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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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esThe anesaloxptin aernt aegr.t It edsnto yalelr heva umhc to do hwti ASRA aovtinact.i It has astolm eiytngvhre ot do htwi a mphonnnoee cldale het eliankal .edit In cinhcro n,tiovgmit you douwl txceep lC- ot eb owl adn =K ot be low ir(aslim ot lba lseutrs in mesoeon thwi mibu.lael) To tncamoeesp orf het low l,C- the somchta has an oiranptter chhwi hseacnexg -Cl rof 3CHO.- Trerfhe,eo C-l lliw eb eeripdnehls in hte smh,ocat whiel -HCO3 wlil iesrcane in hte lbdoo, gciauns an .laolaisks In illcokaat sst,eat eht ++H/K tnorrapeit lwli iegbn to avita,tec sihngfti K+ TNOI sllce a(e)hlypmaoik nad agrnicinse H.p ARAS lbborpay pasly a relo in kamgni teh mleoiyhapak sweor utb het knaiella etdi si emor timrotnpa r.hee

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spaceboy98  ntIs kllaaein itde etlerda ot an nrecseia ni Hp ferat lma?se oruY ocgil si on ipnot but 'mI nto suer eehhrwt we anc yplpa taht ontcpec eer.h +1
kevin  oetccpn anc be ipapdel hree euscabe ew nede ot tlepere hte Cl- in dreor ot ractee H;lC the hmtcoas 'soentd rcea fi C-l si lwo in smeu,r noyl atht Cl- si wol ni eth eaapirtl esllc and os llwi ppmu uto HC-O3 in sit epexnes +
usmleaspirer  hyw si +K wo?l +


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 +6  upvote downvote
submitted by ∗hayayah(1212)
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Wtih cocihrn tnigm,ivo you eols oteecrtlysel dan a tol fo .daci tI rgiestrg tmeablcio sloiaskla hcihw is yhw lla eht emsur auesvl rae lwo o(r no hte eowrl den of teh aonlmr ergan) cpexte fro aranebibtoc.

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ergogenic22  sdrdceeae K+ (fmor easirdenc AARS deu ot mevluo lsos) nad eresdeacd l-C so(ls of HCl frmo eth moc,shat) Akssllaoi mfor loss of CHl dan htus hhig Fcbr boar i. hsti seoanr hhgi ot imd geran K si rwgno +5
sbryant6  u'nlWdto nsaiceerd SAAR aedl to icrneasde ?N+a The eranws swhos dreecdeas N.+a +3
sbryant6  ,Aslo mebreemr Bumliai avsreoN is soaiacsdet with ielkph.oayma +1
sugaplum  so eht rngea hety avge rfo K si -6?3 os 23. is LWN ?thne ro ear we jstu otegrniap no "it is on the rewlo nde of amnrol in p"sed +2
dbg  dmosiu evsell ni roipcyl ssntesio ravy, tognhni llraye l,scacis anc eb ghih as in this sace pyilms ued ot hynordtai, can olw ni rtoeh sesac if sorldenaote aeadgmn to srevree htta to the toehr eexrmte +1
skonys  ,eccoim"olHyphr pmhlyokicae atbcelomi laisoakls si eth lsacisc eyeteolcrlt and -ieacdbsa lnmecabai of cryiplo s"nssetio mofr eadepmsc nebdih lVnw gayp.iatmoli = oemvlu lsos cde( iskn )rutgo as lelw sa sols of +,H C-l and a(tw+hNi 2)0H ;tg&- Maioeltbc .kAosalsli ssLo fo H+ aecuss eircsnea 3-OHC teronntie as elwl sa K+ ithfs tion ellcs okiam(ehpayl 1FA9 .8)75 +

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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nI lmotieacb aks,oialls uiptsomas voesm ntoi eht clsel

eTh sosl ni ulomve hrghuto eimess rrstggei ASRA igultesnr in easeindrc deorAlsteno eseerla nda rfhteur suastmipo iotceexnr

a.pde/sp/tnte6wbtlwhw:te./1/ait1

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 +3  upvote downvote
submitted by iamapotato(3)
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oN one eher eehrdtbo to altycual dusiscs sa'wth ggnoi s.ohnTi is a to1mhn- dlo wonneb.r

eH vtsmoi after fdnsieg,e yda-5 tohr.iys

tA 1 mtnho old, with tmigoinv etafr ,esdfeign it is smot ilykle a sace of OYPCIRL NETSOSIS edu ot rpyyphorthe of hte icoylpr pntsrhiec luusaly( ocscur 6 ekwse l)ea.rt

eDu to hmi ovmtigni smhtaoc ns,otcnet eh llwi EOLS -C,l +K, dan +.aN

eH liwl LAOS lsoe +H. iThs is ywh uoy go iton eht libteomca olksaslai itwh a tartlsnue irnaecse ni eht H3CO-.

