year-old man has a 1-hour history of ...
7.48 pH, 30 mm Hg PCO2, 75 mm Hg PO2 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—shak360(19)
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The difficult aspect of this question was making the jump from noting he has asthma (which was not obvious to me) and then that he might be hyperventilating and then the final jump to respiratory alkalosis (due to low CO2 from the hyperventilation). If you can make those jumps, you just pick the answer with the high pH, and low CO2 (of which there is only one option).

I guess the acute onset and the high minute ventilation do indicate asthma but it is hard to catch. Dyspnea and hypoxia stimulate an increase in respiratory drive, which in turn leads to tachypnea or increased tidal volume; hyperventilation occurs leading to respiratory alkalosis as acidic CO2 is eliminated.

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