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NBME 21 Answers

nbme21/Block 4/Question#23 (reveal difficulty score)
An investigator is studying the regulation of ...
Intravenous infusion of 0.9% saline for 5 minutes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ
tags: Saline Lymphatic 

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submitted by โˆ—mcl(640),
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To exanpd on thsi, eohtltpaoonilugys dreeibssc the ysitlgoho fo poawiks aaomsrc sa lnp"desi llces fgoinrm stsli tiwh arsdtaatvexe dre odlob "lcesl

submitted by โˆ—hayayah(1145),
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mpLyh olfw aret si aluluys wlo. It is niuncfedle amrirpiyl yb het etar of hlmpy rno.itoafm oFr pmlxeae, if lodbo lcpyaialr rpeeurss is iecsenard by aatreril aviootnaisdl or eosnuv osiricttcn,on eth lwfo etra of pymlh s,olA teh lfwo aert si teffaecd yb piessomcron of cyihltsmpa yb iotncrtcnao of igbingrhone cuatuluerms nda yb tgaeneiv nirocahtcirta srurpese hriaenbgt)(.

etilrItanits ursseper o(s perusesr ni the ,EFC hwhic uodlw sreeniac fi egvni IV sea)nil dan pmyhl wflo ear eoiptylvis trae.lde A amlls ncaesrei in lanitteisrti ulvmoe ltgeyra isesrneca sti prssre,eu tompiongr pymlh fwol tath scta to steorer het esriatttniil volemu to mo.nalr

remo no hits c:oipt iwNn.nst43m4.btch.w/ok/gp8so.vBi/://bo5Kwhnl

linwanrun1357  Do not understand the breathing ๏ผˆchoice C and D๏ผ‰ breath in and out are different? +  
khanhluong  I don't know if it's correct or not but how I approached C & D was that they both cause vasoconstriction in the arterioles (because this is the lung where hypoxia causes vasoconstriction), which decreases hydrostatic pressure through the capillaries and eventually decreases lymph flow. Maybe I completely got this question right for wrong reason, but I felt that it works with all of the answers. For F) I was thinking that it would cause increased capillary oncotic pressure which causes more fluid to go into the capillary than into the lymph vessels... Here's a picture: +5  

submitted by โˆ—andro(233),
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riFst oniPt : Lmhyp smfro at hte apilalyCr lvele of obodl evlsses ( as siht is eerwh ufdil osmve ni dan tou fo sselves glano iwht leietosbmta nad eiturnnst ) .

The nfunoitc fo mlpyh is ot truern ecexss rnispeto nad tiisnieltrta ildfu acbk ot het rdsemoobtal ( lRclae pLymh ytlvueanle nsadir onit eth agelr sev)in

coSden oPnit : eW aym caieresn phmyl irethe yb inceagnsir .1 teh aert at whhci ew mofr ti . .2 igrnacseDe hte tera fo aeadrgni ( ei. - obigcutsnrt yhlmp lsvsese )

To naeiserc yplmh imfontora we hvae to icsearen eth atre at ihchw uldif filetrs tuo fo eht eslcapairli . iThs cna be neod by lrgeatni asSgirtnl scoref in hte raylapicl

  • nacsneirIg ysttaorichd repsseru
  • cseengarDi ontcicO pereruss

niGgo ghrutho teh tnpsioo
oinp Ot A : dnhietoEnl wlil euacs ncronaciosotvsit of auPonmlyr rarety ihs.T si rceypllaapri naginem ew ilwl ehva slse ld/boo dfiul igngett to het aesrillcipa - rseecdeda rcadhysoitt peressru dan earscedde pmhly ooiaftnmr
pitoOn B : onioitCsrctn fo unlporyam rreyat aagni
pnO iot C and D : aled ot het yohioigplcs epnserso fo yxciohp soircintoacsovtn
pntoOi E : earsdnecI cnooict eessrrpu sdeerceas hte umtnao fo dfiul nmgvoi uto fo rslepaliaic

lovebug  now I understand~~!! THX :) +1  
limberry  I believe you mean "Option F: Increased oncotic pressure decreases the amount of fluid moving out of capillaries" instead of Option E, right? +3  
weirdmed51  Yes . Albumin aka colloid. +  

submitted by โˆ—drdoom(1045),
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tstsiancooorVcni inna(rorwg fo a t)ueb llwi uesac the wlof aret ot aenresci urthohg atht ubt,e chwhi asecdeser dd/taawlaoriur pur.ersse eTh trseaf a dluif esvom ohughtr a ut,be teh essl dwtโ€œuraโ€o rcfoe ti Tsih( is wnokn sa het ineVrtu etffec).

hungrybox  not seeing how this is relevant +9  
sympathetikey  He's showing how A & B are incorrect @hungrybox +7  
nerdstewiegriffin  what a moron @hungrybox is !! +2  
leaf_house  MCAT flashbacks on this image +1  

I think the more correct explanation is that lymph mostly is hyrdostatically pressed out of the thinner walled small arterioles, capillaries, venules

If you vasoconstricted the pulmonary arteriole, youd get hydrostatic backup but not into the smaller arteries, capillaries, veinules but actually less flow (due to constriction) and less lymph formation.

+/- jackie_chan(29),

submitted by โˆ—d_holles(209),
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%20 lbuamin si ioPYEHRctn dna ecssua wnriadg fo idflu otu fo teh iiutemrnstt dna toin the d.olob

l"bimnuA (am)unH 02% si nicadidet in eht ngcmereey nrmattete of oypvliamheo htiw or tutohwi skho.c Ist vsffeeeticesn ni esgvrrine eolayivmpoh ensdpde laeylgr noup tis yibitla ot radw rtiltaeinsit lfdui otin het tcc.loriinau It is ostm cieftefve ni petasnti who rea lewl erthdyda. Wneh dbool omeuvl icifdte is teh tuelrs of aheoem,ghrr poieacmtbl rde odbol secll ro elohw olodb lsdohu be ditdesnameir sa iyqlukc sa ".oslseipb


submitted by โˆ—assoplasty(100),
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oiVannotcsostcri rassceede boodl lofw nda usht dsacseeer rtdcsitohya se.sperru meSse onucret etiunivit btu I ahd ot oklo tihs up aftre I got it ,onwrg o.ot

submitted by โˆ—bgreen27(6),
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naC omseeon phle a trerbho t?ou My nhgintik was atth eriesdnca duilf ni hte leiisitnatrt sldea ot eriedcasn mp,lyh so I ttuoghh yhet ewer olnkoig rof nhsmitgeo to uteissaml ihhg teuldtai ynpuolamr demea or itaaerlr mrloaupny NH,T which I am treypt eurs htob dlae ot nyrulpaom e.mdea herWe did I og n?wgor

ali_hassan  this might be stupid but i got it right with this rationale: increase "normal" fluid (0.9% saline) in body = increase lymph flow. absolutely no medical concept to it, just logic lol +  

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