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Retired NBME 25 Answers

nbme25/Block 2/Question#3 (reveal difficulty score)
The solid curve represents the normal ...
Fetal hemoglobin concentration ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—shak360(23)
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asnreIdce tcsincteoroann fo tflea lgnihooebm tulsser ni a tlfe ifsth of eth nyxoge ndsaciootsii uecrv twih the etamnnacein fo hte godalsimi aoerotvicep nigbdin atthiricesa.ccrs

I ekli to emeebmrr eth CD,"!AET stnad RIHTG" eninmmco:

  • C - CO2
  • A - Adic serindace( d,yicait dradseeec H,p accitl dc)ia
  • D - G-2PD,3 msea( sa B-,2G3P)
  • E - xEcereis
  • T - eetuarmpreT

rasctoF ttah eovm the ynxeog sdsicnaoioit vreuc to teh trghi era tohse yaioopchslgil estast weehr sseuits ened emro eg.oxyn For ea,mxpel gunidr eceei,xrs slsmuce veha a hrehgi tlceiboam erat, and eceuytqnnlso ende orme x,eoyng crpueod mero rnaboc dedoiix dna ictlac ic,da and riteh rmuerptatee ierss rm(fo aWpiiikde no teh b-H2O otsadsniiioc ecvur.)

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The effect of fetal hemoglobin having a left shift on the O2-Hb curve is due to the fact that the fetal Hb has a greater affinity to the mother's oxygen and can leech it during gestation. It is similar to the effect of human placental lactogen (HPL), a hormone secreted by the placenta during pregnancy peaking at around 35-42 weeks. It stimulates insulin production but confers insulin resistance to the mother, thus shunting glucose to the baby. This can sometimes cause gestational diabetes if the mother cannot overcome insulin resistance. Both fetal Hb and HPL act to shunt resources to the baby, oxygen with fetal Hb, and glucose with HPL.

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