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Retired NBME 20 Answers

nbme20/Block 1/Question#37 (reveal difficulty score)
A 1-month-old male newborn is brought to the ...
Na+: 132; K+: 3.2; Cl−: 90; HCO3−: 37 🔍 / 📺 / 🌳 / 📖
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 +8  upvote downvote
submitted by apop(8)
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eTshe eaonptsilnax anret taer.g tI tdnose lelary hvea muhc to do twhi RASA tv.oiaacint It sha tlaosm tegiyvhner ot od wthi a npoemnohen alecdl eth nllakeai ie.td In rihoccn mnigit,tov oyu ludwo etexcp lC- to eb owl adn K= ot eb lwo l(siimar to alb rsuslet in eonomes hwti almlieub). oT staonepecm for hte owl C,-l hte stcahom ahs an rntpartieo wchih aecxshgne -lC rfo CH.3-O ferehoe,Tr Cl- lwli eb hleprdeeisn ni eth ts,omach ilhew -3OCH will icreneas ni eth d,loob incagsu an ol.iasslka In acolatkli sst,tea het K/++H treotiarnp will gnieb to eic,tvaat ginshift K+ NOIT escll a)i(yeamlpohk dna anigsencri .Hp RAAS payrlobb sylap a role ni nkmagi eth haklemiapyo werso utb the lklaeian tedi si rmeo imoapnttr .eerh

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spaceboy98  nIts lialanke edit laerdet ot na nceiresa in Hp aetfr mas?el roYu loicg si on ipnto tub 'mI tno uesr ehrthwe ew cna pylap thta ncpteco her.e +1
kevin  ectoncp can eb pidaepl rhee eebscau ew dnee to retlepe hte -lC in rdore ot aetcer C;lH eht hmtoacs ed'tnos arce if -Cl si wol in m,resu nloy ttha -Cl is owl ni eth ipaealtr llsec and so wlli pmpu out -HC3O in ist nxeesep +
usmleaspirer  wyh is K+ w?lo +


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 +6  upvote downvote
submitted by ∗hayayah(1212)
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tWhi nhcciro mitngv,oi you eols eytorelsclte nad a otl fo cda.i tI isertggr bmolaceit iloalsask whhci si yhw all the emsur aeusvl ear olw o(r on eth ewrol ned of teh rlanmo nrgae) ecptex ofr brabc.nteoai

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ergogenic22  edeascrde +K rmo(f senrdciae ARSA ued to moevul s)osl adn seddecrea lC- ossl( of lCH romf hte com,)thsa Aoisklals ofrm ossl of lHC dna htsu ihgh oicFba.b rr hits eanors ghhi ot imd anerg K si rwngo +5
sbryant6  'dnotuWl drencsaei ASRA adel to ncedsiear +?aN ehT nwsear hwsos erdesaced a.+N +3
sbryant6  o,lAs rrbmeeme lmaiBui vNsoare is iacsostdea ithw .amoyeklhiap +1
sugaplum  os eht nraeg tyhe veag rof K si -63? os 23. si NWL tneh? ro aer we jsut iengoptra on "ti si no het eowrl den fo moalrn ni "sedp +2
dbg  msduoi leelvs ni ociylrp essotsin yrv,a itghnon raylel ccsil,as nac be ghhi as in itsh seca ylmisp eud ot o,ntydriah nac owl ni hotre cssae fi snltdoreaeo dmngaea to rreeves htta to hte etohr xeetmer +1
skonys  ypiHr"lcoe,mcoh kahcpmolyie milatbeoc lisaolaks si the icsscal cyeoletterl dan acibe-ads acbeimnal of oprylic se"tnioss romf mpdeasce hibden nopayiVglatlmi.w = evlmuo slos dec( skin )turgo as ellw as slos fo H+, -lC and +iwt(aNh )H02 ;-tg& lMtaebcoi lsA.ilkaso sLso fo H+ saucse ceisnera HO3-C eintrntoe sa llew sa K+ hfist onti slcle pmeylhoaki(a FA91 .5)78 +

From amboss: The loss of gastric hydrochloric acid from emesis results in increased bicarbonate concentration in the blood and decreased chloride. Some potassium is also lost through vomiting. Hypovolemia leads to an activation of RAAS, which exacerbates metabolic alkalosis via increased bicarbonate reabsorption (as a result of angiotensin II). Aldosterone also causes renal secretion of potassium and hydrogen ions, further exacerbating both hypochloremia and metabolic alkalosis.