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kamilia20  :ytck:esh igmtnoiv cessau ssol of RTEWA grearte hant sou→mid aeencdirs rusem →iumdso SIECDNARE remus lotayli,mso oS NA lilw esaecedr to,o utb on thta fra +


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 +1  upvote downvote
submitted by ark110(1)
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utB twah is hte ceeeidffnr eeewbnt noipot A nad oniotp C 123;( .49; 90; )35

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sympathetikey  K+ 'ludnthos e.caeirsn 'tsI gvinom iotn clesl edu ot tlamecbio lkloiasa.s +
home_run_ball  nI het erlatapi ecll fo the ed ogys m htrcanoH nois era fdmeor mrfo eht tioincaodssi fo inbrcoac .iadc aWter si a vrye rmnoi ocsuer fo gedhrnyo inos ni nmcoopasri to irbccaon .icad Coacrnbi aicd si froedm mrfo cnabor dxiioed adn terwa by nccoabri Tsanhyd reh.ea abceibrtnao ion )O−H(3C is hcndeagxe ofr a orilhdec nio −lC)( no eht lasba eisd fo eth llec nad eht bnearioatbc esdsuiff nito eth euovns olb,od igaedln ot na iakllean deit nheonp.meno +1
ergogenic22  ARAS cnieaesrs fomr moevul sosl, nad usht mreo netoredsaol daesl to owl K+ +1
sinforslide  hereT sornaes orf a.ymoahkilep , strFi omse K+ si tslo in iracsgt d.usfli en, ocS d H+ ssifth tou fo elslc nad K+ tsisfh oitn llsec ni aobicltme .oTlk, sai ahdsril FEC lvuome ctoncraniot sah ausdce aedeirscn rscioenet of aroltdone.es +3


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 +1  upvote downvote
submitted by ∗rainlad(33)
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,ocrphiclyHome ehaylmoicpk icatlomeb iaoasllks si the csilsca rlyecttoele dan si-abdaec lcnbiaaem fo rilyopc isson.set

etsPrnsite ioivmtng lsrestu in slso fo lHC. eTh eorhldic osls surltse in a wol bdool irhceodl leevl hhiwc apmisir eth kdiy'nse iylaitb ot trxecee irbbcae.tnao sThi si eth otfacr tath setvrenp nciteocror of het llaoiakss egaindl to oailetbmc .salskailo

A sdcneroay rydhsmsrloianpteoe lspvodee deu to eth daecesedr bodol eolu.vm eTh hghi ladreetoson llesev ucsesa teh ienykds to ientar aN+ (to torcecr eth vnaluraarcsti ueolvm plin,eo)etd adn ceterex iesrcaedn omasnut fo K+ tion eht urien lsr(geintu ni a wol dobol eelvl fo smoup.)stai

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 +0  upvote downvote
submitted by thefoggymist(12)
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I ntdo' etg s.thi tn'Sdolhu eth inkeyds asttr itogrrecnc het iabrcb ellsve refa 5 d?yas The dldeeay espah fo hte ircncotero ciesn heyt keat t.m.i.e nad ni eth seiqnuto ethyer' gnksia ne "Wwo". veha maobtlice olisskaal insce HLC si sol,t os teh yodb wlil tyr ot orecrtc ti ifrts yb ihonevpnelrttyai and atrle by iedneacrs eexncroti of ci.babr ibBrca lsudoh eb ol.w.. nu(lsse 'Im sismgin neighmtos deu ot egnbi aeseutx)hd

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thefoggymist  rmevnediN, I nhikt I otg ti. eBat tnldtcaieare eclsl onctan tnconifu dna rcteeex bacirb ueascbe we otdn' ahev lcio.hder Yea yplaeatprn I swa ht.euesaxd +


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 -3  upvote downvote
submitted by ∗amirmullick3(76)
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eryV seay tqn.uosie ulbisNnooi o.imvt 1 mhnto e.ag ostM lkleyi rnecisao si oylcpir .itsesnso

The vnmogtii ceusas sslo fo ClH so we hvea teh milryochheoa,p and relna eitompncaosn fro iths H lsos bis y iesevrprgn torpsno at hte xpeseen of K os atth eivgs mhlo.pyaeiak sA teh asesedi si a,emdn teh a rrodwre in eth gmiae of eth sctmoha is mohots elcsum hhpptrroyey of hte clpoyri aruilmcssu uao,mcse hfengr tmoi dospveae-hil assm ftel on taila.nppo hTis si a tbmileaoc alslskioa becaeus iutwtho -Cl, the sleCa3O l/CoblatrHa cxhageenr lliw ton wk,or so uoy tareni 3OCH.

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