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NBME 21 Answers

nbme21/Block 4/Question#25 (reveal difficulty score)
An 80-year-old woman cannot concentrate her ...
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 +33 
submitted by mcl(641),
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onPsoi yvi iergrtsg a ptey VI ipntteyiesvisyrh m(aedetdi yb T l;el)cs nlyo oen fo het sanewr ceihosc temisnno T eslc.l


 +24 
submitted by cantaloupe5(85),
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h’seS tinnkagi 045 sOmm pre dya os ehs esend to etxceer 504 msmO per dya to taimnian iuu.beqimlri ouY c’ant tujs cteeexr mssOm’ by htvssmelee -- tyhe veha ot be ivelssddo in eosm nomuat of aewtr.

sLt’e ysa uyo etcrxee 045 sOmm iwth 005 mL of wreat -- that amnse your nisdeyk rae tncncetroiang uneri :ot

054 mmOs ÷ 500 mL = 900 m/LsOm

But hte mmuixam tsih y’adsl iksdney nca cctrnnateeo eirnu to si 450 L,/smmO so hes has ot eeetcxr rmeo aetrw ot egt ti tath et.dliu htaT mouatn of aerwt is 1 ,L seabcue 504 mOms/1 L = 045 Ls./mOm

wNo ’shteer nontghi npotsgpi her fomr rxgeecitn het 045 Osmsm in na nvee meor uliedt uerni -- orf almxepe if seh arkdn na exrta L of teraw oen ad,y teh ynkseid dcoul get idr fo thta taexr L wiht the same unoamt fo 405 Omms by tniliudg the nerui ot 054 Omsm ÷ 2 L = 225 OmLms/. tBu het nsuieoqt ssak fro the imimnum atmuon of trewa -- whchi si 1 L yb eht ksyeind +( 1 L rmof het retho ffuts ofr a lotta of 2 L).

shieldmaiden  Thank God you explained where that liter came from because Flashvoyger just took it out a magic hat and I was completely lost +  
skonys  Would be tears be included in the Insensible Water loss? +1  
skonys  *my :.( +  



 +22 
submitted by flashvoyger(22),
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heT euqisnto si asgkin yuo ohw humc twera sumt the nawom teka ni ot nitaianm eht sema oaolltmsiy. ihTs mwoan kesta ni 504 Omms fo usetlo pre .ayd sTih is a tnui fo rmmsetauene -- inkht of it liek gs.arm

oFr rhe ot keep the meas sallyomiot seh tmus etecrxe 540 mmOs rpe day. heT nylo yaw ofr reh ot erxetce teh uetlso is aiv teh sy.dkein hTe yoln ywa for erh eiynskd ot cetxeer 540 mOsm is if yeth eeetcxr 1 rleti of ratwe soal. shiT is teh max nniceantctoro atht rhe kdneyis nac rcdu.epo reH( deinysk are ton rpo“feuwl ngohue” to amek erh nuier nay mero cdnactnotere tnah tta)h.

hTis wmoan si sloa ingslo nteoarh retil of teraw ot esec,f wntigsae dan ransiitr.poe hsiT is eht l“beiessnni taewr ”sl.os tahT maens if she oilgsn 1 iterl of aetwr ot wea,ts epsionirrta and ecfes pre day uslp 1 terli fo earwt ot nerui b(usceae she denes to dlvioses reh eotuls ni g!i,nhm)otse ofr erh odblo ot tyas teh emsa ,oaslmiolyt seh smut epralec eht wreat esh tlos shtu ,ustm at mmin,umi nirkd 2 ltiser of eartw rpe ady.

jean_young2019  great explanation!Thank you! +  



 +15 
submitted by burningmoon(18),
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Wr1)eat( Kg1 wr=Lte1a ksa45/wmt mOegr0 ar/swe05Om4Lm=t Mtnawir e OH2 dnedee to losdsvie 045 tulsoe yb ineykd si 1L w)Wr r2etatea( hOret s(fece et a=a.L1T: lotl) r(a1ew)+t w=)2(Laet2r

ali_hassan  this is what i needed +  



 +10 
submitted by yotsubato(1121),
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siTh niqeuost is psditu. erWat ieantk fro a hhleyat iidvduianl is 0.2 L a .day




 +5 
submitted by madeforupvoting2(14),
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To nmntiiaa lasmap sitlalooym t;&-g eeNd to lytcxae pcearel lal the ufisdl tlos in eht dya

Seh ncntoa etnnaorccet nieur oaevb 504 msg/Okm , os hte minuimm uatmno fo rawte erqidrue ot be tdercxee by seknydi si 1 (to exetrec hte 540 smmO hse asmcuetclua rep y)ad. The inmimum xrecenoit trawe ueqdreri is lraieyesnsc at max coicannro;tnte fi you eerw to ysa dpecour eltrdui e,nriu sya kgO2m5/s,2m htis owdul reireuq 2 L of wtra.e Teh qeitnous satnw het mminmui pbiolsse wrate vlmou,e os we asmsue ’ehss nongcctertnia to the .axm

1 L eosssl rofm ikedyn + 009 mL inilbsseen + 010 mL in stewa adn sfcee = L2 seossl gt&-; deen to inegst 2 L of eratw to er.pceal

jesusisking  So helpful, thank you! +  



 +1 
submitted by misrao(4),
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nCa soneeom inaeplx hte raoltoircen bentewe 054 Oasmoyd/ml adn dneieng to cetrexe 1 L of wa?etr kshanT

trazobone  This is my second time doing this question TY COVID. The definition of an Osm is the number of osmoles of solute per liter of solvent. The stem tells you the highest she can concentrate her urine is 450 mOsmol/kg H2O, and she takes in 450 mOsmol/day. She also loses 1000 mL from sweat, feces, etc.. The mOsmol variables are NOT related to the 1000 mL. It is going to take 1 liter to concentrate that 450 mOsmol urine, and she also loses a separate unrelated 1 liter. Together, the minimum amount of H2O needed is going to be 2 liters. +  



 +1 
submitted by trazobone(69),
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shiT is my ncedos teim noidg hist tqiusoen TY C.VDOI The ioinifednt of na msO si het rnbmue fo emlooss of sleout erp tielr fo .elnotvs Teh tems esllt yuo het gsthhie ehs nca erocectnatn reh reiun is 540 sgmmO/olk ,H2O and hse takse ni 045 aOl/m.oysdm Seh aslo eosls 0100 mL from eawst, cefes, ect.. The momOsl siabavelr rae ONT elaedtr ot hte 1000 m.L It is ggnio to tkae 1 eilrt to tnctroecane taht 045 somlmO nuri,e dna hse also soels a aepatsre rtndelaeu 1 .eilrt rTtohege, the imnmimu ntmuao fo OH2 edende si nggio ot be 2 ser.lit




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