+10/- smpate(20)

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 +5  upvote downvote
submitted by ∗masonkingcobra(408)
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In oamictble asosi,alkl mstiuapso mevos tino eht celsl

heT slos ni lvoeum hgtohru iesmes igsetgrr AARS irelsngtu ni ecsrieand sooAtdlnree lrsaeee nad tfruhre tsmuiaops xeocnerit

wi.ttedw/nlb//.pewttahs1t:ea6/1p

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 +3  upvote downvote
submitted by iamapotato(3)
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oN eon here rodtbehe to ataulcyl issuscd wshta' nogig nhiT.os si a -m1hont lod .ornbwne

eH smvoit rtafe sei,dgnef y5ad- rot.yshi

tA 1 thonm ,dlo hiwt gnmoivit rafet i,deegsnf it si msto lkiyle a csea fo POYCLIR OSESTISN edu to yohtppyhrre of hte royilcp ihsptrnec u(slulay cscuro 6 sweek aetl.r)

ueD ot mhi onvigitm ahtocms snoect,tn he will OLSE l,-C +,K and .N+a

He lilw SAOL oles +H. hsTi is ywh uyo og tnoi eth alebmctio iloaslsak ithw a tasltuern reseanci in teh O.-HC3

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kamilia20  :yeshk:tc vtmiongi aesucs slos fo WERAT tergrea hnat umoi→sd nircdaese remus o→smdui EDRINESCA umser lmoo,ltsayi oS NA ilwl esedrcea oo,t ubt no taht raf +


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 +1  upvote downvote
submitted by ark110(1)
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tuB tahw is teh edecinreff bwnteee ooitnp A dna ipntoo C 2(13; .;49 ;09 35)

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sympathetikey  K+ ounsdthl' nicesr.ae t'sI ogvinm toin esllc due ot ieltbocma io.asaskll +
home_run_ball  nI eht trpilaae lcel fo eth orHsntmda ghy eoc snio rea efmrdo omfr hte soandistiico of baioncrc .acdi Werat si a rvye imonr sureco of dynhrgeo soni ni acmopisrno to cribnoac ai.dc nCarbico acid si edfrmo rmof bnoacr ddioxie dan eawrt by rcciboan Tnhayaeed.hrs biroacaentb oin (C)OH−3 is exhcngdae rof a ihcoredl ino C(−l) no eht aslba idse fo eht llce nda teh btaabneoric usefdisf ntoi teh uosnve o,obld dinleag to an eillaank eidt nnehpooemn. +1
ergogenic22  ASAR sinrasece mrof umolve s,ols and suht mero onltsedroea ldase to olw K+ +1
sinforslide  ehrTe saroesn ofr ahela.pmiyok irF t, s emos +K is olts in isargct fluid.s ,oc edS n +H ihfsts otu fo cslle dna K+ ifssht otni elscl in lmbioatce alhs.iirTasok, ld ECF eumvlo arotntonicc sah uacdse rsadenice ntsoeriec of sl.etednaoor +3


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 +1  upvote downvote
submitted by ∗rainlad(33)
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ryHicpmocl,heo mhocealypki tmlbaicoe ilsokalas is eht sicclsa lecotleyetr dna ciaead-bs lnaaembci fo rclipoy sstnso.ie

estsritenP toivmign slrsuet ni ssol fo CH.l hTe iehrodcl slos tlrsseu in a olw boldo lihoecdr velel whhci irmiaps the ds'yenki alitbyi to eeecrtx raboni.ecabt hsiT is hte aftrco atth pvertesn criercnoto of hte aliasoslk deaglin ot maiotlceb ssoliaalk.

A oerdansyc msyeotorlindspaher pelsevod deu ot eth dsaereedc oblod mevlou. Teh hhig aoldesronet leevls asscue the eisknyd ot tniear +aN (to roctcre het uarlaivancsrt vomule etn),pdleoi dan excetre idnrseeac noatsum of +K oitn het ruine sriltgne(u ni a olw odlob eevll fo oapt.s)smiu

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 +0  upvote downvote
submitted by thefoggymist(12)
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I dt'no teg ti.sh 'hlnotduS the neiydks tstra cirgectrno eth ibcrba vsllee erfa 5 d?asy ehT dleeyda heasp fo the trcicernoo niesc htey etka ..et.mi dan ni eth tnuoqsie yehert' ksiang we"W n".o vaeh cmilabeto asaiskoll necis LHC is lt,os so teh bdoy wlil try to creocrt it irstf yb hpotnliaytvnerie adn telra by neaeicrsd nrocextie of bcriba. riBbac udoshl be .ow.l. nseul(s mI' sgmnsii meshiongt ude to nbeig aes)dhxute

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thefoggymist  er,iNmvden I tnkhi I tgo t.i etBa ectlnierdaat slecl cnnota toinncfu dan ecreetx braibc cuaeesb we don't ehav odc.irhel eaY rpatlapeny I asw te.uxdsaeh +


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 -3  upvote downvote
submitted by ∗amirmullick3(76)
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erVy yase usin.etoq isulnoNoib o.mtiv 1 month ea.g oMts lyelik rnscoiea is clorypi .ssesonti

The imotgivn aseucs loss fo ClH os we ahve hte yiolh,apomecrh and ealnr tnipaoemsonc orf ihst H sosl y sbi vnrripeegs noorpts ta eth esepexn fo K so tath visge a.poyhmiekal As hte esaieds is ,adnem eth rr raowde ni teh eigam of teh hacsmot is sohmot emlsuc ohppteryyhr fo hte rpoiycl ulmruicssa osema,cu tnimhgrfeo eevh-iaslpdo ssma ltef on p.naoptila ishT is a bticomela ksislaalo suebaec ihwoutt Cl,- hte C3/Clbeo OrtHallsaa aergchenx wlil nto wr,ok so ouy tareni H.OC3

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